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Our VOICE: An Interdisciplinary Approach to SharedGovernanceChriste Brewton a , Joe Eppling a & Mattie Hobley aa East Jefferson General Hospital in Metairie , LouisianaPublished online: 06 Jun 2012.

To cite this article: Christe Brewton , Joe Eppling & Mattie Hobley (2012) Our VOICE: An Interdisciplinary Approach to SharedGovernance, Hospital Topics, 90:2, 39-46, DOI: 10.1080/00185868.2012.679910

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Hospital Topics, 90(2):39–46, 2012Copyright C© Taylor & Francis Group, LLCISSN: 0018-5868 print / 1939-9278 onlineDOI: 10.1080/00185868.2012.679910

Our VOICE: An InterdisciplinaryApproach to Shared GovernanceCHRISTE BREWTON, JOE EPPLING, and MATTIE HOBLEY

Abstract. The authors’ purpose was to make public to otherhealthcare executives the demonstrated success of an interdis-ciplinary shared governance process benefiting any healthcareorganization. Main components of a successful model includea conducive work environment free of distractions, availableresources in order to gather information to complete a project,and committees chosen focused on high priority for patientand staff satisfaction, quality, and safety. An essential piece ofthe puzzle is that grassroots staff needs to own the process. Theauthors share the current model and discuss outcomes, success,and lessons learned throughout their decade-long journey.

Keywords: interdisciplinary teams, shared governance

O ur organization is located in southernLouisiana. The facility is a publiclyowned, not-for-profit organization gov-

erned by a volunteer Board of Directors appointedby the Parish Council and Parish President. Thehospital is licensed for 450 beds and has a medicalstaff of nearly 900 physicians. The hospital is one ofthe largest employers in the Parish, with over 3,000employees, of which 750 are nurses.

In 2002, the organization became Louisiana’s firstNurse Magnet Hospital. American Nursing Cre-dentialing Center (ANCC) bestows this honor onselect hospitals that demonstrate excellence in pa-tient care and provide a superior environment forprofessional nurses. The overall goal of the ANCCis to identify the institutions that act as a mag-net by creating a work environment that recognizesand rewards professional nursing (American Nurs-ing Credentialing Center, n.d.). Achieving this sta-

Christe Brewton is the Director of Education and Research at East Jefferson General Hospital in Metairie, Louisiana. Joe Epplingis the Assistant Vice President of Acute, Post Acute and Behavioral Health Services at East Jefferson General Hospital in Metairie,

Louisiana. Mattie Hobley is the Director of Oncology Services at East Jefferson General Hospital in Metairie, Louisiana.

tus positively affects the entire healthcare team andnot just nursing. The chief nurse executive must bea role model committed to the concepts that definethe magnet culture. The work cannot be delegatedto project managers or special project staff; it is thework of the whole organization. How nursing ser-vices are organized, how decisions are made, whois providing input into the allocation of resources,and who is involved in determining the practice ofnursing in the organization are all part of the con-tinual magnet journey. Creating a culture of mag-netism must include transformational leadership,shared governance, peer accountability, freedom tomake decisions (and occasionally mistakes), and acontinuous learning and improving environment(Drenkard 2005). Shared governance is such an im-portant part of living the Magnet culture that it isthe focus of this article.

REVIEW OF LITERATUREA literature search was performed with a focus

on an interdisciplinary approach to shared gov-ernance. The majority of the 150 reviewed arti-cles revealed nursing is the primary discipline withshared governance models. Supported by severalstudies, the promises of shared governance are im-proved patient-quality outcomes, high professionalnurse satisfaction, the ability to recruit and re-tain bright and committed professional nurses, andan energized and engaged nursing staff (Church,

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Baker, and Berry 2008; Bednarski 2009; Kramerand Schmalenberg 2003; Dunbar et al. 2007). Onthe other hand, in the past two decades Tim Porter-O’Grady has published numerous articles on sharedgovernance that extends beyond nursing and is aninterdisciplinary approach. According to him, thereis no specific design or format and is dynamic. Inorder for an organization to be fully empoweredit is centered around the following four principles:partnership, accountability, equity, and ownership(Porter-O’Grady 2001).

There was very little evidence of interdisciplinaryteams involving the entire healthcare organization ina formalized shared governance model. The centerof attention is focused on nursing teams and lesson facility-wide dynamics, clinical effectiveness, oroutcomes of the teams.

