|Author||Title||Type||Source||Comments||Instrument||Kear M, Duncan P, Fansler J, Hunt K||Nursing Shared Governance: Leading a Journey of Excellence||Implementation||J Nurs Admin. 2012;42(6):315-317.||A description of how a community hospital, Lakeland Memorial Hospital, FL, engaged nurses through the nursing shared governance model to select a professional practice model that aligned nursing values and priorities with the organization’s vision and mission.||Anderson E Faye||A Case for Measuring Governance||Research||Nurs Admin Q. 2011;35(3):197-203.||Shared governance is promoted as a management innovation designed to improve outcomes of quality patient care, nurse job satisfaction, productivity, and nurse retention. Reported studies have not measured the degree of governance. The Index of Profession Nurse Governance is a valid, reliable tool that can be used to measure the degree of governance, to assess the status and progress of implementation of governance, and in studies relating shared governance to outcomes.
An example of the use of the Index of Profession Nurse Governance in one hospital to assess the degree of shared governance over time is described.
|Index of Professional Nursing Governance||Ballard N||Factors associated with success and breakdown of shared governance||Implementation||J Nurs Admin 2010;40(10):411-416.||Shared governance, a process for empowering nurses in practice settings, has been widely used for decades. However, despite enthusiasm for the concept, the process is not always successful or falters after successful initiation. To assist nursing leaders trying to implement or maintain SG processes, the author summarizes literature on both human and structural factors that contribute to the success or breakdown of SG practice models. Barriers to implementation and strategies to support implementation, as well as enculturation of SG, are discussed. http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=1071027||Bernreuter M||The other side of shared governance||Commentary||J Nurs Admin. 1993;23(10):12-14.||Problems and solutions with SG.||Bogue RJ, Joseph ML, Sieloff CL||Shared governance as vertical alignment of nursing group power and nurse practice council effectiveness||Research||J Nurs Manage. 2009;17(1):96-104.||This study validates an instrument for measuring the effectiveness of nursing practice councils and offers a framework for measuring and understanding shared governance. Empowerment results from the vertical alignment of nursing group power with nursing unit power practices. The field lacks an instrument for measuring nurses’ practice of power. Two studies (n1 = 119; n2 = 248) are used to validate the Nursing Practice Council effectiveness scale (NPCes). NPCes is a valid and reliable index of nursing practice council effectiveness. This study suggests specific diagnostic tools to understand two levels for actualized power, one at the group or departmental level and one at the unit level. NPCes and the Sieloff-King Assessment of Group Power within Organizations (SKAGPO) can be used together to improve examination of shared governance. Examining group power as well as unit-level practices may give a more complete view of barriers to nurse empowerment. Changing nursing power and practices in an organization may be made more effective by engaging and monitoring vertical alignment of strategies fostering power competencies among nurse leaders an simultaneously supporting nursing practice councils as a means of exercising nurse authority at the unit level.||Nursing Practice Council Effectiveness Scale; Sieloff-King Assessment of Group Power within Organizations||Brodbeck B||Professional practice actualized through an integrated shared governance and quality assurance model||Implementation||J Nurs Care Qual. 1992;6(2):20-31.||Account and structure of SG at St. Peter's Hospital, Albany, NY. Detailed list of educational programs used.||Brody AA, Barnes K, Ruble C, Sakowski J||Evidence-Based Practice Councils: Potential Path to Staff Nurse Empowerment and Leadership Growth||Research||J Nurs Admin. 2012; 42(1):28-33.||This study examines the effects of participation in staff nurse–led practice councils on nurse job satisfaction and professional development. Although evidence-based practice (EBP) has become a key component of improving the quality of care, few studies have examined how implementation of staff nurse led councils model affect the involved nurses. A 3-stage evaluation was conducted with nurses, managers, and executives participating in or involved with EBP councils tasked with improving patient outcomes at six community hospitals in a single non-profit hospital system in Northern California.
Five themes emerged as outcomes: empowerment, meaningfulness, leadership growth, exposure to quality improvement, and vision. Researchers concluded that staff-led councils have the potential to improve quality of care, job satisfaction, vision and leadership provided that managers and executives are sufficiently prepared to work with and support the councils.
