shared governance: time to consider the cons as well as the pros

Journal of Nursing Management, 1999, 7, 193–200

Shared governance: time to consider the cons as well as the pros

M. GAVIN bsc, pgce, msc, ma1, D. ASH ba, rgn2, S. WAKEFIELD rmn, dip. coun.3 and C. WROE rgn, dip. nurs,mihsm4

1Lecturer, Department of Social Work, University of Salford, Manchester, 2Charge Nurse, Spinal Injuries Unit, NorthernGeneral Hospital, SheBeld, 3Community Psychiatric Nurse, Rotherham and 4Contracts Manager, Rotherham DistrictHospital, Rotherham, UK

Correspondence gavin m., ash d., wakefield s. & wroe c. Journal of Nursing Management 7, 193–200M. Gavin Shared governance: time to consider the cons as well as the pros115 RatcliCe TowersBosden Fold Aims This paper aims to provide a critical appraisal of an approach to the managementHillgate and organization of nursing work known as shared governance (SG).Stockport SK1 3 PD Background This approach has its origins in the USA, where, during the past 20 years itUK

has become increasingly influential. The advocates of SG claim that it can, inter alia,improve recruitment and retention rates, boost morale, and help raise clinical skills. Littlewonder that SG in now beginning to make significant inroads into the NHS.Origin of information However, a trawl through the extensive US literature, using printedand online (e.g. BIDS, CINHAL, MEDLINE, etc.) bibliographical sources, suggests thatthe claimed benefits of SG should be treated with caution.Key issues Much of the existing published research appears to be both methodologicallyflawed and lacking in any critical edge. While many researchers and commentators appearonly too willing to highlight what they see as the promise of SG, they shy away fromexploring any potential pitfalls. One consequence of this is that many of the putativebenefits SG is said to confer, may in fact be more apparent than real.Conclusions Nurses and nurse managers need to be apprised of and consider seriously,the possible cons as well as the potential pros of SG, if any promise it may have is to berealized.

Accepted for publication: 31 March 1999

Introduction Jones 1994; Relf 1995; Westrope et al. 1995; Ireson &McGillis 1998). Little wonder then, that 1000 US health

In the USA, the past 20 years have seen shared governancecare providers have adopted it (Porter-O’Grady 1994).

(SG) emerge as an influential approach to the managementand organization of nursing work. For its advocates—and there are many—SG promises, among other things, What is shared governance?to improve staC retention rates and boost morale, encour-

Notwithstanding the apparent popularity of SG in theage the raising of clinical skills and the quality of patientUSA, no single theoretical formulation of just what it iscare, break down disciplinary boundaries and, veryexists. This is not that surprising; as has been notedimportantly, reduce costs (Porter-O’Grady & Finneganelsewhere, modern managerial innovations tend to1984; Etheridge 1987; Ludemann & Brown 1989;

Brodbeck 1992; Jones et al. 1993; Gomberg & Sinesi 1994; be somewhat amorphous in character (Wilkinson &

193© 1999 Blackwell Science Ltd

M. Gavin et al.

Willmott 1995). However, despite the vague nature of claimed increase in satisfaction and commitment, wasthat annual staC turnover, which during year one ofSG, it is possible to identify in the literature a set of core

assumptions, values and principles, from which a logical implementation stood at just under 12%, fell to just 6%by year three.framework can be devised. Thus SG can be defined as an

approach to nursing management which seeks to grant There are, however, problems with this piece ofresearch. For example, the data upon which the findingsnursing staC control over their professional practice and

development and make a genuine contribution to the were based were obtained by means of a self-completionquestionnaire survey, conducted once in each of thewider corporate agenda. At least three core principles

underpin this framework: first, responsibilities for the 3 years, using volunteer samples. The main problem withthis type of approach is that it is not possible to determinemanagement of nursing services must reside with nursing

staC; secondly, authority for nurses to act must be recog- to what extent those who do not volunteer diCer fromthose who do, inevitably raising questions of sample biasnized by and within the organization; thirdly, nurses must

be accountable in terms of the delivery of patient care (Arber 1994). While the numbers taking part in the first2 years of the study were of a level one would realisticallyand their professional conduct.expect for a self-completion questionnaire—70% and66%, respectively—in year three only 38% volunteered.

