The relationship of authority to decision-making behavior: Implications for redesign

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.