|Ethnography, semi-structured phenomenological private interviews, 10-question web-based survey||Brooks B||Measuring the impact of shared governance||Commentary||Online J Issue Nurs. January, 2004;9(1).||Structure is the easy part of implementing SG. More challenging is changing the behaviors and atttitudes of staff and managers, and measuring the benefits of SG.||Brooks F, Mitchel M, Pugh J||Shared governance as a way of involving staff in decision-making||Research||Nurs Times. 1998:96(46):56-57||Ethnographic investigation of shared governance in Kettering General Hospital NHS Trust in the UK looking at commitment to shared governance, communication, and participation. Differences in the perceived value of shared governance were found between those who participated and those who did not participate in councils.||Observation and Interview||Burkman K, Sellers D, Rowder C, Batcheller J||An Integrated System’s Model of Nursing Shared Governance: A System Chief Nursing Officer’s Synergistic Vehicle for Leading a Complex Health Care System||Implementation||Nurs Admin Q. 2012;36(4):353–361.||Seton Nursing reengineered previous models of care and leadership to accommodate rapid growth of its health care system from individual acute care sites to a health care system with consistent quality and standardization of like units across the system. Shared governance promotes collaboration with shared decision making and accountability; however, the role and methods of a system chief nursing officer to connect shared governance across a new system has not been previously described. A system chief nursing officer can significantly influence and guide the nursing strategic direction at all the health care system-related facilities by utilizing a single, systemwide nursing shared governance structure. Using this structure provides a venue to maximize the influence of a transformational leader and creates efficiencies in workforce development, resource management, best practice identification, and spread of initiatives and improvements to adapt to an ever-changing health care landscape. This is the story of one such system chief nursing officer.||Constantinides GH, Tscharner D, Kalpowsky D, Baker-Priebe R||Increasing autonomy: A self-directed MICU||Implementation||J Nurs Manag. 1994; 25 (12):32O-P.||An Account of the implementation of unit-based SG through a self-directed work team (without a manager) on a newly created medical intensive care unit at Greater Baltimore Medical Center, an organization with a hospital-wide SG program.||DeBaca V, Jones K, Tornabeni J||A cost-benefit analysis of shared governance||Research, Implementation, Finance||J Nurs Admin. 1993; 23 (7/8):50-57.||One of the best reports about the cost of implementing SG: direct and unmeasured costs and savings over 5 years at Mercy Health Care, San Diego, CA.||Doherty C, Hope W||Shared governance - nurses making a difference||Implementation||J Nurs Manag. 2000;8(2):77-81.||UK. Leicester Gen Hos. SG councils integrated into existing mgmt structure to increase nurses' involvement in decision-making.||Dunbar B, Park B, Berger-Wesley M, Cameron T.||Shared governance. making the transition in practice and perception.||Implementation||J Nurs Admin. 2007;37:177-183.||Detailed report of the implementation of both nursing division-wide and unit-based councilar shared governance model over two years at James A Haly Veterans' Administration Hospital, Tampa, FL.||Dunton N, Montalvo I, eds.||In Sustained Improvement in Nursing Quality: Hospital Performance on NDNQI Indicators, 2007-2008. Issues Up Close. Quality improvement using NDNQI.||Research||Am Nurse Today. 2009;4(7):34-36.||Excerpt from book reports an increase in RN satisfaction and favorable RN-MD interactions in Westchester Medical Center in rural northwestern Virginia from 2005, 2006 and 2007 after the implementation of shared governance, including unit-based and house-wide councils. No measure of change in governance except the implementation of councils, changes in leadership, and a flattened hierarchy.||NDNQI RN Satisfaction Survey (job enjoyment)||Edwards GB, Farrough M, Gardner M, Harrison D, Sherman M, Simpson S||Unit-based shared governance can work!||Implementation||J Nurs Manag. 1994;25(4):74-77.||Account of how a unit-based SG model was implemented over three years in a 10-bed medical intensive care unit at St Joseph Mercy Hospital, Ann Arbor, MI.||Ellenbecker CH, Samia L, Cushman MJ, Porell FW||Employer retention strategies and their effect on nurses' job satisfaction and intent to stay||Research, home care||Home Health Care Serv Quarter. 2007;26:43-58.||Data from 24,459 nurses from 123 New England home care agencies showed that the only retention intervention that had a statistically significant effect on nurses' intent to stay was shared governance through its indirect effect on job satisfaction. No retention strategy directly affected nurses' intent to stay.||Home Healthcare Nurse Job Satisfaction Scale||Erickson JI, Hamilton, GA, Jones DE, Ditomassi M||The value of collaborative governance/staff empowerment||Research, Implementation||J Nurs Admin. 2003;33(2):96-104.||Longitudinal comparison of empowerment and power scores for members and nonmembers of collaborative governance program at Massachusetts General Hospital.||Conditions of Work Effectivesness Scale (empowerment), Job Activity Scale and Organizational Relationships Scale (formal and informal power)||Ethridge P||Nurse accountability program improves satisfaction, turnover||Research, Implementation, Finance||Health Progress. 1987;May:44-49.||Classic longitudinal study links reorganization of professional practice environment to higher job satisfaction and lower job stress at St Mary's Hospital, Tucson, AZ||Combined job satisfaction instruments (Brayfield and Rothe; Slavitt, Stamps, Peiedmont & Haase) and a job stress instrument (Atwood & Hinshaw)||Flynn MK||Correlates of staff nurse work satisfaction in hospitals with shared governance||Research||Doctoral dissertation. University of San Diego, 1997||Lack of staff nurse participation in hospital decision-making has been cited as a major reason for the dissatisfaction in nursing. Shared governance has been proposed as an organizational model that provides staff nurses with both the structure and the mechanism for having increased decision-making authority. The purpose of this study was to investigate the relationship of organizational culture, perceived importance of involvement and actual involvement in decision-making, the discrepancy between importance and involvement, staff nurse years of involvement in shared governance, control over nursing practice, and work satisfaction among staff nurses working in hospitals with shared governance. A descriptive, correlational design was used to investigate 188 full-time RN staff nurses from three hospitals with shared governance. Organizational culture was eliminated from analysis because of the large amount of missing data. Three multiple regression models were tested. In the final prediction model, control over nursing practice was the strongest predictor of work satisfaction, accounting for 40% of the explained variance. The next most significant predictors were involvement in decision-making, years in shared governance, and years in nursing, for a total of 43% of the variance. Since the variables in the model only explained 43% of the variance, other factors need to be identified to further predict work satisfaction. Based on the findings in this study, staff nurse participation in shared governance is a vehicle for control over nursing practice and work satisfaction.