The US literatureConsequently, in the absence of supporting research, itwould be dangerous to accord too much veracity to theThe rise to prominence of SG in the USA has been

accompanied by what one commentator has described as results of this study. Westrope et al. do say that nurseadministrators’ subjective observations of staC attitudesa ‘literary explosion’ in the pages of the nursing press

(Hess 1994). A trawl through this US literature, however, and behaviours tended to confirm their own findings.However, this is hardly credible as supporting evidence.highlights a number of important issues: that with just a

few exceptions, critical voices are noticeably absent; that Moreover, Westrope and colleagues concede that someof the claimed increase in job satisfaction and commitmentlittle systematic research has been conducted to determine

whether the putative benefits of SG are real and generaliz- may be a result of ‘other simultaneously occurring events’.We are not told what these might be. However, we areable; and that despite all SG projects seemingly sharing a

fundamental commonality in seeking to aCord nurses told that an important reason for launching the SGinitiative was concern over recruitment and retention ofcontrol over clinical practice and professional develop-

ment, as well as enhancing their influence over adminis- staC. Bearing in mind the private-sector nature of UShealth care, one might expect that, faced with problemstrative decisions, there is little by way of agreement about

the precise nature of SG. such as this, employers might be tempted to raise salaries.Could it be that this is what happened here? And mightThese observations have at least the following impli-

cations: first, the almost complete lack of a critical stance this explain at least a large part of the apparent satisfac-tion and commitment? We simply do not know.plainly undermines attempts to evaluate SG implemen-

tations, for while many ‘pros’ may be identified numerous In any event, although staC turnover declined quitemarkedly during the 3 years of the study, it is questionable‘cons’ may be overlooked. Thus, much of the current

literature may portray an overly optimistic view. Secondly, whether this can be wholly attributed to SG. It transpiresthat notwithstanding the initial rationale for introduc-while certain features may be common to all SG projects,

this does not necessarily mean that, ‘staC nurses and ing SG—i.e. recruitment and retention diBculties—thedecline in staC turnover occurred during a period whenadministrators [are] speaking the same language’ (Hess

1995 p. 15). In short, SG may mean quite diCerent things hospitals generally were ‘downsizing’, that is, actuallyshedding personnel. Is it any wonder that staC turnoverto diCerent groups and the ramifications of this for

successful implementation may be profound. fell?Similar findings to those above, are reported by JonesTypical of much of the research on SG in the USA is

that contained in the often-cited paper by Westrope et al. et al. (1993). Conducted again over a 3-year period in asingle hospital, this research is undermined by some of(1995). This paper reports the findings of a longitudinal

study, examining the putative eCects of SG on the job the same methodological failings that marred the workof Westrope and colleagues. Using volunteer samples,satisfaction of nurses in one US hospital over a 3-year

period. Westrope and colleagues claim that their research Jones and her coresearchers only achieved response ratesof 44% in year one, and 33% in each of the two remainingshowed that as implementation of SG progressed, nurses

became both more satisfied with their jobs and more years. To be fair, the shortcomings of the study arerecognized by these researchers. However, it is interestingcommitted to the organization. One of the results of the

194 © 1999 Blackwell Science Ltd, Journal of Nursing Management, 7, 193–200

Shared governance

to note one observation made by Jones et al. ‘Satisfaction research instrument to Hess, Havens suggests that, despitethe reports of widespread implementation in the literature,with pay/reward … increased significantly after

implementing shared governance’ (p. 212: emphasis little evidence of genuinely shared governance could befound in the 221 hospitals that responded to her survey—added). One cannot help wondering why satisfaction with

one’s pay might improve as a result of SG. Is not a more despite the claims of many nurse managers that they hadimplemented or were about to implement SG. Holdingplausible explanation simply that pay increased and thus

job satisfaction? Again, however, we are not told. The that her findings hint at a good deal of conceptualconfusion, Havens speculates that understandings of SGreal point here, however, is that other factors may be

responsible for the eCects attributed directly to SG. And among the nurse managers who acted as her organiz-ational informants may form a continuum, ranging frompay may be one of them.

