A brand-new nursing shortage is revitalizing shared governance. This innovative organizational model gives staff nurses control over their practice and can extend their influence into administrative areas previously controlled only by managers. But nursing shared governance is hard to define. Its structures and processes are different in every organization; and its implementation is like pinning Jell-O ® to a wall. Is it appropriate for every situation? Is it worth the price? And can it really measure up to its glowing reputation? This article presents an overview of nursing shared governance, looking at themes and experiences from its rich 25-year tradition. The author identifies its essential elements, provides guidance for professionals who wish to embark on the journey, and describes the current status of shared governance as of 2004.

governance --- shared governance --- control over practice --- professional practice models --- power --- authority

Shared Governance is an idealized state that many nurse leaders strive to achieve. As a concept in the nurse leader's tool kit of 'best practices', many leaders find that shared governance is attainable; others find that reaching this state of organizational and nurse empowerment is elusive. Dr. Hess proposes that the new nursing shortage is bringing attention once again to the draw of shared governance models where nurses have control over their practice and exert influence over decisions that affect their practice. While some organizations have recently embraced the shared governance strategy with renewed vigor, others have worked long and hard to make shared governance a reality and an integral part of the organizations' operations. The following observations are brought to the reader from the perspective of a nurse executive immersed in major health system transformation at a time of critical under-availability of professional nurses.

This article describes the implementation of a trust-wide shared governance structure in Barts and The London National Health Service Trust in the United Kingdom. Barts and The London is a large teaching trust, employing over 6,500 staff. The implementation process is described in detail and is followed by details of the current shared governance structure, an overview of the evaluation of the structure, and the objectives of each of the four nursing teams: the Quality, Management, Education, and Clinical Practice Teams. Also included are examples of the achievements of each of the teams and a personal account of one nurse who joined the Trust after shared governance had been implemented.

shared governance --- empowerment --- councils --- nursing teams --- facilitation --- effective meetings --- outcomes

Acquiring organizational autonomy and control over nursing practice, through a combination of traditional and non-traditional collective bargaining (CB) strategies, is emerging as an important solution to the nursing shortage crisis. For the past 60 years, nurses have improved their economic and general welfare by organizing through traditional CB, particularly during periods of nursing shortages. During the past decade, however, the downsizing of nursing staffs, systems redesign, and oppressive management practices have created such poor nursing practice environments that improvement in wages no longer is viewed as the primary purpose of CB. Much more essential to nurses is assuring they have a safe practice environment free of mandatory overtime and other work issues, and a voice in the resource allocation decisions that affect their ability to achieve quality health outcomes for patients. The thesis presented in this article is that traditional and non-traditional CB strategies empower nurses to find such a voice and gain control over nursing practice. This article describes the current shortage; discusses how CB can be used to help nurses find a voice to effect change; reviews the American Nurses Association’s (ANA's) history of collective action activities; explains differences between traditional and non-traditional CB strategies; and presents a case study in which both strategies were used to improve the present patient care environment.

collective bargaining --- control over nursing practice --- organizational autonomy --- professional autonomy --- empowerment --- National Labor Relations Act --- interest-based bargaining --- strikes --- mandatory overtime --- distrust of management --- quality health outcomes --- Magnet status --- shared governance --- unions.

Online health promotion materials have great potential to reach persons with disabilities and provide valuable information to this vulnerable population. While health promotion efforts are important for everyone, they are crucial for individuals with disabilities. Yet information needed to support these efforts is often presented in such a way that its access is limited or its content is inappropriate for this population. Whether designing or selecting online materials for individuals with disabilities, nurses can benefit from knowledge about strategies to make web sites more accessible or to assess the accessibility of existing web sites. The task of providing health promotion information to women with disabilities was undertaken as part of the Health Promotion for Women with Disabilities Project at Villanova University College of Nursing. A web site was created as one method of providing information. This paper presents strategies that are used to make this site accessible.

online information --- health promotion --- health education --- disability --- accessible design --- accessibility tools --- telehealth