66 unit 1 | Professional Considerations
Participation in Decision Making
Actions can be taken by managers and higher-level
administrators to empower nursing staff. The
amount of power available to or exercised by a
given group (e.g., nurses) withinan organization
can vary considerably from one organization to the
next. Three sources of power are particularly
important in health-care organizations:
■Resources.The money, materials, and human
help needed to accomplish the work
■Support.Authority to take action without
having to obtain permission
■Information.Patient care expertise and knowl-
edge about the organization’s goals and activities
of other departments
In addition, nurses also need access to opportunities:
opportunities to be involved in decision making, to
be involved in vital functions of the organization, to
grow professionally, and to move up the organiza-
tional ladder (Sabiston & Laschinger, 1995).
Without these, employees cannot be empowered
(Bradford & Cohen, 1998). Nurses who are part-
time, temporary, or contract employees are less
likely to feel empowered than full-time permanent
employees, who generally feel more secure in their
positions and connected to the organization
(Kuokkanen & Katajisto, 2003).
Shared Governance
In shared governance, staff nurses are included in the
highest levels of decision making within the nursing
department through representation on various coun-
cils that govern practice and management issues.
These councils set the standard for staffing, promo-
tion, and so forth. In many cases, a change in the
organizational culture is necessary before shared
governance can work (Currie & Loftus-Hills, 2002).
Genuine sharing of decision making is difficult
to accomplish, partly because managers are reluc-
tant to relinquish control or to trust their staff
members to make wise decisions. Yet genuine
empowerment of the nursing staff cannot occur
without this sharing. Having some control over
one’s work and the ability to influence decisions are
essential to empowerment (Manojlovich &
Laschinger, 2002). For example, if staff members
do not control the budget for their unit, they can-
not implement a decision to replace aides with reg-
istered nurses without approval from higher-level
management. If they want increased autonomy in
decision making about the care of individual
patients, they cannot do so if opposition by another
group, such as the physicians, is given greater cre-
dence by the organization’s administration.
Return to the example of the staff of the critical
care department (Scenario 2). Why did the vice
president for nursing tell the nurse manager that
the plan would not be implemented?
Actually, the vice president for nursing thought
the plan had some merit. He believed that the pro-
posal to implement a nurse-managed model of
care for the chronically critically ill could save
money, provide a higher quality of patient care, and
result in increased nursing staff satisfaction.
However, the critical care department was the cen-
terpiece of the hospital’s agreement with a nearby
medical school. In this agreement, the medical
school provided the services of highly skilled
intensivists in return for the learning opportunities
afforded their students. In its present form, the
nurses’ plan would not allow sufficient autonomy
for the medical students, a situation that would not
be acceptable to the medical school. The vice pres-
ident knew that the board of trustees of the hospi-
tal believed their affiliation with the medical
school brought a great deal of prestige to the
organization and that they would not allow any-
thing to interfere with this relationship.
“If shared governance were in place here, I think
we could implement this or a similar model of
care,” he told the nurse manager.
“How would that work?” she asked.
“If we had shared governance, the nursing
practice council would review the plan and, if
they approved it, forward it to a similar medical
practice council. Then committees from both
councils would work together to figure out a way
for this to benefit everyone. It wouldn’t necessar-
ily be easy to do, but it could be done if we had
real collegiality between the professions. I have
been working toward this model but haven’t con-
vinced the rest of the administration to put it into
practice yet. Perhaps we could bring this up at the
next nursing executive meeting. I think it is time
I shared my ideas on this subject with the rest of
the nursing staff.”
In this case, the organizational goals and
processes existing at the time the nurses developed
their proposal did not support their idea. However,
the vice president could see a way for it to be
accomplished in the future. Implementation of real