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Shared Governance Lets Nurses Be Agents of Change

Nurses are discovering how to transform their frustrations into accomplishments by participating in a form of leadership known as shared governance.

“Shared governance recognizes the professional status of the nurse,” says Kevin Hannifan, vice president and chief operating officer at Hartford Hospital, where shared governance started to take form at the end of 1999. “Instead of having guys like me or directors of nursing telling them what to do, we want them to tell us what to do.”

The specifics of shared governance vary by hospital, but typically nurses and other members on a unit form a council group to evaluate the status quo and recommend changes they deem necessary — changes that can dramatically impact the quality of patient care. Depending on the facility, nurses interested in joining a council are either invited by a manager or may volunteer.

While the concept of shared governance is about 30 years old, hospitals today are revitalizing it as one way to improve nurses’ job satisfaction. This organizational model can also help hospitals earn Magnet status — an award for nursing excellence granted by the American Nurses Credentialing Center.

Shared Governance in Action

At Hartford Hospital, representatives from different shifts and jobs within a unit meet for an hour each month to evaluate patient care and discuss how to implement changes. Decisions are by consensus, not a vote. Councils from different units then meet monthly to exchange ideas.

When she was an ambulatory care staff nurse at Hartford Hospital, Cynthia O’Brien, RN, was invited by her nursing director to join the unit’s practice council, which included three other staff nurses, a physician, a nurse practitioner, a nurse’s aid and an administrative assistant. Initially, staff members were invited by managers to participate in councils, but now those with any level of experience can volunteer.

In spring 2005, some nurses in O’Brien’s group expressed concern about the care of patients who were taking the blood thinner Coumadin. Variations in blood consistency could put patients at risk of life-threatening clotting or bleeding. Once patients on this medication left the hospital, there was no procedure in place to determine how frequently they should return to have their blood tested.