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Sharing responsibility and accountability can improve care

Nurse Leader Weekly, October 30, 2006

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The increasingly critical shortage of professional nurses is a dangerous theme in healthcare. In response to it, more institutions are turning to shared governance-a concept that was introduced into healthcare organizations in the 1970s-as an evidence-based method to curb the shortage's damaging effects (e.g., negative patient outcomes, the high cost of agency staff, and ever-larger registered nurse sign-on bonuses).

In its simplest form, shared governance is shared decision-making based on the principles of partnership, equity, accountability, and ownership at the point of service. This management process model empowers all members of the healthcare work force to have a voice in decision-making, thus encouraging diverse and creative input that will help advance the business and healthcare missions of the organization.

In essence, it makes every employee feel as though he or she is "part manager" with a personal stake in the success of the organization.

This feeling leads to

• longevity of employment
• increased employee satisfaction
• better safety and healthcare
• greater patient satisfaction
• shorter lengths of stay

Those who are happy in their jobs take greater ownership of their decisions and are more vested in patient outcomes. Therefore, employees, patients, the organization, and the surrounding communities benefit from shared governance.

Focus on relationships, not positions

Relational partnerships are built with equity, wherein the value of each participant is based on contributions to the relationship, rather than on positions within the healthcare system.

Although staff nurses are key to recruiting other nurses, nurse managers are key to retaining them. Collateral and equity-based process models of shared governance define employees by the work that they support rather than by their location or position in the system. For example, the manager in the servant leader role retains nurses by providing human, financial, and material resources; support; encouragement; and boundaries for the staff nurse in the service-provider role. Staff nurses, then, are accountable for key roles and critical patient care outcomes around practice, quality, and competency.

Shared governance requires strategic change in organizational culture and leadership. It demands a significant realignment in how leaders, employees, and systems transition into new relationships and responsibilities.

Editor's note: This excerpt was adapted from HCPro's new book "Shared Governance: A Practical Approach to Reshaping Professional Nursing Practice."

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