NURS 721 Week 4 Discussion Board Forum 3 on Consultative and Collaborative Leadership for Change Example

Discussion Board Forum 3: Collaborative Approaches to Leading Change

NURS 721 Leadership, Policy and Ethics, Discussion Board Forum 3

Thread by [Student Name]

The hospital, the councils and the classmates replied to are composites written for a model discussion.

This month I have to decide how to lead our third attempt at bedside shift report on four medical-surgical units. In the first forum I described why the first two attempts failed: both were designed by my office and the education department, delivered through training and enforced through audits, and both collapsed once the audits stopped. The choice now is between two approaches. The first is directive: design a better script with clearer reasons, train again and audit more gently. The second is consultative: give each unit's practice council the task of redesigning shift report, within limits I set, and support their work. This week's readings and the research push me firmly toward the second, but with conditions.

Clawson (2012) argues that leaders who want lasting change must engage the values, assumptions, beliefs and expectations that drive behavior, and that people commit more deeply to what they help create than to what is imposed on them. Our directive rollouts changed what nurses did while they were watched, but never engaged what they believed about report. A council-led redesign begins with those beliefs, because the people in the room hold them.

The research on shared governance supports this, with qualifications. A 2026 scoping review of 29 studies found that shared governance strengthens nurses' professional practice when five elements align: participatory structures, facilitative leadership, a supportive culture, competency development and evaluation; it also found that implementation is uneven across settings (Ventura-Silva et al., 2026). In an integrated care system, 313 nurses who saw more genuine shared decision-making on their units reported less intention to leave, and part of that link ran through their sense of being empowered; together, the two accounted for about a quarter of the variation in turnover intention (Aquino-Maneja et al., 2026). Because the data came from a single survey wave, they cannot establish cause, but the direction matches what our exit interviews tell us. For a director facing both a failed practice change and a retention problem, those findings point the same way.

The conditions matter, though, because consultative leadership does not mean abdicating. I will set three boundaries the councils must work within: report must include the patient at the bedside for at least the safety check, it must use a shared structure across the four units so float nurses are not confused, and it must be ready for a pilot within eight weeks. Within those limits, the councils decide the script, how sensitive information is handled and how the process will be checked. My role is to provide time for council members, data on handoff-related events and access to the evidence, and to decide only if the four councils cannot agree. If they reach a deadlock, I will bring the chairs together, lay out the options and the evidence for each, and make the decision myself in that meeting, explaining my reasons in writing. The approach has a cost: it will take eight weeks rather than the two a directive rollout would need, and each council member will need about six paid hours away from the bedside. I consider that cheaper than a third failure. Consultation fails when leaders ask for ideas they have already decided to ignore, and it also fails when they hand over a problem without saying what must not change.

Jethro watched Moses judging every dispute alone from morning to evening and told him the work was too heavy for one person; Moses appointed capable leaders over smaller groups and kept only the hardest cases (English Standard Version Bible, 2001/2016, Exodus 18:13-26). That passage describes delegation with boundaries, which is what I intend to practice.

Reply to Danielle

Danielle, you asked whether shared governance produces measurable results or just better morale, which is a fair challenge. A recent example from perioperative nursing suggests it can do both. A unit practice council at a military health facility used the Iowa model to implement standardized forced-air warming before elective gynecological surgery; compared with a historical group, the post-implementation group's stay in the post-anesthesia care unit fell by an average of 12.2 minutes, and by 24.3 minutes when outliers were controlled, with an estimated cost avoidance of over $50,000 a year (Atwood et al., 2026). The samples were small, 30 and 19 patients, and the comparison was historical, so the result is suggestive rather than conclusive. Still, it shows a council driving an evidence-based change with measurable outcomes, not just discussion. Clawson (2012) would add that a council that sees its work change outcomes gains energy for the next project. What outcome would your unit's council most want to change?

Reply to Tyrone

Tyrone, your point that night nurses are almost never on your councils because meetings are held at 2 p.m. describes a problem I share. Shared governance that excludes the night shift makes decisions about work it does not see. An oncology program recently described redesigning shared governance for overnight care by creating a night shift council, in response to operational, educational and psychosocial barriers that limit night clinicians' participation and can create inequities between shifts (Co & Salvetti, 2026). For bedside report, the night-to-day handoff is the one most likely to fail, so I plan to ask each unit council to include at least two night nurses and to hold one meeting a month at 7:30 a.m., when the night shift is ending. Ventura-Silva et al. (2026) list participatory structures as a condition for shared governance to work, and a structure that night nurses cannot attend is participatory in name only. Has your organization tried virtual or recorded council meetings for night staff?

References

Aquino-Maneja, E., Searle Leach, L., Li, H., & McGinnis, J. (2026). Predictive relationships among nurses' perceptions of shared governance, psychological empowerment, and turnover intentions. Journal of Nursing Care Quality, 41(4), 370-378. https://doi.org/10.1097/NCQ.0000000000000949

Atwood, B., Romito, K., Garcia, J., Bernaola, M., & Kessinger, S. (2026). The impact of shared governance: Implementing preoperative warming to improve postanesthesia outcomes among gynecological patients. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.08.009

Clawson, J. G. (2012). Level three leadership: Getting below the surface (5th ed.). Pearson.

Co, C., & Salvetti, M. (2026). Redesigning shared governance for overnight oncology care: Development of a night shift council. Clinical Journal of Oncology Nursing, 30(4), 265-269. https://doi.org/10.1188/26.CJON.265-269

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Ventura-Silva, J. M. A., Freire, C. M. F. C., & Zuge, S. S. (2026). Shared governance in the context of nurses' professional practice: A scoping review. Journal of Nursing Care Quality. Advance online publication. https://doi.org/10.1097/NCQ.0000000000000989