Evidence-Based Nursing
Measuring shared governance:
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SHARED GOVERNANCE SPOTLIGHT
One healthcare system’s experience
By Susan H. Weaver, PhD, RN, CRNI, NEA-BC; Robert G. Hess, PhD, RN, FAAN;
Barbara Williams, PhD, RN; Lisa Guinta, MSN, RN-BC, NEA-BC; and Mani Paliwal, MBA, MS
S
hared governance is a nursing manage-
ment model that gives clinical nurses
control over their professional practice
while extending their influence over the
resources that support it.1 Its popularity has
skyrocketed as organizations strive to meet the
American Nurses Credentialing Center’s criteria
for structural empowerment to achieve Magnet®
recognition or Pathway to Excellence® designa-
tion.2,3 But how many nurses participate in real
shared governance? If the model is genuine, how
many nurses can quantify its strengths and weak-
nesses? And how many can formulate an appro-
priate strategic plan for improving the program at
hand based on evidence?
Despite the long-time presence and pervasive-
ness of shared governance (40 years) and pro-
fessional governance (25 years) in the healthcare
industry and literature, hardcore evidence demon-
strating their worth has been slow in coming.4 In
fact, until governance models of any kind involv-
ing healthcare professionals could be quantified,
evidence has been anecdotal and its presence only
alleged by reputation.5
But there’s good news. An extensive assessment
instrument is available to answer the above ques-
tions without saddling staff with an extensive, but
onerous survey. This is how one hospital system
used this tool to its advantage.
The tool
In 1994, the 86-item Index of Professional Nursing
Governance (IPNG) was created, allowing mea-
surement of professional governance—a concept
that encompasses a continuum of traditional,
shared, and self-governance. With rigorous meth-
odology, the IPNG provides empirical evidence of
not only the extent of shared governance imple-
mentation, but also its connection to professional,
organizational, and patient outcomes. In fact, the
IPNG has provided evidence that shared gover-
nance is associated with professional outcomes,
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such as nurse satisfaction and empowerment, and
organizational outcomes, such as a professional
practice environment.6-8 In addition, nurse re-
searchers are now connecting shared governance
with patient outcomes, such as fall rates, fall with
injury rates, pressure injury incidence, medication
management, and patient identification errors.9,10
A recent assessment of the psychometric prop-
erties of the IPNG 2.0 found that the instrument
takes 20 minutes to complete.11 Over the years,
some researchers have reported that nurse respon-
dents didn’t complete the survey, leaving some
subscales completely blank, and requested that the
length of the IPNG be shortened. In 2017, the au-
thor of the tool used factor analysis to reduce the
items to a 50-item IPNG 3.0 version while main-
taining its validity and reliability.
The IPNG 2.0 and the shorter IPNG 3.0 measure
nursing governance along a spectrum from tra-
ditional (administration/management primarily
makes decisions), to shared (shared decision-
making), to self-governance (staff members primar-
ily make decisions). The IPNG has six subscales
representing the dimensions of professional
governance. (See Table 1.)
Participants respond
using a 5-point Likert
scale, ranging from
“nursing management/
administration only” (1),
to “equally shared by
clinical nurses and
nursing management/
administration” (3), to “clinical nurses only” (5).
Our experience
In 2013 and 2015, assessment of nursing shared
governance was conducted at Hackensack Merid-
ian Health’s five southern hospitals—Bayshore
Community Hospital, Jersey Shore University
Medical Center, Ocean Medical Center, Riverview
Medical Center, and Southern Ocean Medical
Nursing Management • October 2018 11
 Evidence-Based Nursing

Center—by surveying nurses utiliz- After the 2015 survey, steps were communication, 3) improve unit-
ing the original 86-item IPNG sur- taken to explore why the nurses per- based council (UBC) meetings, 4)
vey. The majority of respondents in ceived a traditional governance involve night-shift nurses, and 5)
2013 and 2015 had a baccalaureate structure. A survey was sent to increase nurses’ participation.
degree and were clinical nurses. nurses throughout the hospital sys- A task force of clinical nurses,
(See Table 2.) Yet, despite having tem about the strengths, weaknesses, nurse educators, nurse managers,
shared governance in place for opportunities, and threats to the cur- and senior leaders from the five hos-
many years, the nurses perceived rent shared governance model. The pitals was formed to address the
overall governance to be in the tra- nurse respondents identified five ac- survey action items and discuss how
ditional range in both 2013 and tion items: 1) provide education on to move toward a shared decision-
2015. (See Table 3.) shared governance, 2) improve making model. The first step was
holding education programs on
shared governance for all nurses.
