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Shared Governance in Perianesthesia Nursing

Mary Egger

University of Saint Mary

NU 749 Capstone Synthesis

Dr. Kidder

August 14, 2022

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Abstract

Shared governance was examined in a Post Anesthesia Care Unit at the University of Kansas

Health System. The goal of research was to see if introducing a shared governance practice

council would increase nurse morale, satisfaction, and retention of nurses. There are twenty-five

nurses on this unit. A pre and post-implementation survey was sent to nurses to assess the level

of morale and satisfaction before and after the initiation of the council. The end result shows that

shared governance does improve morale from nurses. The IOWA Model was used to help design

the research and structure the project from start to finish. It can be concluded that nurses rely on

shared governance to help solve their workflow-related problems to improve their patient care.
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Shared Governance in Perianesthesia Nursing

Nursing culture and workplace morale ultimately influence patient care and policy

formation. Inpatient hospital units with practice councils are part of shared governance. Shared

governance supports nurses to pursue autonomy in the nursing profession (Kyytsönen et al.,

2020). Nurses are encouraged to work together to make positive workplace changes within their

practice councils. The nurses involved in a practice council can educate staff nurses on issues

specific to their practice. This gives nurses the power and confidence to better their patient care

practices. Shared governance councils are part of Magnet designation, which ultimately

determines the quality of patient care (Hu et al., 2021). Councils promote the professional

development of the nurse (Bleich, 2018). Shared governance is absent within a University of

Kansas Health System’s Post Anesthesia Care Unit. Nurses are being deprived of the ability to

make changes in their workplace. This causes feelings of unhappiness and low morale.

Preliminary data has been collected to determine the current status of nursing morale. The

problem with the lack of a shared governance council is the negative impact of workflow-related

problems, unit morale, and retention.

The capstone project’s focus is to create a practice council for a Post Anesthesia Care

Unit (PACU) at the University of Kansas Health System. Shared governance will improve

advocacy for the nurse's role in the PACU setting. One of the goals of improving nurse advocacy

is also improving the quality of patient care. The staff nurses in the PACU are looking for a way

to grow as nurses and improve overall morale. This opportunity will be beneficial to the morale

of the unit as a whole. Shared governance promotes a positive practice environment to satisfy

patients and increase retention rates (Siller et al., 2016). The goal is to create shared governance

among nurses and improve the quality of patient care, retention, and staff morale.
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Literature Search

The literature review began with a search on the ProQuest Nursing & Allied Health

Source database. The terms “practice council” and “nursing” were entered into the search bar.

There were 137,166 results before the search was narrowed down. The search was modified to

filter articles that were full text, peer-reviewed, and from 2016 to the present. This displayed

28,007 results, even when narrowed down. The articles within this search are seemingly not

relevant to the purpose of my research. Alternately, the terms “shared governance” and “nursing”

were entered into the search bar with 9,267 results. When narrowed down using the same filters

as before, there are 2,534 results. The articles within this search are more relevant, and the term

“shared governance” will be used in application to the development of a practice council for the

purpose of this research.

The search for articles continued in the CINAHL Complete database. The term “shared

governance” and “nursing” was entered, and 1,236 articles resulted. The term “practice council”

did not yield any results that were relevant to the research. The articles were filtered the same as

they were in the ProQuest database. There are 74 articles that remained. The amount of articles

in the CINAHL search was more manageable than in the ProQuest search.

Literature Review

The current state of shared governance was examined through the literature. The

literature review revealed what authors and researchers view shared governance to be in the

nursing profession. It can be said that shared governance has the potential to be a powerful force

in nursing. The basis of research begins with a review of the literature. Many articles were

examined to extract information that will provide structure and inspiration for a shared

governance council in perianesthesia nursing.

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           The majority of the articles reviewed were literature reviews. This helps examine more

literature and uncover other sources of information. A commonly cited source was Timothy

Porter-O’Grady. Upon further research, Timothy Porter-O’Grady has written a comprehensive

book about shared governance called Implementing Shared Governance Creating a Professional

Organization. His definition of shared governance is known as the process in which

empowerment comes from shared decision-making within nursing (Boswell et al., 2017). This

came from an article about shared governance in academic nursing. This is the only article that

showed how shared governance could be applied to an academic setting. This makes this article

unique and adds a different perspective to this project. Though this project does not take place in

an academic setting, the concepts are similar to those articles about shared governance in a

medical setting.

The article by Hole (2020) uses shared governance as a structure for policy formation.