That an association exists between job design and simple input by nurses into decision-making at one end,to complete authority at the other.expressed satisfaction with one’s work has been well

documented. The work of the members of the Tavistock However, Havens attaches a caveat: the length of timebetween starting implementation of SG in the hospitalsInstitute for Human Relations into sociotechnical systems,

carried out during the 1950s and 1960s, showed this quite she surveyed and the commencement of her study, rangedfrom 1 to 3.6 years, with a mode of 1 year. As proponentsclearly. The defragmentation of tasks, team working,

greater responsibility and autonomy, were all positively of SG commonly cite a period of approximately 5 yearsfor successful implementation, then, as Havens acknowl-correlated with improvements in job satisfaction (see, e.g.

Emery & Trist 1960). This would tend to lend at least edges, comparison of the cases she investigated and thosein the literature may not be wholly fair. Even so, Havens’some credence to the work of both Westrope et al. and

Jones et al. and that of the authors of numerous other research suggests the existence of a degree of perplexityand ambivalence about SG on the part of many nursesimilar studies into SG reporting comparable findings.

However, as Stephen Hill (1984) has noted, a survey of managers.the records of all the Tavistock’s experimental workreveals that those workplaces where the greatest content-ment was found, were those where the most money was

SG in the UKearned. Consequently, as Hill goes on to note, one cannotrule out the possibility that ‘… beneficial eCects may be The enthusiasm with which the US health care community

has embraced SG has not been mirrored in the UK.the result of more money rather than work that is moresatisfying’ (p. 89). However, there are clear signs of change, and a number

of accounts of high-profile SG implementations haveRobert Hess is one of the few commentators suggestingthat we should be wary of accepting too readily the claims appeared (Geoghegan 1995; Geoghegan & Farrington

1995; Naish 1995; Legg & Hennessy 1996; Gulland &of those championing the cause of SG (1994, 1995, 1998).During a period of 11 months, Hess (1995) ascertained Payne 1997; Ash et al. 1998; Carlowe 1998; Jackson 1998).

Nevertheless; the UK nursing press has so far largelythe views of more than 1000 nurses in 10 hospitals, usinga survey instrument specially devised by himself: The ignored SG. Moreover, the accounts that have appeared,

interesting as they are, tend to be descriptive, and provideIndex of Professional Nursing Governance (IPNG). Hessclaims that the instrument can provide baseline data, little by way of evaluative data. An exception, is the

recently published, first stage results of an evaluation ofagainst which the progress of SG implementation projectscan be evaluated. The IPNG comprises 88 items relating SG at Kettering General Hospital (KGH) (Mitchell et al.

1998).to various aspects of governance, grouped under sixthematic headings. Launched during 1997, the evaluation at KGH was

intended, like Hess’ work, to provide baseline data relat-Analysis of the survey results revealed that, whilecontrol over practice is emphasized as the major objective ing to staC knowledge and awareness. The results of a

questionnaire survey of 180 nursing staC, grades A to H,of SG in the literature, it had a very low priority fornurses themselves. What nurses see as the most important revealed, among other things, that the overwhelming

majority of respondents positively associated SG withfactor in governance, is control over resources, especiallypersonnel. The crucial lesson here, Hess contends, is that increased communication, better quality care, and

increased involvement in decision making. However, thiswhen discussing governance, nursing managers and nursesmay be talking past each other. situation was almost exactly reversed when respondents

were asked to consider career development, and increasesSupport for Hess’ opinion can be found in work alsocarried out in the USA, by Havens (1994). Using a similar in accountability and autonomy; while a clear majority

195© 1999 Blackwell Science Ltd, Journal of Nursing Management, 7, 193–200

M. Gavin et al.

did not positively associate SG with empowerment, power models (e.g. Porter-O’Grady 1992). While nursing man-agers must see to it that the system operates eBciently,sharing, or clinical development.

These findings are interesting, not least because of their so that high quality care is provided, they have noauthority, notes Bernreuter, over staC, who remain whollyapparent resonance with those of Hess (1995). They show

that the priorities of nursing staC at KGH, as far as the autonomous.Implicit in SG is the transfer of control from supervisoryconcept of governance is concerned, diCer quite markedly,

in many respects, from those outlined in the literature and middle managers to front-line staC nurses. Such atransfer inevitably raises questions as to the role of suchon SG.

