Shared Governance Lets Nurses Be Agents of Change

Nurses can become agents of change and have a greater say in their practice by participating in this form of organizational leadership.

Shared Governance Lets Nurses Be Agents of Change

Nurses are discovering how to transform their frustrations into accomplishments by participating in a form of leadership known as shared governance.

"Shared governance recognizes the professional status of the nurse," says Kevin Hannifan, vice president and chief operating officer at Hartford Hospital, where shared governance started to take form at the end of 1999. "Instead of having guys like me or directors of nursing telling them what to do, we want them to tell us what to do."

The specifics of shared governance vary by hospital, but typically nurses and other members on a unit form a council group to evaluate the status quo and recommend changes they deem necessary -- changes that can dramatically impact the quality of patient care. Depending on the facility, nurses interested in joining a council are either invited by a manager or may volunteer.

While the concept of shared governance is about 30 years old, hospitals today are revitalizing it as one way to improve nurses' job satisfaction. This organizational model can also help hospitals earn Magnet status -- an award for nursing excellence granted by the American Nurses Credentialing Center.

Shared Governance in Action

At Hartford Hospital, representatives from different shifts and jobs within a unit meet for an hour each month to evaluate patient care and discuss how to implement changes. Decisions are by consensus, not a vote. Councils from different units then meet monthly to exchange ideas.

When she was an ambulatory care staff nurse at Hartford Hospital, Cynthia O'Brien, RN, was invited by her nursing director to join the unit's practice council, which included three other staff nurses, a physician, a nurse practitioner, a nurse's aid and an administrative assistant. Initially, staff members were invited by managers to participate in councils, but now those with any level of experience can volunteer.

In spring 2005, some nurses in O'Brien's group expressed concern about the care of patients who were taking the blood thinner Coumadin. Variations in blood consistency could put patients at risk of life-threatening clotting or bleeding. Once patients on this medication left the hospital, there was no procedure in place to determine how frequently they should return to have their blood tested.

Agreeing this issue needed to be addressed, the council extensively researched how often patients should be tested. In September 2005, the hospital implemented new guidelines based on the council's findings.

"It was really invigorating to be part of something that affects patient care in a good way," says O'Brien, now a unit manager. "As a member of the council, you really get past your day-to-day duties and start to think about what you are doing. It makes you think like a professional, and that is the part that is really fulfilling."

Another perk of shared governance is the chance to work alongside physicians to achieve a common goal. "Nurses have historically been under physicians, and to come together collaboratively is really rewarding," O'Brien says.

Taking Ownership

Governance councils can also pursue goals that require input from multiple departments. That was the case at El Camino Hospital, when the emergency department partnership council decided reducing hospital bed wait times by 20 percent was in order.

Meeting in monthly, two-hour sessions, the council, which included physicians, nurses, an emergency department technician and administrative staff, decided to establish a triage area for ER patients who could be treated quickly, thus leaving ER beds free for patients with more serious conditions.

In parallel, the ER council met with radiology and lab council reps as well as the hospital bed coordinator to work through how those units could speed up their processes so ER patients could be moved into hospital beds faster.

After many meetings, the emergency department council achieved its goal. Now the group continually evaluates the process and identifies areas for improvement.

"It takes patience and planning," says Audrey Prairo, RN, a certified emergency nurse and nursing unit coordinator for the hospital's emergency department. "But I find it very fulfilling to implement a new process that makes things run more smoothly. It improves morale, because we take pride and ownership in what we are doing."