Decision-making is a cognitive process that aims at selecting a course of action that is best among several alternative possibilities. Every decision that is made ends up producing a final choice that may or may not prompt an action (Kohlen et al., 2015). The decision-making process should be logical if the best alternative option is to be arrived at. During the decision-making process, a nurse manager must weigh both the positive and negative alternatives associated with each available option before arriving at the best decision. Consequently, a nurse manager must also be in a position to forecast the outcome of each available option that is based on all these options and to determine the best course of action to undertake that suit a particular situation at hand (Oshima Lee & Emanuel, 2013). Good decisions made brings good outcome to the health care organization but on the other hand, bad decisions by nurse manager are costly and bring negative outcomes. This brings out the need for nurse managers to make informed decisions that are friendly to the operation of the hospital. It is very common to hear people saying that it is hard to make decisions but we always make decisions on a daily basis (Hwang & Masud, 2012). For instance, making a decision on the type of meal to have or the type of transport you will use to work. In understanding decision making in nursing management, the paper will cover, the decision-making process, factors that can hinder the process, characteristics of good decisions in nursing management, and various models of making decisions, and the role of decision-making in the nursing profession.
Nurse Managers entrusted with the management of the hospital activities should adopt the decision style profile which is a decision-making assessment that equips them with the most effective and right styles to make decisions to a given situation (Oshima Lee & Emanuel, 2013). Every stakeholder involved in the making of the decision is asked their views on how the problem or change can be implemented. This method serves to ensure that, there is refinement and improvement in decision-making skills of the nurse managers, equips them with research-backed decisions, and ensures that the process is easily accepted by all the parties affected by the change or problem.
A decision tree is another method making decisions that can help health care managers to choose the best course of action. This is a decision support tool that employs a tree-like graph and the possible consequence, the resources cost, and their utility (Kohlen et al., 2015). This method is mostly used in research to find out the strategy that has a higher likelihood of reaching a goal. A decision tree decision nodes represented by squares, chance nodes represented circles, and the end nodes represented by the triangles. Health professionals can also apply this method in making decisions related to research and operation management. This has been witnessed in delegation decision-making tree that has been helping nurses in making a decision concerning delegation. In using this method to make decisions, a nurse has to start with a specific client, the caregiver, and the nursing activity.
Making of decision requires a systematic process. The process of making decision begins at identifying the problems the hospital is facing at that moment (Kohlen et al., 2015). This involves recognizing and admitting that there is a decision to be made. Decisions are only made because there is a need to address a particular problem facing the healthcare organization. It may necessary not be a problem but it can also be an opportunity that the organization needs to seize like opening up a new hospital in a place that has no other health care institution (Triantaphyllou, 2013). Nurse Managers can also make decisions regarding how they cut operational cost in the hospital by coming up with sustainable ways of doing things to reduce expenses.
After the problem facing the hospital has been identified, the next step is seeking information that would clarify the option made (Kohlen et al., 2015). This implies that once the problem has been identified, nurse managers are required to use mechanisms of getting information on how to address the process by use of methods such as evidence-based practices (Hwang & Masud, 2012). Seeking information aims at establishing the main causes of the problem at hand, the processes and the people to be involved in the issue as well as the potential constraints to the decision-making process. This step provides a road map to the decision-making process.
Having sought the information needed, nurse managers should come together and brainstorm for the potential solutions to the issue at hand (Kohlen et al., 2015). This step may take some time to accomplish since different nurse managers have different views on how to come up with the solution to the problem. Some may agree and others may disagree and reach a common ground takes time.
Once brainstorming is over, choosing of the best alternative from the many available is undertaken. This will come after the pros and cons of the course of action have been established (Kohlen et al., 2015). The nurse managers at this stage are allowed to seek additional information concerning the issue and select the best option they feel will favor the decision-making process. Nurse Managers are also allowed to seek advice and more information from outside the organization from consultants; they are not just restricted to information from inside the healthcare organization (Pettigrew, 2014).
