Expiration Date: December 31, 2008.
No CE contact hours (CH) will be given after this date.

Objectives:

1. Define the concept of shared governance in nursing.

2. Describe the advantages and disadvantages of shared governance.

3. Delineate implementation issues associated with nursing shared governance.

Key words: governance, shared governance; control over practice; professional practice models; power; authority

"Can you name just one hospital that practices real shared governance around here?" a newly relocated nurse administrator asked me. A particularly poignant question in a time when shared governance programs were stalled by a sort of implementus interruptus, superseded by impending mergers or shotgun partnerships, or just plain threatened away from innovation by managed care. I did know of several hospitals that had shared governance. In a health care landscape that was wind-blown and torrid, they were flowering like prize blooms. What was it like to work in these gardens? One nurse told me: "We have a voice and are able to participate in decision making. We get to do what we want to as units" (Hess, 1998a, p.5).

This excerpt came from a 1998 editorial, "A Breed Apart – Real Shared Governance," that appeared in the Journal of Shared Governance. Shortly thereafter, like many of the governance programs it promoted, this unique periodical folded.

...a brand new nursing shortage is revitalizing shared governance and its promise is to put control over nursing care in the hands of practicing professionals.

As the last nursing shortage waned, shared governance – an organizational model through which nurses control their practice as well as influence administrative areas – disappeared from many of the some 1000 health care institutions where it had thrived. Some programs were victims of mergers and acquisitions, others just sputtered out from exhaustion. A few enlightened nurse administrators and staff kept their programs going. Others kept remnants of shared governance in play through less transforming participatory management and decentralized structures, which persist even today. With more than enough nurses, some shortsighted top brass turned their attention from addressing who controlled practice to considering more pressing fiscal issues. One anonymous administrator spoke from the dark side: "Why should I care about what staff think? If they don’t like it, I can replace them all tomorrow."

That was a time of plenty. But now a brand-new nursing shortage is revitalizing shared governance and its promise is to put control over nursing care in the hands of practicing professionals and retain these professionals.