SG Articles

AuthorTitleComments
Allen D, Calkin J, Peterson M.Making shared governance work: A conceptual model.Most of the nursing literature offers little substantive rationale for why Shared Governance works or how to evaluate it. This article presents a model of Shared Governance that is based on more than fifty research articles on participation in decision-making. It gives administrators an overview of why Shared Governance impacts satisfaction and organizational commitment. The model should facilitate both designing a Shared Governance system to fit a particular organization and evaluating that system.
Allen-Gilliam J, Kring D, Graham R, Freeman KThe impact of shared governance over time in a small community hospital
This study examined the impact of shared governance (SG) on the professional nursing practice environment of a small community hospital over time. Shared governance has been shown to empower nurses in direct patient care to make decisions about their practice and improve job satisfaction. No research has been found that examined the progression of SG over time in a small community hospital.

Questionnaires pertaining to the professional practice environment, perception of nursing leadership, nurse empowerment, nurse satisfaction, risk of practice errors, and comfort with evidence-based practice were administered to all nurses employed at a 149-bed community hospital in central North Carolina for five consecutive years.

Results showed that nursing leadership and SG explained 90% of the variance in the nursing professional practice environment. This relationship held true for five years. All variables showed continued improvement for four years, until year five when the organization experienced disruptive change. Even during this year, the results did not return to baseline.

To improve the professional practice environment of nurses, hospitals should focus on strong nursing leadership and a sound SG infrastructure.

Unfortunately this study did not measure SG itself over time. Instead, researchers used the Shared Governance Survey, which the article stated measures nurse empowerment. Also, the cited outcomes were old, even though more current studies of outcomes are available.
Anderson E Faye
Nurs Admin Q. 2011;35(3):197-203.
A Case for Measuring GovernanceShared 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.
Ballard N
J Nurs Admin 2010;40(10):411-416.
Factors associated with success and breakdown of shared governanceShared 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
J Nurs Admin. 1993;23(10):12-14.
The other side of shared governanceProblems and solutions with SG.
Bogue RJ, Joseph ML, Sieloff CL
J Nurs Manage. 2009;17(1):96-104.
Shared governance as vertical alignment of nursing group power and nurse practice council effectivenessThis 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.
Bradley CJShared governance and rapid response teams beyond clinical practice: The nurse executive advisory cabinetThis article describes how a chief nursing officer implemented a registered nurse participative governance model throughout an Integrated Delivery Network to influence an administrative staff reallocation (float) policy beyond the traditional shared governance model. The model ues a rapid-response approach to provide accelerated problem solving throughout the organization.
Brodbeck B
J Nurs Care Qual. 1992;6(2):20-31.
Professional practice actualized through an integrated shared governance and quality assurance modelAccount 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
J Nurs Admin. 2012; 42(1):28-33.
Evidence-Based Practice Councils: Potential Path to Staff Nurse Empowerment and Leadership GrowthThis 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.
Brooks B
Online J Issue Nurs. January, 2004;9(1).
Measuring the impact of shared governanceStructure is the easy part of implementing SG. More challenging is changing the behaviors andÿ atttitudes of staff and managers, and measuring the benefits of SG.
Brooks F, Mitchel M, Pugh J
Nurs Times. 1998:96(46):56-57
Shared governance as a way of involving staff in decision-makingEthnographic 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.
Burkman K, Sellers D, Rowder C, Batcheller J
Nurs Admin Q. 2012;36(4):353?361.
An Integrated System?s Model of Nursing Shared Governance: A System Chief Nursing Officer?s Synergistic Vehicle for Leading a Complex Health Care SystemSeton 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.
Chamberlain B, Bersick E, Cole D, et al. Nrsg Manag. 2013;44(10):16-18.Practice models: A concept analysisThis long-overdue concept analysis does a great job of sorting out the differences between professional practice models, care models, care delivery models /system, and shared governance.
Constantinides GH, Tscharner D, Kalpowsky D, Baker-Priebe R
J Nurs Manag. 1994; 25 (12):32O-P.
Increasing autonomy: A self-directed MICUAn 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.
Clavelle JT, Porter-O’Grady T, Drenkard K.
JONA. 2013; 43(11)11:566–573.
Structural empowerment and the nursing practice environment in Magnet® organizationsThis landmark study describes the characteristics of shared governance and its relationship with nursing practice environments in Magnet® organizations.

