Use this work to transform lives and create healthy communities. 

Takeaways:

• Within a shared decision-making model, nursing councils function as the primary mechanism for deliberating, deciding, and acting on specific areas of accountability.
• Successfully integrating new council members requires orientation, engagement, deliberation, dialogue, decision-making, and trust building.

Over the past 35 years, nursing shared gov­ernance (professional governance [PG]) has become the prominent model for nursing professionals to make decisions and take actions in many healthcare organizations. Within this shared decision-making model, nursing councils function as the primary mechanism for deliberating, deciding, and acting on specific areas of accountability—ownership, professional ethics, and value-based decision-making related to practice, care quality, and provider competence. They also aid the creation, generation, and application of nursing knowledge in the interests of advancing individual and community health.

Council work and new council member engagement aid positive and effective decision-making and action. Successfully integrating new council members requires orientation, engagement, deliberation, dialogue, decision-making, and trust building.

Basic council membership expectations

Nursing council members represent their colleagues when making decisions that affect who they are and what they do. For that reason, new members should understand some basics that inform their role and action, including how councils differ from committees, the role of council authority, and the equal importance of council work and patient care.

Councils vs. committees 

Unlike committees, councils don’t advise an authority, they are an authority. Traditionally, authorized individuals or bodies form committees to explore issues, clarify facts, pursue specified responsibilities, and undertake actions delegated to them. Councils, however, have specific accountabilities that include decisional and actionable authority. They authorize bodies within the parameters of the accountability that authority represents. A practice council, for example, has authority over practice decisions, and a quality council has authority over decisions that affect quality definitions and actions. (See Council role basics.)

Council member authority 

Council members have authorization to speak and act on behalf of those they represent. In the case of a nursing council, they represent nursing professionals. Members have the right and responsibility to deliberate and make decisions on behalf of the profession—not individual nurses—that are in the best interests of the profession.

Council work and patient care equivalence 

Members should consider their council work as equivalent to patient care. Excellent patient care represents sound policy and decision-making regarding evidence-based and valid standards, practices, and activities. Without definitive and informative council work, patient care would become subjective, individually determined, and highly variable. When nursing councils make practice decisions they should apply evidence-based learning and practice. For that reason, an individual’s membership on a council should be scheduled as equitably in the staffing cycle as patient care. Little evidence suggests that sacrificing council time helps advance or improve care.

Gearing up for council work

Most new members have little personal experience with a council’s mission, objectives, and work history, so you’ll need to do some catch up work to gain basic knowledge. You can accomplish this in several ways, including the following:

1. Review the minutes of the council over the past year. Get familiar with the council’s work and focus to gain a sense of its priorities and how it functions. As themes emerge, reflect on how they inform and influence your own thinking.
2. Look carefully at the organization’s and service unit’s professional governance structure. Also review the council charter, which explains the council’s purpose and how it fits the overall distribution of accountability and work of each of the components of the professional governance model.
3. Review the expectations of council membership and role contributions. Incorporate the council meeting schedule into your personal work schedule.
4. Council work shouldn’t be considered extra work. Consult with unit leadership to integrate your council duties into your patient care responsibilities. A well-structured professional governance system should have a staffing/workload algorithm for council membership that accommodates meeting times and member obligations. You should never be expected to sacrifice one important part of your professional role for another.
5. Meet with the council leadership or chair before you start the formal membership year. This meeting should aid orientation, set leadership expectations, and clarify council processes and role/service expectations. Use this meeting as an opportunity to share your personal passions and vision for the work of the council, and discuss any outstanding issues not addressed by other orientation activities. During this meeting, the unit manager (the level of manager depends on the breadth and function of the council) should affirm their resource role and model behaviors that enable group process and collective problem-solving.
6. Most long-term professional governance models offer council orientation for new mem­bers. Take advantage of this to learn about council work and membership and also to meet and partner with other new members. (See Orientation content.)

Council membership and peers 

Council membership ultimately makes a difference in the lives of nurses and the work of the profession. Represented nursing staff have a right to expect that council decisions demonstrate the highest levels of deliberation and decision-making excellence.

Remember that you’re representing the best interests of the nursing profession and patient care. Sometimes those interests will reflect the views of individual nurses and sometimes they won’t. Discussion and deliberation inevitably inform and change thinking, which may place you in a difficult position with other staff when the new information or knowledge differs from other’s perspectives or wishes. Effective membership requires decision-making courage and clarity.

