THE NURSE LEADER AND THE DECISION MAKING

INTRODUCTION
Decision making is an indispensable component of management process
and managers life is filled with making decision after desirous. All the managers
including nurse managers see decision making as their central job because they
constantly choose what is to be done, who is to do, when to do, where to be
done, how to do.
DEFINITION OF DECISION
Decision represents a judgment, a final resolution of a conflict of needs,
mean or goals and a commitment to action made in face of uncertainty
complexity and even irrationally.
Lopez
DEFINITION OF DECISION MAKING
t is the art of determining in ones own mind upon an opinion or course of
action!.
Websters Dictionr!
Decision is the commitment of the decision maker to act there by
committing the personnel, material and financial resources of the organi"ation#
towards the action objectives.
Isn"r D!#
$he decision making process involves a problem to be solved, a number
of conflicting objectives to be reconciled a number of possible alternative courses
of action from which the best! has to be chosen and some way of measuring the
value or pay off of alternative course of action.
Don#$ %& C#o'()
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T*+ES OF DECISION MAKING
$here are many type of managerial decision%&
'. (echanistic
). Analytical
*. +udgmental
,. Adaptive
-. .trategies
/. Administrative
0. 1perational
2. 3rogrammed decision
4. 5on&programmed decision
'6. 5on 7outine decision
11. 7outine decision.
Mec)nistic Decision
t is routine and repetitive in nature occurs in a situation involving a limited
number of decision variables where the outcome of each alternative is known. t
solves problem by habitual, responses, standards opening procedures or lyrical
routine. $ool includes charts, lists, matrices, decision tree etc. t is useful in daily
routine and scheduled activities.
An#!tic# Decision
nvolves a problem with a large number of decision variables where the
outcomes of each decision alternative can be computed. $echni8ues used to find
optimal solution are linear programming, network, analysis, inventory recorder
model, statistical analysis. t helps to solve complex problem.
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%'$(,ent# Decision
t involves a problem with a limited number of decision variables but the
outcomes of decision alternatives are unknown. $o increase the desired out
comes good judgment is needed. t is useful in marketing, investment and to
solve personal problems.
A$pti-e Decisions
nvolves a problem with a large number of decision variables where
outcomes are not predictive because of the complexity and uncertainty of
problem decision makers are not able to agree on their nature or on decision
strategies. .o it re8uired contribution of many people with diversed technical
background. n this situation, strategies have to be fre8uently modified to
accommodate new development in technology and environment. 9.g. 7esearch
finding.
Strte(ies Decision
$hese are made by top executives that commit valuable agency resources
to achieve major long term goals. $he nurse executives were successful in
making these decisions with the help of extensive supports network to obtain
crucial problem, information, used mixed scanning to analy"e problem causes
and obtaining support of the agencies dominant coalition in shifting through
alternatives for the best problem solution.
'. Administrative decision
). (id level (anagers
Opertion# Decision
$hese are routine decision governing day to day events that name been
delegated to first level managers and are made according to the proscribed rules
and regulations and instructions.
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+ro(r,,e$ Decision
$hese are routine, repetiaitive, mandated through structured or burean
cratic techni8ue :.tandard operative 3rocedures; which are needed in problem
solution, where it is immediately apparent what information is needed and where
the information can be obtained.
Non.pro(r,,e$ Decision
5on unstructured creative decision that are made to solve problem for
which no well defined strategies are available. t must be made by managers
using available information and their on judgment and is made under the
pressure of time.
Non Ro'tine $ecision
5on routine, non recuting, non recurring and uncertain e.g. <hanging the
way of organi"ing for the delivery of nursing care.
Ro'tine Decision
t is more routine recurring and certain. 9.g. assigning daily pre coverage.
7outine decision are more predictable, where as outcome of the non routine is
uncertain.
+)ses o/ Decision M0in(
$here are three phases in the decision making process. $hey are,
12 Inte##i(ence cti-it!
$his phase of searching the environment for condition calling for
the decision. $his is also called an initial phase!.
32 Desi(n cti-it!
n this phase inventing, developing analy"ing possible conduct of
action are taken in to consideration.
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42 C)oice Acti-it!
$he last phase is the actual choice selecting a particular course
action from those available.
E#e,ents o/ Decision M0in(
Decision maker.
$he decision problem.
$he environment in which the decision is to be done.
$he objective of the decision making
$he alternative course of action
$he outcomes expected from various alternatives
$he final choice of alternatives
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Steps in Decision M0in(
'. 7ecognition of the existence of a problem or
problems.
