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This version was published on August 1, 2008
Western Journal of Nursing Research, Vol. 30, No. 5, 539-559 (2008)
DOI: 10.1177/0193945907310559

Structures and Practices Enabling Staff Nurses to Control Their Practice

Marlene Kramer

Health Science Research Associates, Apache Junction, AZ, mcairzona{at}juno.com

Claudia Schmalenberg

Health Science Research Associates, Tahoe City, CA

Patricia Maguire

Health Sciences Research Associates, Townsend, MA

Barbara B. Brewer

John C. Lincoln Hospital, Phoenix, AZ

Rebecca Burke

The Miriam Hospital, Providence, RI

Linda Chmielewski

St. Cloud Hospital, St. Cloud, MN

Karen Cox

Children's Mercy Hospitals and Clinics, Kansas City, MO

Janice Kishner

East Jefferson General Hospital, New Orleans, LA

Mary Krugman

University of Colorado Hospital, Denver

Diana Meeks-Sjostrom

St. Joseph's Hospital of Atlanta, GA

Mary Waldo

Providence St. Vincent's Hospital, Portland, OR

This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.

Key Words: control over nursing practice • organizational autonomy • shared governance • empowerment • productive work environment • essentials of magnetism


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