A Statewide Study of the Association of Nurse Involvement in Decision Making and Nurse/Patient Outcomes

Thursday, July 14, 2011: 10:35 AM

Janet Houser, PhD, RN
Rueckert Hartman College for Health Profession, Regis University, Denver, CO
Linda Stroup, RN, MSN
Nursing, Metropolitan State College of Denver, Denver, CO

Learning Objective 1: Discuss how levels of nurse involvement are associated with nurse satisfaction, retention, and intent to leave the organization

Learning Objective 2: Review significant relationships between level and type of nurse involvement and patient outcomes, including measures of patient satisfaction, adverse events, and infections

Purpose: This study described nurses’ perceptions about their level of involvement in hospital decisions. The relationship between staff nurse perceptions of involvement and organizational outcomes was analyzed.

Methods: Fifteen hospitals were selected using stratified random sampling, of which nine submitted usable data. The unit of analysis was a Patient Care Unit (PCU), with a final sample size of 54. Data were collected from staff nurses using an electronic survey. These included eleven “involvement” questions, three questions about intent to leave, and the Practice Environment Scale. Eleven PCU outcome indicators included factors representing patient satisfaction, nurse satisfaction, infections, and adverse events.  Correlation and chi square analyzed the strength and direction of relationships. Multivariate analysis of variance (MANOVA) was used to determine if PCUs with high levels of involvement differed on the outcome variables from those with low involvement.

Results: Nurses on PCUs with high involvement were less likely to think of quitting; patients on these units had fewer infections and pressure ulcers.  PCU’s that involved nurses in planning for staffing had higher nursing satisfaction. Formal structures for involvement were not associated with either nurse or patient outcomes. Informal structures were more strongly associated with nursing satisfaction. Involvement in outcomes evaluation was associated with lower pressure ulcers and infections.  Nurses’ perceptions that the organization was supportive of their involvement had the greatest impact; it was associated with lower adverse events, infections, and patient complaints.

Conclusion: Involving nurses in decisions is related to nurse and patient satisfaction and reduced adverse events. It is not necessary to have sophisticated formalized structures in place to affect the outcomes; informal structures may be more strongly related to nurse satisfaction. Involving nurse in examining outcomes may reduce pressure ulcers and some infections. A critical influence is the perception that the organization values nurse involvement in decisions.