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Shared Governance in Perianesthesia Nursing

Mary Egger

University of Saint Mary

NU 749 Capstone Synthesis

Dr. Kidder

July 24, 2022

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Shared Governance in Perianesthesia Nursing

Nursing culture and workplace morale ultimately influence patient care and policy

formation. Inpatient hospital units with practice councils are part of shared governance. Shared

governance supports nurses to pursue autonomy in the nursing profession (Kyytsönen et al.,

2020). Nurses are encouraged to work together to make positive workplace changes within

practice councils. The nurses involved in a practice council can educate staff nurses on issues

specific to their practice. This gives nurses the power and confidence to better their patient care

practices. Shared governance councils are part of Magnet designation, which ultimately

determines the quality of patient care (Hu et al., 2021). Councils promote the professional

development of the nurse (Bleich, 2018). Shared governance is absent within the University of

Kansas Health System’s Post Anesthesia Care Unit. Nurses are being deprived the ability to

make changes in their workplace. This causes feelings of unhappiness and low morale.

Preliminary data has been collected to determine the current status of nursing morale. The

problem with the lack of a shared governance council is the negative impact of workflow-related

problems, unit morale, and retention.

The capstone project’s focus is to create a practice council for the Post Anesthesia Care

Unit (PACU) at the University of Kansas Health System. Shared governance will improve

advocacy for the nurse's role in the PACU setting. One of the goals in improving nurse advocacy

is also improving the quality of patient care. The staff nurses in the PACU are looking for a way

to grow as nurses and improve overall morale. This opportunity will be beneficial to the morale

of the unit as a whole. Shared governance promotes a positive practice environment to satisfy

patients and increase retention rates (Siller et al., 2016). The goal is to create shared governance

among nurses and improve the quality of patient care, retention, and staff morale.
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Literature Search

The literature review began with a search on the ProQuest Nursing & Allied Health

Source database. The terms “practice council” and “nursing” were entered into the search bar.

There were 137,166 results before the search was narrowed down. The search was modified to

filter articles that were full text, peer-reviewed, and from 2016 to the present. This displayed

28,007 results, even when narrowed down. The articles within this search are seemingly not

relevant to the purpose of my research. Alternately, the terms “shared governance” and “nursing”

were entered into the search bar with 9,267 results. When narrowed down using the same filters

as before, there are 2,534 results. The articles within this search are more relevant, and the term

“shared governance” will be used in application to the development of a practice council for the

purpose of this research.

The search for articles continued in the CINAHL Complete database. The term “shared

governance” and “nursing” was entered, and 1,236 articles resulted. The term “practice council”

did not yield any results that were relevant to the research. The articles were filtered the same as

they were in the ProQuest database. There are 74 articles that remained. The amount of articles

in the CINAHL search is more manageable than the ProQuest search.

Literature Review

The current state of shared governance was examined through the literature. The

literature review revealed what authors and researchers view shared governance to be in the

nursing profession. It can be said that shared governance has the potential to be a powerful force

in nursing. The basis of research begins with a review of the literature. Many articles were

examined to extract information that will provide structure and inspiration for a shared

governance council in perianesthesia nursing.

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           The majority of the articles reviewed were literature reviews. This helps examine more

literature and uncover other sources of information. A commonly cited source was Timothy

Porter-O’Grady. Upon further research, Timothy Porter-O’Grady has written a comprehensive

book about shared governance called Implementing Shared Governance Creating a Professional

Organization. His definition of shared governance is known as the process in which

empowerment comes from shared decision-making within nursing (Boswell et al., 2017). This

came from an article about shared governance in academic nursing. This is the only article that

showed how shared governance could be applied to an academic setting. This makes this article

unique and adds a different perspective to this project. Though this project does not take place in

an academic setting, the concepts are similar to those articles about shared governance in a

medical setting.

The article by Hole (2020) uses shared governance as a structure for policy formation.

This is the only article that used the concept of shared governance as a structural component to

research. This showed the strength of the concept shared governance. The impact of shared

governance has on nursing is powerful. Shared governance allows nurses to make informed

decisions that directly impact their practice (Siller et al., 2016). Siller et al. (2016) examined

shared governance in the emergency department. Their research found that shared governance

promoted the attributes of accountability, teamwork, professional development, autonomy, and

empowerment (Siller et al., 2016). Another article noted the empowerment that shared

governance gives nurses. Gordon (2016) discusses the improvement of nurse satisfaction through

the implementation of shared governance. The overall similarity between these articles

demonstrates the impact and importance of shared governance has on the nursing profession. The
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implementation of a shared governance council will intend to have the same impact on the nurses

in the PACU.