Another significant finding to emerge from the KGH managers, not only in the implementation of SG, but alsoin the future organization. On the face of it, empoweringstudy is that some of the higher grade nurses appeared to

be ill informed about the nature of the changes connected nurses, in the ways envisaged in SG, would appear toobviate the need for at least a large part of the lower towith the SG initiative. ‘It is unclear at the present time’,

say Mitchell and colleagues, ‘whether this is a deliberate middle management tiers. Tim Porter-O’Grady, the lead-ing ‘guru’ of SG has stated his views unequivocally. ‘Idissociation or simple ignorance …’ (p. 19). Nevertheless,

one cannot help wondering whether the apparent lack of think’, he says, ‘… there’s little doubt that in future therewill be fewer managers. ECectiveness in a system is inverseawareness on the part of some senior nurses is not

symptomatic of the kind of perplexity and ambivalence to the number of managers you have’ (quoted in: Snell1995 p. 13). Thus, many supervisors and middle managerswhich some of Havens’s (1994) findings suggest.may feel somewhat threatened by developments such asSG (see also, Geoghegan 1995). It would be hardly

The role of nurse-managerssurprising then, if the attitudes of managers towardsdevelopments such as SG betrayed a certain amount ofOver the years, a large body of research evidence has

accumulated that shows clearly that supervisory and perplexity and ambiguity.middle managers often resist the introduction of mana-gerial innovations intended to empower front-line staC

Shared governance in the UK—why now?(Fenton-O’Creevy & Nicholson 1994). For example,during the 1980s, many UK companies, in an attempt to Growing interest in SG in the UK has coincided with the

end of a 20-year period during which the NHS hasemulate the successes of their Japanese counterparts,introduced the idea of the quality circle (Bradley & Hill undergone a radical transformation (Holliday 1995).

While the aim of the Service remains the same as it was1987). A quality circle is:‘… a group of 4–12 people coming together from at the time of its creation in 1948—to provide care free

at the point of delivery and purely on the basis of need—the same work area, performing similar work, whovoluntarily meet on a regular basis to identify, this is now to be achieved in a very diCerent operating

environment to that which existed 50 years ago. Theinvestigate, analyse and solve their own work prob-lems. The circle presents solutions to management separation of the purchase of health care from its pro-

vision, through the creation of quasi market mechanismsand is usually involved in implementing and latermonitoring them’ (Department of Trade & has resulted in the establishment of a service which is

more business-like and more competitive than could haveIndustry 1985).By the beginning of the 1990s, however, this experiment been contemplated a few years ago (Flynn 1992; Edwards

1995). Nowadays, the emphasis is very much on cost-in Japanese methods had clearly failed. It has been arguedthat part of the reason for the demise of quality circles, cutting and eBciency.

Moreover, while the current government claims itswas that they established ‘a structure parallel to thenormal chain of command’ (Hill 1991, p. 405); a structure plans for the Service to mark the creation of The New

NHS (DoH 1997), it is becoming clear that they do notwhich managers saw as contrary to their own occu-pational interests, and thus sought to subvert. According herald a wholesale revision of previous reforms (Baines

& Couper 1998). It appears then, that the central core ofto Hill (1991), in the companies he researched, althoughmanagers had no authority over who joined the quality the reforms of the past 20 years do indeed form the basis

of a new consensus on the future of health care in thecircles, nor the topics discussed, they were, nonetheless,responsible for them. UK (Holliday 1995).

Many parts of the NHS have reacted to the newThe kind of uncertainty which imbued the managementrole, vis-a-vis quality circles, is highlighted by Bernreuter commercial environment by embracing the post-Fordist

(Ritzer 1996) managerial approaches of the private sector,(1993), as typical of the management role in many SG


Shared governance

and attempting to become more ‘flexible’. Among the key Worthington 1996; Buchan op. cit; Maynard 1999). Infactors involved in the move towards the creation of less this regard, one can point to other factors such as thebureaucratic, more flexible, organizational forms are: the increasing casualization the drive towards flexibility indevolution of authority downwards, the flattening of the NHS has borne witness to during recent years (Naishhierarchical structures, the inversion of traditional man- 1995), with short-term contracts being commonplace.agement pyramids, and the slackening of established Additionally, controversy has arisen surrounding newemployment ties through strategies such as short-term working practices such as skill-mix (Fatchett 1994), andcontracts and the development of core and peripheral the role of health care assistants (Snell 1998). Thesework forces: all of which require a major shift in organiz- factors have led to a feeling among some nurses, thatational culture (Handy 1991; Kanter 1994). their jobs are now much less secure (Tross & Cavanagh

