Mary E. Larkin, RN, MSN, CDE
Chelby L. Cierpial RN, MSN, APRN BC
Joan M. Stack, RN, BSN, MS
Victoria J. Morrison, RN, PhD, CIC
Catherine A. Griffith, RN, CNS, APRN, BC, CCRN
The purpose of this article is to demonstrate how active participation on a Collaborative Governance committee can promote empowerment, along with enthusiasm and confidence, while implementing the committee’s mission. This article will begin by delineating the concepts of empowerment theory and describing our institution’s Collaborative Governance structure and the structure of the Nursing Research Committee. Then the mechanisms that have fostered empowerment among committee members will be discussed, and evidence of empowerment among committee members will be presented. This article is offered to encourage more nurses to seek the rewards inherent in committee participation, and to demonstrate the link between committee work, empowerment, and professional development experienced by members of the Nursing Research Committee at our institution.
Citation: Larkin, M., Cierpial, C., Stack, J., Morrison, V., Griffith, C., (March 31, 2008) "Empowerment Theory in Action: The Wisdom of Collaborative Governance"OJIN: The Online Journal of Issues in Nursing. Vol. 13 No. 2.
Key words: empowerment, nursing research committees, power, shared governance, collaborative governance
Empowerment of employees has been identified as a valuable attribute, one that is essential to the effective functioning of an organization (Palmier, 1998). Theoretical discussions about structural power and its relationship to the development of empowerment in employees are abundant in the literature (Kanter, 1993; Kluska, Laschinger-Spence & Kerr, 2004; Sui, Laschinger & Vingilis, 2006). Empowerment has also been shown to be essential to the goals and outcomes of shared governance models (Anthony, 2004; Erickson, Hamilton, Jones & Ditomassi, 2003). Empowerment is evidenced by organizational members who are inspired and motivated to make meaningful contributions and who have the confidence that their contributions will be recognized and valued. At our institution, the Nursing Research Committee, under the umbrella of a successful program of Collaborative Governance, has found consistently that members express feelings of empowerment as a result of their participation on the committee.
This article will delineate the concepts of empowerment theory and describe our institution’s Collaborative Governance structure and the structure of the Nursing Research Committee. Mechanisms that have fostered empowerment among committee members will be discussed, and evidence of empowerment among committee members will be presented. This article is offered to encourage more nurses to seek the rewards inherent in committee participation, and to demonstrate the link between committee work, empowerment, and professional development experienced by members of the Nursing Research Committee at our institution.
Kanter’s (1993) theory of structural empowerment includes a discussion of organizational behavior and empowerment. According to this theory, empowerment is promoted in work environments that provide employees with access to information, resources, support, and the opportunity to learn and develop. Kluska et al., (2004) have noted that psychological empowerment includes feelings of competence, autonomy, job meaningfulness, and an ability to impact the organization. Employees who are empowered are more committed to the organization, more accountable for their work, and better able to fulfill job demands in an effective manner (Degner, 2005). Kanter’s theory has been widely applied to the practice of professional nursing (Kluska et al.; Mangold et al., 2006; Siu et al., 2005), showing how structures within the workplace that facilitate access to resources can empower employees to accomplish their work in more meaningful ways.
As noted by Erickson et al. (2003), “empowerment is thought to occur when an organization sincerely engages people and progressively responds to this engagement with mutual interest and intention to promote growth” (p. 96). Empowerment develops over time as employees gain greater control over their lives and increasingly take part in decisions which affect them. "The findings of Erickson et al. have suggested that membership on a Collaborative Governance committee increased the participant’s sense of empowerment and fostered self-growth and organizational development" (p. 96).
The principles associated with four guiding concepts support successful shared governance structures. These concepts include: equity (the integration of roles to achieve common goals and willingness of each member to contribute collectively toward a common goal), ownership (recognition by the individual of the connection between his or her individual job performance and the success of the organization), partnership ( development of relationships to promote mutual respect, enhanced communication, and collaboration to achieve organizational objectives), and accountability (willingness to invest in decision making and sharing a sense of responsibility for individual and collective outcomes) (Batson, 2004; Porter-O’Grady, Hawkins, & Parker, 1997). When principles related to these concepts are “incorporated into individual and team behaviors, the workforce is empowered to achieve the outcomes of the organization” (Batson, p. 496).
