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The relationship of authority to decision-making behavior: implications for redesign
1Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA.
Research in Nursing & Health
|October 16, 1999
Summary
Healthcare redesign aims to improve quality and reduce costs. This study found that while administrative and professional authority in nursing practice environments have a small impact on nurses' decision-making participation, other factors are crucial for meaningful change.
Area of Science:
- Nursing Practice and Healthcare Management
- Organizational Psychology in Healthcare
Background:
- Healthcare environments undergo redesign driven by cost and quality imperatives.
- Nursing practice environment redesign focuses on care delivery structure and process.
- Enhancing nurses' participation in decision-making is linked to improved patient and organizational outcomes.
Purpose of the Study:
- To investigate the influence of administrative decentralization and professional authority on nurses' participation in caregiving and condition-of-work decision-making.
- To assess the impact of structural elements on the process of nurses' involvement in decision-making.
Main Methods:
- A stratified sample of 300 registered nurses from medical-surgical units participated.
- Statistical analysis was employed to determine the relationship between structural dimensions and decision-making participation.
Main Results:
- Administrative and professional authority explained a small, yet statistically significant, portion of the variation in nurses' participation in decision-making.
- The limited explained variance suggests that increased authority alone may not automatically lead to greater decision-making engagement.
Conclusions:
- Redesigning nursing practice environments requires consideration of multiple factors beyond administrative and professional authority to enhance nurses' participation in decision-making.
- Findings challenge the assumption that greater authority directly translates to increased exercise of that authority.
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