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Shared Governance in Detail

Enhancing nursing practice at BCH


  • Define Shared Governance (SG)

  • Identify the correlation between shared governance, nursing engagement, and patient outcomes

  • Identify the benefits of shared governance & nursing participation in decision making

  • Introduce revised BCH Nursing Vision, Values, Philosophy, and new Care Model

What is nursing shared governance?

  • Organizational framework based on the idea of decentralized leadership that fosters autonomous decision making and professional nursing practice.

  • Implies the allocation of control, power, or authority (governance) among mutually (shared) interested vested parties.

  • Accountability-based approach to structure in which there is a clear expectation that all members participate in the work.

Principles of Shared Governance

  • Partnership

  • Equity

  • Accountability

  • Ownership


  • Creates professional empowerment through the collaborative relationships of all the stakeholders

  • Essential to building relationships

  • Involves all staff members in decisions and processes

  • Equality between members in decisions and processes

  • Links healthcare providers & patients


  • Maintains a focus on services, patients, & staff

  • Integrates roles and relationships into the structures and processes needed to achieve positive patient outcomes

  • Says that no role is more important than another


  • Core of shared governance

  • Willingness to invest in decision-making

  • Accepting ownership of decisions

  • Defines roles, not jobs; cannot be delegated


  • All workers are invested

  • Every role & person has a stake in outcomes

  • Recognition & acceptance of the importance of everyone’s work

  • Relationships supported by processes

Self governance vs. Shared governance

Centralized interactions (Self governance)

  • Position-based

  • Distant from point of care

  • Hierarchical communication

  • Limited staff input

  • Separates responsibility to managers

  • We-they work environment

  • Divided goals/purpose

  • Independent activities/tasks

Decentralized interactions

(Shared governance)

  • Knowledge-based

  • Occurs at point of care

  • Direct communication

  • High staff input

  • Integrates equity, accountability and authority for staff and managers

  • Synergistic work environment

  • Cohesive  goals/purpose ownership

  • Collegiality, collaboration, partnership

Why start this journey?

  • Create an atmosphere for:

    • Optimal patient care

    • Improved quality of care

    • Promoting staff engagement

    • Promoting evidence based practice

    • Recognition of the value of working together

    • Increased personal & professional development

    • Healthy work environment

Benefits of SG for nursing

  • Increased professionalism

  • Increased collaboration & mutual respect

  • Increased control over practice

  • Increased employee satisfaction

  • Increased engagement

  • Increased retention

Benefits of SG for the patient 

  • Increased confidence in healthcare team

  • Increased patient satisfaction

  • Decreased “failure to rescue”

  • Decreased lengths of stay

  • Reduced mortality

  • Reduced patient morbidity

Shared governance framework

  • Nursing is responsible, accountable and has authority over decisions related to practice, quality and competence

  • Management provides the support, encouragement, resources, training and boundaries for success

  • Composed of a coordinating group of staff and management.

  • Is bylaws and rules driven

  • Staff nominated, elect, and/or chosen to participate

Basic requirement for shared governance

  • Committed nurse executive

  • Strong nursing management team

  • Employees must have a clear basic understanding of shared governance.

  • Must chart progress with a plan and timeline for implementation


  • Empowers nurses to promote excellence in nursing practice

  • Shared decision making at point of care

  • Nurses own the nursing practice

  • Allows nurses to network and collaborate among units

  • Improved patient care and safety outcomes.

Nursing Mission Statement

The Mission of Nursing at Boone County Hospital is to provide excellent, compassionate and personalized care focusing on enhancing the well-being of patients and their families.

Nursing Core Values

Our Patients 

The individual needs of our patients and families guide our compassionate nursing care;

Our Team

By working together, as a team, we create an environment that inspires trust, respect, collaboration and accountability to each other and to our patients;

Our Hospital

Our nursing practice reflects the vision of being trusted leaders in promoting the health of those we serve;

Our Community

We are dedicated to serving our community and all who come to us for care—honoring their unique and diverse needs. We perform in a way that communicates we are here to serve.

Our Profession

We are committed to excellence in nursing by creating a culture of lifelong learning that integrates evidence-based practice and professional growth. We pursue the highest standards in quality care, service, and patient satisfaction.

Nursing Philosophy

It is the belief of the Nursing Department at Boone County Hospital that our fundamental purpose is to deliver the highest quality nursing care possible to our patients and by doing so we are reflecting the vision and values of our organization. We support an environment that promotes excellence in nursing practice by emphasizing these key principles:

  • Nursing care for each patient and family is individualized, compassionate, and respectful to needs. We believe patients are participants in their own care having the right to make choices in the delivery of their health care.

  • Nurses collaborate with patients, families, and other health care team members to plan and provide nursing care that will achieve an optimal level of health and wellness.

  • Excellence in nursing practice is achieved through a commitment to lifelong learning and career growth that includes the involvement of the nurse in shared decision making and provides venues for the nurse to advocate for the patient in clinical and organizational practices.

  • We believe in creating a work environment for nurses that nurtures and supports clinical excellence, education, and shared governance, fostering the recruitment and retention of nursing staff who demonstrate the highest integrity, competence, and qualifications.

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