||Frith K, Montgomery M||Perceptions, knowledge, and commitment of clinical staff to shared governance||Research||Nurs Admin Q. 2006;30(3):273-284.||Large SE US medical center surveys one year apart, pre- and postimplementation showed decrease in perception and knowledge, but an increase in commitment to SG.||Adapted Shared Governance Survey (Minors et al)||Gavin M, Ash D, Wakefield S, Wroe C||Shared governance: time to consider the cons as well as the pros||Review||J Nurs Manag. 1999;7(4):193-200.||Methodologic flaws and bias for SG suggests research should be treated with caution.||George V||An organizational case study of shared leadership development in nursing||Research||Doctoral dissertation. Marquette University, Milwaukee, Wisconsin||This case study documented a process of organization change over eight years in one nursing collective's attempt to implement a professional practice model. The qualitative analysis demonstrated the key elements for implementation of shared governance and the establishment of a peer review system. These elements were training for shared leadership, goal setting with feedback, mentoring, and role modeling. The shared leadership training program resulted in significant (p < 000) changes in leadership behaviors and practice autonomy scores as measured by Leadership Practices Inventory and Schutzenhafer Nursing Activity scale, respectively. When managers and staff leaders use shared leadership in a bureaucratic healthcare organization, they strengthen the staff nurse's autonomy at point of service. Implications and recommendations directed to nurse executives, educators, researchers, and clinical staff are included.||Leadership Practices Inventory, Schutzenhafer Nursing Activity scale||George V, Burke L, Rodgers B, et al.||Developing staff nurse shared leadership behavior in professional nursing practice||Research||Nurs Admin Q. 2002;26(3):44-59.||A conceptual model of shared leadership development was applied to a research program at Aurora Health Care - Metro Region in Eastern Wisconsin. Findings demonstrated that the implmentation of a shared leadership concepts program increased staff use of leadership behaviors, professional nursing practice autonomy, and improved patients outcomes.||Smola Assessment of Leadership Inventory, The Leadership Practices Inventory -- Individual Contributor Self or Observer, and the Nursing Activity Scale||George VM, Burke LJ, Rodgers BL||Research-based planning for change: Assessing nurses attitudes toward governance and professional practice autonomy after hospital acquisition||Research||J Nurs Admin. 1997;27(5):53-61.||Medical center surveyed nurses in an acquired hospital for attitudes about the acquiring hospital and the merger, and toward governance and autonomy to guide transition strategies.||Index of Professional Nursing Governance, Nursing Activity Scale (autonomy behaviors)||Gloeckner MB, Robinson CB||A nursing journal club thrives through shared governance||Implementation||J Nurs Staff Development. 2010;26(6):267-270||This article documents the creation and introduction of a journal club for disseminating nursing research to staff through a shared governance council at a Midwestern hospital.||Hall DS||Factors charaterizing supportive nursing care units for registered nurses||Research||Doctoral dissertation. The Graduate School, University of Kentucky, Lexington, Kentucky, 2004.||This two-phase comparative study explored the relationships between nursing unit environment (shared governance, traditional governance, specialized inpatient care unit) with measures of registered nurse occupational stress and occupation-related outcomes in a hospital with a reputation for excellent nursing care. Survey data from 69 staff nurses in one of the three different patient care areas were analyzed using parametric and nonparametric univariate, bivariate and multivariate analyses. A sample of nurses working in each of the units also were interviewed about common work stressors encountered, coping mechanisms used to deal with work stress, decision-making, and sources of work support. No significant differences were found among the three types of nursing unit governance structure on occupational stress, methods of coping with occupational stress, job control, and self-efficacy. Significant differences were found related to amount of supervisor support, coworker support, unit efficacy, turnover, absenteeism, and job satisfaction. Nurses working in the shared governance and specialty units had more job satisfaction, perceived coworker support, and unit efficacy than RNs working in the traditional governance unit. Specialty unit structure was associated with less turnover, and shared governance and specialty unit structure were associated with less absenteeism related to illness. Supervisor support was associated with more positive occupation-related outcomes than unit governance structure. Gender and education were associated with perception of work stress.||Nurse Work Stress Scenarios, Physical Symptoms Inventory, Maastricht Autonomy Questionnaire, Decision Latitude Scale of the JCQ, Collective Efficacy Beliefs Scale, Personal Efficacy Beliefs Scale, Scale of Social Support||Havens D, Vasey J||Measuring staff nurse decisional involvement: The decisional involvement scale||Research||J Nurs Admin. 2003;33(6):331-336.||Description of the development, content, and scoring of the Decisional Involvement Scale, a multipurpose measure that can be used as a diagnostic tool, an organizational strategy, and an evaluative instrument.||Decisional Involvement Scale||Hess R||Measuring shared governance||Research||Nurs Res. 1998;47(1):35-42.||Reports the development, reliability, and validity of the Index of Professional Nursing Governance.||Index of Professional Nursing Governance||Hess R||Slicing and Dicing Shared Governance: In and Around the Numbers||Research||Nurs Admin Q. 2011;35(3):235-241.||Hospitals seeking Magnet status must demonstrate empowering structures and processes that involve nurses in governance and decision-making about their practice. Shared governance — an organizational innovation that legitimizes healthcare professionals’ decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers — can achieve this.
