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Making the Shift to Shared Governance in Nursing: The Benefits Outweigh the Challenges

By Syed Raza, MD, Vice President of Medical Operations, St. Luke’s Health

March 13, 2023 Posted in: Leadership

The ever-increasing complexity of the health care system has led to the need for a generational shift in the way decisions are made. A few decades ago, physicians were considered the final word on any decisions made surrounding patient care. That policy doesn’t work anymore, nor should it. 


It’s now clear to everyone that nursing is the heart and soul of health care, and when bedside nurses and clinical leaders share in the decision-making process, it’s a win-win for all. Not only do patient outcomes improve, but job satisfaction throughout the health care team also improves. As the first in Texas to practice shared governance, St. Luke’s Health has seen firsthand the benefits of such a policy on patients and the organization.


A Needed Cultural Shift

When a health care organization decides to adopt a shared governance policy, a significant adjustment period is inevitable, as this is a big cultural change. Instead of decisions coming from the top down, it becomes a collaborative process. While this can—and should—apply to many aspects of health care, by adopting shared governance in nursing in the hospital setting, we can encourage more positive patient outcomes while creating an atmosphere of inclusion among team members.

What are the main organizational benefits of shared governance in nursing?

  • Nurses become empowered to be drivers of change and innovation when we stop telling nurses what works and what doesn’t. Being in the office instead of on the frontlines, we don’t always know what’s best. Those on the frontlines are more likely to have ideas that will succeed, and other frontline staff are more likely to be on board when ideas come from people who know firsthand. As administrators, we can also become facilitators, allowing nurses’ ideas to flourish.

  • Nurses who feel they are being heard and are part of the process are more likely to be satisfied in their jobs. This is an easily understood concept, but it also means young nurses who start their careers in a shared governance setting will bring their knowledge of the practice to other settings should they work in other facilities, either within the same health care system or elsewhere. Nurses with a shared governance background are becoming highly sought after professionals. In essence, they are the future leaders of this new culture.

  • Shared governance creates a culture of positivity. When all team members’ voices are heard and taken seriously, this automatically helps to create an atmosphere of inclusion, positivity and trust, which leads to increased morale and performance.

Patients Reap the Benefits of Shared Governance

Patients are the real winners when it comes to shared governance in nursing. When health care teams— from nurses to physicians and everyone involved in patient care—take a multidisciplinary approach to care, outcomes always improve.

Many studies show how nursing-sensitive indicators improve significantly under a shared governance structure, including:

  • Urinary tract infections associated with catheters

  • Pressure ulcers acquired at the hospital

  • Falls with injuries

  • Bloodstream infections associated with central lines

When nurses notice a problem or have ideas on how to improve processes for the benefit of the patient, shared governance allows them to bring these ideas directly to nursing leaders. When everyone is on the same page and striving for the same ultimate goal, positive change and better results can happen much faster.


Overcoming Potential Obstacles 

Although implementing a shared governance structure has a multitude of benefits, executing this type of cultural shift also comes with challenges:

  • Getting buy-in from bedside nurses. As ironic as it may sound, establishing a shared governance program requires time and commitment from everyone involved, and bedside nurses may be hesitant in the beginning. Most nurses work 12-hour shifts and may feel they have little time to commit to taking on shared governance. Nurses who work nights and weekends may have even more concerns about how to make the new structure work. Our task then is to communicate openly with all bedside nurses, be transparent about the reasons for the shift, and work around their schedules whenever possible. These efforts will help you build the trust needed to achieve buy-in.

  • Stopping the spread of misinformation. Big changes often engender some level of distress, such as the fear of losing a job, which can lead to misinformation. Again, start by being completely open with the entire nursing staff and clearly communicate the reasons for adopting shared governance. And be quick to dispel any false information that arises.

Get the Ball Rolling

Keep in mind that a shared governance plan in nursing is a big change that requires a great deal of thoughtful planning, as well as care in presenting the policy to everyone involved. There are certain steps you can take to ensure the transition goes as smoothly as possible:

  • Ensure you have buy-in from the entire leadership team before presenting the plan to others.

  • Identify the frontline leaders of the nursing staff, and ensure they understand the benefits that shared governance will have for patients and the organization as a whole.

  • Make sure everyone knows what the ultimate goal is: to improve processes, find solutions and enhance patient outcomes, which will inevitably improve nurse satisfaction.

  • Check in with nurses frequently and hold meetings whenever necessary to ensure there is no confusion or misinformation circulating on the floor.

Remember, communication is key before, during and after the shared governance plan is implemented. Through clear communication and mutual understanding, nurses, leaders, and patients will all reap the benefits of the new process, and the environment will become one of trust and respect.




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