Empowering decisions: The impact of transitioning from a shared to a professional governance structure

Shared governance has long supported nurse participation in decision-making, but traditional models often limit full authority and accountability among clinical nurses. Professional governance extends these principles, granting nurses greater ownership over practice decisions. A four-hospital community health system transitioned from shared to professional governance to strengthen consistency, engagement, and decision-making.

This study evaluated whether transitioning to a professional governance structure improved clinical nurses' perceptions of professional obligation, collateral relationships, and decision-making compared with the previous shared governance structure.

A pre-post design using the Verran Professional Governance Scale (VPGS) measured changes across three domains. Surveys were administered before (n = 280) and after (n = 511) implementation across four hospitals. Mood's median test assessed statistical significance.

System-level VPGS mean scores improved across all domains except at one facility. The greatest gains occurred in decision-making. Collateral relationships showed statistically significant improvement ( P = .049), and decision-making approached significance ( P = .051). Decreased variation in responses indicated greater agreement postintervention. One facility with previously strong engagement showed minimal change.

Transitioning to professional governance improved nurses' perceptions of professional obligation, collateral relationships, and decision-making. Systemwide, facility-specific, and unit-based council restructuring significantly enhanced engagement, with notable improvement in decision-making and collaborative relationships.