Concept of Shared Governance Among Nurses in a Tertiary Hospital in the United Arab Emirates: A Mixed-Methods Study

Abstract

Nurses have always borne the burden of increased workload and challenging practice environment brought upon by the rising nursing shortage and growing complexity of patient care needs. The increasing regulations, tight organizational protocols, and authoritative management style have also contributed to nurses' job dissatisfaction and intent to leave. Nurses have become more powerless and frustrated with their professional practice environment. This is further exacerbated by their inability to make decisions regarding issues that affect their own professional practice which results in nurses leaving in search of better job satisfaction. In response, hospitals are becoming more innovative in their strategies to improve the work environment and retain nurses within their organizations. One of which is through Shared Governance wherein frontline healthcare workers are active and empowered participants in the institutional decision-making process.

This explanatory sequential mixed-methods with triangulation study have assessed the current state of shared governance in a large tertiary hospital in Abu Dhabi, UAE. The first phase of the study utilized the Index of Professional Nursing Governance (IPNG) tool to obtain a baseline measurement of shared governance. In the second phase, Delphi, interview, and Focus Group Discussion (FGD) were conducted to further explain and understand the quantitative results.

The results of the survey showed an overall governance score that is indicative of the presence of a first-level shared governance wherein the management and administration primarily make the decisions in the organization with some staff input. Traditional governance was also found under the Control over Personnel subscale and was consistently described in all three qualitative data collection methods. Results of Delphi generally described nurses' limited access to information as well as minimal control over resources and professional practice while the broad themes that emerged from the interview generally described nurses' lack of administrative committee, limited involvement in goal setting and conflict resolution, and the challenges in shared governance participation. Key results from FGD included the possession of functional shared governance, dissatisfaction, and lack of adequate management support. In general, the minimal sharing of overall governance power, the lack of involvement of nurses in some governance activities, and having a centralized form of management as described by the qualitative findings were all explanatory of the achieved IPNG scores. Overall, opportunities exist in the organization to increase shared decision-making, especially in terms of Control over Personnel, and to improve participation in shared governance by addressing the challenges identified in the interview and group discussion respectively.