Nursing Shared Governance

The goal of our Shared Governance structure and processes at The Childrens Hospital of
Philadelphia is to include staff-based clinical decision making and shared leadership to ensure
high-quality and safe patient care.
The work of Shared Governance is completed by:

Councils: formal gathering of selected experts

Committees: council appointed group to whom an issue is assigned

Work Groups: sub-division of a committee organized for a specific purpose

Champions: a team of unit-based individuals working toward a clinical improvement

goal

Our Shared Governance Model is depicted by four connected circles displaying councils at both
the unit and department level. These councils are: Steering Committee, Supporting Practice and
Management Council, Quality Practice and Patient Safety, and Advancing Practice and
Education.
Quality and safety, nursing research and evidence-based practice are incorporated in the work of
every council. The department strategies are represented in the inner blue ring. Magnet
components are displayed on the outer ring. At the department level, these councils are led by
chairs, who are nurses, elected to two-year terms by their peers.

Focus and scope of Shared Governance councils

Steering Committee: Nurse sensitive indicators, SG structure and operations, communication,
coordination of council work
Supporting Practice and Management Council: Staffing, retention, recognition, financial
stewardship, workflow management, patient and family satisfaction, nurse satisfaction, and
philanthropy
Quality Practice and Patient Safety: Presentation and discussion of clinical practice and
related information, evidence-based quality improvements and safety initiatives in an effort to
strengthen and improve the quality and safety of patient care
Advancing Practice and Education: Competencies, skills, education, CEUs, patient-family
education, professional development and certification

1. http://www.strategiesfornursemanagers.com/supplemental/4428_book.pdf,

2. https://www.freemanhealth.com/Content/Uploads/Freeman%20Health/files/Shared
%20Governance%20Report_final_web.pdf,

3. http://rnforward.businesscatalyst.com/assets/shared-governance.pdf,

4. http://www.asccc.org/sites/default/files/Mt%20Jacinto%20CCD--Shared%20Governance
%20Committee%20Handbook.pdf,
5. http://senate.universityofcalifornia.edu/_files/resources/SHRDGOV09Revision.pdf,
6. http://www.ijhssnet.com/journals/Vol_4_No_6_1_April_2014/27.pdf,
7. http://www.umcelpaso.org/nursing/files/SharedGovernanceNEC.pdf,

Shared Governance: The Theory

The theoretical underpinnings of shared governance come from a broad set of perspectives that
includes organizational, management, and sociological theories. Understanding the variation in
these theoretical viewpoints helps us to appreciate the history of how shared governance models
were designed and implemented. The earliest foundation for shared governance arose from the
human resource era of organizational theories. This era represented the first departure from the
traditions of scientific management. Theorists such as Herzberg (1966) and McGregor (1960)
championed employees as an organizations most important asset encouraging organizations to
invest in employee motivation and growth. Thus, practices such as autonomy, empowerment,
involvement, and participation in decision making were advocated (Bolman & Deal, 1997).
From the human resource era emerged business and management philosophies that directly
influenced the development of shared governance models. For instance, Deming (1986), who
introduced new concepts of quality management, proposed that an organizations work
environment value quality, empower the worker to be more productive, and emphasize
leadership and team building. Forms of shared governance appeared that were formed in alliance
with an organizations quality management initiatives (Gardner & Cummings, 1994; Thrasher et
al., 1992).
From a management perspective, Kanters theory (1977, 1993) on structural power has been
instrumental in the development and formation of shared governance models as care delivery
systems (Edwards et al., 1994; Jones, Stasiowski, Simons, Boyd, & Lucas, 1993; Prince, 1997),
and it has influenced broader redesign initiatives that emphasize work empowerment (Erickson,
Hamilton, Jones, & Ditomassi, 2003; Laschinger, Almost, & Tuer-Hodes, 2003; Laschinger &
Havens, 1996; Laschinger, Sabiston,& Kutszcher, 1997; Laschinger, Wong, McMahon, &
Kaufman, 1999; Sabiston & Laschinger, 1995). The assumptions proposed by Kanter (1977,
1993) suggest that formal and informal power permit access to work empowerment structures
(opportunity, resources, support, and information) that enable workers to accomplish their work.
Being empowered suggests a model of shared governance where decisions are made at the point
of service (Porter-OGrady, 1995).
With the formation of second-generation shared governance
models, the influences from organizational designs, such as selfmanaging work teams, began to emerge (Norby, 1995; Perley &
Raab, 1994; Song, Daly, Rudy, Douglas & Dyer, 1997). The
philosophy behind self-managing work teams assumes those
work groups, who are jointly responsible for achieving goals,
lead themselves (Jones, 2004) and thus have authority and
control over the work and access to information (Perley & Raab, 1994).
With the formation of secondgeneration shared governance
models, the influences from
organizational designs, such as
self-managing work teams, began
to emerge.

