Background
Healthcare systems face increasing complexity alongside persistent nursing shortages. Shared Governance, operationalized through Unit Practice Councils, is a professional practice model designed to strengthen nurse engagement, accountability and evidence‑informed decision-making at the point of care. While Shared Governance has been associated with positive nurse outcomes, evidence on the impact of Unit Practice Councils in European academic settings remains limited.
Objective
To evaluate the impact of introducing Unit Practice Councils on nurse engagement, the nurse practice environment and evidence-based practice (EBP) implementation, and to assess the extent to which Unit Practice Councils are embedded into routine practice inpatient units.
Design
Longitudinal observational study.
Methods
Study was conducted across four inpatient units in a Dutch academic hospital. Data were collected at baseline (T0) and at 12-month follow-up (T1) using the Autonomy to Engagement Scan (A tot Z scan), the Practice Environment Scale of Nursing Work Index (PES-NWI) and Evidence Based Practice Implementation Scale (EBP-I). Generalized Estimating Equations were used to analyze changes over time, accounting for interactions between time, council membership, and measurement (paired vs. unpaired). At T1, the Normalization Measure Development (NoMAD) questionnaire was administered to assess the normalization of Unit Practice Councils into routine nursing practice. Differences between council members and non-members were analyzed using the Mann-Whitney U test.
Study registration
Not registered.
Results
A total of 59 nursing staff participated at T0 and 63 at T1, with 36 completing both measurements. Nurse engagement and the nurse practice environment showed small but significant improvements over time (p = 0.006, β=+0.050 and p = 0.048, β=+0.026) with significant interaction effects for council membership (p = 0.016, β=+0.190 and p = 0.008, β=+0.307), indicating increasing scores among council members. EBP implementation remained unchanged in the full sample (p = 0.957). However, council members participating at both time points demonstrated a large and clinically meaningful increase in EBP-I scores (three-way interaction: p < 0.001; β=+21.98). NoMAD results indicated high normalization levels (median=4.26, IPR=3.86-4.62), with significantly higher scores among council members (p = 0.002, r = 0.39), indicating that Unit Practice Councils were becoming embedded in routine nursing practice.
Conclusion
Introducing Unit Practice Councils, particularly alongside structured EBP training, resulted in clinically meaningful improvements in EBP among council members with continuing membership. Council members also showed early positive trends in nurse engagement and the nurse practice environment, while outcomes in the broader nursing workforce remained stable over the 12‑month period. High normalization scores indicate successful embedding of Unit Practice Councils within routine practice in an academic hospital.