Self-governance: treatment for an unhealthy nursing culture

The concept of participatory management for nurses is based on the premise that nurses' education and experience qualify them for a leading role in the decision making that affects patient care. Rose Medical Center, Denver, initiated a self-governance model in 1980. The Nursing Congress, which is recognized by the board of trustees and the medical executive committee, represents all nursing division employees who have satisfactorily completed the probation period. Its bylaws provide for four officers, three members at large, and representatives from the committees and councils on nursing standards and practice, audit/quality assurance, continuing education and research, career ladders, collaborative practice, human resources, rules and regulations, and bylaws. Since implementing the shared-governance structure, the medical center has documented an annual attrition rate of less than 12 percent, a significant 5-year retention rate, and above-average satisfaction with working conditions. Nursing administrators who seek to improve the working conditions that influence staff retention must avoid thinking that relegates nurses to second-class status and limits their decision-making capacity. This does not mean, however, ignoring the fact that organizational change can be threatening to some individuals. Participatory management models can help nurses translate existing skills into strengths, enabling them to view change as a catalyst for improved conditions. Nursing shortages themselves are not the problem but rather a symptom of the problem, an unhealthy nursing culture. Unless leaders step forward to push for change, the shortage of qualified, talented nurses will persist.