Every day, nurse managers must have to make decisions that determine working conditions of their subordinates, quality of patient care, results of their treatment, and reputation of the hospital. A manager needs to know all the details related to medicine and healthcare, as well as organizational features, to evaluate and satisfy the needs of all parties adequately and effectively. However, various external factors influence the decision-making process as any nurse is obliged to obey the general rules of medical care in her or his state. This work explores such external factors as health policies, regulatory requirements, and health care financing through interviewing a nurse manager and reviewing literature.
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Summary of the interview
Mrs. Smith, a nurse with a total working experience of 10 years, has been a manager since 2016. She believes that during her work, she has sufficiently studied the features of her job position and responsibilities; hence, it is pleasant and useful for her to share her experience. Decision-making process Mrs. Smith considers decisive in the profession of a nurse in general, and especially for a nurse manager, since the work of the staff and the life of patients depends on the right choice.
During the interview, Mrs. Smith answered 15 questions directly or indirectly related to the studied external factors affecting decision-making. Some items were easy for the nurse, so her answers were brief and unambiguous, while others caused difficulties as they required time for reflection and observation from different angles. For this reason, several additional questions were also asked to clarify Mrs. Smith’s answers and her understanding of the research.
Mrs. Smith gave the most detailed answers to questions about regulatory standards, since in spite of their usefulness for making decisions in most cases; sometimes they prevented the choice of the best solutions to the problem. The nurse also gave several examples of such situations and explained her doubts in the decision-making process. She looked the most confident when answering questions about health policy as she considers herself an active member of the medical community and tries always to meet the needs of nurses and patients. Financing questions were not a problem for Mrs. Smith either; however, she replied that this factor has a significant influence on her decisions. Thus, the interview was successful and brought practical results for the study.
Perceptions Related to External Factors That Influence on Decision-Making Process
Health policy is flexible and adaptable at its essence because its primary goal is to ensure the best quality of care and treatment for the population. However, solutions that have an impact on these issues are made by considering the statistics of people’s requests, as well as the information presented by doctors and nurses. For this reason, the participation and suggestions of medical staff are necessary for creating an adequate policy.
Mrs. Smith, in her interview, also notes the above feature and says that she always relies on the benefits of her decisions for positive changes in health policy and selects those that are more useful in this area. Among the examples of such solutions, she cites both mentoring of her subordinates for writing evidence-based articles and suggestions for improving the quality of care, and her ideas that she presented in nursing associations. In addition, similar results are reported from research on organizations encouraging the participation of nurses, since they demonstrate significant improvements in their work through employee initiatives (Kutney-Lee et al., 2016). Consequently, health care policy and the decision of nurses have a mutual impact on each other as the current policy forces managers to make decisions that can offer positive changes for it.
Health standards and requirements are necessary to reduce the likelihood of medical errors and negligence, as well as to facilitate decision-making by nurses and doctors. However, as Mrs. Smith notes, sometimes regulations impede the adoption of the most appropriate decision, since it is equally essential for nurses to show sympathy and follow formal rules. Consequently, in some cases, a nurse manager has to deviate from the norms. Mrs. Smith notices an example of such a situation in her practice when she allowed her subordinate to leave the shift earlier to support her son’s performance at school. She knew that her reject would affect the nurse’s mood and quality of work, so she allowed her to break the organizational rule of the hospital at that time. However, Mrs. Smith also notes that in most cases, rules help her quickly and accurately make decisions when they are appropriate to the situation and avoid undesirable consequences for her patients.
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Moreover, studies demonstrate that regulatory requirements often impede the development of nursing initiatives to use effective but not approved currently methods care (Wall, 2017). At the same time, Traczynski and Udalova (2018) note that the lack of constant checks of nurses improves the quality of service and treatment of patients. Therefore, rules can be an obstacle in adopting the most practical solution if they are inappropriate or outdated. However, usually, regulatory requirements help reduce time and doubts about decision making.
Health Care Financing
Financing medical organizations is a problem for many states because the budget is limited, and the needs of this sphere are constant. For this reason, some hospitals lack funds to develop and improve the quality of service and are forced to seek monetary sources from sponsors, medical organizations, and patients. Mrs. Smith also draws attention to the fact that she has to make decisions on the allocation of the budget, and often it is not enough to satisfy all requests. The issue of financing has a more significant impact than the factor of health policy, since, for example, research or the introduction of new care methods cannot be implemented without additional costs. In addition, to reduce costs, nurse managers often have to make decisions that affect the organizational features of the hospital (Traczynski & Udalova, 2018). Consequently, financing is one of the key decision-making factors for nurses.
A comparison of the answers of Mrs. Smith’s and several studies have shown that such external factors as health policy, regulatory requirements, and financing have varying degrees of influence on decision making. Financing has the most significant impact as it is usually limited and cannot cover all requests. Health policies and regulatory requirements are equally useful for decision making in most cases, but in unusual situations, the second factor can be a source of doubt and controversy. However, any decision is unique, and the nurse manager needs to understand and regulate the influence of all factors for the adoption of the most effective solution.
Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, S., Maguire, P., Dierkes, A., … Aiken, L. H. (2016). Nurse Engagement in Shared Governance and Patient and Nurse Outcomes. The Journal of Nursing Administration, 46(11), 605–612.
Traczynski, J., & Udalova, V. (2018). Nurse practitioner independence, health care utilization, and health outcomes. Journal of Health Economics, 58, 90–109.
Wall, S. S. (2017). The impact of regulatory perspectives and practices on professional innovation in nursing. Nursing Inquiry, 25(1): e12212.