The Collaborative Governance Structure
Many different shared governance models have been implemented in various settings to enhance the work environment. Collaborative Governance, the model which has been implemented at Massachusetts General Hospital (MGH), emphasizes participation and communication within and across disciplines in the decision-making process (Erickson et al., 2003). It was designed to optimize opportunities for clinicians to control their own practice.
Collaborative Governance (henceforth referred to as CG) “is the decision-making process that places the authority, responsibility, and accountability for patient care with the practicing clinician” (Erickson et al., 2003, p.98). CG was identified as a cornerstone of the professional practice model at MGH, an acute care facility in Boston, MA, in 1996 by Jeanette Ives Erickson, who was then the newly appointed Chief Nurse. CG was implemented as part of an organizational effort to enhance empowerment and create an environment in which clinicians have control over their practice. The development of the CG program at MGH, including its purpose, intent, and committee composition, has been previously described by Erickson et al. (2003).
The structures inherent in CG support professional development, empowerment, and commitment to the overall mission of the organization. Membership on a CG committee has been demonstrated to increase staff empowerment and facilitate personal growth (Erickson et al., 2003). There are seven committees which comprise the MGH CG structure: Nursing Practice, Ethics in Clinical Practice, Diversity Steering, Patient Education, Quality, Staff Nurse Advisory, and Nursing Research. The following discussion describes the structure and function of the Nursing Research Committee (NRC) and illustrates how membership on this committee has promoted feelings of empowerment among nurses.
The Nursing Research Committee
The Nursing Research Committee (NRC) (henceforth referred to as the Committee) “operates in concert with six other CG committees to fulfill the vision of the institution’s professional practice model” (Larkin et al., 2007, p. 511). The mission of the Committee is to promote research utilization and foster a spirit of inquiry in clinical practice. The members, who are from diverse practice settings and professional ranks, contribute their perspectives, talents, expertise, and enthusiasm for creating and disseminating new knowledge into a rich clinical practice environment. Recruitment occurs on a regular basis and the term of appointment is two years.
“Initially, the Committee membership consisted of seven staff nurses and a doctorally prepared, nurse coach, who was appointed by the Chief Nursing Officer” (Larkin et al., 2007, p. 511). The Associate Chief Nurse and Senior Nurse Scientist, who facilitated the monthly meetings of the team of CG Committee coaches and Committee co-chairs, guided the establishment of goals that reflected the Committee’s focus and integrated organizational objectives into the Committee’s work. The conceptual framework and the methods that are used by the Committee to support research-based practice have been described in detail by Larkin et al.
In 2002, the Committee leaders realized that the volume of work had increased due to the need to provide staff nurses with the latest evidence to promote quality and safety at the bedside. Subcommittees were established to oversee the Committee’s major initiatives, which were the Evidence-Based Poster Series, called “Did You Know...?”; the Nursing Research Day; and the Nursing Research Journal Club. The Committee membership now consists of 30 members, including a coach, an advisor, two Committee co-chairs, and two co-chairs of each of the three subcommittees.
Mechanisms that Fostered Empowerment in Committee Members
The subcommittee structure was developed as a means to manage more efficiently the significant expansion of the Committee’s core initiatives. The subcommittee structure was developed as a means to manage more efficiently the significant expansion of the Committee’s core initiatives. Prior to this time, the two existing initiatives had had little or no infrastructure to support and sustain them; yet members were cultivating a yet-to-be-actualized third component, specifically a Journal Club. The success of Committee initiatives had depended heavily on the willingness of individual Committee members to assume most of the responsibility for keeping them afloat.
The Committee leaders felt that a subcommittee model could enhance productivity, facilitate an appropriate division of labor, and assure the continuity of agendas through future generations of leadership (Larkin et al., 2007). The subcommittee structure has indeed provided specific opportunities and resources for leadership and professional development, which in turn have helped empower its members, as described below.