Evidence connecting shared governance with clinical, professional, and organizational outcomes has been sparse. Research using the Index of Professional Nursing Governance (IPNG) is changing that. Innovative uses of the IPNG is strengthening new shared governance programs, rejuvenating old ones, and finally connecting innovative models to favorable outcomes.
|Index of Professional Nursing Governance, Index of Professional Governance||Hess R, DesRoches C, Donelan K, Norman L, Buerhaus P||Perceptions of nurses in Magnet hospitals, non-Magnet Hospitals, and hospitals pursuing Magnet status||Research||J Nurs Admin. 2011;41(7/8):315-323.||The objective of the study was to compare perceptions of RNs employed in Magnet®, in-process (ie, hospitals seeking Magnet recognition), and non-Magnet hospitals using data from the 2010 National Survey of Registered Nurses (NSRN).
The NSRN is administered biennially and measures nurses’ perceptions about their profession, workplace environment, and professional relationships. A self-administered mail survey to a national sample of 1,500 RNs was used. Bivariate statistical techniques were used to analyze responses from 518 nurses who indicated their employer’s Magnet status and to examine associations between Magnet status and the nurses’ perceptions of career satisfaction, the nursing shortage, work environment, opportunities to influence the workplace, and professional relationships.
Nurses employed in all 3 groups (Magnet, in-process, and non-Magnet hospitals) were uniformly satisfied with being a nurse, although significantly more Magnet and in-process nurses would recommend nursing as a career than would non-Magnet RNs. Views of workplace safety were similar across groups, with no significant differences in violence, verbal abuse, discrimination, or harassment; however, Magnet nurses reported significantly more musculoskeletal injuries. Magnet and in-process nurses rated opportunities to influence decisions about workplace organization and participate in shared governance and employer-paid continuing education, and relationships with advanced practice nurses and nursing faculty higher than did non-Magnet nurses; relationships with new nurses and physicians were not different across groups.
The Magnet program continues to have a positive influence on nurses, their decision making, and their professional relationships. The paucity of other differences suggests that Magnet, in- process, and non-Magnet organizations are increasingly guided by a shared set of principles that define a positive professional environment derived not only by the Magnet program, but also by other professional organizations and forces.
This survey marks the first time the occurrence of shared governance in American hospitals was measured on a national scale.