Some distinct parallels are observable then, between 1996). Such an occupational context is hardly conducivethe factors just mentioned and SG. Certainly, SG involves to either recruitment or retention.the devolution of authority downwards; a tacit assump- Moreover, in the new world of flexibility, where organ-tion of which is the compression of managerial levels. izations are shrinking vertically, the conventional modelAdditionally, SG demands a radical alteration in the of the career path for nurses has vanished (Lynch 1995).culture of nursing. Thus, one can state unequivocally, The eCect of this is that, if career moves take place atthat SG falls within the ambit of managerially driven all, then they are more likely to be horizontal thanapproaches aimed at enhancing organizational flexibility. vertical. Again, such a development is likely to have someBut what link, if any, exists between SG, and the loosening consequences for both recruitment and retention. Thisof the traditional bonds between an employer and the would be especially so if, notwithstanding the controversyemployed that flexibility is said to entail? noted above regarding Project 2000, nurse education and

training were to move from diploma to degree level. Thefull implications of this may not yet have dawned uponCommitment, motivation and SGthe advocates of SG, but they certainly do not appear to

Over the Christmas and new year period (1998/99), it hashave been lost on senior nursing academics (Porter 1998).

become clear that the NHS is experiencing major diB-By dismantling the old employment relations, flexible

culties in both the recruitment and retention of nursingorganizations cast aside an important element of the

staC (Hencke 1998, see also Carter 1998). Such diBcultiesimplicit psychological contract (Cavanagh 1996).

are, of course, hardly new (Buchan 1998). However,Organizations may be able to adopt flexible structures

reports of staC shortages have recently been given a newvery rapidly in response to changing environmental con-twist, by their being accompanied by rather emotiveditions. But those charged with bringing about suchclaims that nurse education is currently ‘too academic’;structural change fool themselves if they believe the wholeone consequence of this being that many who wouldpanoply of cultural assumptions, expectations, and under-make good nurses are being ‘put oC’, thus contributingstandings, which underpin organizational life, can beto a dearth of qualified staC (e.g. see Brindle 1999a; Eatonchanged as swiftly (Herriot 1992). The upshot of this is1999; Payne 1999). While some within the professionthat the NHS—or at least those parts of it that havewould probably accept that Project 2000 and the locationembraced the notion of flexibility—may, unless it dis-of nurse education and training in higher education maycovers new means of ensuring the commitment of nurseswell deter at least some applicants, it is doubtless fair toin the absence of the motivation provided by opportunitiessay that most nurses would argue vehemently, that at thefor career progression and secure employment, find itselfcrux of the matter is pay. Whether the recent nursing payfacing very serious problems.award will do anything to assuage concerns within the

Some commentators have suggested that managerialprofession regarding levels of remuneration and its impactinnovations, such as SG, may in the future form the basisupon retention and recruitment, is, at best, uncertainof a new psychological contract, one that ‘can lead to(Brindle 1999b; White 1999); though grave doubts havetrust, commitment and mutual benefit’ (Cavanagh 1996been voiced in the nursing press (Comment, Nursingp. 82) for nurses and their employers (see also, McGuinessTimes 1999).1998). This, of course, is pure supposition. Even so, it isParticular issues of education and pay aside, one hasplausible: some nurses may find innovations such as SGto acknowledge that the reasons for the seemingly peren-attractive and highly motivating. The greater account-nial diBculties involved in nurse recruitment and retentionability, self-management, and input into decision-makingare likely to be complex and varied (for a review of some

of the issues, see Bagguley 1996; Soothill et al. 1996; that SG is said to entail, may act as a substitute for


M. Gavin et al.

opportunities for career advancement absent in the attenu- endure a situation where they have responsibility withoutauthority, nurses may be required to be accountable forated, flexible organization.

