Antecedents of Control Over Nursing Practice

Abstract

Control over nursing practice (CONP) is a participatory process through which nurses have input and engage in decision making about the context of practice and unit operations related to nursing practice. CONP has been associated with a number of positive outcomes related to nurse satisfaction, nurse status, effectiveness of patient care, and quality of patient outcomes. However, no comprehensive model has been created nor comprehensive analysis been conducted related to approaches for increasing CONP. This study tested a hypothesized model of antecedents to CONP developed from a review of the literature in nursing, psychology, and organizational management using a complexity theory perspective.The study used a nonexperimental, comparative design. The sample for data analysis consisted of 28 nurse managers and 583 staff nurses from 32 units in 10 hospitals. Existing instruments were used in a paper and pencil format to collect demographic and perceptual data on CONP and the hypothesized antecedent variables. Data were aggregated to provide an analysis of organizational and unit level contextual and variable effects related to CONP.Contextual regression indicated a greater influence of unit-level variables than organizational-level variables on nurses' perceptions of CONP. Regression analyses and revised model testing demonstrated that nurse manager supportiveness, implementation of a formal structure for CONP, and information flow consisting of open and accurate communication were positively related to CONP. Hierarchy of authority was negatively related to CONP. The relationship between CONP and job codification and autonomy varied based upon the measurement of the dependent variable. Manager's perception that participative decision making enhances organizational effectiveness; manager's perception that participative decision making does not reduce their power; nurses' experience, expertise, and educational preparation; and nurses' desire for control did not significantly relate to CONP as hypothesized.This study contributes to nursing research and clarifies strategies for improving the work environment for nurses by delineating antecedents to CONP in the acute care hospital setting. These data will be useful to nurses, nurse managers, and hospital administrators who want to improve patient safety, reduce patient mortality, increase nurse satisfaction, and increase nurse retention.