Redesigning health care environments has occurred in response to cost and q
uality pressures. Efforts to redesign the nursing practice environment have
focused on the structure and process of nursing care delivery. When redesi
gn efforts address the structure of nursing practice systems to facilitate
one important process, nurses' participation in decision making, better pat
ient and organizational outcomes are expected. The purpose of this study wa
s to determine if two dimensions of structure: administrative (decentraliza
tion) and professional authority (expertise) influence the process of parti
cipation in decision making for two kinds of decisions (caregiving and cond
ition-of-work) that nurses make. The stratified sample consisted of 300 reg
istered nurses working on medical-surgical units. Administrative and profes
sional authority accounted for a small but significant amount of variation
in participation in decision making. Because the extent of explained variat
ion was small, the findings may challenge the prevailing assumption that gr
eater authority for decision making results in the exercise of that authori
ty. Redesign of the practice environment therefore must incorporate multipl
e factors in achieving greater participation in decision making. (C) 1999 J
ohn Wiley & Sons, Inc.