Each of these subcommittees was dedicated to one of the three specific Committee initiatives. These subcommittee meetings proved to be a critical step in defining a new structure and process to sustain productivity of the Committee. Initially, the members divided into groups in accordance with their specific area of responsibility during the last 30 minutes of each monthly meeting. As the subcommittees became more cohesive and defined, their meetings expanded in length beyond the initial 30 minutes. Presently, each subcommittee meets for at least an hour each month with additional meetings or communication as needed. Approximately 30 minutes of the Committee meeting is now used to communicate the work of each subcommittee to the Committee-at-large.
Approximately 30 minutes of the Committee meeting is now used to communicate the work of each subcommittee to the Committee-at-large. Each Nursing Research Committee subcommittee (henceforth referred to as a subcommittee) has established a “baseline” of work to be accomplished and has developed an operational notebook outlining objectives and tasks to be completed. These notebooks include specific instructions, timelines, and examples to direct subcommittee activities. They have become a useful and ready resource for the work of the subcommittee. Establishing defined objectives and targeted tasks has resulted in clearer expectations and more measurable outcomes for the subcommittee’s performance. New members can now build more quickly on what was previously accomplished and contribute more readily to the ongoing subcommittee work. Speeding up this new member ‘orientation’ process has allowed more time to refine the work of the subcommittee and develop new ideas.
The development of the subcommittees has proved to be an efficient way to use the limited resources of personnel and time, and has become an integral part of the structure of the Committee. This structure has allowed the members to commit to a specific area of interest within the overall Committee. New members are now routinely invited to join the subcommittee of their choice. This allows subcommittee members to concentrate on a specific area in which they are personally invested, thus focusing their time, energies, and creative abilities on achievable goals and specific initiatives that are of interest to them.
As each subcommittee’s work grew in complexity, the leadership structure expanded to include subcommittee chairs to guide the work and assume accountability for expected outcomes. When the Committee leaders recognized the vital role of the subcommittee chairs, they decided that it was necessary to mentor and develop future leaders for both the subcommittees and for the Committee-at-large. Each subcommittee now has a senior and junior co-chair. The senior co-chair takes the responsibility to guide and assist the junior co-chair in leading the subcommittee meetings. This collaboration has fostered the acquisition of leadership skills and provides for important continuity as the Committee continues to take on new members. In turn, the subcommittee infrastructure has helped to unveil leadership ability and talent in Committee members; potential leaders continue to be identified as they display aptitude for key competencies essential to the success of the Committee.
...the subcommittee infrastructure has helped to unveil leadership ability and talent in Committee members; potential leaders continue to be identified as they display aptitude for key competencies essential to the success of the Committee.The mentoring process has cultivated new leaders by coaching new members in navigating the organizational culture. Newer members have also been prepared for independent leadership through role modeling and experiential learning (Griffith et al., 2007b). The mentoring relationships have served to guide member participation, drive Committee initiatives, and support professional growth and leadership skills.
Illustrations of Empowerment in Action
The synergism of a rich clinical practice environment, a supportive administration, and the subcommittee structure has provided Committee members with numerous opportunities to develop both personally and professionally. The setting has proved to be an ideal environment for members to acquire attributes of empowerment. The discussion below includes specific examples of the Committee’s work, followed by quotes from the members describing their experiences and illustrating how the Committee work has empowered them. Although anecdotal and experiential in nature, these examples reveal the association between Committee participation and empowerment. This project was reviewed by the Human Research Office of Partners HealthCare System (an integrated health system including Brigham and Women’s Hospital and MGH, along with other community hospitals and healthcare services). The Partner’s Human Research Committee concluded that this activity of creating this manuscript to describe the Committee work and explain how it led to member empowerment did not meet the definition of human subjects research requiring Institutional Review Board review and approval.
As noted above, four guiding concepts and their related principles support successful shared (collaborative) governance structures. This section will now explain how the application of these concepts and their associated principles has promoted empowerment of the Committee members as evidenced in the members’ expressions of competence, autonomy, sense of job meaningfulness, and ability to impact the organization.