|2010 National Survey of Registered Nurse||Howell JN, Frederick J, Olinger B, Leftridge D, Bell T, Hess R, Clipp EC||Can nurses govern in a government agency?||Research||J Nurs Admin. 2001;31(4):187-195.||VA medical center surveyed nurses' perceptions of governance to determine the degree to which a shared governance model had been implemented. This is the first article that explores how the certain restrictions and characteristics of an organization or organizational system, like the VA, can determine how SG looks after it is implemented.||Index of Professional Nursing Governance||Jenkins J||A nursing governance and practice model: what are the costs?||Research, Implementation, Finance||Nurs Econ. 1988;6:302-311.||5-yr cost comparison after SG implementation at Southern tertiary MC: 3%increase in meeting time, 14% reduction in meeting hrs per budgeted FTE.||Kennerly S||Perceived worker autonomy: The foundation of shared governance||Research, Commentary||J Nursing Admin. 2000;30(12):611-617.||Indepth analysis of autonomy in relationship to SG and previously published implementation studies and concept analysis. Builds on author's previous longitudinal outcomes study of SG implementation at a Midwestern hospital system and questions previous as||Autonomy subscale of Index of Work Satisfaction (Stamps & Piedmonte); Index of Job Satisfaction (Brayfield & Roth); Organizational Commitment Questionnaire (Porter & Smith); Peer leadership subscale of Supervisory and Peer Leadership intrument (Taylor & B||Kennerly SM||Effects of of shared governance on perceptions of work and work environment||Research||Nurs Economics. 1996;14(2):111-116.||Pre- and postimplementation of modified councilar model (6 and 18 months), based on Path-Goal Theory of Leadership at 450-bed Midwestern hospital; sample size between 113 and 150. Initiating SG did not significantly influence job satisfaction, anticipated turnover, and perceived effectiveness. Increases in autonomy were not sustained over time.||Anticipated Turnover Scale (Hinshaw & Atwood); Autonomy subscale of Index of Work Satisfaction (Stamps & Piedmonte); Index of Job Satisfaction (Brayfield & Roth); Organizational Commitment Questionnaire (Porter & Smith); Peer leadership subscale of Superv||Kovner CT, Hendrickson G, Knickman JR, Finkler SA||Changing the delivery of nursing care. Implementation issues and qualitative findings||Research||J Nurs Admin. 1993;23(11):24-34.||Evaluation of programs piloted in 37 hospitals to alleviate the nursing shortage in the 1990s. The NJ state Nursing Incentive Reimbursement Awards funded the programs, which included three shared governance implementation sites.||Kramer M, Schmalenberg C, Maguire P, et al||Structures and practices enabling staff nurses to control their practice||Research (qualitative, quantitative)||West J Nurs Res. 2008; 30(5): 539-559.||State-of-the-art mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.||Conditions of Work Effectiveness Questionnaire-II||Laschinger HKS, Havens DS||Staff nurse work empowerment and perceived contol over nursing practice. Conditions for work effectiveness.||Research||J Nurs Admin. 1996;26(9):27-35.||Study using Rosabeth Kanter's Structural Theory of Organizational Behavior to examine relationships between staff nurses' perceptions of work empowerment and control over practice, and job satisfaction and perceived work effectiveness. Many positive correlations discovered among a sample of 127 nurses.||Conditions of Work Effectiveness Questionnaire (Kanter),Control Over Nursing Practice (Gerber), Multifactor Leadership Questionnaire (Bass)||Latta LC, Davis-Kirsch S||Developing a Robust Professional Practice Model using a Shared Governance Approach||Implementation||J Ped Nurs, 2011, In Press||A description of the development and implementation of a framework for nursing practice in a freestanding children's hospital, Seattle Children's Hospital, and the subsequent improvement process used to transition that framework into a robust professional practice model (PPM). The development of a PPM encompassing all aspects of nursing in all clinical settings is an important milestone on a successful Magnet journey. Strategies for linking the PPM to core processes and structures of nursing are shared. Plans for further study to demonstrate the relationship of a PPM to patient outcomes are discussed.||Lee C, Yang K, Wu S, Lee L||The effectiveness of implementing an unit-based shared governance model [Chinese]||Research||J Nursing Res (China). 2001;9(2):125-36.||Unit-based SG resulted in an increase in nursing professional governance and work satisfaction for nurses; enhanced partnership between nurses and managers; staff nurses perceived increased autonomy, authority, and expressed opinions to managers more freq||Index of Professional Nursing Governance, Index of Working Satisfaction||Lee L, Yang K, Lee C, and Wu S||An evaluative study of the effects of the implementation of UBSG on nurses’ perceptions of professional governance [Chinese].||Research||J Nursing Res (China). 2001;9(1):5-13.||Nurses in a unit-based SG had a higher level of participation in decision-making and professional practice than those in a traditional unit. Experimental n=29, control=24.||Index of Professional Nursing Governance||Malleo C, Fusilero J||Shared Governance: Withstanding the Test of Time||Implementation||Nurse Leader. 2009;7(1):32-26.||Account of revitalizing a shared governance program at MetroHealth Medical Center, Cleveland, OH, using a unique senate structure with a membership of staff nurses only.||McNulty JA||Perceptions of nurses practicing in a shared governance environment||Research, Qualitative||Master's thesis. School of Nursing, University of Alaska, Anchorage, November, 2002.||Descriptive qualitative study explored eight hospital nurses' perceptions of practicing in a shared governance environment through semistructured interviews. Six categories emerged: synergy, professional development, relationships/networking, barriers and challenges, outcomes, and comparing to other systems.