Shared governance for nursing. Part II: Putting the organization into action

Shared governance is a major departure from traditional management-drive systems. It requires commitment and investment from all of nursing. It builds on the trust developed in the nursing service between all participants who deliver nursing care. It requires management and clinical teams to work closely and redefine their roles. The need for mutual understanding and support is undeniable. Unfortunately, there has not been much reason for that trust to develop at a rate and a level it should in most health care facilities. As institutions move to higher levels of interaction to compete and survive and as the nursing shortage requires hospitals to address the role of the nurse, hospitals are laying the groundwork for nurses to play a larger role in governance and control. These circumstances, among others, stimulate interest and provide a basis on which nurses can work together, whether in management or clinical positions, to strengthen the accountability and role of nurses in managing their services and their practices. Moving to shared governance affects the way in which nurses work and relate to the organization. The use of collective bargaining strategies, movement of the nurse into areas of control over issues that institutions once considered beyond his or her role or right, and conflict management strategies will have to change to facilitate the move of nurses into the main-stream of decision making. As the institution moves from a hierarchical structure to a multiservice setting and a more responsive market-based organization is created, nurses will have to play a stronger role in marketing and managing their practices. This flexibility extends to moving health care services out of the institution and into the community and the home and requiring nurses to become more invested in processes and mechanisms that affect what they do and how they do it. If nurses are to have a place in creating policies and define their part in unfolding the future of health care, they must be able to reorganize their services, create stronger peer-based governance approaches, and exhibit stronger control in the exercise of their practices. That will not happen by accident, nor will there be many people from other disciplines who will be heralding this cause for nurses. Before others in policy-making positions move over to provide the necessary space for nurses, the practicing nurse will have to operate and manage his or her practice at the same level and in a similar manner as other professional workers who are outside of the typical dependent, vocational employee role.(ABSTRACT TRUNCATED AT 400 WORDS)