Interdisciplinary committees are diverse groupsof professionals, who as part of a team, use newknowledge and skills necessary to be effective com-mittee members (Gaguski and Begyn 2009). Suchskills include (Redman 2006) (1) learning and un-derstanding the expertise, knowledge, and values ofeach health profession; (2) knowing how to workcooperatively and collaboratively with other disci-plines and professions; and (3) identifying skills tofunction in a group including the ability to assessgroup dynamics and communication, negotiation,and conflict resolution skills.

Interdisciplinary committees have a vast range ofknowledge and experience upon which to draw inorder to make sound decisions. To promote problemsolving and acceptance of responsibility, one mustbe knowledgeable of the various stages of groupdevelopment and effective small group dynamics.

Initial Shared Governance is ImplementedThe American Organization of Nurse Executives

advocates a supportive culture of safety. The nurseexecutive’s role in enhancing patient and staff safetyin any healthcare organization includes leading,guiding, and supporting best practices across all dis-ciplines. The nurse executive, along with organiza-tional leadership, must also commit to building andmaintaining a culture of safety within the work en-vironment (American Organization of Nurse Exec-utives 2006). Leaders demonstrate support of a safeand efficient work environment by encouraging staffto implement evidence-based practice, integrateclinical findings in daily practice, utilize computer-based clinical decision support systems, and definequality measures (Carroll 2002). The Chief Nurse

Executive (CNE) supports a decentralized and par-ticipatory management organizational structure bypromoting staff autonomy and accountability, andfacilitating shared governance through committeestructure. Improvement teams, committees and var-ious other cross-functional teams have existed at thehospital for many years.

In August 2002, the Nursing Leadership Coun-cil (NLC) comprising the CNE and three vicepresidents of nursing, met to enhance and expandthe strategic plan (Saylor 2007). Recognizing thatshared governance is a structure that would movethe hospital forward, the need for more involvementfrom the grassroots level of the organization wasacknowledged. NLC believed this structure wouldimprove communication and teamwork across theorganization and assist in providing the best pa-tient care possible. Any movement toward such ashared governance approach would require signifi-cant changes in structure and function.

To set the tone and structure for shared gover-nance, it was critical to address fundamental tenets,beginning with the development of philosophy andmission statements. Bylaws were written to guidecommittee structure and outline team roles and re-sponsibilities. Communication went out through avariety of venues to staff describing the new sharedgovernance approach and inviting them to volun-teer or nominate a coworker to participate. Com-munication methods included e-mail, informationsessions, leadership meetings, and one-on-one solic-itation. Forums were held to promote the new con-cept of shared governance and get staff and leader-ship commitment. However, this initial model washeavily populated with managers: nursing supervi-sors and/or directors serving as chairpersons andco-chairpersons of committees. The inclusion ofnonnursing members was always encouraged andplayed a vital role in group process and function-ing but in the beginning assumed a supportive rolerather than a decision-making role within the sharedgovernance model. Major lessons learned with theinitial model were the following:

• Staff need to be more involved.• The front-line staff must run the committees and

be accountable for the work generated from theirefforts.

• Leaders have to change roles. No leader shouldbe a committee chair.

• Leaders should assume the responsibility of facil-itators for the groups.

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• Committee participation should be interdisci-plinary.

Evolution to an Interdisciplinary Model forShared Governance

The processes of transitioning to an improvedmodel began in January 2007. The main focus ofthis new shared governance model was to be inter-disciplinary, enabling the entire organization to beinvolved. Although the organization’s team mem-bers have always had a voice in the decisions anddirection of the hospital, the changed culture of theorganization empowered all staff to more positivelyaffect the outcomes of the institution. It is with thisin mind that the shared governance structure tookon a much needed new structure. A contest washeld to select the name for the new model, withVOICE ultimately being chosen by the committeemembers. VOICE stands for Vital Organization forthe Inter-disciplinary Culture of Excellence and itbecame the name for our shared governance initia-tive.

Choosing CommitteesVOICE began with four main committees: Cre-

ating Our Culture, Quality Unity Empowerment,Clinical Practice, and the Educational GoverningGroup. These committees were chosen based ofthe purpose of each group: staff satisfaction, qual-ity, practice based on evidence and research, andthe importance of education. In addition to thesefour committees, Falls, Skin and Wound Assess-ment Team, and a staff-driven advisory committeeto work on our new clinical computer system wereadded to the shared governance structure. As activ-ity grew in the areas of evidence based practice andnursing/clinical research, the Interdisciplinary Evi-dence Based Practice and Research Committee wasadded in 2010. The following is a brief explanationof the current eight interdisciplinary committees inVOICE. Additional information can be found inTable 1.