However, that SG might make the prospects of a a situation for which they are not responsible (see Salvage1985). Senior managers may be only too willing to6-month casual contract on a D-grade salary a more

enticing proposition for newly qualified nurses, those relinquish overt control over, and accountability for,thorny and contentious issues such as clinical practice,returning to the profession, or those considering training,

may be stretching credulity too far. If job security is to while retaining their grip over the deployment and use ofavailable organizational resources. True, SG seems tobe a thing of the past, and career ‘progression’ horizontal,

if at all, then only substantial increases in pay for all aCord nurses at least the potential to wield some influencein relation to managerial concerns, such as resources. But,qualified staC, and a raising of the current level of the

student bursary are likely to improve recruitment and as has been observed by others, influence is diCerent fromcontrol and contributions to managerial issues can beretention rates (Coombes & Porter 1998; Gulland 1998;

Kenny 1998; Lankshear 1998; Payne 1998). ignored as well as acted upon (Havens 1994).Notwithstanding the rhetoric of SG then, the reality

may be that nurses are to be empowered in relation toProfessionalization and SG

practice issues but only within the confines of resourceconstraints set by managers. Caramanica and RosenbeckerSome nurses may see SG as a route to enhanced pro-

fessional status. If so, they would be wise not to build (1991 p. 46) have argued that nurses’ ‘… absolute partici-pation in all decisions is neither realistic nor desirabletheir hopes too high. After all, the history of the NHS

during the past 20 years has been marked by persistent [but] increased staC input provides information, expertiseand skill which can improve a department’s functioning’.attempts to divest professional groups of their autonomy

by bringing them under managerial control (Harrison This may well be true. But for SG discourses toemphasize accountability in such a context leads one1988; Flynn 1992; Harrison & Pollit 1994). The advent of

clinical governance, announced in The New NHS (DoH inescapably to ask the following question: is SG reallyabout empowering nurses, or rather enhancing their1997; see also, The Health Service Journal 1998) suggests

that this is a trend that is likely to continue. This begs exploitation? (see McArdle et al. 1995).the question: will NHS managers be willing to counten-ance the emergence of a nursing profession with increased

Towards a more critical perspectiveautonomy, able to challenge management on an equalfooting? One surely has to admit that on the face of it, it Some might argue that SG promises nurses so much, that

if only a fraction of what it does can be delivered, thendoes not seem likely.What managers may accept, however, and what SG it must be worth pursuing. This may or may not be true;

much more empirical research is required. However, itmay help facilitate, is the establishment of a well paid,professional nursing elite, provided, perhaps, that the should not be forgotten that SG is a managerially driven

initiative, and the priorities of managers and those ofextra costs can be oCset through the increased employ-ment of poorly paid health care assistants (Ranade 1997). nurses might not always converge. If managers see SG

largely as a means to cut costs and ‘improve eBciency’—The announcement last Autumn that a new ‘super nurse’grade is to be introduced, suggests that such a possibility as at least one senior nurse manager’s published views

seem to imply (Geoghegan 1995)—then the prospects foris all too real (see, e.g. Coombes 1998). Quite what theimpact of this development, and the creation of a nursing long-term success are questionable; even if its introduction

is legitimized through the language of empowerment andelite more generally, might be on standards of patientcare is not clear; although the political power of the accountability. Economic benefits accruing to organiza-

tions, wrought upon the back of diminished career oppor-profession as a whole may well suCer as a result (Salter& Snee 1997; see also, Salvage 1985; Mackay 1989). tunities and an intensification of nursing work, do not

seem to add up to a recipe for either harmonious employeeFurthermore, SG is said to be primarily directed atempowering nurses to take enhanced control over their relations or improved patient care.

In the USA SG has, according to one commentator,clinical practice. Yet nurses can only realize meaningfulcontrol in the context of what are very labour intensive developed into a fad (Bernreuter 1993). This is not diBcult

to fathom. SG is, for some, a seductive idea and thoseactivities, where they enjoy significant control overresources (Hess 1995). In most SG models, however, who fall for its apparent charms may be blind to its

dangers. UK nurses need to be more cautious than theirresource issues remain the province of management. Thus,in SG, while supervisory and middle-management may USA counterparts appear to have been if the putative


Shared governance

Management Science, Models and Techniques (Churchman C.W.benefits of SG are to be realized and the potential& Vehulst M. eds), Oxford University Press, Oxford, 36–51.drawbacks avoided.

Etheridge P. (1987) Nurse Accountability Program ImprovesThe brief, foregoing discussion then, has been an

Satisfaction, Turnover. Health Progress, May.attempt to contribute to a more critical examination of Fatchett A. (1994) Politics, Policy and Nursing. Balliere Tindall,the SG phenomenon. It is not intended to rubbish SG. London.