Structural empowerment is a core Magnet model component illustrated through shared governance. Not much f literature exists describing it and its relationship to the nursing practice environment in Magnet organizations. E-mail surveys of Magnet chief nursing officers and leaders of their organization’s nursing practice council were conducted using the Index of Professional Nursing Governance (IPNG) and the nursing Work Index–Revised (NWI-R).

In Magnet organizations, the primary governance distribution is shared governance, with most subscales in the IPNG within the shared governance range. Total and subscale scores on the NWI-R ranged from 1.35 to 1.48, with significant, positive correlation between total IPNG score and total NWI-R score (r = 0.416, P < .001), as well as the NWI-R and IPNG subscales. This study provides new evidence that demonstrates the positive relationship between shared governance and the nursing practice environment in Magnet organizations.
Dearmon VA, Riley BH, Mestas LG, Buckner EB.Bridge to shared governance: developing leadership of frontline nurses.Transforming health care systems to improve quality is the responsibility of nurse executives and frontline nurses alike, yet frontline nurses are often ill-prepared to share leadership and accountability needed for transformation. The aim of this qualitative study was to describe the process used to build leadership capacity of frontline nurses engaged in resolving operational failures interrupting nursing care. The leadership development process served to bridge staff transition to shared governance. This institutional review board-approved qualitative research was designed to identify the effects of mentoring by the chief nursing officer and faculty partners on leadership development of frontline nurses working to find solutions to operational failures. Twelve nurses from 4 medical surgical units participated in a Frontline Innovations' nurse-led interdisciplinary group, which met over 18 months. Transcriptions of audiotaped meetings were analyzed for emerging process and outcome themes. The transcripts revealed a robust leadership development journey of frontline nurses engaged in process improvement. Themes that emerged from the mentoring process included engagement, collaboration, empowerment, confidence, and lifelong learning. The mentoring process provided frontline nurses the leadership foundation necessary to initiate shared governance.
DeBaca V, Jones K, Tornabeni J
J Nurs Admin. 1993; 23 (7/8):50-57.
A cost-benefit analysis of shared governanceOne 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.
Densmore J, Gbadebo C, Johnson C, Whitehead D.Shared leadership: Leaders and shared governance—Working together to improve staffing at WellStar Kennestone Regional Medical CenterHealthcare organizations in the United States and around the world are challenged with securing and retaining nurses at the bedside. WellStar Kennestone Regional Medical Center is confronting the challenge by developing a multipronged approach. Recruiting and retaining talented nurses with the skill sets to meet the clinical needs of a complex patient population in order to continue providing quality care is a top priority. The chief nursing officer and nursing leadership understand that confronting this persistent matter will require a multifaceted tactic. This article highlights leadership working with frontline team members in a Shared Governance model to set in motion processes that ensure appropriate staffing is available to deliver world class healthcare
Doherty C, Hope W
J Nurs Manag. 2000;8(2):77-81.
Shared governance - nurses making a differenceUK. 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.
J Nurs Admin. 2007;37:177-183.
Shared governance. making the transition in practice and perception.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.
Am Nurse Today. 2009;4(7):34-36.
In Sustained Improvement in Nursing Quality: Hospital Performance on NDNQI Indicators, 2007-2008. Issues Up Close. Quality improvement using NDNQI.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.
Edwards GB, Farrough M, Gardner M, Harrison D, Sherman M, Simpson S
J Nurs Manag. 1994;25(4):74-77.
Unit-based shared governance can work!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
Home Health Care Serv Quarter. 2007;26:43-58.
Employer retention strategies and their effect on nurses' job satisfaction and intent to stayData 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.
Erickson JI, Hamilton, GA, Jones DE, Ditomassi M
J Nurs Admin. 2003;33(2):96-104.
The value of collaborative governance/staff empowermentLongitudinal comparison of empowerment and power scores for members and nonmembers of collaborative governance program at Massachusetts General Hospital.
Ethridge P
Health Progress. 1987;May:44-49.
Nurse accountability program improves satisfaction, turnoverClassic longitudinal study links reorganization of professional practice environment to higher job satisfaction and lower job stress at St Mary's Hospital, Tucson, AZ
Fisher CA, Hubbard MLExtending evidence through shared governanceUsing shared governance structures to disseminate evidence-based practices through the hospital
Flynn MK
Doctoral dissertation. University of San Diego, 1997
Correlates of staff nurse work satisfaction in hospitals with shared governanceLack 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.
Franklin B, Murphy M, Cook PShared governance in an Army clinic: Implementing unit practice councilsOne army facility's implementation of shared governance through the creation of a unit practice council.
French-Bravo M, Crow GShared governance: The role of buy-in in bringing about changeThe term buy-in can be found in almost any article considering individuals’ participation in an initiative. At the time of this writing, a Google search of buy-in resulted in 10.5 billion hits. The term buy-in seems intuitive, yet many healthcare organizations struggle to implement and sustain initiatives that depend on nursing buy-in and involvement. The purpose of this article is to identify prerequisites to buy-in and factors that facilitate buy-in which, when cultivated, may positively influence nurse engagement. In this article, the authors discuss the concept of buy-in, identify prerequisites for buy-in, consider factors to enhance buy-in, and present scenarios of what happens when buy-in happens, when it almost happens, and when it fails. They also consider future directions to facilitate buy-in by nursing staff members.
Frith K, Montgomery M
Nurs Admin Q. 2006;30(3):273-284
Perceptions, knowledge, and commitment of clinical staff to shared governanceLarge SE US medical center surveys one year apart, pre- and postimplementation showed decrease in perception and knowledge, but an increase in commitment to SG.
Gavin M, Ash D, Wakefield S, Wroe C
J Nurs Manag. 1999;7(4):193-200.
Shared governance: time to consider the cons as well as the prosMethodologic flaws and bias for SG suggests research should be treated with caution.
George V
Doctoral dissertation. Marquette University, Milwaukee, Wisconsin
An organizational case study of shared leadership development in nursingThis 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.
George V, Burke L, Rodgers B, et al.
Nurs Admin Q. 2002;26(3):44-59.
Developing staff nurse shared leadership behavior in professional nursing practiceA 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.
George VM, Burke LJ, Rodgers BL
J Nurs Admin. 1997;27(5):53-61.
Research-based planning for change: Assessing nurses attitudes toward governance and professional practice autonomy after hospital acquisitionMedical 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.
Gloeckner MB, Robinson CB
J Nurs Staff Development. 2010;26(6):267-270
A nursing journal club thrives through shared governanceThis 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.
Graham-Dickerson P, Houser J, Thomas E, Casper C, ErkenBrack L, Wenzel M, Siegrist M. J Nursing Admin. 2013;43(5):286-292.The value of staff nurse involvement in decision makingThis study explored the perceptions of hospital-based staff nurses regarding their involvement in decision making and looked at the ways nurses would like to be involved in decision making. How nurses want to be involved and the extent to which hospital-based staff nurses are involved in formal and informal structures for decision making remain unknown.

