Shared Governance in Nursing Homes the Concept

Shared Governance in Nursing Homes

The concept of shared governance in nursing is not a new one, but rather has been recognized since the 1970s as a key indicator of excellence in the nursing practice and specific departments and institutions (Cherry & Jacob 2005, pp. 276-8). In a study of nursing home facilities in particular, it was determined that nursing leadership style had a great deal to do with levels of staff turnover, suggesting that shared governance ad other more open and empathetic leadership styles are conducive to more effective nursing and more satisfactory nursing practice (Donoghue & Castle 2009). There are a number of other factors that influence nursing practice, including patient loads, specific areas or specializations of practice, and a host of economic and social factors. Leadership style, however, is one of the most easily changed factors with a large degree of influence on the practice and profession of nursing, and for this reason has been selected as the focus of this brief examination.

"Shared governance" is a term that has made its way into many different industries and areas of human endeavor, and it is not always used consistently even within a single discipline. In nursing, shared governance is a basic schema of leadership and collaboration in which practicing nurses play a role in the administration of their department and institution by advising on decisions that will impact care, raising concerns in a recognized and respected manner, and responding in kind to concerns raised by administration. More a philosophy and style than an actual code or plan of governance, shared governance enables nurses to practice most effectively and allows administrators to make more informed decisions (Milward et al. 2010).

The impact that shared governance can have on the quality of nursing care provided by an institution or specific department has been well documented in literature covering a wide range of institutions, from mental health networks to standard hospital institutions to nursing care and assisted living facilities (Milward et al. 2010; Schalk et al. 2010; Cherry & Jacob 2005; Havens & Aiken 1999). Research into specific interventions that have improved leadership styles and governance patterns are still relatively scarce, making it difficult to go about implementing change in an evidence-based manner, but the evidence that such governance is highly effective when achieved is indisputable (Schalk et al. 2010). This alone warrants the attempt by any institution to implement a system and philosophy of shared governance and both an administration and nursing staff that is more responsive and open.

There have also been clear conclusions drawn from ongoing research that change is needed in the way nursing homes and assisted living facilities are governed and regulated (Walshe 2001). Staffing issues in such facilities and in the nursing industry as a whole have increased pressures on existing nurses, and can compound feelings of inadequacy, non-appreciation, and work stress (Walshe 2001; Wunderlich et al. 1996). Nurses themselves can actually be a major force of change in the organizational culture and governance styles that exist in nursing homes in particular, given their level of contact with patients, their families, and administrators (Burger et al. 2009). This suggests that a push for shared governance that came as a cohesive and rational move from nurses would be effective and lead to positive change.

A comparison of two mental health networks provides clear evidence of the difference that shared governance can make. The two networks selected for the study were comparable in most regards, including demographics, size, staff level, etc., but differed in the style of governance that was employed (Milward et al. 2010). One of the networks relied a greater degree on shared governance, seeking input from nurses and from patients in making administrative decisions, while the other was more "traditionally" structured with administration taking input on a limited basis, but generally making decisions on its own (Milward et al. 2010). Indicators of care efficacy, patient and nurse satisfaction, and other factors demonstrate that the network with a shared governance philosophy was more successful in terms of its stakeholders' outcomes than was the network that relied more on administrative discretion and authority than any sense of shared knowledge and power (Milward et al. 2010).