1. Clinical Practice Committee: To facilitate theintegration of evidence-based findings into rel-evant aspects of clinical practice by having re-search and education provide the basis for cur-rent, comprehensive clinical practice.

2. Quality Unity Empowerment Team: To reviewand monitor identified quality indicators andsubsequent data elements relating to quality pa-tient care and safety initiatives. Emphasis will be

placed on the enhancement of continuous per-formance improvement and include focusing onthe quality care standards set forth by regulatoryagencies.

3. Creating Our Culture: To foster, in a collab-orative effort between the hospital and the en-tire population we serve (team members, physi-cians, volunteers, patients, and the community),the development and implementation of recruit-ment and retention programs that assist in build-ing foundations of our workforce culture.

4. Educational Governing Group: To provide ed-ucation that is culturally diverse, standardized,and focused on prevention as well as teaching.

5. Computer Advisory Committee: To facilitatechanges and workflow processes related to theelectronic medical record (EMR). These en-hancements will focus on improving patientsafety and quality, meeting regulatory standards,and increasing efficiency and effectiveness for theend user.

6. Skin Wound and Assessment Team: To re-duce pressure ulcers at the hospital. They dothis through educating patient, families, teammembers, and physicians.

7. Falls Committee: To reduce preventable fallsand the severity of injury with patients.

8. Interdisciplinary Evidence-Based Practiceand Research Committee: To facilitate the useof educational opportunities, effective commu-nication, and available resources for clinical staffregarding research processes and evidence-basedpractice.

StructureFirst, these eight VOICE committees are com-

prised only of staff level team members, as direc-tors and supervisors are ineligible to be committeemembers. Second, each of the staff led commit-tees has adopted its own charter, and with electedco-chairs, controls the committee agenda and out-comes of the group. Third, all committees haveassigned clerical staff with laptops, thus enablingthe ability to take minutes and complete projects.Fourth, all committees have co-facilitators that areleaders. These facilitators do not have voting privi-leges. Last, key resources are available to the sharedgovernance committees either by being at the meet-ing or being accessible through pager/email. Exam-ples of such resources include marketing, informa-tion technology, legal counsel, and education andresearch.

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TABLE 1. VOICE Committee Grid

Currentcommittee Charter Previous committees Current participants

ClinicalPracticeCommittee(CPC)

To facilitate the integration of evidence-basedfindings into relevant aspects of clinical practiceby having research and education provide thebasis for current, comprehensive clinical practice.A simple two-thirds majority vote of those CPCmembers present is required to pass a resolution.Enhance quality clinical care by providing anenvironment for interdisciplinary collaborationand professional development, establishing andrevising guidelines for practice based onrecognized nursing and clinical research, availablescientific evidence, and/or expert opinion,supporting advanced practice roles in partnershipwith advanced practice nursing committee, andto review, recommend changes, and approveclinical forms in partnership with formscommittee.

• Guidelines for Practice

• Clinical Research• Clinical Practice 10 RNs• Magnet Steering 1 LOTR• Advanced Practice Nurse 1 Pharmacist• Interdisciplinary Clinical

Guidelines Committee1 RRT

• Documentation 1 Clerical

CompasAdvisoryCommittee(CAC)

To facilitate changes and workflow processes relatedto COMPAS. These enhancements will focus onimproving patient safety and quality, meetingregulatory standards, and increasing efficiencyand effectiveness for the end user. Review,recommend, or approve adjustments to proposedCERNER or EJGH changes in Powerchart thataffect users from multiple areas. The currentCOMPAS Educator will remain as a constantmember of the group. The Clinical ApplicationsDesign and Development Supervisor and aDirector/Supervisor of Nursing unit will hold theco-facilitator role.

