Is Shared Governance the answer to the Nursing and Midwifery staffing crisis?

Traditionally, within the NHS, a leader is seen to be somebody in a position of power; someone whom has a senior place within hierarchy. What if you asked frontline staff members to make decisions that would habitually be made by a person who doesn’t have direct contact with patients, relatives or carers? Swihart (2011) defines the principles of Shared Governance of partnership, equality, accountability and ownership at the point of care, empowering all members of the healthcare workforce to have a voice in decision making. This facilitates a diverse and creative input to advance the vision of the organisation.

At Nottingham University Hospitals we define Shared Governance as: “Shared Governance is where staff have collective ownership to develop and improve practice”. We explored whether Shared Governance could work as a way to engage our Nurses and Midwives in 2011 with support from the Foundation of Nursing Studies and created our pilot council in 2012.

Thus far we’ve implemented Shared Governance at NUH in two ways:-

1) Promoting and fostering a facilitative rather than directive leadership approach in our Nursing & Midwifery organisation

2) Using Nurse & Midwife led councils as a vehicle to implement Shared Governance.

We currently have 25 councils in practice across our organisation, individually they meet for 6.5hrs a month and spend this time talking about changes, planning improvements and then implementing their projects. Each council will have a chair who will attend our monthly Leadership Council, chaired by our Chief nurse where the feedback their successes and ‘what could be better if...’ on a trust wide platform.

Enabling this new leadership approach has not been without it’s barriers, we’ve challenged leadership styles, turned our decision making hierarchy upside down and disputed the status quo. On top of this our council members are often junior frontline staff therefore educational support has been needed in project management, service improvement and measuring outcomes.

Two facilitators were employed in 2014 to act as advocates and coaches for the implementation of shared governance trust wide. In just 12 months our councils have saved their wards money, challenged the leadership styles of their ward, improved patient safety and outcomes.

In a recent survey 100% of our council members agreed or strongly agreed that they felt more able to challenge and change practice in their clinical area. We consider all of our nursing and midwifery workforce ‘bedside leaders’ as we believe they should be the ones driving forward our agenda.

The future is bright for Shared Governance at NUH- we are conducting a mixed methods study into our work, evaluating how we can make our unit practice councils multidisciplinary and continually evolving our culture of shared leadership.

However I think this is more than just NUH- this is the whole of the NHS that needs to consider how it can embrace and move Shared Governance forward. We need to ask ourselves as leaders- what should empowerment look like across our workforce and what does it truly mean to be a ‘bedside leader’?
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