Senior nurse administrators as decision makers in an era of environmental change : a thesis presented in partial fulfilment of the requirements for the degree of Masters in Business Studies at Massey University
The purpose of this thesis is to examine the activities of senior nurse administrators as decision makers responsible for planning and policy issues in large hospitals. The focus is on the effect environmental change has on these decision makers. Nineteen-seventy-nine marked the end of a decade of considerable change for nurses, nursing and the health services of New Zealand. In 1979 there were 46 nurses in appointed positions as chief, supervising principal or principal nurse of major regional or hospital nursing services in New Zealand. This total population was selected for the research study. There was a 63% response rate to a mailed questionnaire sent in November 1979. The effect of having a very small research population is reflected in the quality of data. However, there is some very interesting material from which inferences can be made in light of the model developed by the researcher. Seventy-nine per cent of the nurses participating in the study have been appointed to their present position from 1970 onwards and so have not had experience as an executive decision maker prior to the transitional era of the 1970's. Fifty-two per cent of these respondents have been nursing for more than 30 years and so have had long term exposure to working within bureaucracies. Fifty-six per cent of respondents have completed or partially completed university degrees and diplomas during the decade of the 1970's. Nursing qualifications do not reflect a move towards acquiring comprehensive registrations which became a possibility in this decade. There is evidence of some changes in organisational structure and decision making strategies. Forty-one per cent of the respondents are no longer responsible to medical administrators for their decision making, 17% are part of executive management teams, and 19% report that they receive important information for decision making by means of group discussion. There is also evidence of these nurses acknowledging formal organisation group structures. If these nurses are active participant members in these groups, then it can be conjectured that not only will the organisation, but maybe these groups will also be buffers to the effects of environmental change. The use of economic aspects of health services as indicators of information, that is considered as important by these decision makers, is a means of ascertaining subjective material. It is clearly demonstrated that finance and manpower have major effects on these nurses' decision making processes when compared with other input economic aspects of health services. Output aspects that are seen to be interlinked with finance and manpower, e.g. effectiveness of services, evaluation of quality of care, etc, are also seen to have considerable or very considerable effects on their decision making processes. The results of this research study demonstrate that these nurses are responding to environmental change with some individual, geographical and organisational differences being evident.