Stratified cluster random sampling was used to identify hospitals to participate in the study. Staff nurses and chief nursing officers (CNOs) from 10 hospitals in Colorado were invited to participate in this qualitative descriptive study informed by grounded theory. Focus groups with staff nurses and individual interviews with CNOs were also conducted. Safe quality patient care was threaded throughout discussions among the staff nurses and CNOs.

Staff nurses viewed involvement in decision making through the lens of an egalitarian process, whereas administration viewed involvement as soliciting input but making decisions unilaterally.
Hafeman PWhat does it mean to Be part of a system? The role of the chief nurse executive and shared governanceThis article describes how the role of the nurse leader and the shared governance structure has evolved into a divisional structure and how this structure functions in the Hospital Health System, Eastern Wisconsin, in Green Bay, Wisconsin.
Hall DS
Doctoral dissertation. The Graduate School, University of Kentucky, Lexington, Kentucky, 2004.
Factors charaterizing supportive nursing care units for registered nursesThis 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.
Hartley LA. JONA. 2014;44(6):315-317.Implementing shared governance in a patient care support industry.Implementing technology in the clinical setting is not a project, but rather a journey in transforming care delivery. As nursing leaders in healthcare and patient care support organizations embrace technology to drive reforms in quality and efficiency, growing opportunities exist to share experiences between these industries. This department submission describes the journey to nursing shared governance from the perspective of an information technology–based company (Cerner) realizing the goal of supporting patient care.
Havens D, Vasey J
J Nurs Admin. 2003;33(6):331-336.
Measuring staff nurse decisional involvement: The decisional involvement scaleDescription 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.
Hess R
Nurs Res. 1998;47(1):35-42.
Measuring shared governanceReports the development, reliability, and validity of the Index of Professional Nursing Governance.
Hess R
Nurs Admin Q. 2011;35(3):235-241.
Slicing and Dicing Shared Governance: In and Around the NumbersHospitals 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.
Hess R, DesRoches C, Donelan K, Norman L, Buerhaus P
J Nurs Admin. 2011;41(7/8):315-323.
Perceptions of nurses in Magnet hospitals, non-Magnet Hospitals, and hospitals pursuing Magnet statusThe 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.
Howell JN, Frederick J, Olinger B, Leftridge D, Bell T, Hess R, Clipp EC
J Nurs Admin. 2001;31(4):187-195.
Can nurses govern in a government agency?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.
Jenkins J
Nurs Econ. 1988;6:302-311.
A nursing governance and practice model: what are the costs?5-yr cost comparison after SG implementation at Southern tertiary MC: 3%increase in meeting time, 14% reduction in meeting hrs per budgeted FTE.
Kear M, Duncan P, Fansler J, Hunt K
J Nurs Admin. 2012;42(6):315-317.
Nursing Shared Governance: Leading a Journey of ExcellenceA 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.
Kennerly S
J Nursing Admin. 2000;30(12):611-617
Perceived worker autonomy: The foundation of shared governanceIndepth 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
Kennerly SM
Nurs Economics. 1996;14(2):111-116.
Effects of of shared governance on perceptions of work and work environmentPre- 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.
Kovner CT, Hendrickson G, Knickman JR, Finkler SA
J Nurs Admin. 1993;23(11):24-34.
Changing the delivery of nursing care. Implementation issues and qualitative findingsEvaluation 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
West J Nurs Res. 2008; 30(5): 539-559.
Structures and practices enabling staff nurses to control their practiceState-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.
Lamoureaux J, Judkins-Cohn T, Butao R, McCue V, Garcia FMeasuring perceptions of shared governance in clinical practice: psychometric testing of the RN-focused Index of Professional Governance (IPNG)Shared governance is considered an innovative management process model that includes shared decision-making between all members of the healthcare workforce and focuses on nurses’ control over their practice and accountability of care. One specific tool that measures shared governance perceptions of nurses is the RN-focused Index of Professional Governance (IPNG). The objective of this study was to assess reliability and add to the validity of the IPNG by further establishing the construct validity and correlating the