Sofia Warren
Ferris State University
Objectives
 To identify the four basic elements of shared
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governance
To identify the structure model in support of shared
governance
To identify the correlation between shared governance
and relationship based care
To identify the relationship between shared
governance and Magnet recognition
To identify perceptions of how and if shared
governance improves quality and safety outcomes for
patients
What is nursing shared
governance?
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address bar or right click and click on hyperlink.
http://www.youtube.com/watch?v=2WpqO
HZDPUY&feature=player_detailpage
Shared Governance
 Partnership
 Equity
 Accountability
 Ownership
Shared governance model
Partnership
 Builds relationships
 Links the health care provider to the patient
throughout the health care system
 Creates professional empowerment through the
collaborative relationships of all the stakeholders
 Implies the key value of each member in fulfilling the
mission and purpose of the organization
Equity
 Maintains a focus on services
 Is the foundation and measure of value
 Integrates roles and relationships into the
establishment of the structures and processes needed
to achieve positive patient outcomes
Accountability
 Investment in decision-making
 Accepting ownership of decisions
Ownership
 Recognition and acceptance of the importance of each
role
 Recognition that success is determined by how well
each individual does their job.
Self governance vs. Share governance
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Centralized interactions
(Self governance)
Position-based
Distant from point of care
Hierarchical communication
Limited staff input
Separates responsibility to
managers
We-they work environment
Divided goals/purpose
Independent activities/tasks
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Decentralized interactions
(Shared governance)
Knowledge-based
Occurs at point of care
Direct communication
High staff input
Integrates equity, accountability
and authority for staff and
managers
Synergistic work environment
Cohesive goals/purpose
ownership
Collegiality, collaboration,
partnership
Empowerment
“When staff members are clear about their roles,
responsibilities, authority, and accountability they
have a greater confidence in their own judgments and
are more willing to take ownership for decision
making at the point of care” (Koloroutis, 2004).
Theory
 Jean Watson’s Theory of Caring
 Relationship Based Care: Mary Koloroutis
 Kanter’s Theory of Structural Empowerment
Theory of Human Caring
 Care and relationship-centered care is a foundational
ethic for healing practices
 Creates a healing environment
 Delineates the art of nursing through caring-healing
modalities
Relationship Based Care
Relational Partnerships in the
health care setting
 Interdependence
 Collegial relationships
 Team work/collaboration
 Patient centered and lead
 Leading change
 Partnerships
 Direct communication
Kanter’s Theory of Structural
Empowerment
“power as an ability to mobilize resources and achieve
goals”.
 We feel empowered when we have access to
information, support, access to resources and
opportunities to learn and grow
 Strong networks with peers, patients and other
organizational members increase perception of
empowerment
Assessment of the Health Care
Environment
 Institutional framework
 Quality and safety issues
 Satisfaction and engagement
 Obstacles
Shared governance framework
 Grounded in clinical practice
 Nursing is responsible, accountable and has authority over
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all decisions related to practice, quality and competence
Staff nurses are elected to positions by peers
Needs to be implemented organization wide
Management provides the support, encouragement,
resources, training and boundaries for success
Responsibility and accountability based
Composed of a coordinating group of staff and
management.
Is bylaws and rules driven
Basic requirement for shared
governance
 Committed nurse executive
 Strong management team
 Employees must have a clear basic understanding of
shared governance.
 Must be able to chart progress with a plan and timeline
for implementation
American Nursing Credentialing
Center Magnet designation
 Transformational leadership
 Structural empowerment
 Exemplary professional nursing practice
 New knowledge, innovations, and improvements
 Empirical quality outcomes
Magnet Recognition
 Supports nursing practice, identifying nursing
excellence
 Focuses on professional nursing development
 Supports nursing autonomy in practice and decision
making
 Supports nursing involvement in decisions related to
bedside care, education and nursing leadership
Benefits of designation reflected in
shared governance for the patient
 Reduced mortality
 Reduced patient morbidity
 Increased patient satisfaction
“Nursing Leaders must continue to identify and sustain new
strategies to empower nurses so that nurses can continue to be an
integral component in the health care delivery team”
 Improved job satisfaction
 Increased engagement
 Increased retention
Reference:
Barden, A. M., Quinn Griffin, M. T., Donahue, M., & Fitzpatrick, J. J. (2011). Shared
governance and empowerment in registered nurses working in a hospital setting. Nursing
Administration Quarterly, 35(3), 212-218. doi:10.1097/NAQ.0b013e3181ff3845
Root Cause Analysis
 Problem: Poor nursing engagement
 Data Collection: Lack of participation in council meetings
and unit decisions, low safety and engagement scores,
decreased moral.