The best course of action is implemented immediately. There is no need of wasting more time in this stage (Kohlen et al., 2015). The nurse managers are responsible for motivating and rallying the other employees on board. For the decision to be implemented well, it must have the support of all the stakeholders. Decision made has the likelihood of changing after it has been enacted and it is upon the nurse managers to put a monitoring system in place that would enable the monitoring of decision outcomes.
The decision implemented should be thoroughly evaluated to establish if it had achieved the intended outcome (Kohlen et al., 2015). Nurse Managers should be able to learn from the mistakes. If the chosen method doesn’t give the intended solution, it becomes necessary to shift to another possible solution available.
For nurses to make good decisions that are beneficial to the healthcare organization, the decisions made should positively impact others (Oshima Lee & Emanuel, 2013). The hospital has many stakeholders such as the patients, employees, suppliers, owners, and the government and therefore it is important for the decision to be made that do not negatively affect any of these parties. Most importantly, they should serve to improve the welfare of the patients (Hwang & Masud, 2012). Good decisions also should foster opportunities for the healthcare organization. The health care managers should be able to seize opportunities that help in improving the performance of the health sector.
Consequently, good decisions should be executable. This would only be possible if the decisions are made clear. Ambiguity associated with the decision should be eliminated. If the nurse managers ensure clarity of the decision, uncertainty surrounding them would be addressed (Oshima Lee & Emanuel, 2013). Additionally, for a decision to be good, the nurse managers spearheading the process must be willing to be held accountable for the outcome of the process. Most importantly, good decisions are pragmatic; they should try as much as possible to eliminate biasness and self-interest amongst the parties involved (Triantaphyllou, 2013).
Figure 1: shows the decision-making process (Oshima Lee & Emanuel, 2013).
There are some factors that hinder the decision-making process by the nurse managers. Not having adequate information can affect the decision-making process. Having inadequate information brings the feeling of making a decision that has no basis (Ferrell & Fraedrich, 2016). Nurse managers should ensure that they take their time to gather all the information required so that the process may not be disrupted. There are times where the manager can hurriedly undertake the process for the sake of completing it such that it may now allow adequate time to gather information (Triantaphyllou, 2013). If even if the timescale for making the decision is tight, this should not make the gathering of information poor.
However, having too much information can also affect the decision-making process. Having too much information raises cases of conflicting information and this may derail the decision process (Ferrell & Fraedrich, 2016). This problem can be addressed by nurse managers through bringing all the stakeholders together for them to decide which information is important for the process. The timescale for making the decision should also be set clearly.
Having too many people involved in the decision-making has proved to be another factor that affects the process. Everyone has their views and beliefs about a particular issue (Ferrell & Fraedrich, 2016). Everyone will also want their views to be respected and taken into consideration. This poses a big challenge to nurse managers in leading the decision-making endeavor. It is important to entrust one person to lead the process so that a decision might have arrived at one decision is better than having none.
Consequently, vested interest between the parties involved in the decision-making process can also be another setback to arriving at an informed decision (Triantaphyllou, 2013). Sometimes these vested interests may not be expressed by the parties involved but they are crucial to the process. Identifying these interests can be a hard task for the nurse managers spearheading the process since they are not usually expressed for fear of being victimized. But to handle this problem; someone from outside the organization should be involved to help in moderating these vested interests.
Additionally, parties are not having an emotional attachment to the decision-making process makes it hard and difficult for the nurse managers. It becomes hard to make a decision especially if you don’t care about the outcome such decision will have to the healthcare organization (Standing, 2014). Having a structured decision-making process can ensure that this setback has been addressed since it would help reducing complicated decisions, lead the process, and ensures that it is completed within the set time span.
Decision-making has various models that nurse managers need to take into consideration in nursing management. The rational model requires the nurse managers to be rational and completely informed of the decisions they are about to make (Hwang & Masud, 2012). The nurse managers are also required to be intelligent especially in finding occasions for implementing the decisions they make, be in a position where they can invent and design a possible course of action to the organization, chose correct course of action from the available alternatives, and ability to review past choices made regarding to a similar decision (Ferrell & Fraedrich, 2016). This model also requires those involved in making decisions in the health care sector to have knowledge of all the possible alternatives, to equip themselves with repercussions of implanting a given alternative, and the well-organized set of choices for these consequences.
