The Terminology Shift Matters
Since the 1980s, nursing organizations have used the term "shared governance" to describe structures that give nurses a voice in decisions affecting their practice. The concept was revolutionary—moving nursing from a hierarchical, task-driven model to one where staff nurses participated in organizational decision-making.
But the profession is moving beyond shared governance toward professional governance, and the distinction is more than semantic. Tim Porter-O'Grady and Kathy Clavelle have been leading this shift, arguing that the word "shared" implies that decision-making authority is owned by administration and generously shared with staff. Professional governance reframes the relationship: nurses own decisions within their professional scope of practice as a matter of professional accountability, not administrative generosity.
A 2025 article in Nurse Leader by Porter-O'Grady, Rollins, and colleagues explored how traditional hierarchical models undermine the autonomy and social mandate of professional nurses. They argue that an ideal organizational and professional governance model should position councils to facilitate collaboration between clinical nurse chairpersons and nursing leaders, supported by the Chief Nursing Officer.
The Evidence Base
A 2024 randomized controlled trial published in the Journal of Nursing Management by Hamdan and Jaafar evaluated the impact of implementing a shared governance model on professional governance perceptions among 440 nurses at a 1,200-bed tertiary hospital in Riyadh. Using the Index of Professional Nursing Governance (IPNG), researchers measured governance perceptions before and eight months after implementation. The intervention included seven councils: Practice, Quality and Patient Safety, Education and Professional Development, Recruitment and Retention, Research and Evidence-Based Practice, Leadership, and Unit-Based Council Chairperson's Council.
Additionally, a 2025 article in the Online Journal of Issues in Nursing by Hlebichuk and colleagues described a governance assessment and standardized training initiative foundational to the transition to professional governance. In their organization, 89% of respondents agreed to change the current governance structure, and 80% supported the transition from shared to professional governance.
What Changes in Professional Governance
From participation to accountability
Shared governance invites nurse participation. Professional governance requires nurse accountability. Councils are not advisory bodies that make recommendations to leadership—they are decision-making entities with defined scopes of authority and responsibility for outcomes.
From permission to ownership
In shared governance, nurses may need administrative approval to implement practice changes. In professional governance, nurses have authority over practice decisions within their professional domain. Leadership's role shifts from approving to supporting.
From representation to engagement
Shared governance often relies on elected representatives who attend meetings on behalf of their units. Professional governance seeks to engage every nurse in the decisions that affect their practice, with council structures as the coordinating mechanism rather than the sole venue for nurse voice.
Kanter's Structural Empowerment
The theoretical foundation for professional governance draws heavily from Rosabeth Moss Kanter's theory of structural empowerment. Kanter posited that structurally empowered employees achieve more because they have access to information, resources, support, and development opportunities. This theoretical underpinning is directly linked to improved nursing and patient outcomes, and it is a foundational concept in the Magnet Recognition Program's Structural Empowerment component.
Making the Transition
Organizations moving from shared to professional governance should:
- Assess current state using the IPNG or similar validated instrument
- Educate leadership and staff on the principles and expectations of professional governance
- Redefine council charters with clear decision-making authority, scope, and accountability mechanisms
- Build infrastructure for tracking decisions, outcomes, and impact
- Support with resources including protected time, administrative support, and technology tools
- Measure and report governance effectiveness through both process and outcome metrics
A 2025 study published in PLOS ONE by Farghaly Abdelaliem and colleagues concluded that the future of the nursing profession depends on governance planning and participatory decision-making being a part of every organization's strategic plan.
The Practical Impact
The shift matters because it changes behavior. When nurses understand that they own their practice decisions—that governance is not a privilege extended by administration but an accountability inherent in professional practice—the quality of governance activities changes. Councils become more productive. Practice changes are more evidence-based. Outcomes are more rigorously tracked.
Professional governance is not about giving nurses more meetings. It is about recognizing that the profession of nursing comes with the obligation—and the authority—to govern its own practice.
