Nurses' professional judgment not considered in strategic decision-making, says UK study

Nurses' voices and professional judgment is not being utilized in strategic decision making potentially causing dissatisfaction among staff and a lack of high quality patient care, according to new research led by Cardiff University.

The study, known as Pro-Judge, looked at how nurses use professional judgment in making decisions about organizing the nursing workforce to meet patient needs. A corresponding paper is also published in the International Journal of Nursing Studies.

Focusing on three NHS trusts in England and three University Health Boards in Wales the researchers found that while nurses are relied upon to use professional judgment for operational purposes to manage risks during staff shortages, their judgments do not carry the same weight when it comes to agreeing on staffing levels at strategic level.

The team suggest this could result in safe but not necessarily high-quality patient care, leading to professional dissatisfaction, which could impact nurse retention and increase staff shortages—which is critical at a time when nurses leaving the profession is the highest in a decade.

Davina Allen, Cardiff University's School of Healthcare Sciences who led the study said, "Health care systems lean on nurses' professional judgment for operational staffing decisions, valuing their real-world understanding of clinical environments over data. However, when it comes to strategic decision-making, data takes precedence over professional judgment.

"Nurses have voiced their concerns that formal measurement systems often fail to capture essential aspects of care quality and staff well-being, making it challenging for them to express their professional judgment for workforce planning.

"If nurses are to deploy their professional judgment to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care, a vocabulary through which these judgements can be articulated, and a reframing of strategic decision-making to be more inclusive of the clinical perspective."

The study suggests three actions to help: equipping nurses with a vocabulary to articulate their professional judgment for strategic decision-making; being more inclusive of expert nursing clinical and contextual knowledge in health care organizations; and refining staffing systems to generate data that better captures the complexity of care and nursing workload.

Deepa Korea, RCN Foundation director said, "We are very proud that our grants for nurse-led research continue to innovate and make a difference to the nursing profession. With nurse retention rates and staff shortages at a critical rate, it is fundamental that we utilize nurses in the workplace, giving them the tools to empower themselves and appropriate their professional judgment, ensuring that their voices are heard."