The model of bounded rationality also affects the manner in which health professionals can make their decisions. This model assumes that nurse managers do not necessarily need to have complete information regarding a given problem (Hwang & Masud, 2012). This model allows the healthcare givers to search for knowledge concerning a given problem before making any decision. This involves searching for alternatives to a given decision. This process of searching for more ideas can be made easier by identifying regularities in that given environment.
The incrementalist view model allows rooms for the adjustment of any decision to be made. The health care managers entrusted with leading the process can make adjustments to the process whenever they deem necessary to do so (Hwang & Masud, 2012). The changes to be made to the process must be feasible and geared towards solving a certain problem.
The organizational procedures view model appreciates decisions as the results of standard procedures of operating within subunits in the organization (Hwang & Masud, 2012). The existing procedures in the hospital and the thinking of the healthcare professionals pre-programmed the decisions. This model sees decision making as a way of maintaining the status quo in the healthcare at the cost of innovation.
The political view model understands the decision-making process to be a personalized process that is motivated by the agendas of the concerned healthcare professionals and therefore it is not a rational process (Hwang & Masud, 2012). The parties involved in the making of the decision may differ from the organization’s values, goals, and the importance of the information. This process of making decisions is never an ending one since it involves conflicts between the parties concern. In a healthcare organization, there are some healthcare professionals who are only concern with their self-interests and they will do all that is possible for this to happen (Ferrell & Fraedrich, 2016). This is the reason as to why you may witness in a hospital when one group of healthcare givers wins in a given battle, the other group that lost may re-group to make sure that they are the one who will win the next time a given decision is required to be made.
Consequently, the garbage can model of making decisions describes the process as an organized anarchy. This model assumes that there are many parties that can be involved in making decisions in the hospital setting (Hwang & Masud, 2012). Each of these parties has its own views and goals towards decision making. This model also recognizes the existence of fragmentation and chaos in making decisions in healthcare organizations but these differences are not as a result of manipulation as it has been suggested by the political view model (Ferrell & Fraedrich, 2016). The decision is made after a wide consultation with a wide range of opinions from different parties in the institution.
Additionally naturalistic decision-making model investigates and understands the making of decisions in a natural context (Zsambok & Klein, 2014). This model requires the nurse managers to recognize a given problem in relation to the previous experience. This makes the nurses settle for that alternative option that has the likelihood of succeeding. This course of action goes through evaluation by means of simulation.
Decision making plays a vital role in the nursing profession since it helps nurses in their evidence-based practice (Oshima Lee & Emanuel, 2013). Patients and their relatives depend on nurses to give them quality treatment and for them to do this; nurses should continuously research for the new ways of delivering care to them. When good decisions are made concerning the evidence-based practice, the outcome realized would bring a positive impact to the society.
Decision making also helps the nurses to think critically so as to meets the needs of the patients and that of the society at large (Ferrell & Fraedrich, 2016). This is made possible since, through the decision-making process, they are able to think critically between the alternatives to arrive at the best course of action and the end result of this is quality care to the patients.
Consequently, good decision-making skills help the health profession to make ethical decisions especially when they are faced with an ethical dilemma (Oshima Lee & Emanuel, 2013). Nurses have to make crucial decisions in adhering to the principles of autonomy and beneficence so that they may not infringe the rights of the patients and also the code of ethics that govern their profession.
Conclusively, health care managers work in a complex system that is faced by numerous legal, economic, ethical, technical, organizational changes take place. The decision made by the health care managers has a direct impact on the organization. An excellent decision brings a positive outcome to the organization while poor decision making is a liability to the organization. For a good decision to be in an organization there is a systematic process that has to adhere to by the parties involved in making the decision. However, as we have seen, there are factors that affect the decision-making process and therefore, these factors should be put into consideration. This paper has therefore proved that decision making in an integral part in nursing management.
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