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Certification Program was established to assess nurse work environments for core
values, nurse autonomy and engagement, safety conditions, and high standards of patient care
(Elgie, 2007).
This paper will examine and analyze the history of SG in nursing, its business and
nursing theory base, and the role of the Magnet
Certification
Program, and the pivotal IOM publications striving to initiate a national culture of patient safety
were all factors leading to the widespread implementation of SG that is seen in the healthcare
environments of today.
Theoretical Base
Kanters Theory of Organizational Empowerment
One important theory in the development of shared governance models has been Kanters
Theory of Organizational Empowerment (Anthony, 2004). Rosabeth Moss Kanter received her
PhD at the University of Michigan and is a business professor at Harvard Business School
(Hindle, 2008). Her early work was in sociology and has broad implications in her insight into
organization behavior. Her theory of organizational empowerment states that an individuals
perceived power has implications on their work behavior (Hindle, 2008). Kanters theory asserts
a correlation between an individuals perceived access to power and opportunity with increased
positive work behaviors and attitudes (Nedd, 2006). Key concepts in Kanters theory are:
perceived formal power, perceived informal power, access to resources and information, and
support (Anthony, 2004). This theory was utilized in the development of SG to address and
support the desired changes in the nurse work environment of increased equity and autonomy
resulting in increased job satisfaction and retention. A study by Nedd (2006) explores the
ISSUE ANALYSIS PAPER 7
question of whether nurses perception of perceived power (informal and formal) and perceived
structural empowerment opportunities were correlated with their intent to stay employed at that
job. Strong correlation was found between study empowerment variables (Nedd, 2006). This is
supportive evidence that SG increases job satisfaction and retention.
Swansons Caring Theory
Swansons Caring Theory is a mid-level nursing theory that is based upon the idea that,
caring about patients is as important to patient well-being as caring for them (Tonges &
Ray, 2011, p. 374). Kristin Swanson, a registered nurse, earned her PhD from the University of
Colorado. She developed her Theory of Caring after doing work with patients who had
experienced a pregnancy loss. Swansons Theory of Caring focuses on the nurse delivering
nurturing care based upon her own system of values and knowledge base (Swanson, 2009).
Swansons Theory of Caring is integral in the development of important professional
practice models that are utilized nationwide; examples include the Carolina Care Model (Tonges
& Ray, 2011) and Relationship-Based Care (Creative Healthcare Management, 2014).
Professional practice models are implemented to assist institutions in achieving goals for
performance. Relationship-Based Care is a professional practice model that incorporates six
basic components: teamwork, leadership, patient-care delivery system, outcomes management,
resource-driven practice, and professional nursing practice (Shellner, 2007). These outcomes are
highly desirable in todays healthcare environment. They implement change at the cultural level
and focus on core values; changes needed to address the requirements brought forth by the
changes in the focus of healthcare. Swansons Theory of Caring is an integral part of
Relationship-Based Care model (Creative Healthcare Management, 2014).
ISSUE ANALYSIS PAPER 8
Research-Based Justification of Shared Governance
Qualitative Benefits
Several studies show correlation between SG implementation and one or more of the
following qualities: intent to stay, empowerment, lowered turnover rates, and increased
measures of positive practice environment.
Studies measuring anticipated turnover rate among critical-care (Hauck, Quinn Griffin, &
2011) and behavioral health nurses (Smith, Capitulo, Quinn Griffin, & Fitzpatrick, 2012) show
significant correlation between reports of empowerment and a lowered anticipated turnover rate.
One study examining job satisfaction and turnover rate after revision of a clinical ladder program
with SG, showed high levels of job satisfaction and low levels of turnover after implementation
(Winslow, Knight, Rossen, Fickley, Richards & Rumbley, 2011). There is also been shown to
be a correlation between organizations with Magnet