Equity, which suggests mutual respect for the individual and the combined effort and contributions required to achieve a common goal (Batson, 2004), is demonstrated through the existing subcommittee structure. This structure has created opportunities for all members to begin to contribute to the Committee’s goals immediately upon joining a subcommittee. Each subcommittee places a high value on the contributions from each member and relies on these contributions to advance the work of the team. Members experience the satisfaction of making a measurable contribution, recognize the importance of their work, and become inspired to make further contributions, as noted in the following quotes from two Committee members:
-) I was and continue to be supported by other Committee members and leaders whom I utilize for everything from discussing journal articles to understanding how to set up teleconferencing at presentations.
-) The members exude a spirit of support, camaraderie and old fashioned brain power which is guided and buoyed by the Committee chairs and coach who are generous with their time, heart and soul. Pooled together, this atmosphere fosters a breeding ground of energy, fresh ideas and entrepreneurial ventures, which underpin the formula for success.
These Committee members recognized and appreciated the group support which enabled them to help move the work of the committee forward.
An example of Committee members making a mutual effort to contribute to a common goal can be seen in the operation of the Journal Club. The bi-monthly Journal Club hosts a nurse researcher who presents her/his original, published research (Griffith, Larkin, Cierpial, Gettings, & Capasso, 2007a). Committee members are directly involved in identifying researchers, hosting the presentation, and structuring the ensuing discussion. These presentations personalize the research process and stimulate thought about the applications of findings to practice. As one Committee member noted:
-) Attending a journal club session makes you feel like you are part of the research. It doesn’t matter what the topic is, I feel I can apply the findings to my practice because we are all taking care of patients.
Another member explained:
-) Each subcommittee member is active in mining for presenters, planning the sessions, preparing, and presenting a summary of the nurse researcher’s program of research. We take turns coordinating each session by introducing authors and facilitating the closing of the discussion.
These nurses were excited about their ability to make a positive contribution to the organization through group involvement in research.
The principle of ownership has been described as recognition by the individual employee of the connection between the employee’s specific job and the overall success of the organization (Batson, 2004). Pride in one’s work and attention to detail are signs of ownership. Members have expressed considerable pride in their participation in the Committee and its accomplishments. They regularly contribute articles describing the Committee’s work to the hospital newsletter. The Committee chairs describe with pride the work performed by the subcommittees as they introduced guests and visitors to committee members. Members also exhibit pride when they encourage colleagues to join the Committee. Quotations from three members illustrate this pride:
-) Our Committee is most proud of our innovative recent accomplishments: the development of our sub-committee structure and our succession planning model as well as our new and continuing forums to bring research to life.
-) Observing the many accomplishments of fellow members has been inspiring. To see the work of my peers being highlighted so favorably within MGH gives me a sense of pride to belong to such a productive and dynamic group.
-) The leadership and the membership of the NRC has been a constant source of inspiration and motivator in my evolving nursing career. I was proud to be a small part of this Committee.
The meaningfulness of the members’ Committee work is seen in the enthusiasm and commitment evidenced by these nurses.
Establishing partnership relationships promotes mutual respect, increases communication and collaboration, and helps to achieve organizational objectives (Batson, 2004). The Committee structure has provided numerous opportunities to establish such partnerships.First and foremost is the mentoring process, through which incumbent leaders and new members work together to advance the Committee’s objectives. This mentorship allows new members to contribute immediately by taking responsibility for some portion of the work, with the support of Committee leadership and peers. This leads to an increase in their confidence and inspires increased participation over time. As one of the newer members stated,
-) Now, as a co-chair of the Journal Club I have the opportunity to create and shape goals for the subcommittee as well as provide support for newer members of the group.
The subcommittee structure in particular has proven to be effective, not only in sustaining productivity, but also in empowering members to explore their innate potential for innovation, creativity, partnership, and leadership. Each subcommittee provides opportunities for members to assume increasing responsibility, with the potential for assuming a leadership position. In 2006 the Committee leadership was more clearly defined by establishing a succession plan modeled after the leadership structure of Collaborative Governance. Each subcommittee now has a senior and junior co-chair whose responsibilities include overseeing the subcommittee initiatives, communicating the work of their group to the Committee-at-large, participating in presentations representing the Committee, and mentoring new members. This succession plan guarantees a leadership continuum including new members and more experienced members. It allows each member to develop according to her/his interest, comfort level, and available time. One member is quoted as saying,
-) The subcommittee structure sustains our productivity while the succession-planning model ensures a framework to mentor new members, affording rich opportunities for personal and professional development.
