Leadership in Nursing: Centralized vs Decentralized Management, Shared Governance, and Nursing Care Models

Running head; Leadership in nursing 1
Leadership in Nursing
Student’s name
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Leadership in nursing 2
Question 1
Centralization and decentralization are the two main structures of an organization. An
organization can adopt either structure in the running of its activities to achieve certain desired
outcomes. In a centralized management, Harper, (2015) the power to make decisions is
concentrated at the top management. The decisions made at the top are communicated to other
levels of workers in a rather vertical system. However, in a decentralized management, the
power to make decisions is delegated to other levels of staff. The decisions made at the
decentralized organization reflects team participation and delegation.
According to Piper, & Schneider, (2015) one major difference between the centralized
and the decentralized organization is the structure and authority. In a centralized system, few
people make decisions and pass the decisions to the other workers at lower levels of
management. The decision making in the centralized organization is comparatively slow but it
reflects higher levels of coordination and leadership. The centralized structure is largely
practiced in small organizations. On the other hand, in a decentralized system, the authority to
make decisions is delegated to different levels of management across the management structure.
The decision making is relatively faster and there is collective responsibility and sharing of
burden. This system is mainly practiced in larger organizations.
In my unit, I would prefer the decentralized organization despite the fact that it is a small
unit with only 25 medical beds. The main reason is that the decentralized system unlike the
centralized system empowers the employees to propel the organization forward by having the
organization’s objectives and goals when carrying out activities and discharging duties. Again,
when people are empowered to make decisions, they are not only bound to implement these
decisions but they are also obliged to ensure that they work for the common good of the

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organization. Decision making is also considerably faster in a decentralized system which
increases performance of the employees argues Thomas, (2015). It is therefore in my view that a
decentralized system would be more effective as opposed to a centralized one.
Question 2
Shared governance refers to collaboration with staff in decision making to achieve
desired outcomes such as high quality care, professionalism and competence and developing a
holistic approach to care. Shared governance focuses on six major aspects which include;
defining the confinements of decision making, collaborative efforts between staff and workers,
meeting formally and more often, agendas to be discussed are planned and disseminated prior to
the meeting, relationship between members and staff is guided by well stipulated and spelled out
principles and finally, there is continued strive for consensus in decision making which reflects
shared decision making.
Blais, (2015) holds that shared governance has several advantages that makes it an
effective and efficient model of governance. Shared governance empowers employees as they
feel an integral part of the organization. The model encourages accountability from employees as
it has a natural system of ensuring checks and balances where every employee has a stake in
decision making and implementation process. Shared governance also encourages
communication and team work among employees which helps to improve quality and
consistency. Better decisions are arrived at due to involvement of a larger team.
The disadvantages of shared governance are; for one, it slows decision making as the
workers struggle to achieve a consensus decision. The time taken to plan and organize various
activities also slows the progress of the organization. Another disadvantage is that the fact that