Fenton-O’Creevy M. & Nicholson N. (1994) Middle Managers:Rather, it is an attempt to provide a more considered andTheir Contribution to Employee Involvement. Employmentreflective view. Ultimately, this may prove to be of moreDepartment, SheBeld.use to those committed to promoting the interests of

Flynn R. (1992) Structures of Control in Health Management.nurses than the often rosy-hued prescriptions dispensed Routledge, London.by the advocates of SG. Geoghegan J. (1995) Caring and sharing. The Health Service

Journal, 23 November.Geoghegan J. & Farrington A. (1995) Shared governance: developing

a British model. British Journal of Nursing, 4, 13.Gomberg S. & Sinesi L. (1994) A collaborative interaction modelReferences

and the implementation of shared governance. Holistic NursePractitioner, 8, 3.Arber S. (1994) Designing samples. In Researching Social Life

Gulland A. (1998) Pay day, Nursing Times, 29 April.(Gilbert N. ed.), Sage, London, 68–92.Gulland A. & Payne D. (1997) Daisy chain power. Nursing Times,Ash D., Gavin M., Wakefield S. & Wroe C. (1998) Shared

93, 4.Governance at Doncaster Royal Infirmary: an Evaluation,Handy C. (1991) The Age of Unreason. Arrow, London.Doncaster Royal Infirmary and Department of SociologicalHarrison S. (1988) Managing the National Health Service. ShiftingStudies, University of SheBeld, SheBeld.

the Frontier? Chapman Hall, London.Bagguley P. (1996) Nurses and the new industrial relations, InHarrison S. & Pollit C. (1994) Controlling Health Professionals.Themes and Perspectives in Nursing 2nd edn (Soothill K.,

Open University Press, Buckingham.Henry C. & Kendrick K. eds), Chapman & Hall, London,Havens D.S. (1994) Is Governance Being Shared? Journal of Nursing325–336.

Administration, 24, 6.Baines D. & Couper N. (1998) The cultivated commissioner. TheThe Health Service Journal (1998) Opinion, 23 April, 15.Health Service Journal, 30 April.Hencke D. (1998) Nursing crisis looms, The Guardian, 29 January.Bernreuter M. (1993) The Other Side of Shared Governance. JournalHerriot P. (1992) The Career Management Challenge. Sage, London.of Nursing Administration, 23, 10.Hess R. (1994) Shared Governance: innovation or imitation? NursingBradley K. & Hill S. (1987) Quality circles and managerial interests.

Economics, 12, 1.Industrial Relations, 26, 1.Hess R. (1995) Shared Governance. Nursing’s 20th century towerBrindle D. (1999a) Learning diBculties, The Guardian, 27 January.

of babel. Journal of Nursing Administration, 25, 5.Brindle D. (1999b) Dobson’s pay sweetener for nurses, TheHess R. (1998) Measuring Nursing Governance. Nursing Research,Guardian, 2 February.

47, 1.Brodbeck K. (1992) Professional practice actualized through anHill S. (1984) Competition and Control at Work. Gower, Aldershot.integrated shared governance and quality assurance model.Hill S. (1991) How do you manage a flexible firm? The total qualityJournal of Nursing Care Quality, 6, 2.

model, Work, Employment and Society, 5(3), 397–415.Buchan J. (1998) Your country needs you, The Health ServiceHolliday I. (1995) The NHS Transformed, Baseline Books,Journal, 16 July.

Manchester.Caramanica L. & Rosenbecker S. (1991) A pilot unit approach toIreson C.L. & McGillis G. (1998) A multidisciplinary shared govern-shared governance. Nursing Management, 22, 1.

ance model. Nursing Management, 29, 2.Carlowe J. (1998) Governing the future. Nursing Standard, 12, 29.Jackson P.A. (1998) Shared governance—a personal view. BritishCarter H. (1998) ‘StaC nurses give better care’, ‘Agency recruits fill

Journal of Theatre Nursing, 7, 11.huge shortfall in NHS’, The Guardian, 29 January.Jones P.K. (1994) Developing a collaborative professional role forCavanagh S.J. (1996) A ‘new’ psychological contract for nurses:

the staC nurse in a shared governance model. Holistic Nursesome management implications, Journal of Nursing Management,Practitioner, 8, 3.4, 79–83.