Table 1: IPNG and IPNG 3.0 subscales Then, since the voice of the nurse is
the cornerstone of nursing shared
Personnel Who controls personnel and related structures governance, communication was en-
Information Who has access to information relevant to governance activities hanced by providing all nurses with
hospital email so there was an addi-
Resources Who influences resources that support professional practice
tional way to communicate vital in-
Who creates and participates in committee structures related to governance formation across the system. Next,
Participation
activities the UBC meetings were redesigned.
Practice Who controls professional practice The traditional monthly staff meet-
ings were merged with the UBC
Who sets goals and negotiates the resolution of conflict at various organizational
Goals
levels meetings with a shared agenda, led
by the UBC chairperson and facili-
tated by the manager. Because
Table 2: Demographics clinical nurses across the system are
required to attend at least 50% of the
2013 (N = 469) 2015 (N = 326) 2017 (N = 599)
unit meetings, this initiative height-
Years Mean (SD) Mean (SD) Mean (SD) ened participation. Night-shift
Years at organization 13.56 (10.18) 15.38 (10.52) 15.07 (11.41) councils were also developed at
every hospital because clinical nurses
Years as an RN 20.5 (12.7) 21.03 (12.91) 21.78 (12.98) working the night shift wanted to be
Highest degree in nursing n (%) n (%) n (%) involved in shared governance and
have a forum to address issues that
RN diploma 67 (14) 35 (11) 49 (8)
are unique to them.12
Associate degree 145 (31) 102 (31) 159 (27) Last, and most important, a Nurs-
Baccalaureate degree 196 (42) 153 (47) 303 (51) ing System Council Day was initi-
ated to better engage clinical staff in
Master’s degree 53 (11) 31 (9.5) 74 (12) meaningful problem-solving. Each
Doctoral degree 3 (1) 4 (1) 10 (2) hospital’s chief nursing executive
recruited six clinical nurses, a nurse
Missing 5 (1) 1 (0.5) 4 (1)
manager, and a nurse educator to
Job title n (%) n (%) n (%) attend the Nursing System Council
Educator and/or advanced Day to have frontline nurse partici-
practice nurse 21 (4) 11 (3) 28 (5) pation in decision-making. New
councils emerged to add or replace
Nurse manager/assistant nurse
manager/coordinator/administrator 51 (11) 31 (10) 97 (16) the existing system councils, includ-
ing the ambulatory council, infor-
Clinical nurse 386 (83) 270 (83) 441 (74) matics council, professional growth
Other/missing 10 (2) 14 (4) 33 (5) and development council, quality
and safety council, new knowledge

12 October 2018 • Nursing Management www.nursingmanagement.com

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.


and innovation council, and transi-
tions of care council. These councils
meet simultaneously on the morning
of Nursing System Council Day, fol-
lowed by an education program. The
Nursing System Council Day con-
cludes with the coordinating council,
which was formed so that clinical
nurses and leaders from all councils
can review and discuss ideas, sug-
gestions, and issues brought up from
nurses throughout the system.
After the new shared decision-
making structure was in place for
18 months, an assessment of nurs-
ing shared governance was con-
ducted with nurses at six hospitals,
including Raritan Bay Medical
Center, to determine the extent to
which they perceived that shared
governance had been implemented
throughout the system. The 50-item
IPNG 3.0 was used and system-
wide scores, as well as campus-
specific scores, were calculated.
The results from this survey indi-
cated that, overall, nurses through-
out the six hospitals perceived that
nursing governance was within the
shared governance range; that is,
governance was shared between staff
and administration/management.
