Staff nurses describe control over nursing practice (C/NP) as a professional nursing function made up of a variety of activities and outcomes. Greater acclaim, status, and prestige for nursing in the organization are viewed as a result, not a precursor, of C/NP. Interviews with 279 staff nurses working in 14 magnet hospitals indicated that effective C/NP requires some kind of empowered, formal organizational structure, extends beyond clinical decision making at the patient care interface, and is the same as or highly similar to what the literature describes as professional autonomy. From constant comparative analysis of nurses' descriptions of C/NP activities, five ranked categories of this real-life event emerged. The basis for the categories and ranking was “who owned the problem, issue, and solution” and the “degree of effectiveness of control” as reflected in visibility, viability, and recognition of a formal structure allowing and encouraging nurses' control over practice. Hospital mergers and structural reorganization were reported to negatively affect the structure needed for effective C/NP. Almost 60% of these magnet hospital staff nurses stated and/or described little or no C/NP.
Get full access to this article
View all access options for this article.
References
1.
Aiken, L. H., & Patrician, P. (2000). Measuring organizational traits of hospitals: The revised nursing work index. Nursing Research, 49, 146-153.
2.
Aiken, L. H., Sloane, D. M., & Lake, E. T. (1996). Satisfaction with inpatient acquired immuno-deficiency syndrome care: A national comparison of dedicated and scattered-bed units. Medical Care, 35, 948-962.
3.
Aiken, L. H., Smith, H., & Lake, E. (1994). Lower Medicare mortality among a set of hospitals known for good nursing care. Medical Care, 32, 771-787.
4.
Blaufuss, J., Maynard, J. B., & Schollars, G. (1992). Methods of evaluating turnover costs. Nursing Management, 23(5), 52-59.
5.
Buchan, J. (1999). Still attractive after all these years? Magnet hospitals in changing health care environment. Journal of Advance Nursing, 30(1), 100-108.
6.
Buckles-Prince, S. (1997). Shared governance: Sharing power and opportunity. Journal of Nursing Administration, 27(3), 28-35.
7.
Conger, J., & Kanungo, R. (1988). The empowerment process: Integrating theory and practice. Academic Management Review, 13, 471-483.
8.
deBaca, V., Jones, K., & Tornabeni, J. (1993). A cost-benefit analysis of shared governance. Journal of Nursing Administration, 23(7/8), 50-57.
9.
Ethridge, P. (1987). Nurse accountability program improves satisfaction, turnover. Health Progress, 5, 44-49.
10.
Evan, K., Aubry, K., Hawkins, M., Curley, T., & Porter-O'Grady, T. (1995). Whole systems shared governance. Journal of Nursing Administration, 25(5), 18-27.
11.
Gerber, R., Murdaugh, C., Verran, J., & Milton, D. (1990). Control over nursing practice scale: Psychometric analysis. Poster presentation, National Conference on Instrumentation in Nursing, Tucson, AZ.
12.
Glaser, B., & Strauss, A. (1967). The discovery of grounded theory. Chicago: Aldine.
13.
Hastings, H., & Waltz, C. (1995). Assessing the outcomes of professional practice redesign. Journal of Nursing Administration, 25(3), 4-42.
14.
Havens, D., & Aiken, L. (1999). Shaping systems to promote desired outcomes. Journal of Nursing Administration, 29(2), 14-20.
15.
Hess, R. G. (1995). Shared governance: Nursing's 20th century Tower of Babel. Journal of Nursing Administration, 25(5), 14-17.
16.
Jones, L., & Sparki, M. (1989). Increasing nursing autonomy and recognition through shared governance. Nursing Administration Quarterly, 13(4), 11-16.
17.
Jones, C. B., Staslowski, S., Simons, B., Boyd, N. J., & Lucas, M. D. (1993). Shared governance and the nursing practice environment. Nursing Economics, 11, 208-214.
18.
Kennerly, S. (1996). Effects of shared governance on perceptions of work and work environment. Nursing Economics, 14, 111-116.
19.
Kennerly, S. (2000). Perceived worker autonomy: The foundation for shared governance. Journal of Nursing Administration, 30(12), 611-617.
20.
Kramer, M., & Hafner, L. P. (1989). Shared values: Impact on staff nurse job satisfaction and perceived productivity. Nursing Research, 38(3), 172-177.
21.
Kramer, M., & Schmalenberg, C. (1988a). Magnet hospitals: Part I: Institutions of excellence. Journal of Nursing Administration, 18(1), 13-24.
22.
Kramer, M., & Schmalenberg, C. (1988b). Magnet hospitals: Part II: Institutions of excellence. Journal of Nursing Administration, 18(2), 11-19.
23.
Kramer, M., & Schmalenberg, C. (1993). Learning from success: Autonomy and empowerment. Nursing Management, 24(5), 58-64.
24.
