Empowering nurse leaders

Team Concepts Collaborative decision making: Empowering nurse leaders By Linda S. Burkett, DNP, MSN, RN, FCN D ecision making is significant to every professional organization, guiding trajectory and success. Understanding the complexity of decision making is imperative, as is recognizing the unique human dimensions inherent in the decision-making process.1-3 Personality type directly influences how individuals make decisions. For this reason, decision making is an elemental component of the Myers-Briggs Type Indicator (MBTI), a 93 forced-choice-question personality assessment tool. Corporations have been using the MBTI for over 60 years to develop leaders and gain insight to enhance collaboration, team building, problem solving, career development, management training, counseling, and conflict resolution. Foundational to the MBTI is Carl Jung’s theory of dichotomous personality types—extraversion/introversion, energy sensing/intuition, thinking/feeling, and judging/perceiving—which determine behaviors, inclinations, and priorities, each innate to decision making and significant to collaborative work.2 Extraversion is a preference for the outside world, activities, and others. Introversion is a preference for personal thoughts, memories, and experiences. A sensing preference is characterized by a penchant for facts, concrete data, and specifics. An intuition preference is characterized by a penchant for assessing the big picture, focusing on relationships, connections, and identifying patterns. Thinking reflects a person’s tendency to be objective in decision making, stepping away from the circumstance to analyze and apply reasoning. Feeling reflects a person’s tendency to be subjective in decision making, stepping into the circumstance, considering the impact on all stakeholders’ values, and applying empathy. Judging indicates people who prefer to organize the world. Perceiving indicates people who prefer to experience the world.4 Methods The purpose of this study was to assess the impact of MBTI educational modules for personality type www.nursingmanagement.com comprehension and application by nurse leaders to enhance collaborative decision making. A shared governance council at a 228-bed facility within a seven-hospital network in western Pennsylvania was selected as a pilot study venue. The shared governance council included full-time formal and informal nurse leaders, representing administration, inpatient units (orthopedics, psychiatric, oncology, ICU, telemetry, ED), and outpatient radiology. All members were female, with educational backgrounds that included diploma, associate, BSN, and MSN degrees; a range of years in nursing from 5 to over 20; and a range of years in nursing leadership from 1 to over 20. Eight of the 10 council members completed the 4-month study. The sample size was strategic for a deepdive investigation into the topic. A noted gap in the literature was assimilating personality types into the collaborative decisionmaking process. The author created a conceptual framework representing the correlation of personality types to decision-making styles and its impact on leadership constructs. (See Figure 1.) Without a published tool to specifically measure nurse leader collaborative decision making enhanced by MBTI application, a leadership training survey created by Dr. Marc DeSimone was used as a focused assessment. With permission and consultation, “How Well Do You Participate in Collaborative Decision Making?” was created as a 10-item assessment, using a 5-point Likert scale (1 = “not at all”; 5 = “very much”). The tool queried seven constructs of nursing leadership recognized by research findings: trust, peer appreciation and understanding, collaboration, communication, professional growth, ethical conduct, and Nursing Management  September 2016 7 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Team Concepts evidence-based practice.2,5-8 In addition, it surveyed three constructs of decision evaluation: value (appropriate merit and benefit to all stakeholders), expediency (efficient use of time and a defined process), and pragmatism (practicality of implementing the decision within fiscal and strategic confines).9 Every effort was made to ensure the assessment’s validity and reliability. This study employed descriptive content analysis and survey meth- Figure 1: Conceptual framework4,5,9,10 Decision-making process Subjective expected utility theory + type theory MBTI personality dichotomies Define problem Extraversion/introversion Focus and energy Collect data Identify options Sensing/intuition Information and perception Assign utility/weigh outcomes Project risk Thinking/feeling Evaluation and synthesis Add stakeholders’ values Make final decision Judging/perceiving Orientation to outer world Implementation Act on decision Evaluate decision Decision value Constructs of nurse leader decision making Trust Colleague appreciation and understanding Collaboration Communication Professional growth Ethical conduct Evidence-based practice 8 September 2016  Nursing Management Decision expediency odology, utilizing an interrupted time-series design of four monthly education sessions, with pre- and postintervention assessments. Open discussion and group observation provided qualitative data and feedback. Member self-report methods were implemented to discern perceived improvement. Individual session usefulness was evaluated by asking: 1. Empowering nurse leaders