||Minnen TG, Berger E, Ames A, Dubree M, Baker WL, Spinella J||Sustaining work redesign innovations through shared governance||Implementation, Finance||J Nurs Admin. 1993;23(7/8):35-40.||Introduction of multidisciplinary unit boards into a centralized shared governance was used to support work redesign and cost savings on a 31-bed orthopedic unit at Vanderbilt University Medical Center, Nashville, TN.||Minors SP, White JB, Porter-O'Grady T||Assessing shared governance: An example of instrument development in a hospital setting.||Research||Topics in Manage. 1996;1:187-196.||Development of a 9-item instrument that measures the construct of SG, including understanding, commitment, and personal perception of SG.||The Shared Governance Survey||Mitchell M, Brooks F, Pugh J||Balancing nurse empowerment with improved practice and care: an evalution of the impact of shared governance||Research, Implementation||NT Res. 1999;4(3):192-201||UK. Kettering Gen Hos NHS Trust. Ethnographic study finds early impact of SG on professional environment and nursing culture, not patient care.||Moore SC, Hutchison SA||Developing leaders at every level. Accountability and empowerment actualized through shared governance||Implementation.||J Nurs Admin. 2007;37(12):564-68.||Kanter's theory of structural empowerment used in implementing shared governance at Vanderbilt University Medical Center, Nashville, Tennessee. The model includes a monthy shared governance support group sessions.||Moore SC, Wells NJ||Staff nurses lead the way for improvement to shared governance structure||Implementation||JONA. 2010;40(11):477-482.||The Magnet® model encompasses structural empowerment, transformational leadership, exemplary professional practice, and new knowledge, innovations, and improvements. As the American Nurses Credentialing Center reminds us, great leaders, structures, and nurses lead to great knowledge, innovation, and outcomes. One organization experienced the wisdom in this model through restructuring the system-wide staff nurse councils. The authors describe the steps by which this restructuring was accomplished and some of the positive effects on the work environment. The investigators measured whether participation in a system-wide staff nurse council would improve perceptions of workplace empowerment and organizational commitment; no statistical significance was found pre- and post-implementation, although nurses who participated in the councils had a higher informal power score than nurses who did not.||Conditions for Work Effectiveness Questionnaire, Organizational Commitment Questionnaire||O'May F, Buchan J||Shared governance: a literature review||Review||Int J Nurs Stud. 1999:36:281-300.||Review of 48 articles (1988-1998) describing SG implementation.||Overcash J, Petty LJ, Brown S.||Perceptions of Shared Governance Among Nurses at a Midwestern Hospital||Research||Nurs Admin Q. 2012;36(4):E1–E11.||The purpose of this project was to determine whether nursing education, work experience, certification, employment position, setting (inpatient/ambulatory), participation in shared governance, and age were related and predictive of scores on the Index of Professional Nursing Governance (IPNG). The significance was to provide a basis on which to enhance a nursing shared governance model resulting in enhanced patient care. This prospective, cross-sectional study included nurses in any type of nursing role and with any level of educational preparation. An analysis of variance was employed to identify strength of relationships among the categorical or ordinal variables and regression models for the continuous variables. General linear models were used to identify the variables most predictive of IPNG scores. The mean IPNG score was 186.5. No significant relationships were found among demographic measures and IPNG scores. A reported role in shared governance, when combined with work setting (inpatient or ambulatory), was predictive of IPNG scores. Nurses who worked in the inpatient setting reported higher mean IPNG scores.||Index of Professional NUrsing Governance||Pinkerton S||The unit practice council: Center of professional practice||Implementation||Nurs Economic. 2008:26(6):401-403.||Report on organizing and tracking the activities of 93 unit practice councils (UPCs) in the Jackson Health System in Miami, FL. Examples of positive outcomes of the UPCs include improved patient and staff satisfaction, improved quality outcomes, and cost savings to the organization.||UPC Implementation Guide||Prince SB||Shared governance. Sharing power and opportunity||Research||J Nurs Admin. 1996;27(3):28-35.||Pre- and postimplementation SG survey of unit-based model on mother/baby GYN unit in a 900-bed Alabama hospital used Rosabeth Kanter's framework for work effectiveness. Author-developed survey tool||Prybil LD||Nursing involvement in hospital governance||Commentary||J Nurs Care Qual. 1996;27(3):28-35.||Assessment of degree of involvment of nurses (with physician comparisons) in hospital boards.||Reif D||A staff-managed ICU||Implementation||Nurs Manage. 1995;26(2):32H.||A short account of the development, implementation, and difficulties of a self-governing model, where staff formally took on all managerial duties after a unit manager left at Hartford Memorial Hospital, Hartford, WI.||Rheingans J.||The Alchemy of Shared Governance: Turning Steel (and Sweat) Into Gold||Research||Nurs Leader. 2012;10(1):40-42.||Little data is available that examines the impact of shared governance on patient outcomes. The purpose of this research study was to describe the nursing environment at a community non-profit Magnet® hospital and examine the relationship between shared governance and caring on both nursing and patient outcomes.
Shared governance and caring were independent variables in this study. Dependent variables were divided into nursing (job satisfaction and employee engagement) and patient outcomes (safety climate, patient satisfaction scores, and unit-specific patient quality outcomes).
