Shared governance: For nurses, it began as greater autonomy

Cheryl Portner, RN

Cheryl Portner, RN

By Cheryl Portner, RN, MSN
Vice President, Staff Development & Training

Nursing’s history provides great insight into how many of our current trends, models and practices began and evolved, and at Nurse.com we have a world of nursing history in past issues of the Nursing Spectrum and NurseWeek (now combined into Nurse.com magazine) print publications we have stored in our office libraries. They’re filled with pertinent nursing news and important professional topics from the past quarter century, and I enjoy leafing through them and finding, in their musty, aged pages, what nurses have been talking about and working on over the years.

Recently, I looked at a number of issues from the late ’80s and early ’90s and found topics that ranged from the nursing shortage, the image of nursing and the BSN as minimum preparation for entry into practice, to nurses taking control of their own practices and having more professional autonomy. One issue explored the potential for an employee bill of rights that called for inclusion of such things as clear communication, timely feedback, management transparency and employee involvement in policy and procedure development. Another described the opening at a local hospital of a new and innovative nursing unit that would be “self-governed.”

Then I found a 1990 issue that may have been one of the first in which we covered the relatively new concept of shared governance — a nursing model that was going to grow, become widely accepted and have a major effect on the professional practice of nursing. It said nurses would have greater autonomy in their practice and would accept accountability for their actions. It said they would lead and make decisions on how their units run; they would assume management for the care provided to their patients; and they would lead new practice councils, decision-making task forces and staff committees. Employee opinions would be listened to and valued, and they would feel more empowered and involved. This new shared governance was heralded as a concept and a model that was going to take hold and reshape and reform how nursing is practiced. As it turns out, that was a pretty accurate prediction.

Nurses now seek employment in facilities because they have shared governance models; it has become not only an expectation but the accepted norm for professional nursing practice. It has made nurses feel more deeply invested in their workplaces and has increased their levels of satisfaction. It has not been easy to integrate into all organizations, but once in place it often has resulted in the autonomy, responsibility and accountability that was envisioned. It has created nurses who are initiators of change, leaders of quality improvement and fiscally responsible team members — and it’s the model the American Nurses Credentialing Center looks for when granting Magnet status to facilities.

Much of what was foretold about shared governance in those old issues on my office shelf has become reality, but we’re not finished yet. Shared governance will continue to grow and improve patient care and practice. Over time, it will give increased strength to nursing leadership and professionalism. And according to some nurse leaders, it will become more highly integrated into organizations, maybe even include patients and the community, and perhaps it will move the nursing educational entry-level debate forward. The challenge is ours for the taking.

Continuing education resources

Shared governance: What it can mean for nurses

Workplace empowerment: What nurses need to know

Use your power! Structural empowerment and nursing. This course is FREE till Nov. 14, 2013.

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4 Responses to Shared governance: For nurses, it began as greater autonomy

  1. Robert Hess says:

    For even more info, go to the Forum for Shared Governance, http://www.sharedgovernance, and register as a Member.

  2. While shared governance is what is happening in many institutions as stated it is not happening in others. I am studying the problem of the orientation given to new graduate nurses within my organization. How are we to expect shared governance within our organizations and bring young nurses into this important model of nurse empowerment when we are not giving them the necessary tools as novice nurses to care for patients. I still today see the standard six week orientation model within my organization that was utilized when I began as nurse 24.5 years ago. Should we not begin with how we train the future nursing force in oder that they are able to become participants in shared governance?
    Shirley

    • Kay Gremmels says:

