Nursing practice models provide the structure and context to organize the delivery of care. Shared governance is a model of nursing practice designed to integrate core values and beliefs that professional practice embraces, as a means of achieving quality care. Shared governance models were introduced to improve nurses’ work environment, satisfaction, and retention. The purpose of this article is to review representative published evidence of shared governance and to evaluate whether shared governance has lived up to its promise and potential. Theoretical and empirical evidence will be examined and discussed in an attempt to answer whether shared governance, as an organizational form of nursing practice, has achieved the positive outcomes it intended.
Key Words: shared governance, professional practice models, nursing models
"Reorganization in health care institutions is currently the rule rather than the exception. All health care players are attempting to strategically position themselves in the marketplace. What do these changes mean for nursing: How can nursing best respond?" (Porter-O’Grady, 1987, p. 281). These words written 25 years ago are as relevant and appropriate today as they were then. During these years nursing administrators have responded by restructuring and evaluating nursing care delivery systems to meet the challenges of maintaining a professional practice in a cost and resource constrained environment while focusing on achieving positive patient, nurse, and organizational outcomes.
Nursing in acute care is delivered under a group practice model that provides the structure and context to organize the delivery of care (Brennan & Anthony, 2000). Various configurations of practice models have emerged that range from those that are based on patient assignment (such as team nursing), accountability systems (such as primary nursing), managed care (such as case management), to care systems explicitly based on professional values and ideals of autonomy, decision making and participation (Anthony, Brennan, O’Brien, & Suwannaroop, in press). These latter models include those identified as shared governance models. Conceptually, governance models are appealing because they are designed to integrate core values and beliefs that professional practice embraces as a means to achieve quality care. However, over the past several decades, administrators, researchers, and clinicians have struggled to understand what shared governance is, how it works, and whether it in fact works. The purpose of this article is to review representative published evidence of shared governance and to evaluate whether shared governance has lived up to its promise and potential.
Shared Governance: The Theory
The earliest foundation for shared governance arose from the human resource era of organizational theories.
The theoretical underpinnings of shared governance come from a broad set of perspectives that includes organizational, management, and sociological theories. Understanding the variation in these theoretical viewpoints helps us to appreciate the history of how shared governance models were designed and implemented. The earliest foundation for shared governance arose from the human resource era of organizational theories. This era represented the first departure from the traditions of scientific management. Theorists such as Herzberg (1966) and McGregor (1960) championed employees as an organization’s most important asset encouraging organizations to invest in employee motivation and growth. Thus, practices such as autonomy, empowerment, involvement, and participation in decision making were advocated (Bolman & Deal, 1997). From the human resource era emerged business and management philosophies that directly influenced the development of shared governance models. For instance, Deming (1986), who introduced new concepts of quality management, proposed that an organization’s work environment value quality, empower the worker to be more productive, and emphasize leadership and team building. Forms of shared governance appeared that were formed in alliance with an organization’s quality management initiatives (Gardner & Cummings, 1994; Thrasher et al., 1992).
From a management perspective, Kanter’s theory (1977, 1993) on structural power has been instrumental in the development and formation of shared governance models as care delivery systems (Edwards et al., 1994; Jones, Stasiowski, Simons, Boyd, & Lucas, 1993; Prince, 1997), and it has influenced broader redesign initiatives that emphasize work empowerment (Erickson, Hamilton, Jones, & Ditomassi, 2003; Laschinger, Almost, & Tuer-Hodes, 2003; Laschinger & Havens, 1996; Laschinger, Sabiston,& Kutszcher, 1997; Laschinger, Wong, McMahon, & Kaufman, 1999; Sabiston & Laschinger, 1995). The assumptions proposed by Kanter (1977, 1993) suggest that formal and informal power permit access to work empowerment structures (opportunity, resources, support, and information) that enable workers to accomplish their work. Being empowered suggests a model of shared governance where decisions are made at the point of service (Porter-O’Grady, 1995).