scale scores to measures of satisfaction obtained from the National Database of Nursing Quality Indicators (or NDNQI) survey. There were 76 respondents representing six units in one hospital. We reported high reliability for each one of the six subscale scores as well as for the total score (Cronbach alphas of 0.94 and higher). Construct validity was supported by the invariance of the scores across age groups along with schooling and experience levels. Concurrent validity was supported by a correlation of the IPNG score with job enjoyment (r = 0.437, p = 0.002) and the desire to recommend the hospital as a place of employment (r = 0.442, p = 0.001). The IPNG should also be tested in other healthcare professionals as its scoring ability can compare management, units and departments.
Laschinger HK, Havens DSStaff nurse work empowerment and perceived contol over nursing practice. Conditions for work effectiveness.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.
Latta LC, Davis-Kirsch S
J Ped Nurs, 2011, In Press
Developing a Robust Professional Practice Model using a Shared Governance ApproachA 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
J Nursing Res (China). 2001;9(2):125-36.
The effectiveness of implementing an unit-based shared governance model [Chinese]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
Lee L, Yang K, Lee C, and Wu S
J Nursing Res (China). 2001;9(1):5-13.
ÿAn evaluative study of the effects of the implementation of UBSG on nurses? perceptions of professional governance [Chinese].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.
Malleo C, Fusilero J
Nurse Leader. 2009;7(1):32-26.
Shared Governance: Withstanding the Test of TimeAccount 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
Master's thesis. School of Nursing, University of Alaska, Anchorage, November, 2002.
Perceptions of nurses practicing in a shared governance environmentDescriptive 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.
Meyers MM, Costanzo C. Shared governance in a clinic system.Shared governance in healthcare empowers nurses to share in the decision-making process, which results in decentralized management and collective accountability. Share governance practices have been present in hospitals since the late 1970s. However, shared governance in ambulatory care clinics has not been well established. The subjects of this quality project included staff and administrative nurses in a clinic system. The stakeholder committee chose what model of shared governance to implement and educated clinic staff. The Index of Professional Nursing Governance measured a shared governance score pre- and postimplementation of the Clinic Nursing Council. The Clinic Nursing Council met bimonthly for 3 months during this project to discuss issues and make decisions related to nursing staff. The Index of Professional Nursing Governance scores indicated traditional governance pre- and postimplementation of the Clinic Nursing Council, which is to be expected. The stakeholder committee was beneficial to the initial implementation process and facilitated staff nurse involvement. Shared governance is an evolutionary process that develops empowered nurses and nurse leaders.
Minnen TG, Berger E, Ames A, Dubree M, Baker WL, Spinella J
J Nurs Admin. 1993;23(7/8):35-40.
Sustaining work redesign innovations through shared governanceIntroduction 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
Topics in Manage. 1996;1:187-196.
ÿAssessing shared governance: An example of instrument development in a hospital setting.Development of a 9-item instrument that measures the construct of SG, including understanding, commitment, and personal perception of SG.
Mitchell M, Brooks F, Pugh J
NT Res. 1999;4(3):192-201
Balancing nurse empowerment with improved practice and care: an evalution of the impact of shared governanceUK. 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
J Nurs Admin. 2007;37(12):564-68.
Developing leaders at every level. Accountability and empowerment actualized through shared governanceKanter'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
JONA. 2010;40(11):477-482.
Staff nurses lead the way for improvement to shared governance structureThe 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.
Mouro G, Tashjian H, Bachir R, Al-Ruzzeih M, Hess R. Nursing Economic$. 2013, 31(4):184-89.Comparing Nurses' Perceptions of Governance Related to Hospitals' Journeys to Excellence Status in the Middle EastThe interest in the Magnet Journey extends to the Middle East. The results of this study revealed nurses in hospitals that are on the Journey to Magnet perceive that decision making is shared between nursing management/administration and staff nurses.