      Hi Shirley,
      I’d like to respond to your post. I think the subject of orientation for new novice nurses into the workforce, and I am assuming you mean- a hospital environment, leaves much to be desired now a days. I have difficulty remembering how my orientation as new novice nurse went back 30 something years ago as a new diploma RN, but do remember I felt very prepared to hit the ground running. and took my job seriously. I have been a hospital bedside nurse here in NJ for most of those 30 years in a variety of specialties- Oncology, Med/surg/, Cardiac medical telemetry, cardiac surgery step down as staff and Travel nursing and just recently back into the hospital environment in neuro telemetry. As an RN without the BSN, during the 2008 recession, and with hospitals not wanting to hire agency RN’s, I was forced to take temporary out of the box nursing assignments in government contracting on the Air Force base in Telehealth and primary care, doing nursing in services in long term care facilities all over the state and as a temp assignment with the department of health during H1N1 in outbreak investigations. I was away from the hospital beside for 2 years, what I have found in coming back is an utter disgrace. I was oriented by RN’s who were 1-5 years out of school who explained things so confused that I could not make heads nor tails of what they were talking about and doubt if they knew either. These were simple basic nursing procedures; And this is a magnet facility!!. I was treated like I was the stupidest thing on earth. Once off orientation, what I found in those rooms was an even bigger horror- I found NGT tubes hooked up to high continuous suction that were sucking out the patients stomach lining to where the young nurse told me in report, the patient was GI bleeding Well I guess he was! I was told to call the wrong doctor for issues, I am seeing the reporting off shift’s work being dumped on the next shift because “nursing is a 24 hr a day job”- these include obtaining PEG feedings and pump tubing’s that have to obtained from dietary which is closed at midnight and needs security to open up, so some nurse avoid the time it takes out of their shift because of short staffing and use the old tubing again for the next 24 hrs, I see nurses who do not know their cardiac drugs but are working a telemetry floor, I see new nurses giving IV push Fentanyl on a telemetry unit, patients who have fallen out of bed and hit their heads on the floor who have sustained cerebral bleeds and the assistant nurse manager ( with only 15 year experience, poor judgment and a vindictive attitude) insisted the patient was fine and ‘just put her back into bed”, needless to say, this was reported to the state DOH as a sentinel event, young ICU nurse who transfer patients out of the unit with clotted off PICC lines and don’t know that the different concentrations of PD fluids are not interchangeable. I have to show new novice BSN’s how to straight cath a patient for a specimen, a patient pull out their trach not once but twice. Again, this is a magnet facility.
      Shared governance in this facility exists in name only with this monster of an assistant nurse manager. This Assistant nurse manager has so many complaints against her from staff going to the Human Resource dept, I don’t know how she keeps her job. The complaints include making discriminatory remarks where she “can’t tell one African American from the other” and asking a nurses aide “what are you f-ing deaf”. The unit I work on is a “social cocoon”- where we are not to be pulled off the floor into other areas of the hospital and we therefore don’t know other nurses in the other areas. The amount of favoritism that goes on is unbelievable . Her young novice nurse informant taped me calling a doctor for a patient request for medication on her iphone, converted the taping to a text message and read it back to me. A blatant terminatable and unethical HIPAA violation.
      This current nursing work environment is nothing like the work environments we experience back in the 1980’s and 1990’s. Back then nurses were more skilled, more mature and better equipped to handle the demands of nursing. We had our faults and our bullies but we did not make nursing look an inept as it does with today’s workforce. This facility has gotten rid of most of its older nurses and 6 more ( experienced ICU nurses at that) have just walked out the door since January 2014. I am trying to make it the 7th because I can not tolerate the Assist nurse manager’s vindictive behavior anymore. My goose was cooked with this manager when she found out I was in school for my BSN with all 4.0’s and 9 credits toward my MSN. A magnet facility!! shared governance??? No way. A coworker of mine years ago used to say ” God doesn’t like ugly” and “What goes around comes around” I have seen enough in my day to know- this is true. If nursing doesn’t clean up it act and begin to behave professionally, there will be no more nursing profession and we will not have to worry about shared governance and magnet designation. This profession can not keep going on like this with patients as complexly ill as they are today and a nursing workforce that is so immature and unable to comprehend the scientific subject matter that is taught to them in their nursing courses.

  3. How to participate in shared governance should be part of basic nursing education at this point in time. Not only for nurses, but for all healthcare professionals

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