While most of the aforementioned theories address the worker directly, some shared governance
models have been guided from the perspective of the leader (DeBaca, Jones, Tornabeni, 1993;

Kennerly, 1996). These leadership theories operate from the supposition of shared leadership;
and the role of the leader is to facilitate, coach, model, and serve as an information resource
(Minnen et al., 1993).
Turning to yet another perspective, the sociology of professions has also strongly influenced
shared governance (Havens, 1994; Westrope, Vaughn, Bott, & Taunton, 1995). In these
perspectives professional autonomy is the basis for managing the care environment (Maas &
Jacox, 1977). Society grants professionals, by virtue of their specialized knowledge, the right to
control their own activities (Greenwood, 1966; Merton, 1960) and be self-directed in the
performance of their work. Thus, shared governance, as an organizational form, has potential to
bridge differences between the traditional bureaucratic models, characterized by centralized
decision making, with professional models that are distinguished by independent authority for
decision making.
Each of these theoretical influences arises from a particular set of organizational, management,
or professional lenses that have similarities and differences. These perspectives are similar in the
broadest sense in that they assert that the professional nurse is an important stakeholder in the
organization. As such, nurses should actively participate in controlling the work environment and
in making decisions that are necessary in carrying out their scope of work to perform their
professional tasks. Conversely, these disciplinary perspectives differ in their orientation to the
degree that they range from the nurse being "granted" the power to function autonomously
(Kanter, 1977) to the nurse having the professional right to act autonomously (Maas & Jacox,
1977). These opposing orientations may underlie how shared governance is defined and
implemented.
In the past 25 years, these philosophies have been integrated into the professional practice of
nursing. Early descriptions of shared governance describe it as an accountability-based system
for professional staff (Porter-OGrady, 1987). As our understanding of shared governance has
increased, conceptual models depicting it have evolved from linear, reductionistic representations
(Allen, Calkin & Peterson, 1988; Ortiz, Gehring, & Sovie, 1987) to dynamic, integrated circular
representations (Evan, Aubry, Hawkins, Curley, & Porter-OGrady, 1995; McDonagh, Rhodes,
Sharkey, & Goodroe, 1989) that reflect its multidimensionality. The evolution of these
representations may reflect transitions from first generation models of shared governance that
were aligned with bureaucratic traditions to second generation models that reflected broader
multilevel involvement (Minnen et al., 1993).
The diversity of theoretical perspectives has resulted in a variety of contemporary definitions of
shared governance. Hess (1998) describes governance as including the "structure and process by
which organizational participants direct, control, and regulate the
many goal oriented efforts of other members" (p. 35). OMalley The diversity of theoretical
(as cited in Prince, 1997), portrays shared governance as an perspectives has resulted in a
of
contemporary
"accountability-based governance system that shares power, variety
definitions
of
shared
governance.
control, and decision making with the professional nursing staff
within a clinical decision making framework" (p. 28). Porter-OGrady (2001) says that shared
governance, as a dynamic, is a way of conceptualizing "empowerment and building structures to

