Professional Governance: Another New Concept?

About 40 years ago, Luther Christman, PhD, RN, FAAN, wrote about an autonomous nursing organization where nurses would be empowered to control their nursing practice. His idea was an early framework for shared governance. As a young doctoral student, I explored shared governance as a concept; I became increasingly frustrated trying to understand what it was. Many organizations adopted what they considered shared governance and then adapted it to their setting and culture. In 1990, my dissertation chair and then editor of Nursing Research, Florence Downs, PhD, RN, FAAN, challenged me to define and measure shared governance as I conducted my research. After exploring the literature for 2 years, I realized that shared governance was just 1 component of a larger conceptVprofessional governance. I defined professional governance as Ba multidimensional organizational characteristic that encompasses the structure and processes by which professionals direct, control, and regulate goal-oriented efforts of one another.[As an overarching concept, I theorized that professional governance encompassed a continuum of traditional governance (the bureaucracy that most of us have been brought up with), to shared governance, to selfgovernance (a not-so-hypothetical situation where nurses might own a hospital and employ managers to help them run it). To measure these types of professional governance, I subsequently developed and tested 2 instruments: the Index of Professional Nursing Governance and the Index of Professional Governance, the latter a more generic version for nurses, physicians, pharmacists, and allied health professionals. Today, they are still the most widely cited valid and reliable instruments for measuring professional governance, which includes shared governance. Nursing shared governance is an organizational innovation invented by nurse managers that gives staff nurses legitimate control over their practice and extends their influence into areas previously controlled by managers. It is the whole middle part of the continuum between traditionaland self-governance. But shared governance is not just the midpoint of equally shared power; it is a matter of degrees on the continuum on both sides of that midpointVa matter of what and how much is shared. And no matter how fluffy or ethereal the language applied to shared or professional governance by caring professionals is, any governance is still about authority, control, influence, and power. It does not necessarily have to be a zero-sum game where if I have power over this, you do not, but it still answers the simple question: BWho rules?[ This is still a valid question in every conceivable healthcare organization where professionals work. Because both professional governance and shared governance have repeatedly appeared in literature for more than 30 years, imagine my surprise when a few months ago, I read an article stating it was time for Bclarifying and modernizing the term shared governance by shifting to professional governance,[ as if this term was something new. Despite what was referred to as an in-depth-literature review, not a single past reference to professional governance was cited. I was left wondering what could be new in this old term. Although 4 attributes were introduced as characteristics