Was this session interesting to you? 2. Did this session add new knowledge for you? 3. Do you think the session informs dimensions of communication for collaborative decision making? 4. Was the presenter effective? 5. Did you attend session one, completing the collaborative decision-making assessment and the MBTI? This evaluation was completed after each session using a 5-point Likert scale (1 = “not at all”; 5 = “very much”) to measure member buy-in and appraisal of the presented materials. Decision pragmatism Session one began with an introduction and opening comments made by the sole facilitator, a certified MBTI practitioner. Informed consent was obtained, with participation signifying member agreement. The preintervention assessment tool “How Well Do You Participate in Collaborative Decision Making?” was administered. The MBTI was given and results were revealed, followed by a best-fit education module to confirm personality type through further explanation and member self-report. Voluntarily disclosed member personality types were then displayed on a poster, serving as a team type table. Session two was conducted by the investigator, beginning with a review of personality type descriptors. Group discussion enabled a safe environment for member feedback on personality type comprehension, self-awareness, and insight into www.nursingmanagement.com Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Team Concepts www.nursingmanagement.com Figure 2: Members’ dichotomous personality types 8 7 6 5 4 3 2 1 0 Extraversion/ introversion Sensing/ intuition Thinking/ feeling Judging/ perceiving Figure 3: Nursing leadership constructs and decision evaluation improvement 50 62.5 62.5 Decision pragmatism 62.5 Decision process expediency 87.5 25 25 25 Ethical conduct Evidence-based practice Decision value to stakeholders 50 Professional growth Communication Collaboration Trust 0 Appreciation and understanding 100 90 80 70 60 50 40 30 20 10 0 Percent personality type propensities. Members shared new understanding of personal inclinations toward methods of engagement, information collection, and problem resolution. Discussion of the team type table followed, demonstrating group strengths and personality gaps. The decision-making process was described: define the problem; collect data; identify options; assign utility/ weigh outcomes; project risk; add stakeholders’ values; make the final decision; act on the decision; and evaluate the decision by value, expediency, and pragmatism.9 Discussion incorporated the influence of personality type on each step. Four diverse activities were completed to explore personality type influence on decision making per scenario. Clear differences in approaches and priorities were noted by type. Session three explored the impact of individual perception and information processing on decision making. A detailed illustration was briefly presented. What the members recalled about the picture was discussed to demonstrate how differently people perceive and interpret information, aligned with personality type. Empowering nurse leaders

Divided by type dichotomy, members were asked to resolve a nurse staffing challenge. Solutions were compared, highlighting the influence of personality type. Session four included recognizing team strengths and gaps by increasing member understanding, group trust, communication, and collaboration. The decision-making process was used to navigate a critical decision team scenario. Attention was given to personality type preferences, outcomes, and stakeholder values. Discussion of the impact of personality type on nurse leadership constructs, best practice, and shared governance council collaboration followed. Additional open dialogue about the project, activities, learned knowledge, application capacity, and personal disclosures occurred, and the postintervention assessment tool was administered. Results The MBTI and best-fit education module disclosed member self-report of personality type. (See Figure 2.) Most members had a preference for feeling over thinking. What draws individuals into caring professions is typically an empathetic, subjective viewpoint, defined as feeling.4 More members reported a preference for extraversion over introversion, common to groups and demonstrated by participation degrees during discussions. Sensing/intuition and judging/perceiving had equal representation. The coded matched analysis for the pre- and postassessment revealed that all members reported improvement in nursing leadership constructs and decision evaluation. Nursing Management  September 2016 9 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Team Concepts (See Figure 3.) Individual improvement ranged from 10% to 70%, according to outcome comparison. The greatest collective improvement was reported in collaboration at 87.5%. High improvement was reported in group trust, decision process expediency, and decision pragmatism at 62.5%. Peer appreciation and understanding, as well as communication, revealed a 50% improvement. All other constructs reported a 25% improvement, with the exception of personal professional growth, which showed no perceived change during the 4-month project. Group discussion revealed that each member declared an initial moderate-to-high regard for this construct and didn’t waiver. Empowering nurse leaders

