Professional Governance and Shared Decision-Making

Allowing employees to be involved in decisions that impact their work increases engagement and strengthens the voice of individual contributors. True professional governance and shared decision-making have direct care staff at the core of decisions impacting their practice and patient care areas, increasing their autonomy and validating their professional competence (1). Things organizations can do to enhance professional governance and shared decision-making:

  • Genuinely focus on relationship building, create a sense of common purpose and embrace collaboration (2).
  • Evaluate current decision-making structures and processes to determine how practice-related decisions are made (1, 2)
  • Fully invest in nurses collaborating with leaders to make decisions (shared decision-making) rather than requesting nurse input (participatory management) on policies and procedures impacting practice (1, 3, 5).
  • Consider direct care level councils containing the following attributes:
    • Participants have personal accountability and ownership for their work (3). 
    • Decision-making is shared between the direct care team and management as collaborators focused on outcomes and goals for the populations served (1, 3, 5). 
    • Ensure councils have the education, resources, support, and protected time necessary to guide the practice environment and own the outcomes (1, 3, 4, 5, 6).
  • Maintain bi-directional communication and feedback as plans and protocols are formulated (1, 2).
  • Build leadership trust by supporting nurses in professional governance and clearly articulate expectations and authority levels (1, 3, 5, 6).


  1. ​​Orton, A. (2021). Supporting nursing autonomy through shared governance. Nursing Management, 52(12), 44–46.
  2. Owen, D., Boswell, C., Opton, L., Franco, L., & Meriwether, C. (2018). Engagement, empowerment, and job satisfaction before implementing an academic model of shared governance. Applied Nursing Research, 41, 29–35.
  3. Clavelle, J. T., Porter O’Grady, T., Weston, M. J., & Verran, J. A. (2016). Evolution of Structural Empowerment. JONA: The Journal of Nursing Administration, 46(6), 308–312.
  4. Amberson, T., Graves, J. M., & Sears, J. M. (2022). Implementing the Total Worker Health Program in a Shared Governance Context. Journal of Emergency Nursing, 48(4), 342–347.
  5. Porter-O’Grady, T. (2019). Principles for sustaining shared/professional governance in nursing. Nursing Management, 50(1), 36–41.
  6. Rodwell, J., McWilliams, J., & Gulyas, A. (2016). The impact of characteristics of nurses’ relationships with their supervisor, engagement and trust, on performance behaviours and intent to quit. Journal of Advanced Nursing, 73(1), 190–200.