Equally important are openness and transparency with nursing staff about council processes. This approach requires an effective communication–feedback loop between council members and staff peers. In the face of important or controversial issues, remind your peers that all council meetings are open and encourage them to attend and share their insights and views within the format of the council structure.

Most councils make definitive and directive decisions, but during their formation, valuable input serves to inform and advance effectiveness and veracity. Rather than argue or disagree with your peers outside of council meetings, engage them within the council’s deliberations. When staff attend open council meetings they can raise questions, provide insight, and observe the council’s processes to gain an understanding about the rationale behind decisions and actions.

Council effectiveness isn’t measured by decision popularity and agreement. Thoroughness, validity, accuracy, appropriateness, and legitimacy of council work and action on behalf of nursing truly measure council success. (See Communicating with peers.)

New is good

Experienced and inexperienced council members bring value, but longstanding members may view new members as having little to offer at the beginning of their tenure. However, research by Alexandre and colleagues demonstrates that this is only partially true. As a new member, you have options and opportunities not necessarily available to those who’ve been council members for some time. For example, your beliefs, habits, and experiences aren’t influenced by the council, which allows you to contribute unformed, unique, and unrefined thinking that may enhance council processes. Inexperience can aid creative and innovative dynamics essential to sound decision-making.

In addition, recognize your unique skills and talents and their value at the council table. Although you must be open and available to learning and engaging with the council’s culture and processes, embrace your gifts and express your contribution in a way that enriches deliberations and informs council decisions.

A council member mentor can help formalize this dynamic and provide support during orientation and integration within the council. Share questions and concerns with your mentor and listen to their insights, which can help you contribute to council work. (See What new members offer.)

Exciting work

Professional council work provides an opportunity for individual nurses to work with other clinical and management leaders to transform and advance nursing principles, values, protocols, measures, and practices. This work, and the collective partnership nurses establish with other disciplines, reveal the power and positive impact nurses have on an individual’s journey to health and in creating and sustaining community health. The skills displayed and the work accomplished within professional councils not only affect nursing practice and its outcomes but also demonstrate the essential collegiality and partnership among nurses within interprofessional teams. This cooperative energy ultimately transforms people’s lives and helps build healthy communities. New professional governance council members deserve a welcome embrace as they commit to this important undertaking.

Tim Porter-O’Grady is a senior partner at TPOG Associates in Tucson, Arizona, and a clinical professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Georgia. 

References

Alexandre JD, Waldzus S, Wenzel M. Complex inclusive categories of positive and negative valence and prototypicality claims in asymmetric intergroup relations. Br J Soc Psychol. 2016;55(3):457-83. doi:10.1111/bjso.12148

Brom H, Carthon JMB, Sloane D, McHugh M, Aiken L. Better nurse work environments associated with fewer readmissions and shorter length of stay among adults with ischemic stroke: A cross-sectional analysis of United States hospitals. Res Nurs Health. 2021;44(3):525-33. doi:10.1002/nur.22121

Christman L. The autonomous nursing staff in the hospital. Nurs Adm Q. 1976;1(1):37-44. doi:10.1097/00006216-197600110-00006

Clavelle JT, Porter-O’Grady T, Weston MJ, Veran JA. Evolution of structural empowerment: Moving from shared to professional governance. J Nurs Adm. 2016;46(6):308-12. doi:10.1097/NNA.0000000000000350

Porter-O’Grady T. A response to the question of professional governance versus shared governance. J Nurs Adm. 2017;47(2):69-71. doi:10.1097/NNA.0000000000000439

Porter-O’Grady T. Interdisciplinary Shared Governance: Integrating Practice, Transforming Healthcare. Boston: Jones & Bartlett; 2009.

Porter-O’Grady T. Shared Governance for Nursing: A Creative Approach to Professional Accountability. Rockville, MD: Aspen Systems; 1984.

Swihart D, Hess RG. Shared Governance: A Practical Approach to Transforming Interprofessional Healthcare. 4th ed. Middletown, MA: HCPro; 2021.

Wang D, Waldman DA, Zhang Z. A meta-analysis of shared leadership and team effectiveness. J Appl Psychol. 2014;99(2):181-98. doi:10.1037/a0034531

Key words: professional governance, accountability, nursing councils