Effect of Using a Developed Guideline for Staff Nurses Participation in Decision Making and Empowerment on their Organizational Commitment

Introduction

Nurses constitute the largest professional group in the health care system and make up about half the total workforce in the health care area.  Today there is a greater emphasis on participatory management, otherwise known as employee involvement in decision making, when employees `involved in decision making, staff absenteeism is reduced, there’s greater organizational commitment, improved performance, reduced turnover and greater job satisfaction.  Participation generally defined as a process in which influence is shared among individuals who are otherwise hierarchically unequal (1,2).

Decision-making (D.|M) considered as one of the most nurse's important tasks in management and choosing the method of decision-making and be the most important skills of a manager. Unfortunately, participation in decision-making is often restricted and neglected by nursing profession, which leads to increase the level of anxiety and frustration among nurses.   Participation in decision making; was considered as maintaining factors  for satisfaction of nurses, thus;  the low participation rate of nurses in the higher level of the hierarchical system of hospital caused the feeling of disability, D.M is often restricted to chief executives (2).

In recent years management and staff nurses need to become up to date  &fashionable through advocating of their employment in various approaches so that they must know what   means by  empowerment ;it means that staff nurses employees, &managers, or teams at all levels in the organization have the power to make decisions without asking their superiors for permission and help. It also considered as a key ingredient in achieving the mission, vision, and strategic direction of health care organization (3). Empowerment facilitating  organizational commitment, learning and innovation, in order to achieve empowerment, manager must provide the necessary means, such as, delegating more formal authority to make specified decisions, offering increased training opportunities to develop expertise and self -confidence, providing more resources and access to information to be able to implement effective decisions, in additional to that avoiding the sudden withdrawal of shared power at the first sign of trouble(4).

Organizational commitment encourages extra role behaviors among staff nurses in times of decreasing resources such as that facing all sectors of national health care (6,7,8).   Hence, utilization of human and non-human resources of hospital and the achievements of hospital goal depends on nurse's commitment and satisfaction, also organizational commitment define as the level of which an employee is faithful to his /her organization (9).  

Significance of the study:

Today with the current insufficiency of economic resources and shortage of nursing staff, it is essential for most of the organization to permit a surface of freedom and involve their employee's in decision making in order to be empowered to performing at a high level to ensure high quality patient care (10,11) Nurses' responsibilities for patient care will increase. As result nurse, need more autonomy and participation in decision No one can deny that presence of a link between shared work setting (participative decision -making) and empowerment that each one leads to the other interrelated and dependable relationships  that can end with organizational commitment as an indicator for the organizational effectiveness 3.

    Moreover, many measures that organization must take to enhance staff nurse's decisional involvement, empowerment to reach for organizational commitment to identify the opportunities for change and monitor the attainment of target goal, 12.

Participatory decision-making and empowerment have a wide array of organizational benefits and positively have impact on the Job satisfaction, Organizational commitment, Perceived organizational support, Organizational citizenship behavior, Labor-management relations, Job performance and organizational performance, Organizational profits (8)

Research Hypothesis:

Using of a Developed Guideline for staff nurses participation in decision making and empowerment guidelines has a positive effect on organizational commitment among staff nurses

Aim of the study

The aim of the present study was to identify Effect of Using a Developed Guideline of Participation in Decision Making and Empowerment on Organizational Commitment among Staff Nurses in Minia University and General hospital through:

[1].    Assessing the degree of participation in decision- making, identifying the degree of empowerment and determining the level of organizational commitment among staff nurses that works in each hospital.

[2].    Using of a Developed Guideline of booklet about participation in decision-making and empowerment.

[3].    Examine effect of Using of a Developed Guideline of booklet of participation in decision-making and empowerment ason organizational commitment among staff nurses in Minia University and General Hospitals.

Subjects and Methods

Research design:

A quesi-experimental research design was used in this study

Setting:

The study conducted at Minia University hospital and Minia General Hospital in Minia governorate, Egypt.

Subjects:

The subject included all available staff nurses working in critical care units (CCU& ER, NICU and Dialysis unit) in both hospital, during the period of data collection. Total number is 100 nurses in both Hospitals (Minia University hospital N= 49 staff nurses) and (General Hospital N= 51 staff nurses)

Tools of Data collection:

Three tools were used in this study for data collection

Tool I: Decisional involvement scale (DIS) it was  used for collecting the data for this study it consists of two main parts: Part one: this part concerns with data pertaining personal characteristics of the study subjects as age, nursing qualification, years of experience, Part two: this part consists of Decisional involvement scale:   it aimed at assessing the degree of staff nurses participation in decision making, It developed by Havens and Vasey (2003)13 and ascertained for its validity and reliability by Hassan. H. M; (2007, 12,); consisted of 22 items, sub grouped under six constructs which described as the following (Unit staffing, Quality of practice, Professional recruitment, Governance and leadership, Collaboration/liaison activities, Quality of support staff practice).

