Intensity of case managers' participation in organizational decision making

Prior research has indicated that registered nurse (RN) participation in decision making (PDM) is related to better outcomes in nursing homes and hospitals. Little is known, however, about the roles of community-based case managers (CMs), most of whom are RNs. Data from 68 prenatal case management programs were used to test hypotheses about the intensity of CM PDM and to describe their patterns of involvement in decision activities and mechanisms. CMs were most involved in the activity of "raising the issue" and least involved in "choosing the alternative." However, "choosing the alternative" was the strongest predictor of perceived CM influence over the final choice. When CMs were involved in informal meetings and chance encounters with administrators, they were more likely to be perceived as having influence over the final choices made. Intensity of CM PDM varied by decision level and content, supporting two of the three hypotheses. The findings are discussed in light of prior research and complexity theory.