Shared governance promotes professional practice environments while empowering nurses to help make decisions affecting themselves, their colleagues, and their patients.1 Although specifics vary from organization to organization, the basic premise is the same: both staff and managers participate in the decision-making process.
The 2019 Magnet(R) Application Manual defines shared decision making as "a model in which nurses are formally organized to make decisions about clinical practice standards, quality improvement, staff and professional development, and research."2 Shared decision making and shared governance figure prominently in the Magnet component Structural Empowerment. Organizations that achieve the Magnet credential feature flat, flexible, decentralized environments in which nurses are involved in shared governance, decision-making structures, and processes that establish standards of practice and address opportunities for improvement.2
The idea of shared governance is not new. Its origins date back to the 1970s as a strategy to close the gap between nurses' responsibility for their own practice and the decision-making process at leadership and management levels.1 Today, it is embedded into nearly every healthcare setting. Robert Hess, founder and chief executive officer of the Forum for Shared Governance,3 writes that the model is now so widespread it impacts not only nurses but also all members of the healthcare team, including patients and families. "In many settings, they are all at the decision-making table," Hess says.3
A growing body of research links shared governance to nursing excellence, as well as patient, organizational, and professional outcomes. Fisher et al4 found that a well-established shared governance structure has the potential to improve not only staff satisfaction and retention but also core professional practice values that impact the quality of patient care.
Shared Governance in Times of Crisis
The COVID-19 pandemic has shed new light on the enduring role of shared governance as a strategy to manage crisis situations. Hess et al5 note that a well-established model enhances communication and can be used to quickly respond to emergent issues, fast-track practice changes, create new workflows and processes, reeducate staff, protect the safety of clinicians and patients, and facilitate the transition back to business as usual.
Shared governance also promotes an environment of support and encouragement, keeping nurses connected, not only to their coworkers but also to the organization's bigger perspective.5 With staff at the center of the decision-making process, they are empowered to deliver high-quality patient care and exert their influence over the resources necessary to support it. For example, as COVID-19 impacted hospitals from coast to coast, staff quickly became experts on personal protective equipment and other critical supplies.
Magnet: Ensuring All Voices Are Heard
Magnet Recognition(R) from the American Nurses Credentialing Center addresses many of the elements that contribute to successful shared governance and an empowering work environment. Pursuing the credential helps shore up factors that create an inclusive, supportive workplace, factors such as appropriate resources; strong, supportive leadership; nurse engagement and recognition; mutual respect; and a collaborative culture.6
Wei et al7 found a strong link between a positive workplace and nurse outcomes such as psychological health, emotional strain, job satisfaction, and retention. When nurses perceived higher caring behaviors in the work setting, they had significantly lower scores on compassion fatigue, stress, and burnout and higher scores on work relationships, job satisfaction, and compassion satisfaction.
With these factors at the forefront, Magnet organizations are in a strong position to give nurses direct involvement in decision-making processes that impact every aspect of the care environment. In the chaotic early days of the COVID-19 pandemic, shared governance provided the structure for nurses to influence care delivery, ultimately saving lives.5
Magnet nurses at NewYork-Presbyterian/Columbia University Irvine Medical Center put it best: "The Magnet framework that is in place helped lead us through this crisis," says Hollis George, MS, RN. "The paradigm shift of nurse autonomy, transformational leadership, shared governance, and interprofessional collaboration all played a critical role."
"Our strength as an organization was a good combination of excellent leadership and an empowered and engaged workforce," says Patricia Punzalan, MA, RN, NE-BC. "The principles of shared decision-making, interprofessional collaboration, front-line engagement, and professional ownership and accountability that we built for 6 years in our journey to Magnet brought us to a level of excellence and resilience in our efforts to respond, recover, and thrive."
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