Transforming work place relationships through shared decision making

Aim Using Donabedian's Structure-Process-Outcomes (SPO) paradigm, this study explored the SPO linkages related to nurse-nurse leader shared decision making around workload issues, such as safe staffing assignments. Background Shared decision making represents nurses' control over practice, which is associated with positive nurse outcomes, such as job satisfaction. This study is based upon four project sites where nurse-led project teams addressed workload issues. Methods Participatory action research was used, with the authors acting as participant observers. Four sites were case ordered and analysed: least successful to most successful outcomes. Cross-case matrices were constructed to identify SPO linkages. Data included observation field notes, interviews and focus groups. Results Operations leaders with formal access to empowerment structures, such as information and resources, were the critical link to successful outcomes. Sites with conflict that blocked team-operations leader relationships were unable to engage in effective, sustainable decision making. Conclusions Effective work relationships among teams consisting of staff and front-line leaders contributed to successful outcomes, but team-operations leader relationships made the biggest difference. Implications for nursing management Formal access to power through leadership is critical for building and sustaining processes that promote and sustain nurses' control over practice.