Empowering frontline nurses for shared governance

The ANCC Magnet Recognition Program recognizes healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practices.

Earning the Magnet designation means a hospital has met rigorous criteria and delivers exceptional nursing care. It’s a sign that a hospital’s patient care is meeting metrics for quality and satisfaction, fueled by nursing that is notable for its compassion and efficiency.

In order for hospitals who apply for Magnet status and earn this designation, they must demonstrate an effective shared governance structure. What shared governance means is that hospitals empower nurses and other clinicians in the decision-making process, supporting a model that trusts caregivers with reacting to patient needs based on established best practices – and their own good judgement.

Those not involved with shared governance sometimes have difficulty understanding how it all works, considering the appearance of a lack of hierarchy. Plus, it may look quite differently form one hospital to the next because every hospital designs its own framework for shared governance based on unique ideas and values of hospital leadership and culture. In fact, it would be fair to say there are as many models for shared governance as there are Magnet hospitals because each hospital operates a little differently – even if the goal of improving patient care, safety and satisfaction is the same.

Encourage Decision-Making at the Frontline
Earlier in my career, I was the Chief Nursing Officer (CNO) at a Magnet Hospital – a 1,200-bed university medical center. We used a shared governance model to ensure that nurses at the bedside felt their voices were heard, and they had some control over the technologies, processes and decisions that would affect their clinical practice.

To accomplish this practice model, we structured committees representing every nursing discipline across the hospital, from ICU, labor and delivery, NICU, medical/surgical, and beyond. Each committee was focused on meeting the unique needs of each nursing team, as opposed to implementing some blanket shared-governance rule across the facility that didn’t accommodate the needs of every nurse. Every nursing unit had the opportunity to develop their own council, giving everyone a say, and each council was made up of nurses who worked the unit, took care of the patients, and understood what a day in the life of a nurse was like in that unit.

This wasn’t a situation where leadership made top-down decisions without the input and direct involvement of frontline staff, which would go against the core tenants of shared governance. The practice councils met once a month to discuss policy, practice, workflows, products and technology. If a vendor came into the hospital with a product, that vendor would go before the practice council in every unit and make its case to the frontline nurses before any adoption was made. If and only if those frontline nurses felt the product was of value and would enhance their practice would then they refer the vendor to the house-wide practice council, who would then make a final decision on its adoption.

In our case, the house-wide practice council was made up of a single representative from each unit practice council. Once a product review went to the house-wide practice council, the vendor would be invited back, and nurses from all different disciplines would then have an opportunity to express their opinions about what they were seeing and what was being offered up. If the product passed through the house-wide practice council, then it was referred up to the executive level.

I was at the executive level, and I can tell you this: If a product made it through all those councils and reached my desk, I always approved it because I knew due diligence had been done. More importantly, I knew frontline staff liked this product and wanted it to be adopted. That was almost always good enough for me. I might have a few budgetary questions or thoughts about timing or logistics, but I was always mindful that a veto would destroy the concept of decision-making by the frontline, thus undermining the philosophy of shared governance. And so, I only used my veto when it was absolutely necessary.

Adopt a Core Value of Shared Governance
A particular Magnet credentialing criterion specifically addresses nurse involvement with technology decision making. It requires that hospitals describe how nurses were involved in designing the rollout or implementation of a technology to improve nursing practice in the organization. To all nurses on the Magnet journey, it is vital they are supported with the right technology that will not only empower them to better care for patients, but also make their lives easier while they do their jobs.

In short, the best way for a hospital to earn a Magnet designation and adopt a true policy of shared governance is to make sure nurses can act like nurses. When technology is a hindrance to workflow and takes nurses away from their patients, the end result is burnout and a feeling of disconnect between the frontline and those at the top. That’s the opposite of what leadership should want. The beauty of shared governance is that front-line nurses share in making decisions about what will allow them to function well and thrive. Shared governance is focused on empowering the people who work every day making life better for patients and families.

To that end, technology that improves nursing care – and makes the lives of nurses easier – is a vital component, one that will naturally be embraced from the ground up if it genuinely produces such a result. The trick is to ensure the genuine needs of frontline nurses are understood completely during the adoption of any technology. By making shared governance a core value frontline clinicians, technology, and hospital leadership can work harmoniously to improve the healthcare experience for patients, families and care teams alike.


Rhonda Collins, MSN, RN, is the chief nursing officer at Vocera, where she works with hospitals and health systems around the world to improve clinical communication and workflows.

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