support it" (p. 470) and embodies four principles: partnership, accountability, equity, and
ownership.
Although these definitions differ in their depth, scope, and reflection of the influences of
theoretical perspectives, common characteristics exist. These include autonomy and
independence in practice, accountability, empowerment, participation, and collaboration in
decisions that affect individual patient care, the more general practice environment, and group
governance (Burnhope & Edmonstone, 2003; DeBaca et al., 1993). These characteristics
represent professional nursing ideals. Thus governance models that are based on these ideals
should translate into the realities of the organization through organizational designs that allow
nurses the freedom to fully participate in the practice of nursing and in shaping the work
environment in which patient care occurs.
However, despite some consensus on several of the key characteristics of governance models, the
variations in the theoretical underpinning from which they are derived results in definitional
ambiguity that invariably leads to implementation of alternative forms that are adapted on a caseby-case basis (Hess, 1998). For instance, four configurations of shared governance have been
described by OMay and Buchan (1999). Unit-based systems are governance models specifically
tailored to an individual nursing unit. Councilor models are designed using any number of
department level councils as a method to coordinate clinical and administrative activities.
Administrative models reflect an executive level of coordination over the activities of smaller
councils. Seen less frequently is the congressional model, where all nursing staff belong and
work is given to cabinets.
As these various forms of shared governance are implemented at different organizational levels,
the extent of authority, decision making, and participation that resides with the bedside nurse
varies (Bernreuter, 1993). Further, the boundaries defining governance can range from direct
patient care decisions to decisions for managing the work environment (Burnhope &
Edmonstone, 2003; Hess, 1995). Hence, shared governance models have taken on variations in
form and scope. Consequently, designing rigorous empirical evaluations of the process itself and
the effects of shared governance can be difficult.
Shared Governance: The Evidence
The evidence supporting the benefits of shared governance models ranges from case study
exemplars, where implementation stories are told, to formalized, research-based evidence. The
exemplars describing implementation of shared governance largely represent earlier work and
provide a road map for designing governance structures both on the unit and at the divisional
level (Alvarado, Boblin-Cummings, & Goddard, 2000; Evan et al., 1995; Ireson, & McGillis,
1998; Jacoby & Terpstra, 1990; Jones & Ortiz, 1989; McDonagh, et al., 1989; Ortiz, Gehring, &
Sovie, 1987; Peterson, & Allen, 1986a; 1986b; Relf, 1995; Shidler, Pencak, & McFolling, 1989).
These studies provide anecdotal evidence of success with subjective appraisals of outcomes that
include better relationships and team harmony, fewer conflicts, job satisfaction, communication,
collaboration, professional growth, and lower turnover (Anderson, 1992; Brooks, Olsen, RiegerKligys, & Mooney, 1995; Daugherty & Hart, 1993; Evan et al., 1995; Kovner, Hendrickson,
Knickman, & Finkler, 1993). While these outcomes reflect the important product of shared

governance, there has been little attention paid to evaluations describing the extent to which
shared governance is implemented (OMay & Buchan, 1999). Hess (1998) argues that
examination of outcomes at any level is suspect if we cannot measure the extent that governance
exists. Toward this end, he has developed and validated an 88-item instrument to evaluate the
distribution of governance (Hess, 1998). Despite the development of this tool, it has had very
limited use by other researchers. In one specific study, George, Burke, and Rogers (1997) used
Hess tool to evaluate nurses perception of governance after hospital acquisition.
Parallel to the descriptions and anecdotal appraisals of shared governance are the research-based
studies that focus on the outcomes of shared governance and which refer to the benefits to the
organization, nurse, and patient. As described in the review that follows, the vast majority of
these evaluations report the findings of shared governance in a single setting with either crosssectional or longitudinal time frames.
Organizational Outcomes
Changing to a governance model of nursing most often involves moving from a hierarchical
structure to the councilor structural form of shared governance that targets decision making
across types of decisions (OMay & Buchan, 1999). Moving decision making to a different
organizational locus has reportedly both a direct and indirect financial impact. In general, the
evidence suggests an improved financial picture after implementing shared governance, resulting
from either cost savings or cost reductions. Jenkins (1988) found that the change in committee
structure resulted in an overall increase in the number of hours spent in meetings, but the
meeting hours per full time employee (FTE) dropped. In the
evaluation by DeBaca et al. (1993) of a councilor model of
shared governance, nearly six million dollars in saving was In general, the evidence suggests
improved financial picture
realized over five years and was attributed to the elimination of an
after
implementing
shared
temporary agency nurses and reductions in recruitment and governance, resulting from either
orientation costs. Considerable savings were realized even after costing savings or cost reductions.
accounting for the financial investment of implementing a
governance model. In a quasi-experimental matched group design, Zelauskas and Howes (1992)
found that over a 30-month period, the shared governance unit outperformed the control unit.
When compared to baseline, the shared governance unit had a 1.5% reduction in non salary costs
per patient day, 18% fewer sick hours per FTE, and an 11% reduction in turnover. Finkler and
colleagues (1994) evaluated the costs associated with initiatives to improve recruitment and
retention across 37 hospitals. In the three hospitals where shared governance models were
implemented, there were lower innovation costs per bed as compared to other delivery models
such as case management, and a 7.5% improvement in RN hours per patient day; but there were
no differences in the number of nurses recruited.
In some instances, the financial performance related to productivity, cost efficiency and
effectiveness, working conditions, length of stay, absences, and turnover have been reported but
not substantiated with explicit data (DeBaca et al., 1993; Jenkins, 1988). Else financial
performance was associated with the implementation of shared governance along with other
organizational changes such as case management, product line management, and quality

