Shared governance thrives when nurses step up and participate

Jane refused to attend the monthly Tuesday nursing shared governance council activities where many staff nurses discussed issues of clinical practice, management, education and quality.

Jane, a nonparticipating committee of one, held her own meeting up and down the hospital halls. “I’ve been working in this place for 15 years, and nothing gets better,” she said. “Last year, administration started this nursing shared governance program. This year, I still have the same crappy assignment, except there are fewer nurses on the floor to help me. They’re all at the stupid committee meetings. I don’t know why nurses are making policies anyway — that’s what the managers are for.”

Thanks for sharing, Jane, I thought, but that’s what managers used to be for. Magnet and Pathways to Excellence programs have changed expectations shared by most organizations these days. I remember another nurse’s perceptions of new governance models:

Margaret was a nurse manager in a local hospital where she had implemented a unit-based nursing shared governance program that changed the power structure of her immediate work environment. Her empowered unit was isolated in a suppressed hospital like a vent in a capped landfill.

Professional nurses in her unit had significant influence over many areas that previously only managers controlled, such as budgeting, scheduling and performance appraisals, as well as control over clinical practice. Margaret and the staff shared responsibility, accountability and authority for most unit-related decisions.

She had asked me to visit as a silent, informal consultant to see if there were yet more areas into which they could extend their professional governance program. I asked Margaret about the “silent” part.

“We have a good thing going here,” she told me. “We don’t want word of our program to get out to the rest of the hospital. We don’t want anything to ruin it.”

Some nurses have always resisted the traditional supervisory structures that whipped many of us through our training and early employment. In the past 40 years, administrators, managers and theorists have joined these nurses to introduce programs of participatory management and nursing shared governance into mainstream nursing administration. There are important differences among these two programs, however.

Although participatory management only permits limited, management-directed staff decision making, the more progressive shared governance models redistribute authority in many areas among staff and management on a permanent basis.

These progressive programs have shared two commonalities: They redistribute power to more nurses and — despite the loss of bargaining chips, such as nursing shortages and the advent of cost-conscious, personnel-eliminating downsizing and rightsizing of hospitals — these empowering programs endure and keep appearing.

There are four reasons for the persistence of governance innovations that alter the power structure in organizations where professionals dominate the work.

1. Professionals are guardians of a social contract.

Professionals bring the values of their collegial group to the workplace. In organizations with many such groups, there may be tension between conflicting goals and values, for example, between delivering quality care and maintaining financial viability. Because the public has mandated that healthcare professions advocate for health as part of their social contract, administrators must recognize the authority of their voice.

2. Operations are a blur and getting faster.

The flow of information in organizations is now so fast and intricate that managers cannot control decision-making from day to day. To be effective, managers have had to give up information and control to enable staff to make operational decisions. By listening to staff during the day, managers sleep better at night.

3. Values from the 1960s linger.

The ‘60s didn’t come and go without effect. Baby boomers, with a track record of challenging the legitimacy of established authority, have dominated the workplace and rejected an iron rule. You can expect this view of authority to persist as Gen Xers, millennials, Gen Zers and future generations take the reins of practice from retiring baby boomers.

4. Managers can’t be the clinical experts.

One of the premises that made bureaucracies so effective in the historical past was that managers were experts in the work of the organization. If the factory made buggy whips, then the managers were the best buggy-whip-makers. But the complexity and continual growth of professional knowledge has made it difficult for nurse managers to excel clinically and managerially at the same time.

Yet, today’s managers need enough clinical credibility to retain staff trust and the ability to know when staff nurses are making the right choices. Expedient managers hand over clinical decision-making to staff experts.

Professional empowerment in organizations demands a parallel set of obligations from nurses. Practitioners need to be visible and verbal advocates for quality healthcare in their institutions. We can incorporate that advocacy into every practice decision and our daily work life.

And when we criticize or challenge the established order, we need to be able to offer a better one — or at least be willing to participate in improvement efforts.

When professionals refuse to use their expertise for the betterment of the organizations in which they work, they are sabotaging its efforts, damaging their own credibility and breaking a social contract with their patients.

More information about nursing shared governance can be found on the Forum for Shared Governance’s website.

Nurses from Jane’s unit eventually sent her a message: In a democracy, no vote is a vote to support the choices of others, and no participation is an endorsement of the status quo. The participation you withhold from our nursing shared governance meetings might deny us essential information we need to make effective decisions. So, Jane, bring your attitude, negative ballistics and clinical expertise to the meeting. We can take it, and we need to be in this together. We need your participation to improve your job, our practice and our hospital. And don’t wait until the sixth Tuesday of every month.

Courses related to ‘professional practice’

WEB308: Creating a Professional Practice Environment in any Healthcare Setting
(1 contact hr)

Regardless of your work setting, research shows that an improved work environment is linked to less nurse burnout and less job dissatisfaction. Creating a professional practice environment is no easy task! Whether you are a nurse manager or staff RN, there are many ways you can influence change for the better!

CE373-60: Emotional Intelligence Helps RNs Work Smart
(1 contact hr)

Emotional intelligence is a new concept in nursing; initial research studies indicate that EI is an important part of successful nursing practice. Although research on EI is at the developmental stage, regardless of the theoretical framework used, there is agreement that EI includes the concepts of emotional awareness in relation to self and others, professional efficiency and emotional management. Applying EI concepts to nursing has the potential to support professional nursing practice and to improve patient outcomes. This module will discuss the concept of EI, describe how it can help nurses enhance their work lives and provide strategies for developing one’s own EI.

CE721: Interoperability: Better Care Through Better Information Sharing
(1 contact hr)

Interoperability is the ability of different information systems and devices that can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data so it can be understood by a user. This continuing education module provides nurses with an overview of interoperability in the context of health information technology with a focus on how interoperability affects healthcare delivery.

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