This is the only article that used the concept of shared governance as a structural component to

research. This showed the strength of the concept of shared governance. The impact shared

governance has on nursing is powerful. Shared governance allows nurses to make informed

decisions that directly impact their practice (Siller et al., 2016). Siller et al. (2016) examined

shared governance in the emergency department. Their research found that shared governance

promoted the attributes of accountability, teamwork, professional development, autonomy, and

empowerment (Siller et al., 2016). Another article noted the empowerment that shared

governance gives nurses. Gordon (2016) discussed the improvement of nurse satisfaction

through the implementation of shared governance. The overall similarity between these articles

demonstrates the impact and importance of shared governance on the nursing profession. The
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implementation of a shared governance council will intend to have the same impact on the nurses

in the PACU.

           An article by Kyytsönen et al. (2020) suggests that shared governance enhances a nurse’s

leadership skills. This fact is enough to support shared governance councils among staff nurses.

The goal of shared governance is to encourage nurses to lead nurses. This is accomplished

through strengthening relationships and partnerships among various departments (Brennan &

Wendt, 2021). Strengthening relationships among nurses will improve the quality of patient care

through teamwork. Through shared governance, nurses also have the ability to shape their

workplace (Sulit Oriza et al., 2016). Nurses have the impact to change the way they practice

through shared governance. Shared governance gives nurses the voice they need to increase

satisfaction in their profession. Nurses are able to view their care practices through a holistic

viewpoint with shared governance (Bleich, 2018).

           The article by Costley & Clark (2021) describes implementing a shared governance

council in a medical unit. This article provides this project with inspiration and structural ideas.

The first meeting establishes goals (Costley & Clark, 2021). This will allow the council members

to have a frame of reference moving forward in shared governance. Clear communication and a

bulletin board for unit education were other ideas extracted from this article. 

           The overarching concepts related to shared governance in nursing were uncovered

through the literature review. There were some differences among the articles. Some articles

were literature reviews, while others examined hospitals with shared governance and those

without. An article by Hu et al. (2021) surveyed the nurses of two hospitals before and after

implementing shared governance in one of the hospitals. This inspired a survey for this project.

Overall, the articles provided definitions for shared governance and related ideas. The goals of
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this project will be accomplished, and shared governance will help the perianesthesia nurses at

the University of Kansas Health System.

Framework

The building blocks of any project begin with concepts from a nursing theory. Basic

principles are drawn from theories to create a framework. The framework for shared governance

in a Post Anesthesia Care Unit will be drawn from the Social Learning Theory and IOWA

Model. Concepts from each theory will be present within this project and will guide the purpose.

A critique of each theory is necessary to determine the level of congruence to the purpose

of the project. The Social Learning Theory is a learning theory in which the goal of learning is

self-efficacy (Billings & Halstead, 2020). Learning is accomplished through social interaction

and requires consistent attention, repetition, and reproduction of the content being learned

(Billings & Halstead, 2020). The social aspect of this theory is helpful in a workplace with

nurses. Nurses learn from social settings once their education is over. This learning theory was

selected because the goal of creating a shared governance nursing council is to educate staff

nurses on new workflows and policies. Nurses will be able to implement new practices from

their own input. The social aspect of learning is appealing because of the environment in which

staff nurses work. For this reason, this theory is heavily considered as the framework. The Social

Learning Theory will be the guide.

The IOWA Model is essential to the implementation of evidence-based practice. One of

the goals of creating a shared governance nursing council will be to implement evidence-based

practice. Through the IOWA Model, the quality of nursing care can improve. In the IOWA

Model, there are five steps. The steps include identifying a problem, appraising it, synthesizing
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research, designing a plan, and integrating the plan (Haulesi Chiwaula et al., 2021). This theory

has the potential to be used as a framework for developing a shared governance council.

Methods

The concept of shared governance was examined and studied through the lens of research

articles and observation. The goal was to determine if a shared governance council would

increase morale, retention, and a solution to problems among nursing staff. The goal was

evaluated through methods inspired by research and input from the staff nurses.

A literature review revealed current research on shared governance councils. The

background research helps provide ideas and concepts for the framework of the project. The only

resources required for this project will be the survey, internet, a printer, and a computer. The

participants are nurses in the University of Kansas Health System’s Pre/Post Anesthesia Care

Unit. There are 25 nurses within this department. It is anticipated that the staff nurses will see an

increase in job satisfaction through the development of this project. Shared governance increases

nurse empowerment and satisfaction (Boswell et al., 2017). The increase in job satisfaction will

increase overall morale, retention, and help nurses solve their work-flow-related problems. The

staff nurses were contacted by email to fill out a survey before and after a shared governance

council was created. The council functioned for a few meetings before data was collected again.