With the formation of second-generation shared governance models, the influences from organizational designs, such as self-managing work teams, began to emerge.
With the formation of second-generation shared governance models, the influences from organizational designs, such as self-managing work teams, began to emerge (Norby, 1995; Perley & Raab, 1994; Song, Daly, Rudy, Douglas & Dyer, 1997). The philosophy behind self-managing work teams assumes those work groups, who are jointly responsible for achieving goals, lead themselves (Jones, 2004) and thus have authority and control over the work and access to information (Perley & Raab, 1994).
While most of the aforementioned theories address the worker directly, some shared governance models have been guided from the perspective of the leader (DeBaca, Jones, Tornabeni, 1993; Kennerly, 1996). These leadership theories operate from the supposition of shared leadership; and the role of the leader is to facilitate, coach, model, and serve as an information resource (Minnen et al., 1993).
Turning to yet another perspective, the sociology of professions has also strongly influenced shared governance (Havens, 1994; Westrope, Vaughn, Bott, & Taunton, 1995). In these perspectives professional autonomy is the basis for managing the care environment (Maas & Jacox, 1977). Society grants professionals, by virtue of their specialized knowledge, the right to control their own activities (Greenwood, 1966; Merton, 1960) and be self-directed in the performance of their work. Thus, shared governance, as an organizational form, has potential to bridge differences between the traditional bureaucratic models, characterized by centralized decision making, with professional models that are distinguished by independent authority for decision making.
Each of these theoretical influences arises from a particular set of organizational, management, or professional lenses that have similarities and differences. These perspectives are similar in the broadest sense in that they assert that the professional nurse is an important stakeholder in the organization. As such, nurses should actively participate in controlling the work environment and in making decisions that are necessary in carrying out their scope of work to perform their professional tasks. Conversely, these disciplinary perspectives differ in their orientation to the degree that they range from the nurse being "granted" the power to function autonomously (Kanter, 1977) to the nurse having the professional right to act autonomously (Maas & Jacox, 1977). These opposing orientations may underlie how shared governance is defined and implemented.
In the past 25 years, these philosophies have been integrated into the professional practice of nursing. Early descriptions of shared governance describe it as an accountability-based system for professional staff (Porter-O’Grady, 1987). As our understanding of shared governance has increased, conceptual models depicting it have evolved from linear, reductionistic representations (Allen, Calkin & Peterson, 1988; Ortiz, Gehring, & Sovie, 1987) to dynamic, integrated circular representations (Evan, Aubry, Hawkins, Curley, & Porter-O’Grady, 1995; McDonagh, Rhodes, Sharkey, & Goodroe, 1989) that reflect its multidimensionality. The evolution of these representations may reflect transitions from first generation models of shared governance that were aligned with bureaucratic traditions to second generation models that reflected broader multilevel involvement (Minnen et al., 1993).
The diversity of theoretical perspectives has resulted in a variety of contemporary definitions of shared governance.
The diversity of theoretical perspectives has resulted in a variety of contemporary definitions of shared governance. Hess (1998) describes governance as including the "structure and process by which organizational participants direct, control, and regulate the many goal oriented efforts of other members" (p. 35). O’Malley (as cited in Prince, 1997), portrays shared governance as an "accountability-based governance system that shares power, control, and decision making with the professional nursing staff within a clinical decision making framework" (p. 28). Porter-O’Grady (2001) says that shared governance, as a dynamic, is a way of conceptualizing "empowerment and building structures to support it" (p. 470) and embodies four principles: partnership, accountability, equity, and ownership.
Although these definitions differ in their depth, scope, and reflection of the influences of theoretical perspectives, common characteristics exist. These include autonomy and independence in practice, accountability, empowerment, participation, and collaboration in decisions that affect individual patient care, the more general practice environment, and group governance (Burnhope & Edmonstone, 2003; DeBaca et al., 1993). These characteristics represent professional nursing ideals. Thus governance models that are based on these ideals should translate into the realities of the organization through organizational designs that allow nurses the freedom to fully participate in the practice of nursing and in shaping the work environment in which patient care occurs.