           An article by Kyytsönen et al. (2020) suggests that shared governance enhances a nurse’s

leadership skills. This fact is enough to support shared governance councils among staff nurses.

The goal of shared governance is to encourage nurses to lead nurses. This is accomplished

through strengthening relationships and partnerships among various departments (Brennan &

Wendt, 2021). Strengthening relationships among nurses will improve the quality of patient care

through teamwork. Through shared governance, nurses also have the ability to shape their

workplace (Sulit Oriza et al., 2016). Nurses have the impact to change the way they practice

through shared governance. Shared governance gives nurses the voice they need to increase

satisfaction in their profession. Nurses are able to view their care practices through a holistic

viewpoint with shared governance (Bleich, 2018).

           The article by Costley & Clark (2021) describes implementing a shared governance

council in a medical unit. This article provides this project with inspiration and structural ideas.

The first meeting establishes goals (Costley & Clark, 2021). This will allow the council members

to have a frame of reference moving forward in shared governance. Clear communication and a

bulletin board for unit education were other ideas extracted from this article. 

           The overarching concepts related to shared governance in nursing were uncovered

through the literature review. There were some differences among the articles. Some articles

were literature reviews, while others examined hospitals with shared governance and those

without. An article by Hu et al. (2021) surveyed the nurses of two hospitals before and after

implementing shared governance in one of the hospitals. This inspired a survey for this project.

Overall, the articles provided definitions for shared governance and related ideas. The goals of
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this project will be accomplished, and shared governance will help the perianesthesia nurses at

the University of Kansas Health System.

Framework

The building blocks of any project begin with concepts from a nursing theory. Basic

principles are drawn from theories to create a framework. The framework for shared governance

in a Post Anesthesia Care Unit will be drawn from the Social Learning Theory and IOWA

Model. Concepts from each theory will be present within this project and will guide the purpose.

A critique of each theory is necessary to determine the level of congruence to the purpose

of the project. The Social Learning Theory is a learning theory in which the goal of learning is

self-efficacy (Billings & Halstead, 2020). Learning is accomplished through social interaction

and requires consistent attention, repetition, and reproduction of the content being learned

(Billings & Halstead, 2020). The social aspect of this theory is helpful in a workplace with

nurses. Nurses learn from social settings once their education is over. This learning theory was

selected because the goal of creating a shared governance nursing council is to educate staff

nurses on new workflows and policies. Nurses will be able to implement new practices from

their own input. The social aspect of learning is appealing because of the environment in which

staff nurses work. For this reason, this theory is heavily considered as the framework. The Social

Learning Theory will be the guide.

The IOWA Model is essential to the implementation of evidence-based practice. One of

the goals of creating a shared governance nursing council will be to implement evidence-based

practice. Through the IOWA Model, the quality of nursing care can improve. In the IOWA

Model, there are five steps. The steps include identifying a problem, appraising it, synthesizing
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research, designing a plan, and integrating the plan (Haulesi Chiwaula et al., 2021). This theory

has the potential to be used as a framework for developing a shared governance council.

Methods

The concept of shared governance will be examined and studied through the lens of

research articles and observation. The goal is to determine if a shared governance council will

increase morale, retention, and a solution to problems among nursing staff. The goal will be

achieved through methods inspired by research and input from the staff nurses.

A literature review revealed current research on shared governance councils. The

background research helps provide ideas and concepts for the framework of the project. The only

resources required for this project will be the survey, internet, a printer, and a computer. The

participants are nurses in the University of Kansas Health System’s Pre/Post Anesthesia Care

Unit. There are 25 nurses within this department. It is anticipated that the staff nurses will see an

increase in job satisfaction through the development of this project. Shared governance increases

nurse empowerment and satisfaction (Boswell et al., 2017). The increase in job satisfaction will

increase overall morale, retention, and help nurses solve their work-flow related problems. The

staff nurses will be contacted by email to fill out a survey before and after a shared governance

council is created. The council will function for a few months before data is collected again. The

pre and post survey will consist of a short list of questions to gather mostly qualitative data. This

data will provide a basis of information on the current viewpoint of the unit from the staff nurses.