12 RNs

3 RNsCreating Our

Culture(COC)

To foster, in a collaborative effort between EastJefferson General Hospital and the entirepopulation we serve (team members, physicians,volunteers, patients and the community), thedevelopment and implementation of recruitmentand retention programs that assist in buildingfoundations of our workforce culture. Increasediversity awareness throughout the hospital andtake advantage of the diverse perspectives of allteam members to enhance team membersatisfaction and hospital performance.Re-examine the Dress Code policy and makerecommendations on revisions to Administration.Find fun ways to communicate to team members.Evaluate and make recommendations regardingthe best way to “re-energize” our Guest Servicesculture. To promote the professional developmentof team members by encouraging, facilitating,and rewarding the Team Member’s sense ofaccountability for the practice of their disciplineand for the mentoring of fellow team members atEJGH. There will be Chair and Co-Chair. Thecouncil would vote on these appointments.Membership would comprise 10-12 teammembers. Three nursing team members, threeclinical team members, and four nonclinical teammembers. Two additional team members of anydiscipline, but not to exceed four nurses.

1 Anes. Auditor1 Chaplain, 1EMT

• Reach In/Reach Out 1 Guest Svcs. Liaison• Image 1 HIM

Co-coordinator• Values 1 Recruiting

Supervisor• Peer Review 1 Security Officer• Spirit Team 1 Social Worker

1 Clerical

(continued on next page)

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TABLE 1. VOICE Committee Grid (continued)

Currentcommittee Charter Previous committees Current participants

EducationGoverningGroup (EGG)

To provide patient education that is culturallydiverse, standardized and focused on preventionas well as teaching. Determine number of hits tosite with assistance of IT. Determine complianceof handouts being given to patients—report fromCOMPAS indicating when clinical membersdocument handouts given.

• Patient EducationGroup

8 RNs, 1 RD, 1 RRT

• Allied Health 1 RT, 1 PT• Education Council 1 Social Worker• Clinical Instructor

Group1 Clerical

Falls Committee To decrease preventable falls and the severity ofinjury associated with falls in all patientpopulations. Decrease EJGH hospital-wide fallrate to 2.5 falls per 1,000 adjusted patient days orbetter in 2010 (2009 falls rate 3.3%, NDNQIbenchmark 2.5%). Decrease severity level 3 fallsrate to 1% or better in 2010 (SL3 rate for 2009was 2.2%). Identify interventions in order todecrease preventable falls, especially Severity 3falls. Champion standard rounds by utilization ofthe Guide for Patient Comfort Rounds. Conducta nursing research study with a focus on fallsprevention. Falls will report to QUE throughVOICE.

6 RNs, 2 CNAs, 1 PT1 Pt. Transport1 Clerical

InterdisciplinaryEvidence-Based Practice& ResearchCommittee(IEBPRC)

To facilitate the use of educational opportunities,effective communication, and available resourcesfor EJGH clinical staff regarding researchprocesses and EBP practice by linking availableresources with identified needs of clinicalinvestigative teams, expanding communicationand enhancing recognition of scholarly workconducted by clinical team members,orchestrating education of staff on relevant andevolving aspects of Evidence-Based Practice andResearch. Outcomes for the committee will focuson the main areas of responsibility: resources,communication, and education.

3 Staff RNs3 Clinical staff1–2 Research

facilitators1 Non-traditional role

RN1 CNS1 Hospital Librarian

Quality UnityEmpowermentTeam (QUE)

To review and monitor identified quality indicatorsand subsequent data elements relating to qualitypatient care and safety initiatives at EJGH.Emphasis will be placed on the enhancement ofcontinuous performance improvement andinclude focusing on the quality care standards setforth by regulatory agencies. Develop plans forquality improvement, and facilitateimplementation and monitor for effectiveness.Monitor hospital quality care report and otherdata for indications for quality improvement.Monitor National Patient Safety Goals andaddress processes that improve patient safety.

• Staffing Effectiveness• Symptoms

Management• Procedural Sedation 12 RNs• Code/Rapid Response

Team1 RRT

• Medication ProcessReview Committee

• Skin Wound andAssessment Team

Skin Wound andAssessmentTeam (SWAT)Committee

To educate staff and patient family members onprevention measures for pressure ulcers andultimately reduce pressure ulcers at EJGH.

11 RNs, 1 PT, 1Clerical

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ProcessAll interdisciplinary committees meet on the

same day, at the same time (8-hr day), and in thesame room. The day’s agenda is sent out to allVOICE members the week before the meeting date.The structure allows all of the committees to focuson set projects, maximize collaborative decision-making, and utilize available resources. Each personin that meeting is considered a resource to the entiregroup. As an example, it is not uncommon to havea nurse analyst be asked to spend a few minuteswith another committee to listen to their ideas thatwould include computer changes. Before this struc-ture was developed, work often came to a halt untilthose questions could be posed to the appropriateresource.