One hundred forty survey packets were returned from 31 nursing units at Sarasota Memorial Hospital (SMH). Using the Index of Professional Nursing Governance, the overall level of shared governance was 182 (range: 86-430), which places the hospital in the qualifying, but lower, range of shared governance. The overall self-assessed caring score was 4.3 (range 1-5), the overall safety climate survey score was 4.4 (range: 1-5), and the overall job satisfaction score was 3.9 (range: 1-5). Shared governance scores were statistically significantly different by work status, hospital unit/department, council participation, and professional certification; caring was significantly different by unit; safety climate varied significantly by unit; and job satisfaction was noted to be significant by unit, council participation, type of nurse, position of nurse, and professional certification. Regression analyses demonstrated significance of specific shared governance subscales (goals and practice) and caring subscales (comforting and clinical) in predicting multiple job satisfaction subscales and overall safety climate. Due to the limitation by number of units within this hospital system, statistical significance was not achieved when regressing shared governance and caring onto patient outcomes at the unit level; however large R2 values were noted with multiple indicators, including fall rates (.699), fall with injury rates (.788), pressure ulcer incidence (.423), medication management (.560), and identification errors (.403). Employee engagement and patient satisfaction (.401 and .803, respectively) were also large, but not statistically significant.
The shared governance score validates that SMH is making progress in shared governance. Self-assessed caring scores indicate nurses’ perceptions are consistent with the chosen SMH nursing theory of Watson’s Theory of Caring. Shared governance and job satisfaction both improved with council participation. The Goals subscale of the IPNG were helpful in predicting Safety Climate and multiple job satisfaction results. The clinical subscale of the caring survey is important in predicting job satisfaction. And with a larger future sample providing ample power, shared governance and caring could be evaluated for their impact on patient quality outcomes.
|Index of Professional Nursing Governance, Caring Nurse-Patient Interactions Scale, Measure of job Satisfaction, Safety Climate Survey||Root SD||Implementing a shared governance model in a perioperative setting||Implementation||AORN J.2000;72(1):95-8, 101-2, 104.||Account of initial implementation of multidisciplinary SG model in a surgical services department at Santa Rosa Memorial Hospital, CA.||Rundquist JM, Givens PL||Quantifying the benefits of staff participation in shared governance||Implementation||American Nurse Today. 2013; 8(3).||Sanford KD||Shared Governance: One Way to Engage Employed Physicians||Implementation||Healthc Financ Manage. 2012;66(9):44-6, 48||To work better with employed physicians, finance leaders should: Understand classic management theories on what motivates employees. Learn from shared governance models with nurses at Magnet hospitals. Apply best practices in management to all employees, not just physicians.||Stumpf LR||A comparison of governance types and patient satisfaction outcomes||Research||J Nurs Admin. 2001;31:196-202.||Compared to those intraditional units, nurses in SG units had higher contructive culture and lower defensive scores, and higher satisfaction but lower retention. Patient satisfaction was higher in SG units.||Organizational Culture Inventory, Work Satisifaction Scale, Patient's Opinion of Nursing Care||Styer KA||Development of a unit-based practice committee: A form of shared governance||Implementation||AORN J. 2007;86(July):85-93.||Staff nurses in a PACU at Brigham and Women's Hospital, Boston, Massachusetts, implement a modified process of shared governance. An account of issues encountered along the way.||Thrasher T, Bossman VM, Carroll S, et al.||Empowering the clinical nurse through quality assurance in a shared governance setting||Implementation||J Nurs Care Qual. 1992;6(2):15-19.||Description of the quality assurance council within a nursing division-wide councilar shared governance model at Children's Hospital medical Center, Cincinnatti, Ohio. Nurses from six clusters of units participate in the quality assurance council which, in turn, is represented on the hospital quality assurance council.||Thyen MN, Theis R, Tebbitt BV.||Organizational empowerment through self-governed teams. An application in long-term care.||Implementation||J Nurs Admin. 1993;23:24-26.||Short account of initial implementation of a Self Governance Care Team Model to empower staff and residents in a long-term care organization, Saint Benedict's Center and Alternative Services, St. Cloud, Minnesota.||Totten NW, Scott VL||Who's on first? Shared governance in the role of nurse executive||Implementation||J Nurs Admin. 1993;23(5):28-32.||Instead of filling a VP position, five directors of nursing propose to take turns (terms) rotating through the position in a shared governance environment at Fort Saunders Regional Medical Center, Knowville, TN.||Upenieks V||The relationship of nursing practice models and job satisfaction outcomes||Review||J Nurs Admin. 2000;30:330-335.||Critique of six SG interventional studies, focusing on outcomes of job contentment and autonomy.||Westrope RA, Vaughn L, Bott M, Taunton RL||Shared governance, from vision to reality||Research||J Nurs Admin. 1995;25(12):45-54.||Shared governance, division- and unit-based, evaluated before implementation and two times after at Saint Luke's Hospital, Kansas City, Missouri. Shared governance (defined as control over nursing practice) and decision saturation (nurses involved in decisions that are important to them at the work unit and organizational levels) are related to multiple variables of task identity, job involvement, job satisfaction, and commitment. Some positive change in satisfaction, commitment, and turnover attributed to shared governance, although other simultaneously occuring events may have been contributing factors.||Instruments described, but not named||Whitt M, Baird B, Wilbanks P, Esmail P||Tracking decisions with Shared Governance||Implementation||Nurse Leader. 2011;9(6):53-55.||At St Vincent Health System, the multidisciplinary Congressional Decision Implementation Team (CDIT) is a multidisciplinary team tracks the implementation of the Patient Care Governing Congress (PCGC) decisions. This team includes the communication officer, the clinical informaticist, the executive sponsor of the policy development and review council, and a clinical education member. The chief nursing executive (CNE) provides executive support as needed. Little published information exists to guide the process of implementing nursing shared governance decisions. The CDIT team was developed to create an effective plan to implement decisions and disseminate the information to appropriate staff. The team meets monthly on the day after the Congress meeting to discuss the decisions, identify accountability and necessary action steps, establish target completion dates, and track all components on a flow sheet.||Williamson T.||Work-based learning: A leadership development example from an action research study of shared governance implementation||Research||J Nurs Manag. 2005;13:490-499.||Shared governance is an approach to empowering nurses and other healthcare workers to have authority for decisions concerning their practice. Its implementation in the UK has often been part of wider leadership development activity by healthcare organizations seeking to professionally develop their workforce.
