1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

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Doesn't it seem like we're making a decision every minute? Whether simple, complex, or mind-boggling, every decision we make is watched by our staff and colleagues. These decisions offer a significant and truthful glimpse into our values, as well as tell the story of the workplace culture we promote. What messages are you sending with your decisions?

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Doughnuts for breakfast-you aren't health conscious. Staff meetings and celebrations held only during day-shift hours-you don't care about the night shift. No follow-up on new bedside report expectations-you don't think it really matters whether the expectations are met. Organizing the supply room by yourself-you don't value staff input. And these are just the simple decisions!


Ineffective decision making is a major source of frustration for all of us. Using meaningful data instead of knee-jerk reactions to drive decisions is basic, but not consistently done. Building consensus around a decision instead of yes-no voting, or, even worse, autocratic pronouncements, is a solid strategy to improve buy in. Other fundamentals include being true to underlying core values and understanding downstream effects. Deciding how to decide is an important decision for you to make.


Although you're ultimately accountable, aren't the best decisions made when end-user input is sought and considered? Isn't it even better when shared governance structures and processes are used? We've all rolled out decisions that made sense to us but failed when they reached our staff; stakeholder participation is essential. Compliance with regulations and standards may not be negotiable, but how we implement them usually is. The practice of allowing others to make decisions is a gift. It helps people grow, sends a message of inclusion and worthiness, and builds an attitude of decisiveness. If a staff member's decision doesn't produce positive results, it becomes a teaching point. As a leader, you should support the choice and help with the effects.


Sometimes, reaching a decision seems so overwhelming that we simply avoid it. In that case, get help! You may need to talk through the process and your available options with an expert or hold multiple meetings to hash out details. We can't always foresee all of the consequences, and unintended consequences aren't always negative. Downstream effects must be considered, but not to the point of prolonged indecision. Evaluate quickly and regularly, and act on feedback.


Remember that not making a decision is, in fact, a decision. It tells your staff that the status quo is fine and may even send the message that you aren't an effective leader. Strong leaders aren't afraid to make decisions, even if they make a mistake. Communicate the whys and circumstances of your choices, including what's out of your scope of authority. Use all of the resources, tools, and recommendations that you have at your disposal.


Leadership is decision making-all day, every day. Whether you're making a decision or influencing one, make it count.



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