Is Your Nursing Excellence Culture Built for Adversity?

A staffing shortage cancels another shared governance meeting. A disappointing outcome creates pressure for an immediate response. A new leader arrives with a different way of making decisions. Each situation is understandable. What concerns me is what an organization gives up in response.

When pressure rises, shared decision-making can become one of the first things to go. Leaders take the problem back, decide what needs to happen, and tell staff what to do. The people closest to the work lose the opportunity to help assess the issue and shape the response.

That is where I think the real question of sustainment begins. Is our nursing excellence culture built for adversity? Can it hold up through staffing pressures, leadership changes, and difficult outcomes? Or does it depend on conditions being favorable and the same people remaining in charge?

Sustaining nursing excellence means building ways of working that can absorb those changes while preserving what matters: staff participation, professional judgment, ownership, and the ability to improve care.

Shared ownership has to survive pressure

I understand why leaders want to take control when something goes wrong. They are accountable for results. They may face a deadline, a mandate, or a problem that requires immediate action. It can feel easier to make the decision themselves.

But involving staff means more than asking them to carry out a solution. It means allowing them to assess the problem, discuss what could work, and take part in deciding what happens next. That participation gives people a stake in the decision and its outcome.

In the shared governance model I have built, I describe the balance through a ninety-ten rule. The overwhelming majority of decisions should involve staff, with a smaller portion reserved for leaders to address mandates and urgent needs. That is my guiding approach, not a measured percentage or a requirement for every organization.

There has to be judgment. A critical situation may require a leader to act before a group can meet. A mandate may establish a direction the organization must follow. A sound structure allows for those situations. The problem begins when urgency becomes the default explanation for keeping decisions with leadership.

If staff ownership matters when things are going well, it also needs a place when things become difficult. Otherwise, we are teaching nurses that their voice is welcome only when there is little at stake.

Every leader is one of eleven

When I played football, one of the ideas we emphasized was doing your job as one of eleven. Eleven players represent the team on the field. Each has a responsibility, and the play depends on those responsibilities coming together.

The quarterback may receive the most attention, but a successful pass requires the offensive line to block and receivers to run their routes and get open. The quarterback cannot replace everyone else's contribution. Each player needs to understand the play, own their responsibility, and trust the people around them.

I think about leadership in much the same way. A chief nurse, director, or manager brings direction and individual strengths. But the organization also depends on the leadership of clinical nurses, educators, frontline managers, and people working across departments. Formal titles capture only part of that leadership.

In a healthy culture, those people already have a voice. They have responsibilities, judgment, and knowledge the organization depends on. An incoming leader should learn how that system works and how their own strengths can help it succeed.

That leaves room for new ideas. It also requires respect for what is already working. Shared decision-making, nurse autonomy, and professional development should not be dismantled simply because a different person now occupies the leadership role.

The goal is a culture strong enough to welcome new people without losing its identity. Leaders help develop others and keep the team moving. They do their part as one of eleven.

Accountability and flexibility belong together

Staffing is where these ideas meet a difficult reality. It is easy to support participation in principle. Making time for it when a unit is under pressure takes planning, clear expectations, and accountability.

Two terms guide how I discuss this with leaders: accountability and flexibility. Managers and executives need to be accountable for providing time, space, and opportunities for nurses to participate in shared decision-making and professional development. Nurses also have responsibilities in making that participation possible.

For example, in our approach, nurses are expected to attend their monthly shared governance meetings. They also participate in related work and professional development outside those meetings. When a nurse knows about an upcoming activity, they need to tell their supervisor before the staffing schedule is published.

That advance notice gives the manager an opportunity to plan coverage. It makes participation part of the planning process. If the request arrives after the schedule is published, the manager may still accommodate it, but has flexibility to decline. The expectation is clear for both people.

Critical staffing needs can also prevent attendance. A supervisor needs room to make that judgment. Supporting shared governance does not remove the responsibility to respond to an immediate staffing problem.

However, the organization must also review how often that happens. If the same nurse, unit, or service repeatedly misses participation because of staffing, the issue needs to move beyond the individual supervisor. Executives need to examine it, and if it remains unresolved, it needs the chief nurse's attention.

At that point, the question is bigger than whether someone can attend a meeting. We need to ask why the structure repeatedly prevents nurses from taking part in the work we say is essential. What needs to change so participation becomes possible?

Flexibility works when the process is clear and exceptions remain visible. If the rules are undefined and no one reviews the pattern, a temporary accommodation can become the usual way of operating. Accountability applies to the organization as much as to the nurse or manager.

Protect what works, and rebuild what does not

This argument assumes there is a healthy culture worth sustaining. Coming into an organization where staff have little trust and limited influence is a different situation. A new leader may need to build the structures that are missing.

That work requires listening to nurses, understanding what they value, developing shared decision-making, and creating opportunities for professional growth. It also requires visible follow-through. People need to see that what they say leads to attention and action.

In my earlier article, I Don't Try to Be a Transformational Leader, and Neither Should You, I discussed how trust develops through consistent actions. Giving a strong speech can be useful. Following through on a commitment gives staff something concrete to judge.

That matters here because sustaining a culture and rebuilding one require an honest understanding of the starting point. A leader should know what needs protection, what needs repair, and whose experience is missing from that assessment. Nurses throughout the organization need a part in answering those questions.

Having enough people on a staffing schedule is necessary, but it does not tell us everything about the quality of the practice environment. We also need room for nurses to examine evidence, review data, improve their work, and help shape decisions. Those activities are part of what we are trying to sustain.

For me, the test is what happens when those commitments become difficult to keep. Who still has a voice? Who takes responsibility when participation repeatedly falls through? Do new leaders strengthen the culture, and do existing structures help them join it?

Adversity will come in different forms. Our response should preserve the shared ownership that helps an organization move forward. The question for nursing leaders is whether we have built that capacity into everyday work, or whether excellence still depends on the right person being there to hold it together.