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Nurses’ Participation in Clinical and Administrative Decisions in Different Types of Hospital Units

Bacon, Cynthia Thornton, PhD, RN, CNE; Shrestha, Smriti, MS, MA; Jenkins, Marjorie, PhD, RN, NEA-BC, FACHE

JONA: The Journal of Nursing Administration: March 2019 - Volume 49 - Issue 3 - p 163–170
doi: 10.1097/NNA.0000000000000731

OBJECTIVE This study explored the types of decisions and differences in decision making that nurses made in different types of hospital units.

BACKGROUND The relationship between nurses’ participation in decision making and the different types of hospital units where they work is not well understood.

METHODS Nurses’ participation in decision making was explored using the Participation in Decision Activities Questionnaire. The final sample included 307 nurses in 24 nursing units in 6 hospitals.

RESULTS Nurses overall participated more in clinical than administrative decisions, and there were significant differences based on unit type. Critical care nurses had the highest and general care units the lowest levels of participation in decision making.

CONCLUSIONS Nurses in critical care units participated in higher amounts and at higher levels of clinical decisions overall than either intermediate or general care units. Nurse leaders should determine barriers to decision making in general care units and explore mechanisms to increase participation by clinical nurses.

Author Affiliations: Assistant Professor (Dr Bacon), School of Nursing, University of North Carolina at Greensboro; Lecturer (Mrs Shrestha), School of Nursing, North Carolina Agricultural & Technical State University; and Director of Nursing Research (Dr Jenkins), Cone Health, Greensboro, North Carolina.

The author declares no conflicts of interest.

Correspondence: Dr Bacon, PO Box 26170, School of Nursing, University of North Carolina at Greensboro, Greensboro, NC 27402 (

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