1. Decisional Involvement: The Perceptions of Staff Nurses and Nurse Managers Cindy A. Scherb, PhD, RN Janet P. Specht, PhD, RN, FAAN Jean Loes, MS, RN

2. Significance of Study Decisional involvement is the perceived distribution of authority for decisions and activities that govern nursing practice, policy, and the practice environment. (Havens & Vasey, 2003)Decisional involvement is the perceived distribution of authority for decisions and activities that govern nursing practice, policy, and the practice environment. (Havens & Vasey, 2003) Environments with more nurse decisional involvement have better retention. ( McClure & Hinshaw, 2002 )Environments with more nurse decisional involvement have better retention. ( McClure & Hinshaw, 2002 ) The need to provide empirical data to inform nurse administrators about effective organizational features.The need to provide empirical data to inform nurse administrators about effective organizational features.

3. Purpose To explore the nurse ratings of actual and preferred decisional involvement of RNs and describe implications for nurse managers.To explore the nurse ratings of actual and preferred decisional involvement of RNs and describe implications for nurse managers. Used a subset of data from a larger study that examined the relationships among perceived nurse accountability, decisional involvement, job satisfaction, and nursing-sensitive patient outcomes.Used a subset of data from a larger study that examined the relationships among perceived nurse accountability, decisional involvement, job satisfaction, and nursing-sensitive patient outcomes.

4. Methodology Descriptive cross-sectional designDescriptive cross-sectional design Setting: Midwest rural healthcare networkSetting: Midwest rural healthcare network –Serves 14 counties –250 bed referral center –9 rural critical access hospitals –33 primary care clinics –10 specialty clinics

5. Methodology (cont) SampleSample –All staff nurses, charge nurses, and nurse managers employed by the network –Surveys mailed to 837 RNs in two mailings with a return rate of 39%

6. Instrument Decisional Involvement Scale (Havens & Vasey, 2003)Decisional Involvement Scale (Havens & Vasey, 2003) –21 questions measuring actual and preferred levels of decisional involvement –5-point scale reflecting what group has the authority to make decisions 5 = staff nurses only 4 = primarily staff nurses 3 = equally shared by management & staff nurses 2 = primarily management 1 = administration/management only –Cronbach’s Alpha =.91-.95

7. Findings DemographicsDemographics –N = 320 –Age: Mean = 43.39; SD = 10.58; Range 20 – 73 –Gender: female = 97.8% (N = 312) –Work role: Staff nurses = 91.5%; Nurse managers = 7%; Other = 1.5% –Hours worked per pay period: > 64 hrs = 68.2% –Education: Diploma = 12.9%; Associate = 57.2%; Baccalaureate or higher = 29.8% –Years as a RN: Mean = 17.41; SD = 10.57; Range =.5 - 52 –Years at the organization: Mean = 14.23; SD = 9.68; Range =.5 - 46

8. Decisional Involvement Actual Level: Mean = 44.25 (SD = 11.95)Actual Level: Mean = 44.25 (SD = 11.95) Preferred Level: Mean = 58.29 (SD = 10.84Preferred Level: Mean = 58.29 (SD = 10.84 Paired sample t-test: p =.000Paired sample t-test: p =.000

9. Descriptive Statistics on Selected DIS Items Decisional Involvement Scale Items MeanSDMeanDifferenceMeanDifferenceSD SchedulingActualPreferred2.943.521.14.82.571.01 Unit Coverage ActualPreferred2.853.251.21.89.401.04 Selection of Unit Leader ActualPreferred1.612.49.86.85.881.03 Review of Unit Leader’s Performance ActualPreferred1.772.64.88.87.871.11 Recommendation for Promotion of Staff RNs ActualPreferred1.672.48.76.77.81.876 Specification of Number/ Type of Support Staff ActualPreferred1.822.74.82.75.93.925 Conflict Resolution among RN Staff on Unit ActualPreferred2.392.871.02.83.481.04

10. Correlations Between DIS Items and Demographic Variables Years as RNDecentralization Number of CertificationsHoursWorked per Shift Years at the OrganizationShiftWorked Scheduling-.135*-.142* Unit Coverage -.128*-.128* Selection of Unit Leader-.148**-.159**.125* Review of Unit Leader’sPerformance-.127*-.125*-.143*.121* Recommendation for Promotion of Staff RNs -.140* Specification of Number/ Type of Support Staff -.142* Conflict Resolution among RN Staff on Unit-.132*.135*