However, despite some consensus on several of the key characteristics of governance models, the variations in the theoretical underpinning from which they are derived results in definitional ambiguity that invariably leads to implementation of alternative forms that are adapted on a case-by-case basis (Hess, 1998). For instance, four configurations of shared governance have been described by O’May and Buchan (1999). Unit-based systems are governance models specifically tailored to an individual nursing unit. Councilor models are designed using any number of department level councils as a method to coordinate clinical and administrative activities. Administrative models reflect an executive level of coordination over the activities of smaller councils. Seen less frequently is the congressional model, where all nursing staff belong and work is given to cabinets.
As these various forms of shared governance are implemented at different organizational levels, the extent of authority, decision making, and participation that resides with the bedside nurse varies (Bernreuter, 1993). Further, the boundaries defining governance can range from direct patient care decisions to decisions for managing the work environment (Burnhope & Edmonstone, 2003; Hess, 1995). Hence, shared governance models have taken on variations in form and scope. Consequently, designing rigorous empirical evaluations of the process itself and the effects of shared governance can be difficult.
Shared Governance: The Evidence
The evidence supporting the benefits of shared governance models ranges from case study exemplars, where implementation stories are told, to formalized, research-based evidence. The exemplars describing implementation of shared governance largely represent earlier work and provide a road map for designing governance structures both on the unit and at the divisional level (Alvarado, Boblin-Cummings, & Goddard, 2000; Evan et al., 1995; Ireson, & McGillis, 1998; Jacoby & Terpstra, 1990; Jones & Ortiz, 1989; McDonagh, et al., 1989; Ortiz, Gehring, & Sovie, 1987; Peterson, & Allen, 1986a; 1986b; Relf, 1995; Shidler, Pencak, & McFolling, 1989). These studies provide anecdotal evidence of success with subjective appraisals of outcomes that include better relationships and team harmony, fewer conflicts, job satisfaction, communication, collaboration, professional growth, and lower turnover (Anderson, 1992; Brooks, Olsen, Rieger-Kligys, & Mooney, 1995; Daugherty & Hart, 1993; Evan et al., 1995; Kovner, Hendrickson, Knickman, & Finkler, 1993). While these outcomes reflect the important product of shared governance, there has been little attention paid to evaluations describing the extent to which shared governance is implemented (O’May & Buchan, 1999). Hess (1998) argues that examination of outcomes at any level is suspect if we cannot measure the extent that governance exists. Toward this end, he has developed and validated an 88-item instrument to evaluate the distribution of governance (Hess, 1998). Despite the development of this tool, it has had very limited use by other researchers. In one specific study, George, Burke, and Rogers (1997) used Hess’ tool to evaluate nurses’ perception of governance after hospital acquisition.
Parallel to the descriptions and anecdotal appraisals of shared governance are the research-based studies that focus on the outcomes of shared governance and which refer to the benefits to the organization, nurse, and patient. As described in the review that follows, the vast majority of these evaluations report the findings of shared governance in a single setting with either cross-sectional or longitudinal time frames.
In general, the evidence suggests an improved financial picture after implementing shared governance, resulting from either costing savings or cost reductions.
