Decisional Involvement: The Perceptions of Staff Nurses and Nurse Managers

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

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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)
• 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.

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Purpose

• 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.

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Methodology

• Descriptive cross-sectional design
• Setting Midwest rural healthcare network
• Serves 14 counties
• 250 bed referral center
• 9 rural critical access hospitals
• 33 primary care clinics
• 10 specialty clinics

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Methodology (cont)

• Sample
• 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

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Instrument

• 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
• Cronbachs Alpha .91-.95

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Findings

• Demographics
• 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 gt 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

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Decisional Involvement

• Actual Level Mean 44.25 (SD 11.95)
• Preferred Level Mean 58.29 (SD 10.84
• Paired sample t-test p .000

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Descriptive Statistics on Selected DIS Items
Decisional Involvement Scale Items Mean SD Mean Difference Mean Difference SD
Scheduling Actual Preferred 2.94 3.52 1.14 .82 .57 1.01
Unit Coverage Actual Preferred 2.85 3.25 1.21 .89 .40 1.04
Selection of Unit Leader Actual Preferred 1.61 2.49 .86 .85 .88 1.03
Review of Unit Leaders Performance Actual Preferred 1.77 2.64 .88 .87 .87 1.11
Recommendation for Promotion of Staff RNs Actual Preferred 1.67 2.48 .76 .77 .81 .876
Specification of Number/ Type of Support Staff Actual Preferred 1.82 2.74 .82 .75 .93 .925
Conflict Resolution among RN Staff on Unit Actual Preferred 2.39 2.87 1.02 .83 .48 1.04
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Correlations Between DIS Items and Demographic
Variables
Years as RN Decentralization Number of Certifications Hours Worked per Shift Years at the Organization Shift Worked
Scheduling -.135 -.142
Unit Coverage -.128 -.128
Selection of Unit Leader -.148 -.159 .125
Review of Unit Leaders Performance -.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
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T-test Results Between Staff Nurses and Nurse
Managers
Staff Nurse Mean Score Nurse Manager Mean Score p
Actual
Recruitment of RNs to Practice on the Unit 1.88 2.32 .025
Review of Unit Leaders Performance 1.76 2.14 .053
Determination of Unit Budgetary Needs 1.47 1.82 .032
Determination of Equipment/Supply Needs 2.09 2.54 .012
Liaison with Other Departments re Patient Care 2.46 2.91 .030
Preferred
Scheduling 3.55 3.10 .023
Interview of RNs for Hire on the Unit 2.55 2.18 .041
Recommendation of Disciplinary Action for RNs 2.20 1.82 .034
Review of Unit Leaders Performance 2.67 2.27 .039
Specification of Number/Type of Support Staff 2.78 2.23 .001
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Areas of Desired Change
Staff Nurses
Nurse Manager (highest disagreement)

• Scheduling
• Unit Coverage
• Selection of Unit leader
• Review of leaders performance
• Recommendations for promotion of staff
• s type of support staff
• Conflict resolution

• Scheduling
• Interview hiring of nurses
• Recommendation of discipline
• Review of leaders performance
• s type of support staff

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Conclusions

• 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.

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Conclusions (cont)

• 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.

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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 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.

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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 need to address the nurse managers style,
  comfort, and skill with increased decision-making
  on the part of staff nurses.

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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?

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Limitations

• Small sample size and a one site study
• Nurses reluctance to complete questionnaires when
  unit needed to be identified

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Research supported by grants from the Winona
State University Foundation and the Winona State
University Nursing Research Fund.
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Contact Information
Janet P. Specht, PhD, RN, FAAN Associate
Professor College of Nursing The University of
Iowa Iowa City, IA janet-specht_at_uiowa.edu (319)
335-6518
Cindy A. Scherb, PhD, RN Professor Masters
Program in Nursing Winona State
University Rochester, MN cscherb_at_winona.edu (507)
280-5565