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