The pre and post-survey will consisted of a short list of questions (see Appendix A) to gather

mostly qualitative data. This data provided a basis of information on the current viewpoint of the

unit from the staff nurses.

An online survey generator was used to create and document all of the data throughout the

project. The survey provided information on the current status of the morale of nurses on the

unit. This gave the researcher insight into the morale, retention, and satisfaction of the staff
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nurses. A total of six nurses completed the pre-survey while only five completed the post-survey.

This brings a total of eleven nurses taking the survey. Since it was anonymous, it is impossible to

tell if more than one nurse submitted both the pre and post survey. A total of five staff nurses

volunteered to be council members. There were two meetings over the course of two months

before the follow-up survey was administered.

The strengths and weaknesses of this project have been considered. The strengths are the

positive influence a shared governance council may have on the unit. The goal is to improve staff

morale, empowerment, and retention. This was measured through the collection of data

throughout the project. The weaknesses are the lack of control over other staff members

contributing to data collection and ensuring meetings are plausible due to potential schedule

conflicts.

After analyzing the proposed data collection, it was determined that the level of data will

be nominal. The concepts will be named and monitored but will not reach an absolute number. A

simple form of analysis will be determined after the data is recorded. The data will be compared

to the initial collection to determine changes. The purpose statement is the main objective of this

project. The survey questions were aimed at achieving that goal. There was an agreement with

the preceptor regarding the goals, the collection of data, and the overall development of the

project. The staff nurses will determine the outcome of shared governance within the Pre/Post

Anesthesia Care Unit.

Ethical Considerations

The staff nurses at the University of Kansas Health System’s Pre/Post Anesthesia Care

Unit participated willingly in this research project. Each participant volunteered and was given
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the option to stop participating at any time. An IRB application was submitted for this project

before participants were involved.

Results

The pre-survey contained seven questions with the intention of analyzing the unit morale,

satisfaction, and retention of nurses before the implementation of the shared governance practice

council. Of the twenty-five staff nurses, there were six replies. The overall morale of the unit was

rated poorly with 66% identifying it as such. Interestingly enough, 83% of the respondents were

satisfied overall with their job (see Figure 1). After the data was analyzed, the council started

having meetings. These meetings revealed workflow-related problems that were solved with the

help of staff nurses. It was a goal for staff nurses to feel empowered by making changes to their

workflow-related problems. There was a post-implementation survey with questions aimed to

determine if morale and overall satisfaction has been changed. Retention will also be looked at to

determine if any nursing staff has left within this time or voiced the intent to leave. In the post-

survey, there were four questions which mainly discussed job satisfaction and morale (see

Appendix B). Only five nurses took the post-survey which is only 20% of staff nurses. Overall,

60% of respondents note that unit morale has increased since the development of a shared

governance practice council. Over the course of this project, retention was also examined. One

nurse has left the unit in the time of this research study.

Figure 1

Nurse Satisfaction

4
Satisfaction

0
Pre-Survey Data Post-Survey Data

Satisfied Unsatisfied
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Note. This chart shows the satisfaction of nurses before and after the creation of a shared

governance practice council. Six nurses represent the data from the pre-survey while only five

represent the data from the post-survey.

Discussion

The overall implication of implementing a shared governance practice council within the

Pre/Post Anesthesia Care Unit at the University of Kansas Health System has improved morale.

There has been an overall improvement in nurses being satisfied within their role. The purpose of

this project was to determine if creating a shared governance practice council would improve

overall nurse satisfaction, retention, and unit morale. Through research, shared governance was

defined. Shared governance allows nurses to improve their practice and the quality of patient

care (Siller et al., 2016). This shared governance project brought a lot of strengths into the

Pre/Post Anesthesia Care Unit. The major strengths of this project was the engagement of staff

nurses solving their workflow-related problems and advocating for their patient care. Some

limitations of this project include that only 24% of nurses completed out the pre-survey. Another

limitation includes the time constraint and availability of nurses to maintain practice council

meetings. It can be implied that shared governance does in fact increase the satisfaction of nurses

by empowering them to advocate for themselves without the need for leadership to be involved.

The IOWA model was used to create and devise a plan to implement shared governance on this

unit. In the IOWA model a problem is identified, discussed, researched, then a plan is created

and integrated (Haulesi Chiwaula et al., 2021). This design model helped create a framework and
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reference for assessing the data collected from surveys. The overall design of this project has

been beneficial to the researcher and has allowed for data to be used to assess the morale of the

unit. In the spirit of research, there is a need for continued study on the link between shared

governance and nurse morale and satisfaction. The correlation between teamwork and a unit with

shared governance should be examined in future research.

