Strengthening the
Health Care Workforce


Strategies for Now, Near and Far

Section 4  |  Expanding the Reach

Professional Governance Models

Strong leadership is essential for informing and supporting professional shared governance. Effective leaders use the structures of professional governance to build a culture of excellence, where interprofessional teams can exercise accountability for service delivery that advances patient outcomes. Traditionally,these models incorporate shared decision-making between the bedside nurses and nurse leaders, but organizations are looking at ways to expand these models to incorporate the full health care team. Successful professional governance depends on clarity of accountability around practice, quality, competence and clinical knowledge. Clinicians join with managers to inform access and use of resources to support effective clinical practice.

Many of the challenges brought on by the workforce shortages and impact of the pandemic can be mitigated through models that encourage communication and shared accountability, such as shared governance. While there are many approaches to professional governance across nursing, some organizations are using similar structures to collaborate across disciplines to solve problems, initiate innovations, and sustain positive patient outcomes.


Top Takeaways for CEOs

1 Successful professional governance models share three fundamental principles: clinical accountability, professional accountability and clinical decision-making, and distributive decision making.

2 Professional governance models encourage communication, shared accountability and provide a forum for alternate staffing models to grow and retain the nursing workforce.

3 Professional governance models develop emerging leaders, an essential element for longterm workforce sustainability.

  • There are a number of structural elements and characteristics associated with effective professional governance approaches. Below are three foundational principles:

    1. Professional governance is grounded in clinician’s ownership of their practice and their accountability for positively impacting health;
    2. Professional governance provides the infrastructure of clinical decisions and actions resulting in practices and behaviors which impact and advance health care; and
    3. Professional governance provides the structural framework for partnership across the clinical continuum, with organizational leadership, and with the clinical teams that collaborate to advance the health of individuals and communities.

    ‘Shared Governance: The critical concept of nursing shared governance is shared decision making between the bedside nurses and nurse leaders, which includes areas such as resources, nursing research/evidence-based practice projects, new equipment purchases, and staffing. This type of shared process allows for active engagement throughout the healthcare team to promote positive patient outcomes and also creates a culture of positivity and inclusion, which benefits job satisfaction.’

    McKnight H, Moore SM. Nursing Shared Governance. 2022 Sep 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31751052.

  • As you consider your governance structure, think about how it can more inclusively engage clinical staff in clinical decision-making and whether there are opportunities to, in collaboration with the nursing teams, expand the structure to include additional, clinical team members.

      How to Keep your Nurse Governance System Effective and Dynamic
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    When everyone in the organization commits to investing in the governance process and acknowledging their own contributions to the collective work through a shared governance model, organizational, patient safety and satisfaction outcomes often improve.

  • It is beneficial in times of crisis to re-engage a professional governance structure. It can be the simple things — recognizing formally and informally the contribution clinicians make, supporting them through time away from the bedside and counseling, and opportunities to bring clinicians together for short periods of time for peer support. One good way to do this is by maintaining unit councils to keep unit level staff engaged. It also means ensuring that clinicians are involved in a variety of problem-solving approaches at the point of service in the patient’s environment with professional peers, patients, and families who depend on nurses and the clinical team to facilitate, coordinate, and integrate their health journey.

  • As workforce shortages continue to challenge our organizations, a professional governance model can provide a framework for innovating alternate service models to grow and retain the workforce beyond the COVID-19 pandemic. This model encourages teamwork and prioritizes the voice of the bedside team, empowering organizations to usher in a culture shift that fundamentally improves trust and communication organization wide.

  • A shared governance model promotes partnerships and collaboration between nurses and other health care professionals. One organization used LEAN principles in their professional governance structure, resulting in improved efficiencies of processes allowing nurses more bedside time. How? Front-line staff are closest to everyday challenges and can best identify how to improve productivity and remove inefficiencies.