The subcommittee co-chairs work in collaboration with the Committee co-chairs and coach to facilitate the agenda and to identify potential new leaders when their appointment terms expire. Since the development of the succession plan in 2006, two subcommittee co-chairs have advanced to the role of co-chair for the Committee-at-large, and one of the co-chairs of the Committee-at-large has advanced to the coach position. Their previous leadership experiences prepared them for this advancement. The following quote from a Committee member illustrates this mentoring partnership:
-) I started with smaller tasks and moved into more visible and autonomous ones as 2006 progressed into 2007. Almost immediately after joining the Committee I learned about the culture of succession planning that had been created within the group. Throughout my involvement in the Committee succession planning was subtly reinforced at each meeting through member-to-member mentorship. When the opportunity arose this spring for someone to serve as a co-chairperson of the Journal Club, I volunteered to fill this role and was thrilled with the positive response I received. All of these are opportunities to learn and grow professionally while being mentored through the process.
Such reports of progressive leadership development illustrate the sense of empowerment, i.e., the sense of competence, growing autonomy, and personal impact on the organization expressed by committee members.
The “Did You Know?...” poster series, which is a venue to disseminate evidence-based knowledge, has served as an example of successful partnership on multiple levels. The topics are brought forward by expert clinicians; members then work together on producing a poster, with the further assistance of a research librarian and graphic artist. Finally the MGH administration distributes the posters to over 70 patient-care locations throughout the campus. A nurse who participated in this poster series reported:
-) Working on the “Did You Know…?” poster subcommittee allows members to see issues that cross all nursing departments. It requires an immense amount of time, effort and attention to detail and represents true collaboration between our Committee and expert clinicians from many practice settings. Our posters are important and are a source for getting the latest evidence out on so many topics.
This comment illustrates the ability of empowered committee members to impact vast numbers of nurses in a large organization.
The expansion of the former Nursing Research Day into the Nursing Research Expo has provided another example of partnership among membership, leadership, administration, researchers, and clinicians. The original, one-day, annual event included the display of nursing research posters throughout the institution, a presentation by a visiting scholar, internally funded research award announcements, and presentations by previous research award recipients. The expanded vision has preserved these original features and has added a second day to present a Nursing Research Fair, featuring “meet the author” presentations, doctoral consultations for developing research questions, and research-based vendors. Nurse administrators, along with committee leaders, provided oversight and guidance while the subcommittee members implemented the vision of a Research Expo. Many members and attendees have indicated that the Expo was a spectacular success, further reinforcing the rewards of collaborative efforts for Committee members and many other members of the organization.
...the operational notebook proved to be an invaluable resource in responding to the Chief Nurse’s challenge to expand research activities during Nurses Week. Accountability has been described as a willingness to invest in decision making and to assume responsibility for individual and collective performance. It involves a personal commitment to positive organizational outcomes (Batson, 2004). Accountability for the Committee’s success is demonstrated by the commitment and dedication of each member to the work of the Committee. Many members perform additional work on their own time, over and above what is supported by the institution for attending meetings. The subcommittee structure has encouraged members’ involvement in decision making.
With encouragement from the Committee leadership, the subcommittees have taken responsibility for the success of future Committee members by preparing operational notebooks to guide the work of each initiative. As described above, these notebooks have accelerated the acclimation of new members to new challenges while perpetuating continuity of established initiatives. For example, the operational notebook proved to be an invaluable resource in responding to the Chief Nurse’s challenge to expand research activities during Nurses Week. This notebook enabled subcommittee members to focus on innovation without sacrificing the traditional components of Nursing Research Day, which were clearly delineated in the notebooks. One nurse explained the benefits of these notebooks:
-) Because our “products” are so visible, the expectations of each Committee member’s participation and contribution to the team are obvious. The operation notebooks help with setting the baseline expectation; and the leadership structure and communication channels aid in guiding the work along. Our high standards promote on-going evaluation of our work by the group and by our “customers.” A true example of ...[broad recognition occurs] when nurses, who want to utilize our methods and expertise to disseminate their research or knowledge, seek us out.