Nurses in these hospitals positively attribute their involvement and engagement in every aspect of the nursing profession. Shared governance promotes professional accountability and enhances individual autonomy, authority, and control.

The growth of healthcare in the Middle East region with rising expectations for patient care outcomes will challenge the nursing profession in the future. Shared governance will certainly help nurses take ownership in making decisions for patient care and as a result achieve better patient outcomes.
Myers M, Parchen D, Geraci M, Brenholtz R, Knisely-Carrigan D, Hastings C.
JONA. 2013;43(10):509-516.
Using a shared governance structure to evaluate the implementation of a new model of care: The shared experience of a performance improvement committee Sustaining change in the behaviors and habits of experienced practicing nurses can be frustrating and daunting, even when changes are based on evidence. Partnering with an active shared governance structure to communicate change and elicit feedback is an established method to foster partnership, equity, accountability, and ownership. Few recent exemplars in the literature link shared governance, change management, and evidence-based practice to transitions in care models. This article describes an innovative staff-driven approach used by nurses in a shared governance performance improvement committee to use evidence-based practice in determining the best methods to evaluate the implementation of a new model of care.
O'May F, Buchan J
Int J Nurs Stud. 1999:36:281-300
Shared governance: a literature reviewReview of 48 articles (1988-1998) describing SG implementation.
Overcash J, Petty LJ, Brown S.
Nurs Admin Q. 2012;36(4):E1?E11.
Perceptions of Shared Governance Among Nurses at a Midwestern HospitalThe 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.
Pinkerton S
Nurs Economic. 2008:26(6):401-403.
The unit practice council: Center of professional practiceReport 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.
Prince SB
J Nurs Admin. 1996;27(3):28-35.
Shared governance. Sharing power and opportunityPre- 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
J Nurs Care Qual. 1996;27(3):28-35.
Nursing involvement in hospital governanceAssessment of degree of involvment of nurses (with physician comparisons) in hospital boards.
Reif D
Nurs Manage. 1995;26(2):32H.
A staff-managed ICUA 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.
Nurs Leader. 2012;10(1):40-42.
The Alchemy of Shared Governance: Turning Steel (and Sweat) Into GoldLittle 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.
Root SD
AORN J.2000;72(1):95-8, 101-2, 104.
Implementing a shared governance model in a perioperative settingAccount of initial implementation of multidisciplinary SG model in a surgical services department at Santa Rosa Memorial Hospital, CA.
Rundquist JM, Givens PL
American Nurse Today. 2013; 8(3).
Quantifying the benefits of staff participation in shared governance
Sanford KD
Healthc Financ Manage. 2012;66(9):44-6, 48
Shared Governance: One Way to Engage Employed PhysiciansTo 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.
Sonson SL
Nurs Manag. 2013;44(7):49-52.
DNP-prepared APRNs: Leading the Magnet chargeAccount of the potential and real roles of the DNP-prepared APRNs in shared governance
Stumpf LR
J Nurs Admin. 2001;31:196-202.
A comparison of governance types and patient satisfaction outcomesCompared 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.
Styer KA
AORN J. 2007;86(July):85-93.
Development of a unit-based practice committee: A form of shared governanceStaff 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.
J Nurs Care Qual. 1992;6(2):15-19.
Empowering the clinical nurse through quality assurance in a shared governance settingDescription 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.
J Nurs Admin. 1993;23:24-26.
Organizational empowerment through self-governed teams. An application in long-term care.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
J Nurs Admin. 1993;23(5):28-32.
Who's on first? Shared governance in the role of nurse executiveInstead 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
J Nurs Admin. 2000;30:330-335.
The relationship of nursing practice models and job satisfaction outcomesCritique of six SG interventional studies, focusing on outcomes of job contentment and autonomy.
Westrope RA, Vaughn L, Bott M, Taunton RL
J Nurs Admin. 1995;25(12):45-54.
Shared governance, from vision to realityShared 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.
Wheeler RM, Foster JW
J Nurs Admin. 2013:43(7/8):409-414.
Barriers to participation in governance and professional advancement: A comparison of internationally education nurses and registered nurses education in the United StatesThis study compared the perspectives of internationally educated nurses (IENs) and registered nurses (RNs) educated in the United States regarding participation in hospital governance structures and professional advancement.