Jones C.B., Stasiowski S., Simmons B.J., Boyd W.J. & Lucas M.D.Coombes R. (1998) Super scheme or smoke screen? Nursing Times,(1993) Shared governance and the nursing practice environment.16 September.Nursing Economics, 11, 4.Coombes R. & Porter R. (1998) Congress Boos Dobson, Nursing

Kanter R.M. (1994) When Giants Learn to Dance. Routledge,Times, 22 April.London.Department of Health (1997) The New NHS. Modern, Dependable.

Kenny C. (1998) Moonlighting: a student’s lot? Nursing Times,HMSO, London.18 February.Department of Trade and Industry (1985) Quality Circles, DoTI,

Lankshear A. (1998) The cost of caring, Nursing Times, 18 February.London.Legg S. & Hennessy M. (1996) Fair shares in practice? NursingEaton A. (1999) Too clever to care? Nursing Times, 27 January.

Management, 2, 8.Edwards B. (1995) The National Health Service. A Manager’s Tale.Ludemann R. & Brown C. (1989) StaC perceptions of sharedNuBeld Provincial Hospitals Trust, London.

Emery F.E. & Trist E.L. (1960) Socio-technical systems. In governance. Nursing Administration Quarterly, 13, 4.


M. Gavin et al.

Lynch J. (1995) Fast and Loose, The Health Service Journal, 8 June. reducing nursing turnover through the implementation of sharedgovernance. Critical Care Nurse Quarterly 18, 3.Mackay L. (1989) Nursing a Problem. Open University Press,

Milton Keynes. Ritzer G. (1996) The McDonaldization of Society. Pine Forge Press,Thousand Oaks.Maynard A. (1999) Loot is not the only route, The Health Service

Journal, 28 January. Salter B. & Snee N. (1997) Power dressing, The Health ServiceJournal, 13 February.McArdle L., Rowlinson M., Procter S., Hassard J. & Forrester P.

(1995) Total quality management and participation: employee Salvage J. (1985) The Politics of Nursing. Butterworth-Heinemann, Oxford.empowerment, or the enhancement of exploitation? In Making

Quality Critical: New Perspectives on Organizational Change Snell J. (1995) Dancing master, The Health Service Journal,28 September.(Wilkinson A., Willmott H., eds), Routledge, London, 156–172.

McGuiness B.M. (1998) The Change in Employee Loyalty. Nursing Snell J. (1998) A force to reckon with, The Health ServiceJournal, 9 April.Management, 29, 2.

Mitchell M., Pugh J. & Brooks F. (1998) Baseline Survey: shared Soothill K., Williams C. & Barry J. (1996) Understanding nurseturnover. In Themes and Perspectives in Nursing 2nd edn (Soothillgovernance. IHSR, Luton University, Luton.

Naish J. (1995) Give up your power. Nursing Management, 2, 6. K., Henry C. & Kendrick K. eds), Chapman & Hall, London.Tross G. & Cavanagh S.J. (1996) Innovation in nursing management:Naish J. (1995) Nursing crisis returns. Nursing Management, 1, 8.

Nursing Times (1999) Comment. 27 January. professional, management and methodological considerations.Journal of Nursing Management, 4, 143–149.Payne D. (1998) Sterling work, Nursing Times, 4 February.

Payne D. (1999) The knives are out for P2000, Nursing Times, Westrope A., Vaughn L., Bott M. & Taunton R. (1995) Sharedgovernance. From vision to reality. Journal of Nursing27 January.

Porter R. (1998) Boost career paths, say top nurses, Nursing Administration, 25, 12.White M. (1999) New nurses to get 12pc rise, The Guardian,Times, 1 April.

Porter-O’Grady T. (1994) Whole systems shared governance: cre- 2 February.Wilkinson A. & Willmott H. (1995) Introduction. In Making Qualityating the seamless organisation. Nursing Economics, 12, 4.

Porter-O’Grady T. & Finnegan S. (1984) Shared governance for Critical: new perspectives on organizational change (WilkinsonA. & Willmott H. eds), Routledge, London.nursing: a creative approach. Aspen Systems, Rockville.

Ranade W. (1997) A Future for the NHS? Health Care for the Worthington D. (1996) Nurse supply modelling. In Themes andPerspectives in Nursing 2nd edn (Soothill K., Henry C. &Millenium. Longman, London.

Relf M. (1995) Increasing job satisfaction and motivation while Kendrick K., eds), Chapman & Hall, London.


shared governance: time to consider the cons as well as the pros

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