The paper presents the findings of an interview with a nurse manager who works in a setting that integrates shared governance (SG). SG models imply that representatives from distinct units and/or every nursing role will participate in the process of change, and they may be of tremendous help in reorganizing hospitals’ current care delivery systems. Greater nurse empowerment and professionalism, better work attitudes, improved job satisfaction, staff retention, etc. are a few of the possible benefits of SG resulting from the sense of influence over practice and the autonomy associated with it (Hastings, Armitage, Mallinson, Jackson, & Suter, 2014).
Since SG implies a continual negotiation of problems among the involved parties and the open access to information, it can also potentially result in the resolution of conflicts (Wilson, 2014). Nevertheless, as stated by the interviewee, in the situation when each team member has the autonomy, inefficient delegation, and allocation of nurses’ responsibilities and roles may pose a significant ethical issue, especially in case a practitioner does not have sufficient experience and skills needed to perform effectively.
The interview revealed that SG may be inefficient due to two main factors, i.e., excess workload and the lack of skills. These problems may also undermine communication productivity and cause interpersonal problems. Since in SG, every nurse plays the role of a leader and is responsible for the work function in the context of both collective decision-making and autonomy, it may be difficult for inexperienced practitioners not to feel abandoned and not to lose control over the situation.
Thus, from the point of view of the nurse manager, the lack of a supportive environment often becomes a significant barrier to effective SG. In this way, continual overwork or the absence of a direct management’s involvement can prevent nurses from practicing within the scope of professional competence and result in the feeling of helplessness. It means that to minimize the emergence of ethical issues, as well as the potential harm to patients’ safety and care quality, the balance between nurses’ autonomy and the unit leaders’ supervision is required. However, the interviewee did not suggest that practitioners’ access to decisions should be restricted. Conversely, she emphasized that managers must be focused on the creation and maintenance of control over the work environment.
In the selected hospital, the ability to balance and reduce workloads and improve shifting models was often limited. When facing this problem, the management strived to develop and implement appropriate communication instruments allowing nurses to exchange duties, e.g., notes, records, short meetings, etc. The team leaders also designed unit-specific protocols to instruct nurses on priorities in organizing care and responding to patients’ needs. Additionally, to ensure practitioners’ commitment to their duties even in the absence of sufficient support sources, the management focused on the integration of excellent motivation, knowledge-sharing, and conflict management systems into the hospital’s culture.
Although, first of all, ethical principles of nurses should be applied to the work with patients, that are similarly applicable to practitioners themselves. The principles relevant to the resolution of the mentioned issue include fidelity and integrity. By developing and improving the work environment and communication culture, hospitals can show their commitment to the virtue of caring (fidelity) − they promote patient safety and the health of their employees.
At the same time, integrity implies a multidimensional evaluation of the situation and holistic response to identified problems. By addressing the issues at the basic organizational level, i.e., work structure, communication, and cultural systems, the team and its leaders may generate benefits for individual performance, patients, and the hospital as a whole.
Hastings, S. E., Armitage, G. D., Mallinson, S., Jackson, K., & Suter, E. (2014). Exploring the relationship between governance mechanisms in healthcare and health workforce outcomes: A systematic review. BMC Health Services Research, 14, 479. Web.
Wilson, K. L. (2014). Nurses perceptions of shared governance two years post implementation of a councilor shared governance model. Web.