Balancing nurse empowerment with improved practice and care: An evaluation of the impact of shared governance

Abstract

This paper reports on the preliminary findings of a two-year ethnographic study of the implementation of shared governance at Kettering General Hospital NHS Trust. Key aims of the study were to identify the impact of shared governance on clinical practice and patient care, and the effects of its implementation on nurses and midwives. The findings suggest that the early impact of shared governance related primarily to effects on the professional environment and culture of nursing, particularly increased information-sharing and feelings of empowerment. Impact on patient care and service delivery was limited, with key obstacles to successful implementation including poor communication systems, lack of a means of publicising the work of shared governance councils, and difficulties finding the best ways of managing time spent away from clinical areas on practice and professional development issues. There was evidence that shared governance could have an indirect impact on patient care in the longer term. We suggest that it may have to be accepted that, initially, the early impact of shared governance is felt mainly by health professionals, and that the desired impacts on service delivery are the indirect benefits of more empowered and professionally accountable nurses and midwives in the longer term.