Changing to a governance model of nursing most often involves moving from a hierarchical structure to the councilor structural form of shared governance that targets decision making across types of decisions (O’May & Buchan, 1999). Moving decision making to a different organizational locus has reportedly both a direct and indirect financial impact. In general, the evidence suggests an improved financial picture after implementing shared governance, resulting from either cost savings or cost reductions. Jenkins (1988) found that the change in committee structure resulted in an overall increase in the number of hours spent in meetings, but the meeting hours per full time employee (FTE) dropped. In the evaluation by DeBaca et al. (1993) of a councilor model of shared governance, nearly six million dollars in saving was realized over five years and was attributed to the elimination of temporary agency nurses and reductions in recruitment and orientation costs. Considerable savings were realized even after accounting for the financial investment of implementing a governance model. In a quasi-experimental matched group design, Zelauskas and Howes (1992) found that over a 30-month period, the shared governance unit outperformed the control unit. When compared to baseline, the shared governance unit had a 1.5% reduction in non salary costs per patient day, 18% fewer sick hours per FTE, and an 11% reduction in turnover. Finkler and colleagues (1994) evaluated the costs associated with initiatives to improve recruitment and retention across 37 hospitals. In the three hospitals where shared governance models were implemented, there were lower innovation costs per bed as compared to other delivery models such as case management, and a 7.5% improvement in RN hours per patient day; but there were no differences in the number of nurses recruited.
In some instances, the financial performance related to productivity, cost efficiency and effectiveness, working conditions, length of stay, absences, and turnover have been reported but not substantiated with explicit data (DeBaca et al., 1993; Jenkins, 1988). Else financial performance was associated with the implementation of shared governance along with other organizational changes such as case management, product line management, and quality assurance models so the independent influence of shared governance could not be established (Brodbeck, 1992).
One of the early but enduring goals of shared governance was to improve the work environment of nurses, their satisfaction, and retention (Kennerly, 2000; O’May & Buchan, 1999; Rose & Reynolds, 1995). The studies reviewed here defined and operationalized the work environment in a variety of ways, utilized designs that vary in scientific rigor, and typically sampled from single sites. Studies reported findings that supported mixed conclusions as to whether or not shared governance improves the environment.
Studies reported findings that supported mixed conclusions as to whether or not shared governance improves the environment.
Similar to the studies using anecdotal exemplars, Thrasher et al. (1992) used a descriptive case analysis methodology. These investigators identified the benefits of using a quality assurance council in shared governance as a method to increase nurse autonomy, authority, and accountability.
A number of pre/post shared governance implementation studies demonstrate its effect on the work environment. Jones et al. (1993) evaluated the work environment after implementation of shared governance on 29 patient care units over a three year time period. This model included councils on both the unit and departmental level. Statistically significant improvements in the decision-making style of managers were seen in the second year. Professional job satisfaction improved in all three years and organizational job satisfaction and anticipated turnover improved during the second and third years. However, there was no improvement in group cohesion or job stress. Similarly, Edwards et al. (1994) reported a perceived increase in autonomy, communication, decision making, and sense of team when shared governance was implemented on one intensive care unit.
Prince (1997) evaluated the effects of implementing shared governance on the unit based work environment using a pre/post survey design with site specific instrumentation. Of 34 staff nurses responding to the survey, after shared governance was implemented, there was a 6-7% improvement reported in receiving information nurses needed to do their job and information being received in a timely way. Paradoxically though, nurses reported an approximately 21% increase in never being told about changes that affect their work. Similarly, there was an 8% decrease in job satisfaction and a 31% decrease in committee work. However, nurses reported a heightened awareness of nurse empowerment. Turnover rates remained unchanged.
Westrope et al. (1995) described a councilor model of shared governance in one hospital with implementation processes occurring at both the organizational and unit levels. Shared governance was operationalized as control over practice. Midway through their three year implementation, control over practice was moderately related to task identity (r = .54), job involvement (r = .31), satisfaction with worker interaction, quality of care, and job enjoyment (r’s = .23 to .27), and organizational commitment (r = .42). Satisfaction and commitment increased the longer shared governance was in place. Over the three years, turnover rates declined from 19% to 6%.
Using investigator-developed instrumentation and a pre/post design, Ireson and McGillis (1998) reported that after 12 months, there was greater sense of cooperation among employees, and nurses felt their contributions made a difference to their department, but there was no change in their sense of contribution to the hospital or patients. However, there was an improvement in unit-based patient satisfaction. Further, nurses reported that shared governance provided the structure for more effective and lasting problem solving.