Scoring system: responses were scored under five-point Likert scale ranging from one to five, which  1= totally administrative/ management decision, 2= primary administration/ management with some staff nurses input, 3= equally shared by administrative/ management and staff nurses, 4= primary staff nurses, some administration/ management, and 5= staff nurse only,  all component had a positive scoring

The total score of each subscale was calculated by summing up the scores of its items, and the total divided by the number of the items, if the total score were less than 60% considered as low decisional involvement, 60%or more indicated high degree of staff nurses involvement.

Tool II: The Condition of Work Effectiveness Questionnaire-II (CWEQ-II). This tool aimed at assessing the degree of staff nurses empowerment, this tool developed by Laschinger, & Wilk, 1999, 2001)14 a modification of the original CWEQ and translated by El Sayed .W.A, (2008)4.  It consisted of 44 statements, divided into four elements (access to information, access to opportunities, access to support, and access to resources). Scoring system: responses were scored under five –point Likert scale that ranging from one to five, which 1= strongly Disagree, 2= Disagree, 3=to some extent, 4=agree and 5= strongly agree. All components had a positive scoring. The total score of each subscale calculated by summing up the scores of its items, and the total divided by the number of the items, these scores were converted into a percent score.

If the total score were less than 60% considered as low structural empowerment, 60%or more considered as high structural empowerment.

Tool III: Structured Organizational Commitment Questionnaire:

Structured Organizational Commitment Questionnaire developed by Meyer & allen1997(15), adopted and translated by Hosni .E.K,(2014 ) (5) and modified by the researcher, aimed at assessing the level of commitment among staff nurses it  consisted of 34 items, Grouped under six categories which described (Feeling experience at work, Identification, Investment, equity, trust, and resistance).

   Scoring system: responses were scored under five –point Likert scale that ranging from one to five, which 1= strongly Disagree, 2= Disagree, 3=to some extent, 4=agree and 5= strongly agree. All components had a positive scoring. The total score of each subscale calculated by summing up the scores of its items, and the total divided by the number of the items. These scores were converted into a percent score.

If the total score were less than 60% considered as low organizational commitment, 60%or more considered as high organizational commitment

Tools Validity and reliability

The tools were submitted to a panel of five experts in in the field of nursing administration at Minia and Ain Shams University confirmed its validity. Modifications on the tools were done according to the panel judgment in relation to appropriateness of the content and sequence accuracy of items.

Reliability of the tools (І, ІІ, ІІІ) were performed to confirm validity of tool and calculated statistically. The internal consistency measured to identify the extent to which the items of each tool measure the same concept and correlate with each other by Cronbach’s alpha test were .70, .96 and .97 respectively

Pilot study:

A pilot study was carried out on 10 staff nurses. The aim of the pilot study was to test the feasibility of the study, and finally clarity and applicability of the preliminary tool. It also served to estimate the time required for filling the questionnaire sheets which was 20 minutes. They were included in the main study subjects during the actual collection of data. The process of pilot study took one weeks’ (from15/3 to 21/3) in March 2016.

Ethical consideration:

A written initial approval was obtained from the research ethical committee of the faculty of nursing, Minia University. The researcher introducing herself to the directors and discussed the aim of the study, then met the head nurse of each department, and introducing herself with discussed the aim of the study and determined the suitable time to meet the study participants and collect the data. Nurses were reassured that all information obtained was confidential and would not affect their professional evaluation. Moreover, oral consent was obtained from each participant

 before the nurses participate in this study, the nature, the aim, methods, and anticipated benefits of the study was explained. The researcher informed the participation is voluntary and they have rights to withdrawal at any time without giving any reasons.

Data collection procedure:

The official approvals were obtained from medical and nursing administration of Minia university hospital. Prior to collection of data,  a formal letter issued from the dean and vice dean of post graduate studies and research at faculty of Nursing, Minia university, and the approval of ethical committee. Submitted to medical and nursing administrations and the heads of the units for obtaining their permission and help to conduct the study. The letters also listed the data needed for the study.