Voice members are our future leaders. As a com-mitment to their professional development, thereare educational sessions offered to the group. Theeducational sessions are topics that the commit-tee members recommended from an annual educa-tional survey. Currently VOICE has an educationalsession every month rotating the educational time(half hour and an hour) with the hour session ap-proved for contact hours.

At the end of the day, each group has time toreview its minutes and prepare for report out. Eachcommittee has approximately ten minutes to high-light their work of the day and share pertinent in-formation with all VOICE members. Each VOICEmember is considered an ambassador and is ex-pected to bring back relevant information to theirdepartments. All leaders are invited to attend reportout, as it is important for them to be aware of theprogress and accomplishments of the committees.Committee minutes are emailed to the CNE andposted on the facilities’ intranet for all team mem-bers to read.

Members of VOICE designed our model seen inFigure 1 to illustrate how the shared governanceprocess works. The environment is created to begoal-driven, facilitate two-way communication, andconducive to getting work accomplished within thetime allotted. Throughout the day, the hourglassmodel rotates several times, denoting the dynamic,fluid nature of the process. At the end of the VOICEday, the hourglass has stabilized and completely in-verted symbolizing completion of committee workand communication to VOICE members and hos-pital leaders.

OUTCOMES AND METRICS

Specific Committee Outcomes Relate toOrganization’s Strategic Plan

Throughout the entire organization, the hospi-tal focuses on excellence with measurements fallingunder six pillars. These six pillars include service,finance, quality, people, community, and growth(Studer 2003, 49–51). In keeping with the organi-zational focus on excellence, VOICE outcomes havea direct positive impact on each of the six pillars.The following includes excerpts of the committees’achievements and accomplishments.

Service. For the Computer Advisory Committeemore than 31 computer workflow enhancementswere made that impacted the clinical operationsthroughout the organization. Many of these new orrevised designs were recommendations from otherVOICE committees. Other major accomplishmentsincluded the following:

• Improvement of computer down time process;• Implemented backup of electronic order sets and

paper forms for down time use;• Coordinated pilot of new computer carts and

selected a new standard for the hospital; and• Assistance to clinical applications department

with implementation and improvements to edu-cation tree approach to computer education andtraining for staff.

People. The Education Governing Group in-creased participation in “Eggstravaganza” by chang-ing a stationary educational exhibit to a roving stylein-service, bringing the education directly to theteam members. When beginning education as a sta-tionary event it had 30 participants; when doingroving in-services, this increased by 20% and con-tinues to improve.

Quality. The Skin Wound Assessment Team hasincreased staff awareness regarding accurate skin andwound assessments while incorporating the use oftechnology. The C5 handheld device allows clini-cal staff to take electronic pictures, which can beimported into the EMR for better skin and wounddocumentation. The C5 project went hospital wideon August 2010 and has had positive results. Over-all there was a 31% reduction of hospital-acquired

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FIGURE 1. VOICE Illustrative Model.

wounds from the first quarter to the fourth quarterof 2010. This is a direct impact of accurate doc-umentation upon admittance, and hold the staffnurse accountable for through assessments.

Finance. The Falls Committee’s major accom-plishment has been the reduction of level 3 fallswith serious injury from a high of 13 per year in2009 to an all time low of 4 in 2010. This has asignificant financial impact, as healthcare organiza-tions do not get reimbursed for care and treatmentof patients who sustained a preventable fall occur-ring in the organization.

Growth. The Clinical Practice Committee assiststhe organization to continually grow while incorpo-rating evidence-based practice into organizationalpolicy and procedures. The committee’s major ac-complishment has been reviewing multiple elec-tronic resources and selecting the final application tovalidate current standards and practice. This grouphas also developed a process to review and integratethe evidence-based practice procedures in to thehospital’s guidelines. In 2010, a total of 51 guide-lines were reviewed and approved. The old formscommittee has been integrated allowing 50 formsreviewed and approved in this same year.

Community. The Creating Our Culture Commit-tee has elevated team member participation in hos-pital and community events. These events includecollecting of school supplies for public school chil-dren, working with Second Harvesters, gatheringbooks and pajamas for shelters, hosting the Trunkor Treat event for team members’ children (close to

1,000 children to safely trick or treat) and adopt-ing a senior citizen during Christmas (Senior Santaprogram for nursing home residents). Over 500 giftswere distributed to residents of five nursing homesin 2010.