Action research is a participatory approach to enquiry which fitted well within the study described here that sought to strengthen shared governance decision making in a UK councillor model. This opinion paper argues that action research is in fact a work-based learning mechanism. As such action research can maximise learning at an individual, group, and organizational level through working with research participants in a participatory way in their own work settings. The study underpinning this article employed a single-case study design. Sub-cases comprising two shared governance councils were focused on. A maximum diversity sample of eight council members were individually interviewed and a focus group interview of eight council members was carried out. Over two hundred hours of participant observations of shared governance councils were undertaken. Decision-making processes were compared and contrasted through development of data displays that tracked each decision-making process observed from inception to resolution or end of fieldwork. In this way council members’ development was tracked through their day-to-day involvement in shared governance processes.
Action research has been demonstrated to be an effective means of work based learning. Use of its application with a shared governance development example has aided the provision of evidence for this claim.
Dr Tracey Williamson
|Face-to-face interviews and participant observations||Wilson B, Squires M, Widger K, Cranley L, Tourangeau A||Job satisfaction among a multigenerational nursing workforce||Research||J Nurs Manag. 2008;16(6):716-23.||This study explored generational differences in job satisfaction, which can help to staff off the international nursing shortage. Job satisfaction, a strong and consistent predictor of retention, may differ across generations. Understanding job satisfaction generational differences may lead to increasing clarity about generation-specific retention approaches.
The Ontario Nurse Survey collected data from 6,541 Registered Nurses. Participants were categorized as Baby Boomer, Generation X, or Generation Y based on birth year. Multivariate analysis of variance explored generational differences for overall and specific satisfaction components.
In overall job satisfaction and five specific satisfaction components, Baby Boomers were significantly more satisfied than Generations X and Y.
This study concluded that job satisfaction needs to be improved for younger generations of nurses. Nursing Management Strategies to improve job satisfaction for younger generations of nurses may include creating a shared governance framework where nurses are empowered to make decisions. Implementing shared governance, through nurse-led unit-based councils, may lead to greater job satisfaction, particularly for younger nurses. Self scheduling or job sharing may be other potential approaches to increase job satisfaction, especially for younger generations of nurses. Another potential strategy would be to aggressively provide and support education and career-development opportunities.
|Winslow SA, Fickley S, Knight D, Richards K, Rosson J, Rumbley N||Staff nurses revitalize a clinical ladder program through shared governance||Implementation||J Nurses Staff Dev. 2011 Jan-Feb;27(1):13-7.||After 20 years of a static clinical ladder program at Martha Jefferson Hospital, Charlottesville, Virginia, the clinical ladder program was completely redesigned using a staff nurse-led shared governance structure to re-envision the program as an innovative, staff leadership model to meet the organizational nursing mission and vision strategic plans around retention and professional development. The literature demonstrated a lack of outcome-driven findings on the sustainability of hospital-based clinical ladder programs. The authors cover the rationale for their clinical ladder model, the process used for revision, the implementation strategies, and the specific outcomes tracked regarding nurse satisfaction, affiliation, retention, and participation of staff nurses advancing to the optional upper levels of the ladder.||Zuzelo P, McGoldrick TB, Seminara P, Karbach H||Shared governance and EBP: A logical partnership?||Implementation||Nurs Manag. 2006;37(6):45-50.||While the relationship between shared governance and evidence-based practice is still in its early stages, the Albert Einstein Healthcare Network believes these separate models of care share the same processes and equate to solid, successful nursing.|