Nurses’ participation in hospital governance is reported to contribute to empowerment. No research has examined how IENs’ perceptions about participation in governance compared with those of US RNs.

Semistructured interviews were held with 82 nurses in 2 urban hospitals. Forty nurses were reinterviewed to follow up on themes.

Internationally educated nurses and US RNs shared similar perspectives. Nurses in both samples did not value participation in governance, lacked guidance about how to advance, and preferred to at the bedside.

Strategies to encourage nurses to participate in and value governance and professional advancement opportunities should be explored and adopted.
Whitt M, Baird B, Wilbanks P, Esmail P
Nurse Leader. 2011;9(6):53-55.
Tracking decisions with Shared GovernanceAt 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.
J Nurs Manag. 2005;13:490-499.
Work-based learning: A leadership development example from an action research study of shared governance implementationShared 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.


Contact details:

Dr Tracey Williamson

Research Fellow (Older People/User Involvement)

Salford Centre for Nursing, Midwifery &
Collaborative Research

University of Salford

Room C715 Allerton Building

Frederick Road

Salford
M6 9PU


T.Williamson@salford.ac.uk

Wilson B, Squires M, Widger K, Cranley L, Tourangeau A
J Nurs Manag. 2008;16(6):716-23.
Job satisfaction among a multigenerational nursing workforceThis 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.

Wilson J, Speroni KG, Jones RA, Daniel MG.
Nursing. 2014;44(7):19-22.
Exploring how nurses and managers perceive shared governanceThis study explored differences between direct care nurses' and nurse managers' perceptions of factors affecting direct care nurses' participation in unit-based and general shared governance activities and nurse engagement.

In a survey research study, 425 direct care RNs and nurse managers were asked to complete a 26-item research survey addressing 16 shared governance factors; 144 participated (response rate = 33.8%).

Most nurse participants provided direct care (N = 129, 89.6%; nurse managers = 15, 10.4%), were older than 35 (75.6%), had more than 5 years of experience (76.4%), and worked more than 35 hours per week (72.9%). Direct care nurses' and managers' perceptions showed a few significant differences. Factors ranked as very important by direct care nurses and managers included direct care nurses perceiving support from unit manager to participate in shared governance activities (84.0%); unit nurses working as a team (79.0%); direct care nurses participating in shared governance activities won't disrupt patient care (76.9%); and direct care nurses will be paid for participating beyond scheduled shifts (71.3%). Overall, 79.2% had some level of engagement in shared governance activities. Managers reported more engagement than direct care nurses.

Nurse managers and unit-based councils should evaluate nurses' perceptions of manager support, teamwork, lack of disruption to patient care, and payment for participation in shared governance-related activities. These research findings can be used to evaluate hospital practices for direct care nurse participation in unit-based shared governance activities.
Winslow SA, Fickley S, Knight D, Richards K, Rosson J, Rumbley N
J Nurses Staff Dev. 2011 Jan-Feb;27(1):13-7.
Staff nurses revitalize a clinical ladder program through shared governanceAfter 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.
Winslow S, Hougan A, DeGuzman P, Black AWhat's being said about shared governanceAccount of shared governance as a component of a professional practice model at a 176-bed, VA community hospital, where a home-grown instrument measured the engagement of nurses in shared governance.
Zuzelo P, McGoldrick TB, Seminara P, Karbach H
Nurs Manag. 2006;37(6):45-50.
Shared governance and EBP: A logical partnership?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.