Increased job satisfaction. Through antidotalevidence, it has been noted that participation inVOICE positively affects job satisfaction. The fol-lowing are examples of VOICE members’ com-ments:

• A registered nurse (RN) on the Quality UnityEmpowerment Team stated, “VOICE allows staffto know the hospital is listening.” VOICE pro-vides an avenue to be a part of the process toimprove the system resulting in enhanced patientand employee outcomes.

• A care manager on the Skin Wound and Assess-ment Team stated, “VOICE gives the power backto staff to make decisions in their day to day care.”

• A clinical PharmD stated, “Clinical PracticeCommittee, with review of policies, emphasizesthe importance of the front line staff involved inthe process.”

• A physical therapist stated, “I’ve learned a lot byattending VOICE days and always go back to mydepartment to share what I have learned. I haveused information about falls prevention to keepmy patients safe.”

• An emergency medical technician stated, “I havebeen participating in VOICE for three years andhave seen the positive impact that Creating OurCulture has on our Team Members and the Com-munity.”

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• An RN on Clinical Practice stated, “By partici-pating in VOICE, I feel included and valued ineveryday operations of this hospital.”

As mentioned previously in this article, VOICEmembers are our future leaders whether that lead-ership is realized at the bedside or within an ad-ministrative role. Since 2007, four of our VOICEmembers have been promoted to leadership posi-tions.

Continual Improvement and New ChangesAnnually VOICE assesses the current year and

gives feedback for improvement for the upcom-ing year. Changes made in the past and future ismade with the effort of continual enhancements tothis evolving journey. For 2011, many changes weremade. There will be a reduction of the typical 8-hrday to 6 hr, facilitators have been rotated, chartersreviewed/revised with focus on membership needs,and clerical support was assessed along with redistri-bution for the committees. Education will continueto be provided monthly. As Tim Porter-O’Gradystated, “The pace of change is unrelenting and in-exorable” (Porter-O’Grady, 2008). The benefit thisorganization has reaped has been and continues tobe a positive force with the interdisciplinary effortsthat have demonstrated growth, improved commu-nication, and focused on moving forward.

ACKNOWLEDGMENTS

Thanks to Janice Kishner, RN, MSN, MBA, FACHE, ChiefNurse Executive, for her vision and support to our organiza-tional shared governance. Thanks to Dr. Barbara Bihm, RN,

DNS, Nurse Researcher, and Bernie Cullen, RN, MSN, NEA-BC, Clinical Research Coordinator, for their encouragementand guidance in the publication process.

REFERENCES

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American Organization of Nurse Executives. 2006, April18. Guiding principles: The role of the nurse executivein patient safety. http://www.aone.org/aone/resources/PDFs/AONE GP Role Nurse Exec Patient Safety.pdf (accessedDecember 13, 2010).

Bednarski, D. 2009. Shared governance: Enhancing shared gov-ernance. Nephrology Nursing Journal, 36 (6): 585.

Carroll, J. 2002. Crossing the quality chasm: A new healthsystem for the 21st century. Quality Management in HealthCare 10 (4): 60–1.

Church, J. A., P. Baker, and D. M. Berry. 2008. Shared gov-ernance: A journey with continual mile markers. NursingManagement 39 (4): 34–40.

Drenkard, K. 2005. Sustaining magnet: Keeping forces alive.Nursing Administration Quarterly 29:222–41.

Dunbar, B., B. Park, M. Berger-Wesley, and T. Cameron. 2007.Shared governance: Making the transition in practice andperception. Journal of Nursing Administration 37:177–83.

Gaguski, M., and P. Begyn. 2009. A unique model of sharedgovernance. Oncology Nursing Forum 36:385–88.

Kramer, M., and V. Schmalenberg. 2003. Magnet hospitalnurses describe control over practice. Journal of Nursing Re-search 25:434–452.

Porter-O’Grady, T. 2001. Is shared governance still relevant?Journal of Nursing Administration 31:468–73.

Porter-O’Grady, T. 2008. Creating an innovative nursing or-ganization. http://www.tpogassociates.com/reference/2008/innovativenursing.pdf (accessed December 27, 2010).

Redman, R. W. 2006. The challenge of interdisciplinary teams.Research and Theory for Nursing Practice 20:105–7.

Saylor, D. L. 2007. Shared governance: Your opinion matters.Nursing Critical Care 2 (6): 12–3.

Studer, Q. 2003. Hardwiring excellence. Gulf Breeze, FL: FireStarter.

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