 Possible Causal Factors: Breakdown in communication,
disinterest, lack of knowledge lack of resources, lack of
support.
 Root cause: Perceived lack of value and empowerment.
 Recommended Solution: Provide unit support to
participate, improve available resources, support
opportunities for growth and promote autonomy in
practice.
Obstacles to shared governance
 Poor collaboration
 Poor communication
 Resistance to change and implementation of change
 Lack of interest
 Lack of concern to effect change
 Lack of consensus
 Lack of clarity related to roles and responsibilities
Please cut and past to address bar
or right click and click on hyperlink
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age&v=XowMzXDko1I
ANA Standards
 Standard 10: Quality of Practice
 Standard 11: Communication
 Standard 12: Leadership
 Standard 13: Collaboration
Quality and Safety Education for
Nurses
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QSEN competencies
Patient Centered Care
Teamwork and Collaboration
Evidence Based Practice
Quality Improvement
Informatics
Safety
Summary
 Increased nursing retention related to increased job
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satisfaction
Improved patient care and safety outcomes.
Improved financial viability
Empowerment of nurses through promotion of
nursing excellence
Nursing excellence and Magnet recognition
Closing…
 Research implies that shared governance can have a
positive impact on nursing satisfaction and potentially
patient outcomes.
 More research needs to be done
 Shared governance empowers nurses to develop
practice
 Allows nurses to network and collaborate among units
and departments
References
Alligood, M., & Tomey, A. (2010). Nursing Theorists and Their Work (7th ed.). Maryland Heights, MO: Mosby.
American Nurses Association (2010). Nursing Scope and Standards of Practice (2nd ed.). Silver Springs, MD.
American Nurse Association.
Armstrong, K., & Laschinger, H. (2006). Structural empowerment, magnet hospital characteristics, and patient
safety culture: making the link. Journal of Nursing Care Quality, 21(2), 124-134.
Barden, A.M., Quinn Griffin, M. T., Donahue, M., & Fitzpatrick,J. (2011). Shared governance and empowerment in
registered nurses working in a hospital setting. Nursing Administration Quarterly, 35(3). 212-218. doi:
10.1097/NAQ.0b013e3181ff3845
Brewton, C., Eppling, J., & Hobley, M. (2012) Our voice: an interdisciplinary approach to shared governance.
Hospital Topics 90(2), 39-46. doi: 10.1080/00185868.2012.679910
Burkman, K., Sellers, D., & Batcheller, J. (2012). An integrated system’s nursing share governance model: a system
chief nursing officer’s synergistic vehicle for a leading a complex health care system. Nursing Administration
Quarterly 36(4), 353-361. doi: 10.109/NAQ.0b013e31826692ea
Koloroutis, M. (Ed.). (2004) Relationship-Based Care: A model for Transforming Practice. Minneapolis, MN:
Creative Healthcare Management.
References
Larkin, M.E., Cierpial, C.L., Stack, J.M, Morrison, V.J., Griffith, C.A. (2008). Empowerment Theory in
action: the wisdom of collaborative governance. OJIN: The Online Journal of Issues in Nursing. 13(2)
doi:10.3912/OJIN.Vol13No02PPT03
Nursing Theories (2012). Jean Watsons’ philosophy of nursing. Retrieved October1, 2012 from
http://currentnursing .com/nursing_theory/Watson.html
Porter-O’Grady, T., Finnigan, S. (1984). Shared Governance for Nursing: a Creative Approach to
Professional Accountability. Aspen Publication. Rockville , Maryland.
Quality and Safety Education for Nurses (2012). Pre-licensure knowledge, safety and attitude
competencies. Retrieved October1, 2012 from http://www.qsen.org/overview.php
Swihart, Diana (2006). Shared Governance: A Practical Approach to Reshaping Professional Nursing
practice. HCPr o, Inc. Marblehead, MA
Yoder-Wise, P. (2011). Leading and Managing in Nursing (5th ed.). Elsevier. St. Louis, MO.