Giving Nurses a Stake in Day-to-Day Decisions

When nurses are encouraged to contribute to decisions that affect their
daily practice, they are more likely to report improved job satisfaction.
That’s the conclusion of a research study completed by Cleveland Clinic
clinical nurses.

“Although participation in shared decision-making may require time, resources and a hospital culture that fosters communication and ongoing improvement, shared governance programs that foster shared decision-making are an important investment,” says primary investigator Tina DiFiore, MSN, APRN, NNP-BC, CNS, an advanced practice nurse at Cleveland Clinic Hillcrest Hospital.

“As front-line caregivers, nurses can offer unique perspectives that ensure decisions are grounded in patient needs and practical clinical realities; they know firsthand how policies and workflows affect outcomes,” she says. “Including nurses in the decision-making process also fosters a sense of ownership, improves morale and strengthens trust between leadership and staff — ultimately leading to safer, more efficient and more compassionate care. It’s critical for nurses to have a voice.”

Hillcrest Hospital implemented a shared governance model in 2012,a move that provided nurses with more opportunities to weigh in on administrative decisions, she notes. The hospital also initiated a formal CI program the same year, which was designed to empower clinicians at every level to make changes that enhance operations and patient care.

Because both shared governance and CI activities often require nurses to step away from the bedside to participate in council/committee/planning and initiative implementation meetings, the research team felt it was important to understand how shared decision-making and CI were related and whether they — individually or together — are associated with job satisfaction, DiFiore notes.

To measure research outcomes, a crosssectional, prospective research study was developed using survey methods.

Study specifics

Nurse investigators asked clinical nurses (including assistant nurse managers) to complete an anonymous survey in 2023 at multiple Cleveland Clinic hospitals in Ohio. Participants were asked about the level of control and influence they had over different aspects of their jobs, the amount of access they had to information and their ability to negotiate solutions to problems and conflicts. The survey also asked nurses to describe their experience with CI processes and overall satisfaction with their practice.

DiFiore says she and her research team discovered a few key takeaways: Shared decision-making was positively associated with nurses’ job
satisfaction and active involvement in CI activities on their units. However, researchers also learned that statements on the survey reflecting shared decision-making were often not completed by clinical nurses, ultimately reflecting that shared decision-making was not applied uniformly by nursing leaders or that clinicians did not feel comfortable making decisions affecting their unit.

Value of nurse-informed decisions

“All hospitals want an engaged workforce — clinicians who look for solutions and try to provide the best care they can for their patients,” DiFiore says. “The survey responses reflected what’s happening in the real world. Although equal participation in decision-making is ideal, clinical nurses who are not formal leaders may not wish to make decisions that affect every caregiver on the team. More importantly, we learned that it matters a great deal to simply have a voice. Being able to provide input and personal perspectives while knowing that leaders are listening is a big step toward a greater sense of job satisfaction.”

Moving forward, DiFiore hopes that her team’s research findings can help hospital leaders (formal and informal) understand the value of giving clinical nurses a seat at the table and a stronger voice.

“Clinical nurses need to be given time to participate in committees and other decision-making activities,” she says. “We need access to data, including budgets and quality improvement process outcomes and we need to have influence over day-to-day clinical unit decisions,” she says.