11. T-test Results Between Staff Nurses and Nurse Managers Staff Nurse Mean Score NurseManager p Actual Recruitment of RNs to Practice on the Unit 1.882.32.025 Review of Unit Leader’s Performance 1.762.14.053 Determination of Unit Budgetary Needs 1.471.82.032 Determination of Equipment/Supply Needs 2.092.54.012 Liaison with Other Departments re: Patient Care 2.462.91.030 Preferred Scheduling3.553.10.023 Interview of RNs for Hire on the Unit 2.552.18.041 Recommendation of Disciplinary Action for RNs 2.201.82.034 Review of Unit Leader’s Performance 2.672.27.039 Specification of Number/Type of Support Staff 2.782.23.001

12. Areas of Desired Change SchedulingScheduling Unit CoverageUnit Coverage Selection of Unit leaderSelection of Unit leader Review of leader’s performanceReview of leader’s performance Recommendations for promotion of staffRecommendations for promotion of staff #s & type of support staff#s & type of support staff Conflict resolutionConflict resolution Scheduling Interview & hiring of nurses Recommendation of discipline Review of leader’s performance #’s & type of support staff Staff NursesNurse Manager (highest disagreement)

13. Conclusions Nursing staff perceived they had low actual involvement in decision making, but they did not want a lot of decision making either.Nursing staff perceived they had low actual involvement in decision making, but they did not want a lot of decision making either. Years as a RN and the perceived decentralization of the organization were most often correlated with 7 of the DIS items.Years as a RN and the perceived decentralization of the organization were most often correlated with 7 of the DIS items.

14. Conclusions (cont) Staff nurses perceived they had significantly less actual involvement in decisions related to 5 areas than did the nurse managers.Staff nurses perceived they had significantly less actual involvement in decisions related to 5 areas than did the nurse managers. In 5 areas (only one similar between the actual & preferred) staff nurses preferred to be involved more than the nurse managers perceived they should be involved.In 5 areas (only one similar between the actual & preferred) staff nurses preferred to be involved more than the nurse managers perceived they should be involved.

15. Implications The DIS is an excellent tool to critically assess any dissonance that may exist between the perception of decision making involvement between nurse managers and staff nurses.The DIS is an excellent tool to critically assess any dissonance that may exist between the perception of decision making involvement between nurse managers and staff nurses. The DIS can help to prioritize where more effort should be made to increase decision making involvement. The areas that stand out are in looking at the resources for the unit and leadership skills and abilities.The DIS can help to prioritize where more effort should be made to increase decision making involvement. The areas that stand out are in looking at the resources for the unit and leadership skills and abilities.

16. Implications (cont) The low desired decisional making involvement may be a lack of exposure to the possibilities, rather than a lack of desire for more decisional authority.The low desired decisional making involvement may be a lack of exposure to the possibilities, rather than a lack of desire for more decisional authority. The need to address the nurse manager’s style, comfort, and skill with increased decision- making on the part of staff nurses.The need to address the nurse manager’s style, comfort, and skill with increased decision- making on the part of staff nurses.

17. Implications (cont) The implications for younger, less experienced nurses joining a group that is satisfied with their decisional authority may mean that these newer, less experienced nurses will choose not to stay. Are these generational differences?The implications for younger, less experienced nurses joining a group that is satisfied with their decisional authority may mean that these newer, less experienced nurses will choose not to stay. Are these generational differences?

18. Limitations Small sample size and a one site studySmall sample size and a one site study Nurses reluctance to complete questionnaires when unit needed to be identifiedNurses reluctance to complete questionnaires when unit needed to be identified

19. Research supported by grants from the Winona State University Foundation and the Winona State University Nursing Research Fund.

20. Contact Information Janet P. Specht, PhD, RN, FAAN Associate Professor College of Nursing The University of Iowa Iowa City, IA janet-specht@uiowa.edu (319) 335-6518 Cindy A. Scherb, PhD, RN Professor Master’s Program in Nursing Winona State University Rochester, MN cscherb@winona.edu (507) 280-5565