In a quasi-experimental design conducted by Kennerly (1996), nurses working on shared governance units had more interpersonal conflict after six months. However, no other differences were found in nurses’ autonomy, role ambiguity, role conflict, self-perceived effectiveness, job satisfaction, organizational commitment, or anticipated turnover at either 6 or 18 months. Similar findings were reported by Zelauskas and Howes (1992) who reported no differences at 6, 12, and 30 months in aspects of the work environment (skill variety, task identity, feedback, dealing with others, friendship opportunities) except for an increase in autonomy at 30 months.
In a post implementation only descriptive study, Ludemann and Brown (1989) evaluated a congressional model of shared governance on work environment characteristics (personal power, workload, climate for innovation, influence) and job satisfaction. Although methodologically weak, nurses were asked to recall (at 18 and 24 months) their attitude toward the work environment before shared governance was implemented as well as to measure their current attitude. Nurses reported their work environment post implementation to be significantly more positive as compared to their recall of the work environment 18 months earlier. However, the absolute mean difference was small (.12 on a scale of 1-6). The amount of influence nurses reported was also statistically significant but again the mean difference was small (.56 on a 1-5 scale).
Richards et al. (1999) evaluated the effects of a councilor model of shared governance on the overall culture of excellence. Interestingly, after two years, there was a statistically significant decrease in autonomy, but an increase in being close to the customer and a perception that the organization was leaner with more decentralized decision making. In a qualitative analysis, nurses reported a feeling of empowerment and improved communication.
Nurse satisfaction has been considered a key outcome of shared governance and has often been included in the evaluations of the work environment as described above. However, because a professional practice model, such as shared governance, is believed to enhance nurse satisfaction, it has also been addressed specifically. As in the evaluation of other outcomes, consistent relationships between shared governance and nurse satisfaction have not been found. In some cases, nurse satisfaction was found to improve when shared governance was implemented (Jones et al., 1993; Ludeman & Brown, 1989; Vilardo, 1993; Zelauskas & Howes, 1992); yet others have reported no change or decreased satisfaction (Hastings & Waltz, 1995; Prince, 1997; Zelauskas & Howes, 1992).
Stumpf (2001) conducted a multisite ex post facto correlational study involving 16 patient care units across 5 hospitals. Comparing units with shared governance models (n = 8) to units with traditional governance models (n = 8), nurses working on the shared governance units had a more positive composite constructive culture, as well as higher job satisfaction that reflected greater satisfaction with the work, professional status, cohesion, and administration. Shared governance units however, reported a lower retention rate than the traditional units.
In an extension of the evaluations of shared governance, Hastings (1995) used a secondary analysis to compare the outcomes of a hospital-wide change to governance between nurses working in different specialties. Nurses working in ICUs (n = 11 units) had higher job satisfaction, increased perceptions of giving high quality care, and were more positive about peer support and involvement in decision making than nurses working in general units (n = 15 units).
In summary, the organizational, work environment, and job satisfaction outcomes of shared governance have not consistently supported its anticipated benefits. In general, there have been reported financial improvements in shared governance environments, but the indicators vary by study. Additionally, some of these improvements have not been objectively supported but have been based on subjective appraisals. Benefits to the work environment have been generally disappointing. Indicators and measures assessing the work environment varied widely across studies. While in many cases, there have been improvements in those characteristics, such as autonomy, communication, and decision making that is consistent with professional ideals, these have not been consistent over the range of studies having multiple designs, sampling, and measurement strategies. Other presumed benefits of shared governance that reflected improved work team dynamics such as cohesion, commitment, and conflict were similarly mixed. Likewise, turnover has been found to improve, decline or remain unchanged. Inconsistencies reported in job satisfaction not only included whether or not it improved but also included variations in how it was operationalized.
The review of the literature leads nursing scholars, administrators, and practitioners to ask whether or not shared governance, as an organizational form for nursing practice, has lived up to its potential.
