NURSING PARTICIPATION IN HOSPITAL DECISION-MAKING (POWER).

Description

Greater knowledge of nursing participation in hospital decision-making is relevant not only to understanding the many dimensions of the hospital's decision-making process, but also to specific outcomes that affect the viability of hospitals as organizations, and the development of nursing as a profession. Seldom, however, have studies addressed the combination of power elements and organizational elements as they relate to hospital nursing. This study examined the nature of nursing participation in hospital decision-making and how various attributes of the hospital organization, the nursing department, and the individual nurse influence the extent of the nurse administrator's participation in hospital decision-making, and the related outcomes of one's job satisfaction and commitment to the hospital organization. A cross-sectional research survey design was used in this study. It was conducted in 24 general hospitals in Baltimore, Maryland. The subjects of the study included full-time registered nurses employed as executive, middle and first-line nurse administrators (n = 606) with an overall response rate of 87%. All participating nurse administrators completed questionnaires to obtain self-reported data. Additional data was obtained from the office of the director of nursing within each hospital, and from documents obtained from the Maryland and the American Hospital Associations. The responses from the nurse administrators indicate that they desire a greater participative role, and that their expectations for participation in hospital decision-making are not being met, particularly in the areas of budget and planning. They see themselves as least frequently involved when compared with physicians, administrators and trustees. The findings from this study suggest that the most important predictors of a nurse administrator's participation in hospital decision-making are one's preference for participation, committee membership and position level. In turn, these predictors are enhanced by the organizational variables of higher nursing membership on medical staff committees, nursing director as vice-president of the hospital, and a higher ratio of nurses to physicians. In addition, participation in hospital decision-making and work autonomy were found to be significant predictors in this study of the job satisfaction and commitment of the nurse administrators.

Subjects