Conclusion

Shared governance has made a positive impact on the nurses in a University of Kansas

Post Anesthesia Care Unit. Through research and theory, a project was designed with the

intention of improving the overall morale, satisfaction, and retention of nurses. This study aimed

at improving the quality of patient care through the empowerment of nurses in shared

governance. Shared governance allows nurses to make informed decisions that directly impact

their practice (Siller et al., 2016). The shared governance practice council has allowed nurses to

solve their workflow-related problems while collaborating with other nurses to improve patient

care.
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References

Billings, D., & Halstead, J.A. (2020). Teaching in nursing: A guide for faculty. (6th ed.). Elsevier

Bleich, M. R. (2018). Shared governance—shared leadership: Opportunities for

development.  The Journal of Continuing Education in Nursing, 49(9), 394-396.

https://doi.org/10.3928/00220124-20180813-03

Bonnel, W., & Smith, K. V. (2021). Proposal writing for clinical nursing and DNP projects 

(3rd ed.). Springer Publishing Company

Boswell, C., Opton, L., & Owen, D. C. (2017). Exploring shared governance for an academic

nursing setting.  Journal of Nursing Education,  56(4), 197-203.

http://dx.doi.org/10.3928/01484834-20170323-02

Brennan, D., & Wendt, L. (2021). Increasing quality and patient outcomes with staff engagement

and shared governance. Online Journal of Issues in Nursing, 26(2).

https://doi.org/10.3912/ojin.vol26no02ppt23

Costley, T., & Clark, D. (2021). Professional governance and staff engagement: A new medical

unit establishes an engaged nursing workforce. American Nurse Today, 16(1), 41–46.

Gordon, J. N. (2016). Empowering oncology nurses to lead change through a shared governance

project. Oncology Nursing Forum, 43(6), 688–690. https://doi.org/10.1188/16.ONF.688-

690

Haulesi Chiwaula, C., Kanjakaya, P., Chipeta, D., Chikatipwa, A., Kalimbuka, T., Zyambo, L.,

Nkata, S., Jere D. L. (2021). Introducing evidence based practice in nursing care delivery,

utilizing the Iowa model in intensive care unit at Kamuzu central hospital, Malawi.

International Journal of Africa Nursing Sciences, (14).

https://doi.org/10.1016/j.ijans.2020.100272
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Hole, A. (2020). Using shared governance and evidence‐based practice to redesign a nursing

policy and procedure manual. Worldviews on Evidence-Based Nursing, 17(2), 170–172.

https://doi.org/10.1111/wvn.12407

Hu, X., Xiang, M., Yang, L., Zhuang, Y., Qu, Y., Wu, Q., Zhu, C., & Wang, X. (2021). Nursing

councils' effectiveness and nurses' perceptions of shared governance in Chinese magnet®

and non-magnet® hospitals: A cross-sectional study. Nursing Economics, 39(6), 304-

310.

Kyytsönen, M., Tomietto, M., Huhtakangas, M., & Kanste, O. (2020). Research on hospital-

based shared governance: A scoping review. International Journal of Health

Governance, 25(4), 371-386. http://dx.doi.org/10.1108/IJHG-04-2020-0032

Siller, J., Dolansky, M. A., Clavelle, J. T., & Fitzpatrick, J. J. (2016). Shared governance and

work engagement in emergency nurses: JEN. Journal of Emergency Nursing, 42(4), 325-

330. http://dx.doi.org/10.1016/j.jen.2016.01.002

Sulit Oriza, N., Winter, V., & Imperial-Perez, F. (2016). Shared governance for a healthy work

environment in a pediatric cardiothoracic intensive care unit. AACN Advanced Critical

Care, 27(2), 152–157. https://doi.org/10.4037/aacnacc2016968

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Appendix A
Pre-Survey Results
Describe the current morale of the unit.
Respondent 1: poor
Respondent 2: Poor
Respondent 3: Low
Respondent 4: I believe the current morale of the unit is overall positive. We have better staffing
than even six months ago, and I think this goes a long way in helping staff to feel supported and
prevent burnout.
Respondent 5: In general, I think morale is ok. On a scale of 1-10 (10 being the best) I would
think its at a 6 or 7 daily. I think there is a lot that is planned to come up in CAPP, such as taking
call/talk of increase case numbers, that is a contributing factor to morale not being the best it
could be. With that said I think the unsatisfactory of taking call comes from the unknown of how
it will run and that most RNs on the unit have not ever had to take call on a job before. When
you implement any change it can be hard for people to adapt at first just due to not knowing what
to expect which is understandable. With being a procedural area, I think morale is a day to day
situation on our unit. It depends on case load, staffing, and leadership that day (who is a UC/RC
that day). I also believe general moral is very different depending on the shift an RN has. If I
were to make an educated guess I would bet that a 0530-0700 RN's moral is higher than a 0900-
1100/closer RN.
Respondent 6: Poor

