Shared governance gives nurses a defined role in decisions about nursing practice and working conditions. The useful question is which decisions nurses can actually make, influence or recommend.
The American Nurses Association's developmental framework describes arrangements with different distributions of authority among staff representatives, managers, councils and nursing executives. The name alone does not establish the decision rights in a particular organization. ANA governance framework
Identify the authority
Start with a real decision, such as reviewing a nursing workflow. Ask who can propose a change, who evaluates the evidence, who authorizes resources and who makes the final decision.
Separate decisions a council can make within its charter from recommendations requiring another body's approval. Record how disagreements are resolved and who must explain a decision to staff.
A structure is easier to understand when those responsibilities are written down. Avoid promising that every council has control over budgets, employment decisions or matters outside its professional remit.
Understand the levels
Johns Hopkins All Children's Hospital describes unit-based councils addressing local practice issues and broader councils addressing common concerns. Its coordinating council links council work and mediates unresolved issues. This is one organization's structure, rather than a required national template. Hospital council description
Use a similar distinction when raising a concern. A unit may be able to test a local communication process, while a change involving several services needs wider participation.
Do not let a question disappear simply because it belongs elsewhere. Identify the receiving group and the expected response.
Make participation possible
ANA's suggested evaluation questions examine staff participation, representation, time to take part and how decisions reach nurses. It also asks whether organizations examine outcomes associated with their governance work. ANA evaluation questions
In practice, ask how colleagues on different shifts can contribute and how representatives bring questions back to them. Clarify meeting coverage, preparation time and access to relevant information.
Attendance is not the same as influence. Review whether a staff proposal received consideration, a decision and an explanation.
Follow one proposal through the process
In this fictional example, nurses report that equipment instructions are difficult to locate. The council defines the problem, checks the existing policy, consults the relevant educators and proposes a limited improvement.
Before testing it, the group identifies the approval needed and the person responsible for follow-up. Afterward, it records what staff found useful, any new difficulty and whether the change should continue.
The example illustrates a decision process, not evidence that shared governance necessarily produces a particular clinical result.
Evaluate the structure itself
Ask whether the same concerns repeatedly return without resolution, whether council membership reflects the people doing the work and whether decisions are understandable to nonmembers.
A useful governance review combines concrete examples with feedback from staff. Meeting counts alone cannot answer whether nurses have meaningful influence.
Ask which decisions a unit practice council can make and which require approval elsewhere.
Related
unit practice councils · professional practice models · nursing leadership.
Sources
- Three Developmental Phases of Shared Governance (accessed 2026-09-17) — ANA.
- Programs and Councils (accessed 2026-09-17) — Johns Hopkins All Children's Hospital.
- Questions to Ask About Shared Governance (accessed 2026-09-17) — ANA.