The review of the literature leads nursing scholars, administrators, and practitioners to ask whether or not shared governance, as an organizational form for nursing practice, has lived up to its potential. In this uncertain health care environment, a straightforward yes or no answer would provide clearer direction to those who are responsible for shaping and evaluating practice models. Unfortunately, the appraisal of the multiple complex and integrated factors of where we have been and what we have done does not offer simple clarity. Several areas for discussion are presented.
Variations in theoretical perspectives lead to variations in implementation. Thus, clarifying these influences may help us to understand the contradictory findings found from the empirical assessment. Autonomy, empowerment, leadership, decision making, and control over practice are recurring concepts in defining shared governance. For example, depending on the theoretical lenses, Kanter’s (1977) framework might suggest that empowerment may lead to autonomy. However, if the sociology of profession set of lenses is used, autonomy leads to self-direction, hence empowerment. Each of these perspectives influences what is studied and how it is studied. The lack of theoretical clarity and common philosophical assumptions in which models of shared governance were designed leads to a disjunction between the theory and the practice. To move forward, a critical question to sort out is whether professional values, such as autonomy and decision-making are defining characteristics of shared governance, whether they are antecedent to shared governance, or whether they are a consequence of shared governance (Kennerly, 2000). The intellectual debate here will be to address what is the most relevant and meaningful theoretical perspective to guide shared governance.
Consistent conceptual guidance has not been evident in designing shared governance models. However, we should not dismiss the value of the existing anecdotal accounts. These individual case studies provide us with conventional wisdom. On one hand, these individual descriptions of implementation offer an experiential representation or "know how" of how this organizational form might be implemented in the field. On the other hand, however, these accounts identify the difficulties inherent in its conceptualization and implementation as a project versus a process, complexities in the management of time, communication, acceptance, and leadership (Burnhope & Edmonstone, 2003; Hibbard, Storoz, & Andrews, 1992; Reif, 1995).
Few studies have used rigorous designs.
Few studies have used rigorous designs. Most assessments of shared governance outcomes are limited to description and cross sectional (e.g., Brodbeck, 1992; George et al., 1997). The few pre-post implementation and quasi-experimental designs that allow for comparisons were usually conducted either in a single hospital or with a limited number of units. In general, response rates to surveys were small and sometimes had too few respondents or too few units to have confidence in the findings (e.g., Ludemann & Brown, 1989; Prince, 1997; Richards et al., 1999). Since multi-institutional research poses multiple challenges and dilemmas, only a few studies were conducted across multiple institutions (e.g., Finkler et al., 1994; Stumpf, 2001). Overall the design and sampling limitations restrict the confidence in and the generalizability of the findings.
A minority of studies were longitudinal. These studies were characterized either by beginning measurement after implementation, without baseline data (Finkler et al., 1994; Ludemann & Brown, 1989; Thrasher et al., 1992) or studies characterized by varying time frames. While longitudinal designs permit the researcher to examine changes in the phenomenon over time, the time intervals in which key outcome variables were measured ranged from 6 months (Ireson & McGillis, 1998) to 60 months (Jenkins, 1988). Implementation of shared governance reflects a cultural change that takes 3 to 5 years to embed (Porter-O’Grady, 1996), thus evaluations done in the early phases of implementation may not reflect the change in governance distribution. The inconsistent findings, like those related to autonomy, satisfaction, and turnover are therefore not surprising. Further, measurements conducted too early may reflect statistical significance, but the effect size may be too small to have practical significance (e.g., Ludemann & Brown, 1989)
...evaluations done in the early phases of implementation may not reflect the change in governance distribution.
There was a wide range of measurement strategies used in the studies that were reviewed. For instance, in some studies, job satisfaction was measured using standardized and well-validated instruments (e.g., Jones et al., 1993; Kennerly, 1996). In other studies, study specific, in-house measures were developed (Brodbeck, 1992; Ireson & McGillis, 1998). It is difficult to make comparisons across sites when important concepts are conceptualized and operationalized differently, so statements about the generalizability of findings must be made with caution.