). Determining the what, why, where, how, and
who of a problem.
*. =arious structuring or resources to solve
problem.
, mpact of alternatives on all facts of the
organi"ation
5 3ositive effort towards attainment of goal
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+rob#e,
I$enti/iction
+rob#e, An#!sis
E-#'tin( t)e
i,pct o/
#ternti-es
Decision (aking.
<ommitment of resources to course of action
Deter,inin( t)e
possib#e #ternti-es
Se#ecti-e o/ n
#ternti-e
I,p#e,enttion o/ t)e
$ecision
1& +rob#e, I$enti/iction
Diagnosing the problem is an essential step for nurse to make
rational decision making. $he first and most important task before
the decision makers is to find and define the problem before he
takes any decision. 9minent author of the subject are of this opinion
that a problem well defined is half solved and a good decision
cannot be taken up unless the decision taken has good grasp of the
problem. .ufficient time should be spent on defining the problem as
it is not always easy to define the problem and to see the
fundamental thing that is causing difficulty and that needs
correction. 7ight answer to the right 8uestion we can have by only
having clear definition.
3& +rob#e, An#!sis
t is the next step in successful problem solving classification is
necessary in order to know who should take the decision and who
should be consulted in taking it without proper classification the
effectiveness of a decision may be jeopardi"ed. $he problem
should be classified keeping in the view of the following factors.
$he nature of decision making
$he impact of the decision on other functions
$he futurity of the decision
$he periodicity of the decision
$he limiting factor relevant to the decision.
4& Deter,inin( possib#e A#ternti-es
$his is a difficult step in decision making. $he nursing personnel should
keep in mind all logical solution to the problems and not only these which
tend to shape up had preconceived or pert solution. $he emphasis should
be to minimi"e the impact of previous solution to the problem. $here is
nothing wrong to take into consideration the previous solutions but the
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thing to be avoided however is relying on these previous solutions as the
only source of ideas.
5& E-#'te t)e i,pct o/ ec) A#ternti-es
n brief, we can list four steps for determining possible alternatives, and
examining their impact.
a; dentify resources > ?ist every thing available to assist in solving
the problem.
b; Develop alternative solution > develop various resources leading to
problem solution.
c; $est each alternatives > Analysis for%
S'itbi#it! > will it solve the problem partially, permanently > or
temporarily@
Fesibi#it! > will it work and how much will it costA can we afford it@
Acceptbi#it! > t is acceptance to know involved and responsible.
d; ?ist benefits, cost and risks associated with each alternatives, each
alternative and improvement, its benefits any cost of action be
weighed. Bhat are the odds and successes of each alternative@
6& Se#ection o/ n A#ternti-e
$his is the final stage of the decision making. $here are four important
criteria for picking the best solution.
I& Mn(e,ent o/ t)e ris0s n$ (ins
$he nurse has to weigh the risk of each course of action against the
expected gains heAshe is to find out the ratio between the expected gains
and the anticipated risks.
II& Econo,!
$hat course of action may be adopted which would give the greatest result
with the least effort.
III& Ti,in(
Decision concerning timing is very difficult to systemati"e. n a
predominantly unhealthy and malnourished country, decisions have to be
taken in time otherwise the communicable diseases may spread.
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I7& A-i#bi#it! o/ Reso'rces
$he most important resources are the human being who will carry out the
decision. 5o decision can be better than the people who have the carry it
out.
T)e N'rse Le$er Ro#e In Decision M0in(
$he nurse leader has to select the type of decision appropriately based
upon the characteristics of the problem.
Accumulate carefully the detailed facts their analysis and interpretation
and to use the broad concepts of human and physical behaviors to predict
future development.
$ake the decision according to the institution and success.
Apply her knowledge and skills while relating the type of decision
1btain as well as consider the aspiratory tradition and attitudes of the
agency
Cse statistics, work study, operational research and management survey
to select the type of decision.
De tactful and viplomatary in taking the decision
<reate non threatening creative and conducive environment while taking
group decision.
3rovide positive feed back to her subordinate.
8ib#io(rp)!
'. Eoel ..<, Fumar 7. :)66,;, 5ursing .ervices! Girst 9dition, Deep
3ublications pvt. ?td. 5ew Delhi 3age 5o% 24&''6.
). Gancies <.(. .ou"a de. <. (asio :)666;, Hospital Administration! third
edition, +aypee Drothers publications, 3.5o% ,'&,-.
*. Harold.F :)66); A text Dook of (anagement, '6
th
edition, (cEraw
publication 5ew Delhi, 3.5o. '42&))*.
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