All four sessions were evaluated by member report. A cumulative graph demonstrated the positive trajectory of evaluation by session, inclusive of interest; added knowledge; informed communication for collaborative decision making; and presenter effectiveness, which scored highest in all four sessions. (See Figure 4.) The escalating results reflected member buy-in and value placed on the project’s content and goals. Significant qualitative data were gleaned from emergent themes shared by participants. (To view the themes, see the Nursing Management iPad app.) The project sample size and supportive context created a safe environment for personal disclosure of thoughts and reflections. Understanding the MBTI helped members define their actions, propensities, and inclinations. Comments were categorized into the common themes of personality type self-awareness, impact on decision making, awareness of other council members’ personality types, understanding of MBTI application in the workplace, and enhanced collaboration with other healthcare disciplines. Productive and positive feedback demonstrated substantial benefits to self, peers, and the interdisciplinary team. Acknowledged inherent limitations of the study were the small convenience sample, an investigatorcreated tool, and self-reported data collection. The personality impact Educating nurse leaders about personality types is increasingly significant to nursing practice. This study exemplifies the prospective benefits Figure 4: Session total mean scores 19.25 18.87 18.1 of incorporating personality types into the nurse leader decisionmaking process. Heightened selfawareness and peer appreciation of the impact of personality types can improve communication and collaboration within nursing and other disciplines. Empowering nurses to engage in decision-making forums brings sage input from the bedside to the boardroom. NM REFERENCES 1. Barrett A, Piatek C, Korber S, Padula C. Lessons learned from a lateral violence and team-building intervention. Nurs Adm Q. 2009;33(4):342-351. 2. Empowering nurse leaders

Bassett S. Accountability in the NHS. Nurs Manag (Harrow). 2012;19(8):24-26. 3. DiMeglio K, Padula C, Piatek C, et al. Group cohesion and nurse satisfaction: examination of a team-building approach. J Nurs Adm. 2005;35(3):110-120. 4. Myers IB, McCaulley MH, Quenk NL, Hammer AL. MBTI Manual: A Guide to the Development and Use of the Myers-Briggs Type Indicator Instrument. 3rd ed. Mountain View, CA: CPP; 2009:5-12. 5. Dougherty MB, Larson EL. The nurse-nurse collaboration scale. J Nurs Adm. 2010; 40(1):17-25. 6. Politi MC, Street RL Jr. The importance of communication in collaborative decision making: facilitating shared mind and the management of uncertainty. J Eval Clin Pract. 2011;17(4):579-584. 7. Brewton C, Eppling J, Hobley M. Our VOICE: an interdisciplinary approach to shared governance. Hosp Top. 2012; 90(2):39-46. 8. Moore J, Prentice D. Collaboration among nurse practitioners and registered nurses in outpatient oncology settings in Canada. J Adv Nurs. 2013;69(7):1574-1583. 9. Hough JH, Ogilvie D. An empirical test of cognitive style and strategic decision outcomes. J Management Studies. 2005; 42(2):417-448. 10. Dowding D, Thompson C. Measuring the quality of judgment and decision-making in nursing. J Adv Nurs. 2003;44(1):49-57. Linda S. Burkett was an RN-BSN program instructor. She’s currently pursuing other venues to apply the components of this project. 17.6 The author has disclosed no financial relationships related to this article. SESSION ONE SESSION TWO SESSION THREE SESSION FOUR DOI-10.1097/01.NUMA.0000491131.60730.d3 10 September 2016  Nursing Management www.nursingmanagement.com Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. .. Empowering nurse leaders