The organizational level where shared governance was implemented also varied. Whether shared governance is implemented on a unit-based or a divisional level of the organization has implications for processes such as communication and decision making. Specifically, the network of communication is considerably larger when shared governance is operationalized on the organization level as compared to a much smaller network on a unit level. Similarly, timeliness of decision making is affected by the organizational location of shared governance. It is intuitively logical that decisions made at the point of action (unit) would be made more quickly than at the broader organizational level. Further, the scope of decisions made by nurses in a shared governance model may also be different. Competing positions have been documented in the literature about unit level implementation. Some challenge whether governance on the unit level is really a governance system at all (Hess, 1994), while others propose the importance of unit level implementation (Hastings & Waltz, 1995).
Assessing the level of analysis also has an empirical consideration. Kennerly (1996) identifies one of the defining characteristics of shared governance as being team decision making. Yet researchers of shared governance have largely limited their analysis to the individual nurse rather than aggregating it to include the unit or relevant work group. If nursing in acute care is a group-based practice, then the realities of shared governance require group-based structures and processes.
Two assumptions about shared governance have been made and taken for granted. First, as Hess (1996) points out, when shared governance models are implemented, it is assumed that governance is redistributed. Without measuring the change in distribution, we don’t know whether the intention of redesign has been achieved. Secondly, Porter-O Grady (1996) reiterates what others have also stated: we presume that nurses want to participate in decision making, but this assumption is also not validated. Certainly, if nurses have authority for decision making, that does not necessarily mean they choose to exercise it (Anthony, 1999), and thus organizational designs will not achieve this end. Future shared governance models will need to reconcile these issues.
...a commitment for investing adequate resources to design and conduct multi-institutional research that evaluates the structure and context in which nursing care is delivered will pay off...
While shared governance has made progress toward living up to its potential, we again need to refer to the question Porter-O’Grady (1987) asked 25 years ago. How can nursing best respond? Nurse researchers can put shared governance research on the spot by increasing the scientific rigor of the research. To do so means that we need to better understand what shared governance is about. Strategies such as workshops and focus groups that clarify its theoretical perspective and direction (determining the antecedents, attributes, and consequences) are needed. To maximize this effort, it must be done in coordination with a consortium of stakeholders. Participation by researchers, administrators, nurse executives, and staff is needed in order to come to a common understanding of the shared governance concept.
Identifying gaps between the perception of shared governance and its actual implementation will continue to serve as a road map for yet another generation of shared governance models. Lastly, a commitment for investing adequate resources to design and conduct multi-institutional research that evaluates the structure and context in which nursing care is delivered will pay off as we then can really begin to understand the contribution of nurses to outcomes.
In summary, the benefit of evaluating whether shared governance has lived up to its expectations is found in how it will help shape the future.
Shared governance, as a care delivery model, requires a paradigm shift.
Shared governance, as a care delivery model, requires a paradigm shift. Porter-O’Grady (2001) succinctly states that shared governance is a way of conceptualizing empowerment and structures to support it. If the essence of shared governance is empowerment, then why has it been so difficult to achieve it as an organizational reality with corresponding benefits? Randolph (2000) concludes that this journey requires a significant transition in how employees, managers, and organizational systems interact. How we as a profession decide to conceptualize shared governance and what assumptions we make may be less important than how we transition into new relationships. The decisions made will need to have stronger theory-practice link so evaluations of new models will build our theory, science, and practice.
Mary K. Anthony, PhD, RN
Dr. Anthony received her PhD in nursing from Case Western Reserve University. Her prior experience as an administrator, responsible for care delivery systems, piqued her curiosity in understanding the effects of redesigning care delivery systems. In her current position, Dr. Anthony has received funding to describe and evaluate models of care. Her research includes how the structure and process of nursing care affect patient, nurse, and organizational outcomes.
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