Advice From the Forum, Confusion Among Consultants
During the last nursing shortage, I was privy to a serious discussion among leaders about replacing the word “nurse.” They believed that its inherent gender bias was discouraging men from swelling nursing’s ranks. I’ve been a guy all of my life and a nurse for more than 30 years; the idea of decoupling nurse from nursing left me cold. Thank God that notion never found traction.
A few years ago at an international nursing research conference, a grande dame of Magnet hospital research asked me if I could stop using the term—shared governance—and replace it with shared something else. I told her, in the face of more than 30 years’ tradition, why lose the term? Now it seems a cadre of misguided consultants is promoting its own governance replacements.
Shared governance is an organizational innovation that gives professionals control over their practice as well as influence over the resources that administrators and managers previously held exclusive control. This multidimensional concept is a complex, but essential characteristic of organizations. It is not synonymous with shared decision-making or shared leadership, both tangential to shared governance. As the fine, informed consultant, Vicki George, RN, PhD, FAAN, president of VMG Consulting and a Forum’s Advisory Board member, puts it, “Shared governance is the structure, shared decision-making is the process, and shared leadership between management and staff is the outcome.” To have a structure to facilitate shared decision-making and shared leadership is to have shared governance. Why call it anything else?
I remember visiting a major Magnet teaching hospital where I was admonished not to use the term governance because it would not only “freak out” the physicians, but hospital board members as well. It is no coincidence that one of the finest shared governance hospitals in the United States, one that has remained firm and committed to the concept of shared governance through 25 years of three major chances in leadership, that the chairman of the board has not only champions this model, but brags about it all over the hospital’s community.
Perhaps shared decision-making or shared leadership are softer, more sellable terms for nervous nursing executives and their bosses. But shared governance is not a commodity. It’s a revelatory, transforming experience for professionals that may have profound effects on professional, organization, and most important, clinical outcomes. In fact, one researcher believes that she is close to linking shared governance to reductions in patients’ falls.
Anything that empowers healthcare professionals in their practice is good, but some consultants are charging big bucks for muddying the waters and implementing watered-down substitutes for real shared governance. And if they get something as basic as this wrong, what else are they missing?