Q During COVID, our CNO suspended our professional governance councils because hospital leadership had moved decision-making to an incident command structure. She said councils took too long to make critical decisions. What's the point of having professional governance if that's true?

COVID certainly challenged a lot of structures and processes in our clinical environment, including nursing professional governance (NPG). In addressing this question, let's first clarify a few basic principles of NPG. Councils are only one aspect of NPG decision-making. They're forums where nurses can express control over nursing accountabilities for practice, quality, competence, and knowledge, but councils alone aren't NPG. Councils are a medium for foundational and long-term decisions about nursing practice and its related issues. They're not designed, nor should they be, for short-term decision-making. However, short-term or critical decision-making should never fail to include nurses when those decisions relate to nurses' accountability for their practice.

NPG is all about the ownership of practice. By regulation (law) and professional mandate, the accountabilities of practice, quality, competence, and knowledge for professional work are owned by the profession and the clinical nursing professionals who make them and act on them. They can never be legitimately removed from the professionals who own them or made by others who don't. If anyone attempts to make decisions for which they're not accountable, they can never achieve the outcomes that depend on the work of those who do own them.

The effective role of the leader is to facilitate, enable, and engage accountable decision-makers in those decisions that are theirs to make. In critical decision-making, the situation's intensity requires immediate deliberation, decisions, and action, so effective decision-making methods must be used. NPG expects and enables this, using huddles for those decisions that require clinical and management convergence to set a direction or confront a challenge. NPG allows for crisis decisions by gathering stakeholders in a just-in-time, collective format to confront and resolve any critical issue. NPG expects nurses to engage in short-term problem-solving in quick digital or spot sessions during which stakeholders work to set a policy or make a practice change. When nurses pursue solutions to practice issues they own, NPG ensures that the right decisions are made in the right place by the right persons for the right purpose and does it efficiently and effectively.

Incident command is never successful when it moves decisions and solutions away from the professional stakeholders who own them. For nurses, this practice results in alienation, loss of engagement, disinvestment, disenfranchisement, and the broken promise of equitable membership in the practice community. In many post-COVID surveys, nurses revealed these sentiments as their reasons for leaving for staffing agencies or leaving nursing altogether. Nurses want to belong, to own their practice, and to make a difference in the lives of those they serve.

For nurse managers, NPG requires that they enable nurses to own their practice and accountabilities. These managers must recognize that they're leading their peers, not their subordinates, and that requires a unique set of leadership skills. Managers don't make decisions for others; they "set the table" for nurse stakeholders and decision-makers, assuring they have the right resources, information, and support to arrive at the best decision possible under any circumstance.

In crisis, leaders don't take decisions from the nurses who own them, they simply alter the way the decision is made. Critical decisions in NPG require just-in-time strategies from nurses (on-the-spot deliberation/decision); short-term decisions require quick response times (huddles, small group action) and problem-driven solutions using immediate, cross-system staff leader-led digital modalities. All of these expressions of NPG ownership and accountability engage clinical nurses in decisions that affect their practice and patient care. Councils aren't the only decision structure for NPG. They're important for long-term strategy, tactics, policy, standards, protocols, practice/quality metrics, and systems issues that need broader deliberation and engagement over time. By using all these approaches to decision-making and accountability, leaders assure that all nurses stay engaged with each other in the expression of their accountabilities (ownership) and that NPG continues to contribute to clinical impact and outcomes in both crisis and quieter times.