Enhancing the Professional Work Environment Through Nursing Engagement in an Academic Medical Center

Shared decision-making and professional governance have long been defining features of American Nurses Credentialing Center (ANCC) Magnet-designated organizations, supporting high-quality outcomes, professional autonomy, and nurse engagement. Within our multi-Magnet-designated academic medical center, part of a larger academic health system, a shared governance structure had been in place for many years. However, to respond to the evolving demands of the academic medical center, the increasing complexity of health care delivery, and the need for stronger alignment between frontline practice and organizational strategy, the leadership and governance model was redesigned to fully integrate professional shared governance into the model with direct care nurses.

The purpose of this article is to describe how an ANCC Magnet-designated academic medical center systematically developed, implemented, and evaluated a transition from traditional shared governance to a robust professional shared governance framework by intentionally engaging nurses at all levels of the organization. This work aimed to strengthen nurses' voice in decision-making; enhance professional accountability; and hardwire structures that align nursing practice, quality, and innovation with organizational priorities.

A pre-post survey design was used to examine nurse engagement over a two-year period spanning the implementation of the professional shared governance model. Validated engagement measures were administered to nurses across the academic medical center before the redesign (2024 presurvey) and after its full implementation (2025 postsurvey). Comparative analyses were conducted to assess changes in overall engagement and in specific domains associated with professional practice, informatics, recruitment and retention, recognition, and evidence-based practice/research.

A total of 248 and 286 nurses responded to the preimplementation and postimplementation surveys, respectively, and their responses were compared. Overall nurse engagement scores increased between the 2024 presurvey and the 2025 postsurvey, indicating stronger perceptions of involvement, influence, and professional support following implementation of the professional shared governance model. The largest gains were observed in domains related to maximizing the capabilities of clinical and information technology to support patients and families; recruitment, retention, and recognition activities; and engagement in evidence-based practice and research opportunities. Clinical nurses demonstrated increased engagement across all measured categories, mirroring the overall pattern of improvement and showing the most substantial gains in the same high-impact domains.

Transitioning from shared governance to professional shared governance within an academic medical center is a complex, iterative, and developmental process that advances over time. Effective professional shared governance structures require intentional design, sustained leadership commitment, and active nurse participation at every level of the organization. To ensure these structures remain meaningful and high performing, they must be continuously evaluated, refined, and adapted to reflect contemporary practice, emerging priorities, and the evolving needs of nurses, patients, and the health system. By leveraging data-driven insights, incorporating innovative strategies, and maintaining a culture of shared accountability and collaboration, professional shared governance can remain agile, forward-thinking, and a powerful driver of nursing excellence and organizational outcomes.