(See Table 4.) More specifically, clini-
cal nurses perceived that they have
access to information, influence over
resources supporting their practice,
control over their practice, and the
ability to set goals and resolve con-
flicts. Furthermore, results from
individual campuses indicated that
nurses at five of the six hospitals
perceived governance to be in the
shared governance range.
After implementation of the new
shared decision-making structure,
governance at these hospitals
changed from traditional to shared
governance. The researchers shared
this results at the system-wide
Nursing Congress and at each of the
hospitals, and discussions ensued
regarding strategies for improvement.
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Evidence-Based Nursing
Table 3: IPNG 2.0 results, 2013 and 2015
2013 2015
N = 469 N = 326
Personnel 30.94 31.08
Information 32.17* 31.02*
Resources 29.74* 29.29*
Participation 26.83* 28.34*
Practice 31.9 31.97
Goals 17.04* 16.69
Total governance 168.62 168.39
*Score within shared governance range
The new shared decision-making
structure will continue to evolve Table 4: IPNG 3.0 results, 2017
and be nurtured until the next sur- 2017
vey in 2019. N = 599
Personnel 16.55
Discussion
Although many hospitals and health- Information 19.85*
care systems have shared governance Resources 24.74*
in place, this doesn’t necessarily en-
Participation 15.99
sure that the underlying principles of
shared governance are embraced, as Practice 15.62*
was evident in our experience. To Goals 11.09*
determine if clinical nurses perceive Total governance 103.84*
they’re truly involved in making deci-
*Score within shared governance range
sions that affect nursing practice, it’s
important to use a tool with estab-
lished validity and reliability such as Additionally, when planning this
the IPNG. Further, the subscales that survey, our research team was con-
compose this tool allow organizations cerned about survey overload due
to assess areas in which shared gover- to competing surveys in which
nance has been implemented, as well nurses were expected to participate,
as areas needing improvement. We such as the National Database of
speculate that the use of the shortened Nursing Quality Indicators® and
version of the IPNG was one factor in employee satisfaction polls. To
increasing survey participation. avoid survey overload and confu-
Conducting a shared governance sion, we conducted our survey at a
survey has its challenges. Organiza- time when there were no other
tions can benefit by careful plan- nursing surveys. And although
ning and implementing strategies nurses may have very good inten-
to facilitate a successful survey. In tions to complete the survey, doing
our organization, a nurse subinves- so may slip their minds as more
tigator was available at each of the pressing concerns arise. To provide
hospitals to promote awareness of reminders, we distributed small
the survey, answer questions, and packets of M&M’s candies on every
troubleshoot unanticipated issues. unit with the attached note,
Nursing Management • October 2018 13
 Evidence-Based Nursing
“ReM&Mber the shared governance
survey.” Lastly, when the results are
obtained, organizations can benefit
by acknowledging the areas that
need improvement. Then it’s essen-
tial to invest the time and energy
into identifying changes that need
to be made and how those changes
will be implemented. It’s critical
during this process to include input
from clinical nurses.
Time well spent
Measuring shared governance is a
time-consuming activity that re-
quires coordination across the
system, but it can be a valuable
and rewarding one. Appropriately
scheduled surveys should be con-
ducted, along with nurturing
shared governance with educational
programs. Nurses wonder about
how often surveys measuring
shared governance should be ad-
ministered. The answer is simple.
You should survey when you think
a change has occurred. After we
used IPNG-derived surveys to en-
hance our governance model, we
14 October 2018 • Nursing Management
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
felt that a change had occurred.
And it had—the evidence indi-
cated that we finally achieved
system-wide nursing shared
governance. NM
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At Hackensack Meridian Health in Neptune,
N.J., Susan H. Weaver and Barbara Williams are
nurse scientists, Lisa Guinta is the Magnet®
program director, and Mani Paliwal is the bio-
statistician for the Institute of Evidence-Based
Care. Robert G. Hess is the executive vice presi-
dent and chief clinical executive for OnCourse
Learning Corp. in Brookfield, Wisc., and CEO
and founder of the Forum for Shared Governance
in Hobe Sound, Fla.
The authors have disclosed no financial rela-
tionships related to this article.
DOI-10.1097/01.NUMA.0000546208.70574.27
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