assurance models so the independent influence of shared governance could not be established
(Brodbeck, 1992).
Work Environment
One of the early but enduring goals of shared governance was to improve the work environment
of nurses, their satisfaction, and retention (Kennerly, 2000; OMay & Buchan, 1999; Rose &
Reynolds, 1995). The studies reviewed here defined and operationalized the work environment
in a variety of ways, utilized designs that vary in scientific rigor, and typically sampled from
single sites. Studies reported findings that supported mixed conclusions as to whether or not
shared governance improves the environment.
Similar to the studies using anecdotal exemplars, Thrasher et al.
Studies reported findings (1992) used a descriptive case analysis methodology. These
that
supported
mixed investigators identified the benefits of using a quality assurance
conclusions as to whether council in shared governance as a method to increase nurse
autonomy, authority, and accountability.

or not shared governance

improves the environment. A number of pre/post shared governance implementation studies
demonstrate its effect on the work environment. Jones et al. (1993) evaluated the work
environment after implementation of shared governance on 29 patient care units over a three year
time period. This model included councils on both the unit and departmental level. Statistically
significant improvements in the decision-making style of managers were seen in the second year.
Professional job satisfaction improved in all three years and organizational job satisfaction and
anticipated turnover improved during the second and third years. However, there was no
improvement in group cohesion or job stress. Similarly, Edwards et al. (1994) reported a
perceived increase in autonomy, communication, decision making, and sense of team when
shared governance was implemented on one intensive care unit.
Prince (1997) evaluated the effects of implementing shared governance on the unit based work
environment using a pre/post survey design with site specific instrumentation. Of 34 staff nurses
responding to the survey, after shared governance was implemented, there was a 6-7%
improvement reported in receiving information nurses needed to do their job and information
being received in a timely way. Paradoxically though, nurses reported an approximately 21%
increase in never being told about changes that affect their work. Similarly, there was an 8%
decrease in job satisfaction and a 31% decrease in committee work. However, nurses reported a
heightened awareness of nurse empowerment. Turnover rates remained unchanged.
Westrope et al. (1995) described a councilor model of shared governance in one hospital with
implementation processes occurring at both the organizational and unit levels. Shared
governance was operationalized as control over practice. Midway through their three year
implementation, control over practice was moderately related to task identity (r = .54), job
involvement (r = .31), satisfaction with worker interaction, quality of care, and job enjoyment
(rs = .23 to .27), and organizational commitment (r = .42). Satisfaction and commitment
increased the longer shared governance was in place. Over the three years, turnover rates
declined from 19% to 6%.

