By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Over the past six months, I have conducted focus groups in two organizations, examining leadership behaviors that influence nurses’ engagement or disengagement in their unit’s shared governance. One of the points I repeatedly heard from younger staff was that nurse leaders did not take action on problems and issues in a timely manner.
When a problem or challenge is within a leader’s circle of influence, nurses today expect you to act decisively and close the loop quickly. When you think about today’s fast-paced world, your nurses can order something from Amazon and see it delivered within days or hours. Yet, it can take weeks to repair essential broken equipment for care. Decision-making in healthcare organizations is also slow, and even simple policy or practice changes can take a considerable amount of time to be approved by multiple committees. Too often, the loop on a decision is never closed. Baby boomers and Generation X tolerated attending meetings where the same agenda item was discussed month after month, but younger staff will not. As one young nurse recently told me in a focus group, ‘Why should I waste my time when nothing happens with our input?‘ He makes a good point.
Many leaders want to exercise caution before making a final decision. But not all decisions leaders make have the same consequences, so they may not need the same level of contemplation. In Jeff Bezos’s book, Invent and Wander, he points out that people often think about their decisions in the same way, even when they don’t. He divides decisions into two categories. The first category is one-way door decisions. These are critical decisions that are highly consequential and usually irreversible. To change one’s mind after the fact can lead to disaster. Bezos believes these decisions should be heavily debated and analyzed from several vantage points.
There is a second type of decision, which Bezos calls a two-way-door decision. These decisions are reversible. If the decision proves to be wrong – you change. Not as much debate is needed with two-way-door decisions because they can be undone. Most daily decisions that we make in nursing would fall into this category.
Nurse leaders today should work to have a bias for action. If the decision can be easily undone, move quickly and make the decision. If the decision can’t easily be undone, take your time. In either case, the key action is to keep staff informed and close decision loops even if the decision is no. Keep in mind that no decision is a decision and one that frustrates staff.
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