Nursing

Blog spotlight: Main goals for instituting a shared decision-making model

Nurse Leader Insider, February 23, 2009

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This week, Barbara Hannon, RN, MSN, CPHQ, coordinator for the ANCC Magnet Recognition Program® at the University of Iowa Hospitals and Clinics (UIHC) in Iowa City, hones in on the aims of shared decision-making models in nursing:

The fundamental belief behind shared governance is that nurses at every level should govern their practice and be included in all decisions that affect their practice. This belief requires a redistribution of influence among managers and staff from one in which all decisions are made by administrators from the "top down" to one in which decisions are agreed upon collaboratively from the "bottom up."

A shared decision-making model's success is dependent on active involvement of nurses at all levels from the bedside to nursing leadership and must be supported at all levels.
The main goals for instituting a shared decision-making model are:

  1. The creation of a method for effective shared decision-making. Shared governance allows for the inclusion of diverse perspectives from multiple viewpoints to solve issues and make decisions. This produces quality decision-making that is easier to implement. Staff nurse perspectives from the bedside can be included alongside perspectives from management, allowing for all sides of an issue to be explored in a common setting. In addition, staff nurse involvement in decision-making increases the likelihood of "buy in" at the unit/bedside level.
  2. The creation of clearly defined lines of accountability for nursing roles. Shared governance allows for a flattening of the nursing hierarchy by creating clear lines of accountability for nursing roles. With a clearly defined model, all nurses have an avenue in which to take questions, problems, and issues. When shared governance is deployed at the point of service and decisions affecting bedside care are made at this level, all staff recognize who made the decision and the accountability for the decision.

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