Kramer, M., & Schmalenberg, C. (2002). Essentials of magnetism. In M. McClure & A. S. Hinshaw (Eds.), Magnet hospitals revisited: Attraction and retention of professional nurses (pp. 25-59). Kansas City, MO: American Academy of Nurses.
25.
Kramer, M., & Schmalenberg, C. (2003). Magnet hospital staff nurses describe clinical autonomy. Nursing Outlook, 51(1), 13-19.
26.
Kramer, M., & Schmalenberg, C. (in press). Magnet hospital staff nurses define “good” nurse physician relationships. Nursing Management.
27.
Kramer, M., Schmalenberg, C., & Hafner, L. P. (1989). What causes job satisfaction and productivity of quality nursing care? In T. Moore & M. Mundinger (Eds.), Managing the nursing shortage: A guide to recruitment and retention (pp. 12-32). Rockville, MD: Aspen.
28.
Laschinger, H.K.S., & Havens, S. (1996). Staff nurse work empowerment and perceived control over nursing practice: Conditions for work effectiveness. Journal of Nursing Administration, 26(9), 27-35.
29.
Laschinger, H.K.S., Wong, C., McMahon, L., & Kaufmann, C. (1999). Leader behavior impact on staff nurse empowerment, job tension, and work effectiveness. Journal of Nursing Administration, 29(5), 28-38.
30.
Lengacher, C. A., Kent, K., Mabe, P. R., Heinemann, D., VanCott, M. L., & Bowling, C. D. (1994). Effects of the partners in care practices model on nursing outcomes. Nursing Economics, 12(6), 300-307.
31.
Lincoln, Y. S., & Guba, E. (1985). Naturalistic inquiry. Thousand Oaks, CA: Sage.
32.
Ludemann, R., & Brown, C. (1989). Staff perceptions of shared governance. Nursing Administration Quarterly, 13(4), 49-56.
33.
McClure, M., & Hinshaw, A. S. (Eds.). (2002). Magnet hospitals revisited: Attraction and retention of professional nurses. Kansas City, MO: American Academy of Nurses.
34.
McClure, M., Poulin, M., Sovie, M., & Wandelt, M. (1983). Magnet hospitals: Attraction and retention of professional nurses. Kansas City, MO: American Academy of Nurses.
35.
McDonagh, K., Rhodes, B., Sharkey, K., & Goodroe, J. (1989). Shared governance at Saint Joseph's hospital of Atlanta: A mature professional practice model. Nursing Administration Quarterly, 13(4), 17-28.
36.
McKay, P. S. (1983). Interdependent decision-making: Redefining professional autonomy. Nursing Administration Quarterly, 7(4), 21-30.
37.
Milton, D., Verran, J., Murdaugh, C., & Gerber, R. (1992). Differentiated group professional practice. Nursing Clinics of North America, 27(1), 23-30.
38.
Nakata, J. A., & Saylor, C. (1994). Management style and staff nurse satisfaction in a changing environment. Nursing Administration Quarterly, 18(3), 51-57.
39.
Perley, M. J., & Raab, A. (1994). Beyond shared governance: Restructuring care delivery for self-managing work teams. Nursing Administration Quarterly, 19(1), 12-20.
40.
Pinkerton, S. (1988). Evaluation of shared governance in a nursing department. In M. K. Stull & S. Pinkerton (Eds.), Current strategies for nurse administrators (pp. 141-150). Rockville, MD: Aspen.
41.
Porter-O'Grady, T. (1991). Shared governance for nursing, part 1: Creating the new organization. AORN Journal, 53(2), 458-466.
42.
Porter-O'Grady, T. (1992). Implementing shared governance: Creating a professional organization. St. Louis, MO: Mosby.
43.
Porter-O'Grady, T. (2001). Worker autonomy: The foundation of shared governance. Journal of Nursing Administration, 31(3), 100.
44.
Relf, M. (1995). Increasing job satisfaction and motivation while reducing nursing turnover through the implementation of shared governance. Critical Care Nursing Quarterly, 18(3), 7-13.
45.
Scott, J., Sochalski, J., & Aiken, L. (1999). Review of magnet hospital research. Journal of Nursing Administration, 29(1), 9-19.
46.
Seigel, S., & Castellan, N. J. (1988). Nonparametric statistics for the behavioral scientists (2nd ed.). New York: McGraw-Hill.
47.
Strauss, A. L. (1987). Qualitative analysis for social scientists. New York: Cambridge University Press.
48.
Strauss, A. L., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage.
49.
Upenieks, V. (2000). The relationship of nursing practice models and job satisfaction outcomes. Journal of Nursing Administration, 30(6), 330-335.
50.
Vilardo, L. E. (1993). Linking collaborative governance with job satisfaction. Nursing Management, 24(6), 75.
51.
Westrope, R. A., Vaughn, L., Bott, M., & Taunton, R. I. (1995). Shared governance: From vision to reality. Journal of Nursing Administration, 25(12), 45-54.
52.
Yin, R. K. (1994). Case study research: Design and methods. Thousand Oaks, CA: Sage.
