Involving Nurses in Shared Decision-Making

Rebecca Hendren, for HealthLeaders Media , February 2, 2010

3. Evidence-based practice and research: "It is the responsibility of the organization to not only have the structures in place, but if you want a robust shared governance model, you have to provide resources for nurses to then do it," says Hitchings. Nurses at LVHN base their practice on evidence, have councils to consider evidence when weighing practice changes, and regularly initiate research projects to determine for themselves the answer to clinical questions.

4. Professional excellence: The organization budgets operational dollars and utilizes donated funds for staff to attend professional development meetings outside the organization. The goal is to have at least one staff member attend every major national nursing conference.

5. Reward and recognition: The organization assigns dollars to each department, based on FTEs, for reward and recognition activities; that department then decides how to spend the money and recognize and reward its staff members.

"What you perceive as reward and recognition may not be perceived by someone else as reward and recognition," notes Hitchings. "Our staff on each unit decide what's important to them."

6. Operations: To many nurses, control over their schedule is a priority. "They work out and determine how they do their schedules," says Hitchings. "One unit will have one way to decide who works Christmas and another unit will do it differently. But it's not decided by a director or some central process or even electronically. Nurses determine the guidelines and create the schedule themselves."

Similarly, staff are involved in the hiring process for managements positions and peer interviews when staff nurses are hired.

Hitchings says shared governance is an important part of life for her organization and she can't imagine nursing not being involved in decision making. "Our senior leadership and middle management recognize the value from staff being involved in decisions," says Hitchings. "And we all recognize the impact it has on staff, and ultimately patient, satisfaction."

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Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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