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

Purpose:
The purpose of this study was to determine the nature and strength of the relationship between staff nurse perceptions of involvement and nursing satisfaction, intent to leave, patient satisfaction, and adverse events.The study also included perception of involvement in planning for staffing.

Background/Significance:
In 2007, the Colorado Governor's Task Force on Nurse Workforce and Patient Care issued recommendations on retention and work environment supporting the need for research authorized by the state legislature in 2008. The study, planned by diverse stakeholders, examined the impact of nurse involvement in decision making on patient and nurse outcomes. A premise of the task force was that involving nurses in decision making on issues of concern affects nursing practice and patient care positively.

Methods:
Fifteen hospitals in a Western state were selected using stratified random sampling; of these, ten agreed and nine submitted usable data. The unit of analysis was a Patient Care Unit (PCU); the final sample size was 54 PCUs. Data collected at the PCU level included eleven indicators grouped into “patient satisfaction,” “nurse satisfaction,” “infections,” and “adverse events.” Correlation analysis and chi square were used to determine the strength and direction of relationships. Multivariate analysis of variance was used to determine if outcome variables differed between units with high and low levels of 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. Informal involvement structures were more strongly associated with outcomes than were formal structures. Involving nurses in outcomes evaluation was associated with lower pressure ulcers and infections. Overall, the perception that the organization was supportive of nurse involvement had the strongest impact, and was associated with lower adverse events, infections, and patient complaints.

Conclusions and Implications for Practice:
Involving nurses in decisions is related to nurse and patient satisfaction and a reduction in adverse patient events. Systems do not have to be highly formalized; informal systems may be as effective. Critical is the perception that the organization values nurse involvement in decisions.