Using investigator-developed instrumentation and a pre/post design, Ireson and McGillis (1998)
reported that after 12 months, there was greater sense of cooperation among employees, and
nurses felt their contributions made a difference to their department, but there was no change in
their sense of contribution to the hospital or patients. However, there was an improvement in
unit-based patient satisfaction. Further, nurses reported that shared governance provided the
structure for more effective and lasting problem solving.
In a quasi-experimental design conducted by Kennerly (1996), nurses working on shared
governance units had more interpersonal conflict after six months. However, no other differences
were found in nurses autonomy, role ambiguity, role conflict, self-perceived effectiveness, job
satisfaction, organizational commitment, or anticipated turnover at either 6 or 18 months. Similar
findings were reported by Zelauskas and Howes (1992) who reported no differences at 6, 12, and
30 months in aspects of the work environment (skill variety, task identity, feedback, dealing with
others, friendship opportunities) except for an increase in autonomy at 30 months.
In a post implementation only descriptive study, Ludemann and Brown (1989) evaluated a
congressional model of shared governance on work environment characteristics (personal power,
workload, climate for innovation, influence) and job satisfaction. Although methodologically
weak, nurses were asked to recall (at 18 and 24 months) their attitude toward the work
environment before shared governance was implemented as well as to measure their current
attitude. Nurses reported their work environment post implementation to be significantly more
positive as compared to their recall of the work environment 18 months earlier. However, the
absolute mean difference was small (.12 on a scale of 1-6). The amount of influence nurses
reported was also statistically significant but again the mean difference was small (.56 on a 1-5
scale).
Richards et al. (1999) evaluated the effects of a councilor model of shared governance on the
overall culture of excellence. Interestingly, after two years, there was a statistically significant
decrease in autonomy, but an increase in being close to the customer and a perception that the
organization was leaner with more decentralized decision making. In a qualitative analysis,
nurses reported a feeling of empowerment and improved communication.
Nurse Satisfaction
Nurse satisfaction has been considered a key outcome of shared governance and has often been
included in the evaluations of the work environment as described above. However, because a
professional practice model, such as shared governance, is believed to enhance nurse
satisfaction, it has also been addressed specifically. As in the evaluation of other outcomes,
consistent relationships between shared governance and nurse satisfaction have not been found.
In some cases, nurse satisfaction was found to improve when shared governance was
implemented (Jones et al., 1993; Ludeman & Brown, 1989; Vilardo, 1993; Zelauskas & Howes,
1992); yet others have reported no change or decreased satisfaction (Hastings & Waltz, 1995;
Prince, 1997; Zelauskas & Howes, 1992).
Stumpf (2001) conducted a multisite ex post facto correlational study involving 16 patient care
units across 5 hospitals. Comparing units with shared governance models (n = 8) to units with

traditional governance models (n = 8), nurses working on the shared governance units had a
more positive composite constructive culture, as well as higher job satisfaction that reflected
greater satisfaction with the work, professional status, cohesion, and administration. Shared
governance units however, reported a lower retention rate than the traditional units.
In an extension of the evaluations of shared governance, Hastings (1995) used a secondary
analysis to compare the outcomes of a hospital-wide change to governance between nurses
working in different specialties. Nurses working in ICUs (n = 11 units) had higher job
satisfaction, increased perceptions of giving high quality care, and were more positive about peer
support and involvement in decision making than nurses working in general units (n = 15 units).
Research Summary
In summary, the organizational, work environment, and job satisfaction outcomes of shared
governance have not consistently supported its anticipated benefits. In general, there have been
reported financial improvements in shared governance environments, but the indicators vary by
study. Additionally, some of these improvements have not been objectively supported but have
been based on subjective appraisals. Benefits to the work environment have been generally
disappointing. Indicators and measures assessing the work environment varied widely across
studies. While in many cases, there have been improvements in those characteristics, such as
autonomy, communication, and decision making that is consistent with professional ideals, these
have not been consistent over the range of studies having multiple designs, sampling, and
measurement strategies. Other presumed benefits of shared governance that reflected improved
work team dynamics such as cohesion, commitment, and conflict were similarly mixed.
Likewise, turnover has been found to improve, decline or remain unchanged. Inconsistencies
reported in job satisfaction not only included whether or not it improved but also included
variations in how it was operationalized.
Discussion
The review of the literature leads nursing scholars,
administrators, and practitioners to ask whether or not shared The review of the literature leads
governance, as an organizational form for nursing practice, has nursing scholars, administrators,
practitioners to ask whether
lived up to its potential. In this uncertain health care and
or not shared governance, as an
environment, a straightforward yes or no answer would provide organizational form for nursing
clearer direction to those who are responsible for shaping and practice, has lived up to its
evaluating practice models. Unfortunately, the appraisal of the potential.
multiple complex and integrated factors of where we have been and what we have done does not
offer simple clarity. Several areas for discussion are presented.
Variations in theoretical perspectives lead to variations in implementation. Thus, clarifying these
influences may help us to understand the contradictory findings found from the empirical
assessment. Autonomy, empowerment, leadership, decision making, and control over practice are
recurring concepts in defining shared governance. For example, depending on the theoretical
lenses, Kanters (1977) framework might suggest that empowerment may lead to autonomy.
However, if the sociology of profession set of lenses is used, autonomy leads to self-direction,

