Developing shared governance leaders

To obtain Magnet® recognition, hospitals must have structures and processes in place that ensure nurses participate in shared decision making. A shared governance (SG) structure meets this criterion. In this process, nurses take an active participatory role in decisions that affect nursing practice. Ultimately, SG positively affects patient outcomes by moving decision making closer to the point of care. It also enhances nurse autonomy, empowerment, and job satisfaction.

The professional nursing staff (PNS) at Rush University Medical Center in Chicago recently celebrated its 30-year anniversary as one of the nation’s first SG nursing organizations. On this occasion, we reflected on the most influential factors contributing to our success and sustainability. One of our strengths has been robust formal mentoring and support for emerging SG leaders.

This article discusses the PNS past presidents’ council, an innovative structure developed to formalize mentorship and support for new organizational leaders. Such a committee can be replicated easily in any SG or professional nursing organization to help maintain organizational
history, support emerging leaders, and drive outcomes.

Past presidents as mentors—and beyond

In 1984, Marcia Pencak Murphy was elected the first president of the PNS. Since then, 22 other nurses have been elected president. Most remained employed at Rush after their terms ended, serving as unofficial mentors for emerging SG leaders. However, their mentoring was informal and sometimes sporadic.

In 2008, during planning for the 25th-anniversary celebration of the PNS, Jessica Walker, then PNS president, asked past presidents to assist with programming and historical information. The meetings that ensued gave the former presidents a chance to talk about current challenges and future direction for the organization. In reflection, Rachel Start, 2009-2011 PNS president, recalled, “The 25th anniversary gave me a unique opportunity to understand how to maximize the work and influence of PNS, philosophically and operationally. I was privileged to meet some of the founding presidents to talk about professional accountability, the imperative of an autonomous nursing staff, and the impact of a practice model that had full parity with other disciplines. With their support, I went into my term with passion and energy to live to the fullest those components that exemplify shared governance.”

Realizing our past presidents had a vested interest in the organization’s success and a desire to continue serving in some capacity, Rush nurses saw the need for a structure. They drafted the concept of the Past Presidents’ Council (PPC), which they announced at the 25th-anniversary celebration. At an inaugural meeting to celebrate the anniversary, the past presidents approved the PPC proposal and affirmed their commitment to serve on the council. The next year, PNS members voted to incorporate the PPC into the SG bylaws, formalizing the council in our structure.


PPC model

In developing the PPC, the former presidents drew inspiration from other nursing organizations, primarily Sigma Theta Tau International (STTI), the Honor Society of Nursing. STTI has a formalized fellowship of past presidents who serve in an advisory capacity to the current STTI president and board of directors. Other organizations, such as the Hospice and Palliative Care Nurses Association and the Society for Vascular Nursing, also have councils made up of former presidents, who serve as advisors to their organizations.

At Rush, we incorporated the American Association of Critical-Care Nurses’ Standards for Establishing and Sustaining Healthy Work Environments (2005) into the guiding values of the PPC. Specifically, we incorporated the standards of true collaboration and authentic leadership.

  • True collaboration means every team member embraces collaboration as an ongoing process and invests in its development to ensure a sustained culture of collaboration.
  • Authentic leadership holds that nurse leaders must demonstrate skilled communication, true collaboration, effective decision-making, and meaningful recognition.

At Rush, we believed the PPC could help inculcate these values in our emerging SG leaders.

PPC goals

Overall PPC goals are for members to serve as advisors to PNS officers, mentor current and future PNS leaders, engage in leadership succession planning, and support the growth and sustenance of our SG organization. A past president chairs the PPC, assuming responsibility for coordinating meetings, driving outcomes, and providing reports to the PNS. The group meets monthly; the PNS president and PPC chair set meeting agendas. Most of the meeting time is dedicated to PNS operations and professional practice matters.

PPC structure

The PPC structure is relatively simple. All nurses who’ve served as PNS president at Rush are offered lifetime memberships on the council, including those no longer employed at Rush. Currently, the PPC has two highly engaged Rush past presidents who now work in other organizations. The PPC allows these leaders to stay connected to the council while letting us benefit from their experiences in other nursing roles. Also, the current PNS president and president-elect, as well as the president of the nursing SG organization at our sister hospital, Rush Oak Park Hospital, are PPC members. (See Where are they now?)

Kathy Pischke-Winn, 1989-1990 PNS president, stated, “I take pride in being a member of the Rush PPC. In my role as Magnet Program Director at University of Chicago Medicine [UCM], I appreciate having a network of strong shared governance leaders and friends. Last year, I reached out to the PPC and they helped organize speakers for a shared governance retreat for an audience of UCM staff nurses and unit managers. I knew I could rely on this group to share their expertise in shared governance.”

Institutional memory

History often repeats itself, even in an SG structure. The past presidents are a great source of institutional memory for current PNS leaders at Rush. The PPC has consulted on such topics as bylaw revisions and interpretation, peer-review process, code of conduct, appeals of disciplinary action, and denials of advancement on the clinical ladder. Past presidents share examples of how they handled these situations and support the current president and president-elect. Erik McIntosh, 2011-2012 PNS president, recalls, “During my term as president, questions arose about the reporting structure of the PNS in the hospital’s quality plan. I was able to consult with the PPC and gather historical information to bring to leadership and build a case for our shared governance organization to report to the board of trustees, just like our medical staff does.”

Mentoring current leaders

The PPC supports leadership development of the PNS president and president-elect. The role of PNS president at Rush can be daunting, and newly elected nurse leaders need support to make an effective transition from the bedside to the boardroom. Dr. Eric Zack, current PNS president, states, “Having a consistent opportunity to engage with past presidents on current issues we face has afforded me not only years of experience from their tenure and how they overcame similar challenges, but access to an amazing collection of wisdom shared by these thought leaders to help us problem-solve.”

Whether your organization is in the planning or development stages of SG, consider the value of creating a formal mentoring structure for current and future leaders of your SG organization. In our organization, the PPC has affected our leaders’ growth and development, along with their leadership trajectory in nursing and health care.

Selected reference
American Association of Critical-Care Nurses. AACN Standards for establishing and sustaining healthy work environments: a journey to excellence. 2005. www.aacn.org/WD/HWE/Docs/HWEStandards.pdf. Accessed July 2, 2014.

Three of the authors work at Rush University in Chicago, Illinois: Cathy Catrambone is an associate professor at the College of Nursing, Elizabeth Myers is a risk manager, and Jessica Walker is a staff nurse. Benson Wright is a patient classification consultant at API Healthcare in Chicago.

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