Shared governance: For nurses, it began as greater autonomy
October 15, 2013 4 Comments
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.
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