hence empowerment. Each of these perspectives influences what is studied and how it is studied.
The lack of theoretical clarity and common philosophical assumptions in which models of shared
governance were designed leads to a disjunction between the theory and the practice. To move
forward, a critical question to sort out is whether professional values, such as autonomy and
decision-making are defining characteristics of shared governance, whether they are antecedent
to shared governance, or whether they are a consequence of shared governance (Kennerly, 2000).
The intellectual debate here will be to address what is the most relevant and meaningful
theoretical perspective to guide shared governance.
Consistent conceptual guidance has not been evident in designing shared governance models.
However, we should not dismiss the value of the existing anecdotal accounts. These individual
case studies provide us with conventional wisdom. On one hand, these individual descriptions of
implementation offer an experiential representation or "know how" of how this organizational
form might be implemented in the field. On the other hand, however, these accounts identify the
difficulties inherent in its conceptualization and implementation as a project versus a process,
complexities in the management of time, communication, acceptance, and leadership (Burnhope
& Edmonstone, 2003; Hibbard, Storoz, & Andrews, 1992; Reif, 1995).
Few studies have used rigorous designs. Most assessments of

Few studies have used shared governance outcomes are limited to description and cross
sectional (e.g., Brodbeck, 1992; George et al., 1997). The few
rigorous designs.

pre-post implementation and quasi-experimental designs that

allow for comparisons were usually conducted either in a single hospital or with a limited
number of units. In general, response rates to surveys were small and sometimes had too few
respondents or too few units to have confidence in the findings (e.g., Ludemann & Brown, 1989;
Prince, 1997; Richards et al., 1999). Since multi-institutional research poses multiple challenges
and dilemmas, only a few studies were conducted across multiple institutions (e.g., Finkler et al.,
1994; Stumpf, 2001). Overall the design and sampling limitations restrict the confidence in and
the generalizability of the findings.
A minority of studies were longitudinal. These studies were characterized either by beginning
measurement after implementation, without baseline data (Finkler et al., 1994; Ludemann &
Brown, 1989; Thrasher et al., 1992) or studies characterized by varying time frames. While
longitudinal designs permit the researcher to examine changes in the phenomenon over time, the
time intervals in which key outcome variables were measured ranged from 6 months (Ireson &
McGillis, 1998) to 60 months (Jenkins, 1988). Implementation of shared governance reflects a
cultural change that takes 3 to 5 years to embed (Porter-OGrady, 1996), thus evaluations done in
the early phases of implementation may not reflect the change in governance distribution. The
inconsistent findings, like those related to autonomy, satisfaction, and turnover are therefore not
surprising. Further, measurements conducted too early may reflect statistical significance, but the
effect size may be too small to have practical significance (e.g., Ludemann & Brown, 1989)
There was a wide range of measurement strategies used in the
studies that were reviewed. For instance, in some studies, job ...evaluations done in the early
phases of implementation may not
satisfaction was measured using standardized and well-validated reflect the change in governance
instruments (e.g., Jones et al., 1993; Kennerly, 1996). In other distribution.

