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The 3 D’s of Shared Governance Decision Making
Most of us don’t feel empowered to influence the decisions made about our work. The Shared Governance Advancement Team, a group of frontline nurses and leaders at U of U Health who aim to advance nursing professional practice, introduce a simple framework (The 3 D’s) that empowers each and every team member to influence local decision-making.

teams begin to huddle and discuss shared governance problems, ideas, needs, and suggestions (PINS), they quickly find that some PINS are simple to resolve as a team, while others feel overwhelmingly beyond their control.

The 3 D’s of Decision Making Framework is a guide for working on PINS as a team:

  1. Discuss
  2. Decide
  3. Do the work—together

Use the table below to determine if this is a decision the team can make on their own:

Next, use this "How to Resolve PINS Guide" to determine the level of difficulty to resolve (L1-L4). It can help you understand how long it will take, who might be needed, and if/when to advance to other councils for assistance. 


Determine PINS priority and whether to pursue.

What is the degree of URGENCY?

  • High = preventing work
  • Medium = needs attention
  • Low = nice to have

What is the FEASIBILITY?

  • Can the PINS be achieved with existing resources?
  • Does the team have bandwidth to address?

Is it IMPORTANT to the team?

  • All members should feel accountable for the group’s decisions and final outcomes.
  • If you don’t have consensus, take a vote! (see Shared Governance Bylaws ↓ )

Designate who will do what, by when.

All members should feel accountable for the group’s decisions and final outcomes.

1.  Identify team members to work on PINS.

  • Ask for volunteers. Start with the individual(s) who identified the PINS. 
  • If no one volunteers, consider if this is something that meets urgency/feasibility criteria and if it should be placed on hold.
  • Consider initially partnering less experienced staff with more experienced staff to foster skill development and increase confidence in abilities.

2.  Once staff are identified to work on PINS:

  • Refer to the “How to Complete PINS Toolkit” for templates to guide your work.
  • Team Chairs enter PINS into Empower U Website and informs manager of support needed (if any).
  • Work with manager:
    • Resources and support
    • Remove barriers
    • Create time for team to work
      • During shift (redistribute workload)
      • Designate protected time away from regular work duties/hours

What happens when we don't all agree?

Disagreement is a normal, healthy part of shared decision making. To help make it easier for teams, the Shared Governance Bylaws has a special section on voting. Team Chairs help lead the voting process. We've adapted the bylaws below to help you get started.

Shared Governance Bylaws - Voting Process

1. Aim for consensus (after critical dialogue, of course)

Consensus occurs when everyone is present and in agreement. We achieve consensus, or group agreement, by discussing ideas and opinions in a respectful manner during huddles or meetings. It's crucial to recognize that disagreement isn't a bad thing; rather, it helps us steer clear of groupthink. Groupthink arises when teams prioritize consensus over critical thinking in decision-making, potentially leading to flawed decisions, limited perspectives, and unwarranted confidence.

2. If no consensus, take a vote!

If everyone isn’t on board, the Team Chair leads a vote using the following four principles:

Representation: “Representation” means that Team Chairs make sure that team members affected by the decision are included in the decision-making. If team members aren’t present for the vote, they can share their vote with another team member or Team Chair before/after the discussion.

  • Voting options (find one that works best for your team):
    • Leave tick marks on PINS
    • Post a voting sheet on unit/in clinic
    • Electronic polls with a deadline

Quorum: A “quorum” is the minimum number of team members that need to be present to make a decision. Team Chairs can determine a quorum for PINS that have limited impact on the team (e.g., L1 PINS). The vote can then be taken by all members present at the time. For Excellence Councils, a quorum must have at least 50% members present of which at least 75% are clinical RNs and no more than 25% can be leaders.

Voting: Team Chairs can also request that absent team members vote on the issue before a final decision is made:

  • Adoption of a decision, with a quorum, is two thirds of the vote (clear majority).
  • Abstentions (declining to vote) are excluded when calculating a vote.

Tiebreaker: The team will adopt the chair/co-chair’s vote(s) as the final direction to resolve any tie-breaker situations.

3.  Appeals process

If a team member(s) strongly disagrees with the final decision or how the decision was made, they can escalate concerns in writing to AskNursing@hsc.utah.edu  no later than 2 days after the motion has passed. A member of the Coordinating Council will review all concerns and help determine next steps.

See the complete Shared Governance Bylaws here.


Annie Kamerath

RN, Outpatient Liver Clinic, University of Utah Health

Consuelo Ogden

RN, South Jordan Health Center Short Stay, University of Utah Health

Jannda Bartlome

RN, Inpatient Critical Care, University of Utah Health

Kim Mahoney

Director, Experience Design, Department of Patient Experience and Accelerate Learning Community, University of Utah Health

Mary-Jean (Gigi) Austria

Magnet Program Director, Nursing Support Services, University of Utah Health

Sara Clark

RN, Outpatient Cardiology, Farmington Health Center, University of Utah Health

Tina Hepner

Director, Sugar House, Redwood, and Redstone Health Centers, University of Utah Health

Zlata Muhamedagic

Sr. Director, Nelson Rehab Hospital, University of Utah Health

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