Before distribution of the questionnaire, the research met the participants according to the time which determined by head of each department, introducing herself and explained the purpose of the study and the components of the tools to the participants in the study setting. Then, the researcher distributed the data collection sheets to respondents individually in their workplace. The filling time for the questionnaire sheet took about 20 minutes. The researchers checked the completeness of each filled form after the participant filled it. Data collection was done during the morning, afternoon, and night shifts two days / week, April, to January 2016-2-17. Two stages of   assessment will be done as the following

The first:   Pre-test will done to: Assess the degree of participation in decision-making, identifying the degree of empowerment determining the level of organizational commitment among staff nurses that works in Minia University Hospital (CCU& ER), Obstetric &gynecological hospital (NICU), Dialysis Hospital. Minia General Hospital (CCU& ER, NICU and Dialysis unit).

Intermediate stage: Developing of guidelines about participation in decision-making and empowerment booklets through reading topics about participation of decision- making and empowerment and their importance on workplace if handled by a good way from organization, management, supervisors, and unit leaders. This booklet was    consisted of introduction about participation of decision- making, empowerment, and their importance and benefits on workplace. Furthermore, it include strategies that used by organization, management, supervisors, and unit leaders for encouragement of a good range of decisional involvement and good degree of empowerment, and finally the staff nurses right for decision –making as the following (Unit staffing, Quality of practice, Professional recruitment, Governance and leadership, Collaboration/liaison activities, Quality of support staff practice). The staff nurses right to be empowered through (Access to information, access to opportunities, access to support, and access to resources) and translated into Arabic to match all nursing categories  and distributing it among staff nurses in the different hospitals after reviewing from experts  and  the supervisors.

The second stage (post- test): Assessing the degree of participation in decision making, Identifying the degree of empowerment determining the level of organizational commitment among staff nurses that works at Minia University Hospital after distribution guidelines booklet about participation in decision making and empowerment.

Finally examine the effect participation in decision-making and empowerment guidelines on organizational commitment among staff nurses at Minia University Hospital included (CCU& ER), Obstetric &gynecological hospital (NICU), Dialysis Hospital and Minia General Hospital (CCU& ER, NICU and Dialysis unit).

Statistical design:

Statistical analysis was done by using Statistical Package for the Social Science (SPSS 20.0). Quality control was done at the stages of coding and data entry. Data were presented by using Data were presented using descriptive statistics in the form of frequencies and percentages, mean and standard deviations, ANOVA test Cronbach alpha coefficient was calculated to assess the reliability of the developed tool through their internal consistency. Probability (p-value) is the degree of significance, if it less than 0.05 was considered significance, the more significance is the result (*), less than 0.001 was considered highly significance (**) and correlation coefficient was done by using Spearman rank

Results

Table (1): distribution of nurses according to personal and socio demographic data of the studied sample N=100

Table 1, showed that the slightly more than half of study subject had diploma degree as related to nursing qualification, and nearly two/third were (25 ˂ 30 yrs.' Old) (28%), as regards to age group. Also the same table showed that slightly more than half percent of nurses had more than 10 years of experience (58%), as regards the experience years.

Table 2: Involvement in decision-making as reported by nurses before and after guidelines, N=100

(*) Statistically significant at p<0.05

Table 2, shows that highly percentage of shared decision between administration and staff nurses, with a statistical improvement after using guidelines for most of subscale of decisional Involvement except the decision  regards to unit staffing, Quality of  professional staff practice was administration only decision.  Moreover, there were a statistical significant differences improvement related to collaboration activities (p-value=0.003 ) , Moreover  as regards quality of support staff practice there were statistical significant differences not improvement (p-value=0.001) after guidelines that indicated a negative effect).

Table (3): Empowerment among nurses before and after guidelines, N=100

 (*) Statistically significant at p<0.05

Table 3 indicates that lower empowerment level in highly percent post guidelines, with a statistical differences not improvement in all empowerment sub scale in  access to information(p-value=<0.001) , Access to opportunities(P-value =<0.001) ( negative effect), in addition presence of a statistical significant differences not improvement as regards to total empowerment score(p-value = <0.001) .

Table 4: organizational commitment among staff nurses before and after the guidelines, N=100

(*) Statistically significant at p<0.05

Table 4, demonstrates that lowered organizational commitment levels, with statistical differences not improvement after distribution of guidelines, except in job equity (p-value=0.02) and investment (P-value=0.001) there were a statistical significant differences improvement after guidelines in all commitment factors