Commentary: Shared governance: a children’s hospital journey to clinical nursing excellence

Shared Governance represents a decentralised model of leadership that creates a culture of staff engagement in which the delivery of nursing care can thrive (Joseph and Bogue, 2016; Porter-O’Grady, 2017). Hess (2004) describes it as a managerial innovation that gives staff control over clinical decisions and influence over areas previously controlled only by managers. Alternatively described as ‘shared decision-making’, the Chief Nursing Officer (England) has included this within current strategic aims, supporting its role in the delivery of care excellence and Shared Governance/Collective Voice (https://www.england.nhs.uk/nursingmidwifery/shared-governance-and-collective-leadership/). Organisations have adapted these terms to describe what Shared Governance means locally, for example, where staff have collective ownership to develop and improve practice, ensuring patients receive caring, safe and confident care. Its success, therefore, lies in placing direct care staff at the centre of decision-making, sharing responsibility and accountability for the decisions that directly affect their daily practice (Taylor, 2016). Indeed, key motivational drivers that positively influence levels of engagement and satisfaction in the workplace include opportunities to improve and enhance the patient experience and feeling valued, despite traditional process-driven systems (Jones et al, 2017).

Shared Governance is a core component of ANCC Pathway to Excellence® and Magnet® recognition programmes (https://www.nursingworld.org/organizational-programs/magnet/; https://www.nursingworld.org/organizational-programs/pathway/), both of which emphasise the foundational role of its four key principles in delivering a culture of excellent nursing care – accountability, equity, ownership and partnership (Porter-O’Grady, 2017). How this impacts on patient care outcomes and is applied to other health care contexts requires ongoing empirical study both in the UK and internationally.

The Saudi Arabian study here uses a descriptive survey design, examining self-reported levels of Shared Governance of 307 (76.8%) nurses working within a Childrens’ Hospital. It is identified as the first study to measure Shared Governance within this setting. Using a validated measure of Shared Governance (Hess, 1998), the study reports a total score of 183.85, indicating that overall staff report an acceptable range of Shared Governance (173–344). However, ongoing improvements were identified in relation to specific domains such as nursing personnel and participation and the need to further embed Shared Governance within clinical practice and education.

The study has a number of limitations, specifically its cross-sectional design, sample size and use of convenience sampling. The Index of Professional Nursing Governance (IPNG) (Hess, 1998) used was the 86-item version, and our experience of utilising this at Nottingham reveals a number of challenges in both the questionnaire burden and translation of American English to UK English for a number of statements and terms used. The authors did not identify this as a key problem but limited the study to staff with a sufficient command of the English language, potentially excluding others with a view on Shared Governance activity. However, it provides new insights into the applicability of an established measure of Shared Governance within an international setting, and offers a baseline on which they plan to build further transformational leadership activity to increase engagement and direct-care leadership of nursing staff.

Biography

Joanne Cooper is Assistant Director of Nursing at Nottingham University Hospitals NHS Trust and holds Honorary Professor positions at University of Nottingham School of Health Sciences and Coventry University. Her research interests are in gastroenterology nursing and more broadly in relation to nursing excellence, including shared governance.