An online survey generator was used to create and document all of the data throughout the

project. The survey will produce information on the current status of the unit. This will give the

researcher insight into the morale, retention, and satisfaction of the staff nurses. A total of five
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staff nurses volunteered to be council members. There will be at least two meetings over the

course of two months before the follow-up survey will be administered.

The strengths and weaknesses of this project have been considered. The strengths are the

positive influence a shared governance council will have on the unit. The goal is to improve staff

morale, empowerment, and retention. This will be measured through the collection of data

throughout the project. The weaknesses are the lack of control over other staff members

contributing to data collection and ensuring meetings are plausible due to potential schedule

conflicts.

After analyzing the data collection, it is determined that the level of data will be nominal.

The concepts will be named and monitored but will not reach an absolute number. A simple form

of analysis will be determined after the data is recorded. The data will be compared to the initial

collection to determine changes. The purpose statement is the goal of the project. The survey

questions will be aimed at achieving that goal. There is an agreement with the preceptor

regarding the goals and collection of data. The staff nurses will determine this within the

Pre/Post Anesthesia Care Unit.

Ethical Considerations

The staff nurses at the University of Kansas Health System’s Pre/Post Anesthesia Care

Unit participated willingly in this research project. Each participant volunteered and was given

the option to stop participating at any time. An IRB application was submitted for this research

before participants were involved.

Results

The pre survey contained seven questions with the intention of analyzing the unit morale,

satisfaction, and retention of nurses before the implementation of the shared governance practice
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council. Of the twenty-five staff nurses, there were six replies. The overall morale of the unit was

rated poorly with 66% identifying it as such. Interestingly enough, 83% of the respondents were

satisfied overall with their job. After the data was analyzed, the council started having meetings.

These meetings revealed workflow related problems that were solved with the help of staff

nurses. It is a goal for staff nurses to feel empowered by making changes to their workflow

related problems. There will be a post implementation survey with a similar amount of questions

to determine if morale and overall satisfaction has been changed. Retention will also be looked at

to determine if any nursing staff has left within this time.

Discussion

The overall implication of implementing a shared governance practice council within the

Pre/Post Anesthesia Care Unit at the University of Kansas Health System. There has been an

overall improvement in nurses being satisfied within their role. The purpose of this project was

to determine if creating a shared governance practice council would improve overall nurse

satisfaction, retention, and unit morale. Through research, shared governance was defined.

Shared governance allows nurses to improve their practice and the quality of patient care (Siller

et al., 2016). This shared governance project brought a lot of strengths into the Pre/Post

Anesthesia Care Unit. The overall strengths of this project was the engagement of staff nurses to

solve their workflow related problems and advocate for their patient care. Some limitations of

this project include only 24% of nurses filled out the pre survey. Another limitation includes the

time constraint and availability of nurses to maintain practice council meetings. It can be implied

that shared governance does in fact increase the satisfaction of nurses by empowering them to

advocate for themselves without the need for leadership to be involved. The IOWA model was

used to create and devise a plan to implement shared governance on this unit. In the IOWA
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model a problem is identified, discussed, researched, then a plan is created and integrated

(Haulesi Chiwaula et al., 2021). This design model helped create a framework and reference for

assessing the data collected from surveys. The overall design of this project has been beneficial

to the researcher and has allowed for data to be used to assess the morale of the unit.
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References

Billings, D., & Halstead, J.A. (2020). Teaching in nursing: A guide for faculty. (6th ed.). Elsevier

Bleich, M. R. (2018). Shared governance—shared leadership: Opportunities for

development.  The Journal of Continuing Education in Nursing, 49(9), 394-396.

https://doi.org/10.3928/00220124-20180813-03

Bonnel, W., & Smith, K. V. (2021). Proposal writing for clinical nursing and DNP projects 

            (3rd ed.). Springer Publishing Company

Boswell, C., Opton, L., & Owen, D. C. (2017). Exploring shared governance for an academic

nursing setting.  Journal of Nursing Education,  56(4), 197-203.

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Brennan, D., & Wendt, L. (2021). Increasing quality and patient outcomes with staff engagement

and shared governance. Online Journal of Issues in Nursing, 26(2).

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Costley, T., & Clark, D. (2021). Professional governance and staff engagement: A new medical

unit establishes an engaged nursing workforce. American Nurse Today, 16(1), 41–46.

Gordon, J. N. (2016). Empowering oncology nurses to lead change through a shared governance

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