studies, study specific, in-house measures were developed (Brodbeck, 1992; Ireson & McGillis,
1998). It is difficult to make comparisons across sites when important concepts are
conceptualized and operationalized differently, so statements about the generalizability of
findings must be made with caution.
The organizational level where shared governance was implemented also varied. Whether shared
governance is implemented on a unit-based or a divisional level of the organization has
implications for processes such as communication and decision making. Specifically, the
network of communication is considerably larger when shared governance is operationalized on
the organization level as compared to a much smaller network on a unit level. Similarly,
timeliness of decision making is affected by the organizational location of shared governance. It
is intuitively logical that decisions made at the point of action (unit) would be made more
quickly than at the broader organizational level. Further, the scope of decisions made by nurses
in a shared governance model may also be different. Competing positions have been documented
in the literature about unit level implementation. Some challenge whether governance on the unit
level is really a governance system at all (Hess, 1994), while others propose the importance of
unit level implementation (Hastings & Waltz, 1995).
Assessing the level of analysis also has an empirical consideration. Kennerly (1996) identifies
one of the defining characteristics of shared governance as being team decision making. Yet
researchers of shared governance have largely limited their analysis to the individual nurse rather
than aggregating it to include the unit or relevant work group. If nursing in acute care is a groupbased practice, then the realities of shared governance require group-based structures and
processes.
Two assumptions about shared governance have been made and taken for granted. First, as Hess
(1996) points out, when shared governance models are implemented, it is assumed that
governance is redistributed. Without measuring the change in distribution, we dont know
whether the intention of redesign has been achieved. Secondly, Porter-O Grady (1996) reiterates
what others have also stated: we presume that nurses want to participate in decision making, but
this assumption is also not validated. Certainly, if nurses have authority for decision making, that
does not necessarily mean they choose to exercise it (Anthony, 1999), and thus organizational
designs will not achieve this end. Future shared governance models will need to reconcile these
issues.
Future Directions
While shared governance has made progress toward living up to its potential, we again need to
refer to the question Porter-OGrady (1987) asked 25 years ago.
How can nursing best respond? Nurse researchers can put shared ...a commitment for investing
governance research on the spot by increasing the scientific rigor adequate resources to design and
multi-institutional
of the research. To do so means that we need to better understand conduct
research that evaluates the
what shared governance is about. Strategies such as workshops structure and context in which
and focus groups that clarify its theoretical perspective and nursing care is delivered will pay
direction (determining the antecedents, attributes, and off...
consequences) are needed. To maximize this effort, it must be done in coordination with a

consortium of stakeholders. Participation by researchers, administrators, nurse executives, and

staff is needed in order to come to a common understanding of the shared governance concept.
Identifying gaps between the perception of shared governance and its actual implementation will
continue to serve as a road map for yet another generation of shared governance models. Lastly,
a commitment for investing adequate resources to design and conduct multi-institutional research
that evaluates the structure and context in which nursing care is delivered will pay off as we then
can really begin to understand the contribution of nurses to outcomes.
In summary, the benefit of evaluating whether shared governance has lived up to its expectations
is found in how it will help shape the future.
Shared governance, as a care delivery model, requires a paradigm
shift. Porter-OGrady (2001) succinctly states that shared
governance is a way of conceptualizing empowerment and
structures to support it. If the essence of shared governance is
empowerment, then why has it been so difficult to achieve it as an organizational reality with
corresponding benefits? Randolph (2000) concludes that this journey requires a significant
transition in how employees, managers, and organizational systems interact. How we as a
profession decide to conceptualize shared governance and what assumptions we make may be
less important than how we transition into new relationships. The decisions made will need to
have stronger theory-practice link so evaluations of new models will build our theory, science,
and practice.
Shared governance, as a care
delivery
model,
requires
a
paradigm shift.

Author
Mary K. Anthony, PhD, RN
E-mail: mxa25@po.cwru.edu
Dr. Anthony received her PhD in nursing from Case Western Reserve University. Her prior
experience as an administrator, responsible for care delivery systems, piqued her curiosity in
understanding the effects of redesigning care delivery systems. In her current position, Dr.
Anthony has received funding to describe and evaluate models of care. Her research includes
how the structure and process of nursing care affect patient, nurse, and organizational outcomes.
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