Empowering decisions

BACKGROUND: Shared governance has long supported nurse participation in decision-making, but traditional models often limit full authority and accountability among clinical nurses. Professional governance extends these principles, granting nurses greater ownership over practice decisions. A four-hospital community health system transitioned from shared to professional governance to strengthen consistency, engagement, and decision-making. PURPOSE: This study evaluated whether transitioning to a professional governance structure improved clinical nurses' perceptions of professional obligation, collateral relationships, and decision-making compared with the previous shared governance structure. METHODS: A pre-post design using the Verran Professional Governance Scale (VPGS) measured changes across three domains. Surveys were administered before (n = 280) and after (n = 511) implementation across four hospitals. Mood's median test assessed statistical significance. RESULTS: System-level VPGS mean scores improved across all domains except at one facility. The greatest gains occurred in decision-making. Collateral relationships showed statistically significant improvement ( P = .049), and decision-making approached significance ( P = .051). Decreased variation in responses indicated greater agreement postintervention. One facility with previously strong engagement showed minimal change. CONCLUSIONS: Transitioning to professional governance improved nurses' perceptions of professional obligation, collateral relationships, and decision-making. Systemwide, facility-specific, and unit-based council restructuring significantly enhanced engagement, with notable improvement in decision-making and collaborative relationships.