This focus on accountability has enhanced empowerment among Committee members as evidenced by the autonomous manner in which they responded to a new challenge.
Another example of accountability was the process of preparing the 2007 Committee annual report. Each subcommittee took the responsibility to summarize their accomplishments for the previous year and to identify goals for the upcoming year. They then reported their accomplishments and goals to the Committee-at-large and assisted the Committee leaders in compiling the final draft. Writing the report as a group gave each participant better insight into how the work of the Committee aligns with, and supports, the objectives of the organization.
As valuable as the work of the Committee has been to the institution, it has proven equally beneficial to the personal and professional development of individual Committee members. Through their Committee work, members have contributed directly to the larger initiatives of the institution while developing their own confidence, capabilities, and perspectives. Committee members have consistently reported feelings of empowerment as a result of their participation. This empowerment has served them well in their Committee work and has given them a sense of competence to take back to their units, again strengthening the institution.
The foregoing review of the Committee’s work illustrates some of the specific structures and processes that have contributed to the empowerment of members. The subcommittee structure in particular has proven to be effective, not only in sustaining productivity, but also in empowering members to explore their innate potential for innovation, creativity, partnership, and leadership.
Perhaps the best conclusion to this discussion can be heard in the following words from a Committee member:
"Reflecting upon my job satisfaction, I can see a noticeable difference since joining the Committee. Never before have I felt such dedication and excitement about my job! I honestly believe that participating in this Committee has made a positive impact on my career and thus I am reaping many positive results. The constant validation from the group that my ideas, efforts, contributions, and time are valued and appreciated has spoken volumes to me. The warm welcome made me feel included in the group. The non-threatening atmosphere helped me to take risks and step outside my comfort zone. Doing so has been fulfilling and rewarding, and in turn I feel strengthened personally. I now feel confident to bring my own research to my work setting. Through my work on the Committee and by developing my own research I am helping to instill in others new interest and curiosity toward nursing research. I truly believe that the empowerment I feel through my work on the Committee has enabled me to go forward with pride and confidence, and as a result I am developing both professionally and personally."
The authors thank Dr. Virginia Capasso, Advisor of the Nursing Research Committee; Jeanette Ives-Erickson, Chief Nurse and founder of Collaborative Governance; and all past and current members of the Nursing Research Committee who have dedicated their time and energy to the quest for excellence. Quotes and narratives were used with permission by Committee members.
Mary E. Larkin, RN, MSN, CDE
Mary E. Larkin is the Manager of Clinical Research, Diabetes Center, and Co-Chair of the Nursing Research Committee at the Massachusetts General Hospital in Boston, Massachusetts.
Chelby L. Cierpial RN, MSN, APRN BC
Chelby L. Cierpial is a Clinical Nurse Specialist in the Cardiac Interventional Unit, Heart Center Nursing, and Co-Chair of the Nursing Research Committee at the Massachusetts General Hospital in Boston, Massachusetts.
Joan M. Stack, RN, BSN, MS
Joan M. Stack is a staff nurse in vascular surgery. She is a member of the Nursing Research Expo Subcommittee of the Nursing Research Committee at the Massachusetts General Hospital in Boston, Massachusetts.
Victoria J. Morrison, RN, PhD, CIC
Victoria J. Morrison is a staff nurse in the Division of Medical Nursing and Co-Chair of the Nursing Research Expo Subcommittee at the Massachusetts General Hospital in Boston, Massachusetts. Dr. Morrison is an Assistant Professor at Salem State College.
Catherine A. Griffith, RN, CNS, APRN, BC, CCRN
Catherine A. Griffith is a Clinical Nurse Specialist in the Cardiac Surgery Division and Coach of the Nursing Research Committee at the Massachusetts General Hospital in Boston, Massachusetts.
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© 2008 OJIN: The Online Journal of Issues in Nursing
Article published March 31, 2008
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