When Nurses Have a Voice, Job Satisfaction Rises, Cleveland Clinic Finds
- Researchers at the Cleveland Clinic found that shared decision-making and participation in clinical improvement projects were linked to higher job satisfaction among nurses.
- Hillcrest Hospital introduced a hospital-wide clinical improvement initiative and a shared governance model to allow clinicians to make informed changes and decisions in patient care and quality.
- The study found that many clinical nurses did not feel comfortable or empowered to make decisions that affect every caregiver on the team.
In a recent study, the Cleveland Clinic found that when nurses contribute to decisions that affect their daily practice, they are more likely to have improved job satisfaction.
In 2012, Cleveland Clinic Hillcrest Hospital introduced a shared governance model, enabling clinical nurses to participate in administrative decision-making. Additionally, a clinical improvement (CI) program was developed, allowing for any healthcare worker at any level to make changes that could enhance the patient experience and quality of care.
“Although participation in shared decision-making may require time, resources and a hospital culture that fosters communication and ongoing improvement, shared governance programs that foster shared decision-making are an important investment,” says primary investigator Tina DiFiore, MSN, APRN, NNP-BC, CNS, an advanced practice nurse at Cleveland Clinic Hillcrest Hospital.
Research Specifics
Clinical nurses, including assistant nurse managers, completed an anonymous survey in 2023 at multiple Cleveland Clinic hospitals in Ohio. The survey asked various questions, including
- The level of control and influence they had over different aspects of their jobs
- The amount of access they had to information
- Their ability to negotiate solutions to problems and conflicts
- To describe their experience with CI processes and overall satisfaction with their practice
“Clinical nurses need to be given time to participate in committees and other decision-making activities,” DiFiore says. “We need access to data, including budgets and quality improvement process outcomes and we need to have influence over day-to-day clinical unit decisions,” she says.
Key Takeaways
Overall, DiFiore found that shared decision-making and involvement in clinical improvement projects led to increased job satisfaction. The team also found that many clinical nurses did not complete survey items about shared decision-making, suggesting that shared governance was not applied consistently or that some nurses did not feel comfortable making unit-level decisions.
“All hospitals want an engaged workforce — clinicians who look for solutions and try to provide the best care they can for their patients,” DiFiore says. “The survey responses reflected what’s happening in the real world. Although equal participation in decision-making is ideal, clinical nurses who are not formal leaders may not wish to make decisions that affect every caregiver on the team.”
The researchers hope their findings will influence hospital leaders to understand the importance of involving clinical nurses in decisions that directly impact them and patient care. For bedside nurses, the study reinforces that having a real voice in unit decisions is closely tied to feeling satisfied in their role.
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