Do you feel you have the power to control changes within the unit?
Respondent 1: no
Respondent 2: Not really
Respondent 3: No
Respondent 4: I believe I have the ability to initiate conversations with ideas for change that may
lead to actual change in the future depending on the viability of the ideas.
Respondent 5: Personally, yes I do. Nevertheless, I believe to make change at this hospital you
have to have a lot of data (2-6months) to make the change so it can take a while.
Respondent 6: No

What changes do you want to see on the unit? (This will be helpful to get practice council
started!)
Respondent 1: More input from staff for decisions regarding staff.
Respondent 2: a fair work load
Respondent 3: Better orientation (anesthesia meds quiz was a great learning tool!) Better
coordination between OR and PACU
Respondent 4: Respondent skipped this question
Respondent 5: I would like to see RC utilized more. I think it is important to keep your RCs
feeling comfortable enough to run the unit on their own if a UC is not here or have meetings to
go to. I think there should be days when UCs staff in and RCs run the unit. This gives the RCs
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the ability to be independent but have UCs available for questions when needed. This would also
keep UCs up-to-date with pre op and recovery skills.
Respondent 6: Less favoritism

What current resources are available to you to make these changes?

Respondent 1: I am not sure.
Respondent 2: Managers
Respondent 3: Resources seem limited
Respondent 4: Unit leadership, relationships with other units/staff throughout the hospital
Respondent 5: I think a lot of RNs do not know how to go about making a permanent change on
the unit. One big resource we have been missing since covid is practice council. A unit educator
and manager are also good resource
Respondent 6: Respondent skipped this question

Would you feel satisfied with nurse led changes on the unit?
Respondent 1: Yes
Respondent 2: Yes
Respondent 3: Yes
Respondent 4: Yes
Respondent 5: Yes
Respondent 6: Yes

Do you have intentions of leaving CAPP in the next 6 months?

Respondent 1: No
Respondent 2: Yes
Respondent 3: No
Respondent 4: No
Respondent 5: Yes
Respondent 6: No

Please rate your overall satisfaction with work.

Respondent 1: Satisfied
Respondent 2: Unsatisfied
Respondent 3: Satisfied
Respondent 4: Satisfied
Respondent 5: Satisfied
Respondent 6: Satisfied
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Appendix B
Post-Survey Results
What does unit morale mean to you?
Respondent 1: Supporting and building each other up.
Respondent 2: Morale is an expressed and unexpressed emotional experience by a group of
individuals working or living within the same environment.
Respondent 3: Cohesiveness, teamwork, safe work environment
Respondent 4: Overall feeling on the unit
Respondent 5: The attitude of people working together

Describe in one sentence the current morale of the unit after practice council.
Respondent 1: Very poor.
Respondent 2: The current morale is much more positive.
Respondent 3: I believe all healthcare workers are fatigued, but I believe CAPP has better morale
than most units.
Respondent 4: The unit is mostly upbeat and supportive.
Respondent 5: There is a great morale on the unit currently due to good communication, high
expectations, many nurses being bonded from working together for so long.

What changes would you like to see on the unit to improve morale?
Respondent 1: There is too much drama on the unit.
Respondent 2: Continued leadership by mature, balanced individuals.
Respondent 3: Less push back regarding taking patients.
Respondent 4: Team building to get to know each other better.
Respondent 5: More social activities outside of work for team bonding.

What is the difference between morale and job satisfaction?

Respondent 1: Morale is how you feel about your work environment and your co-workers. Job
satisfaction is that you feel full-filled with your job. The two are interlinked. If morale is poor
typically job satisfaction is poor too.
Respondent 2: Job satisfaction is individual. It is based on the unique psychology and
experiences of each of us. Morale of the group effects each group member uniquely and has an
impact on the whole.
Respondent 3: Morale is conceptual and individualized, job satisfaction is measurable.
Respondent 4: Morale is the temperature of the unit, job satisfaction is how you feel about what
you do.
Respondent 5: To me, morale has more to do with the impact the environment has on your
mental health. Job satisfaction is more about whether you enjoy doing the tasks/workflows of the
job. I think overall morale can greatly impact your personal job satisfaction

Please rate your overall satisfaction with work.

Respondent 1: Satisfied
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Respondent 2: Satisfied
Respondent 3: Satisfied
Respondent 4: Satisfied
Respondent 5: Satisfied