| Redesigning the structure and process of care is important in today's changing and more complicated health care system. The changes have increased nurses' responsibilities and involvement in decision making. Organizational structure and process influence nurses' decision making. Nurse manager leadership competencies and nurse-physician collaboration are organizational factors that are believed to enhance nurses' participation in decision making. The purpose of this study was to investigate the relationships among staff nurses' participation in three phases of the decision making process related to participation in caregiving and condition of work decisions, nurse manager leadership competencies, and nurse-physician collaboration. The conceptual framework for this study was based on Donabedian's approaches to assessment of quality of care and Holzemer's outcomes model for health care research. A secondary analysis of the Variations in Nursing Practice Model (VNPM) (RO1-NR04274) investigated by Anthony (1998) was conducted.;The data were derived from the questionnaire responses of 279 full-time nonsupervisory registered nurses employed as staff nurses at two urban teaching hospitals and one suburban community hospital in Cleveland. Staff nurses' responses to the Participation in Decision Activities Questionnaire (PDAQ), the two single items reflecting the extent of unit manager's leadership competencies for clinical and administrative issues, and the Collaborative Practice Scale (CPS) (Weiss & Davis, 1985) were drawn from the VNPM study.;The results demonstrated that nurse manager leadership competency for clinical issues had a statistically significant positive correlation with phases of caregiving decisions (r = .14, p < .05 for identification; r = .17, p < .01 for design; r = .12, p < .05 for selection) and with phases of condition of work decisions (r = .17 for identification, r = .18 for design, r = .17 for selection, ps < .01). Leadership competency for administrative issues had a statistically significant positive correlation with phases of condition of work decisions (r = .17 for identification, r = .17 for design, r = .19 for selection, ps < .01). Nurse-physician collaboration had a statistically significant positive correlation with phases of caregiving decisions (r = .25 for identification, r = .23 for design, r = .28 for selection, ps < .01) and with condition of work decisions (r = .23 for identification, r = .27 for design, r = .27 for selection, ps < .01). Among caregiving decisions, the model (leadership competencies for clinical and administrative issues and nurse-physician collaboration) explained 6.3% of the variance in identification, 6.1% for design, and 7.6% for selection. Among condition of work decisions, the model explained 6.9% of the variance in identification, 8.8% for design, and 8.8% for selection. In each test of the model, only nurse-physician collaboration positively contributed to greater participation in decision making.;The VNPM study was funded by the National Institute of Nursing Research, RO1-NR04274, to Dr. Patricia Flately Brennan, the principal investigator from 1995--1996 and to Dr. Mary K. Anthony, the principal investigator from 1996--1998. Permission for access to the data had been provided by Dr. Anthony. |
