Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Team Concepts Collaborative decision making: Empowering nurse leaders By Linda S. Burkett, DNP, MSN, RN, FCN D ecision making is significant to every pro- fessional organization, guiding trajectory and success. Understanding the complexity of decision making is imperative, as is rec- ognizing 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 develop- ment, 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 pref- erence for personal thoughts, memories, and expe- riences. 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 relation- ships, connections, and identifying patterns. Think- ing reflects a person’s tendency to be objective in decision making, stepping away from the circum- stance 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 indi- cates 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 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 Penn- sylvania was selected as a pilot study venue. The shared governance council included full-time for- mal 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 leader- ship from 1 to over 20. Eight of the 10 council members completed the ...

1. Copyright © 2016 Wolters Kluwer Health, Inc. All rights
reserved.
Team Concepts
Collaborative decision making:
Empowering nurse leaders
By Linda S. Burkett, DNP, MSN, RN, FCN
D
ecision making is significant to every pro-

2. fessional organization, guiding trajectory
and success. Understanding the complexity
of decision making is imperative, as is rec-
ognizing 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 develop-
ment, 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

3. 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 pref-
erence for personal thoughts, memories, and expe-
riences. 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 relation-
ships, connections, and identifying patterns. Think-
ing reflects a person’s tendency to be objective in
decision making, stepping away from the circum-
stance 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

4. who prefer to organize the world. Perceiving indi-
cates 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
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 Penn-
sylvania was selected as a pilot study venue. The
shared governance council included full-time for-
mal 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

5. in nursing
from 5 to over
20; and a range
of years in
nursing leader-
ship from 1 to
over 20. Eight
of the 10 council members completed the 4-month
study. The sample size was strategic for a deep-
dive investigation into the topic.
A noted gap in the literature was assimilating
personality types into the collaborative decision-
making process. The author created a conceptual
framework representing the correlation of person-
ality types to decision-making styles and its im-
pact on leadership constructs. (See Figure 1.) With-
out a published tool to specifically measure nurse
leader collaborative decision making enhanced by

6. 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 con-
structs of nursing leadership recognized by
research findings: trust, peer appreciation and
understanding, collaboration, communication,
professional growth, ethical conduct, and
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Team Concepts
Figure 1: Conceptual framework4,5,9,10
MBTI personality

7. dichotomies
Decision-making process
Subjective expected utility
theory + type theory
Extraversion/introversion
Focus and energy
Define problem
Collect data
Identify options
Assign utility/weigh outcomes
Project risk
Add stakeholders’ values
Make final decision
Act on decision
Evaluate decision
Decision
value
Decision
expediency
Decision

8. pragmatism
Sensing/intuition
Information and perception
Thinking/feeling
Evaluation and synthesis
Judging/perceiving
Orientation to outer world
Copyright © 2016 Wolters Kluwer Health, Inc. All rights
reserved.
Constructs of nurse leader
decision making
Trust
Colleague appreciation
and understanding

9. Collaboration
Communication
Professional growth
Ethical conduct
Evidence-based practice
evidence-based practice.2,5-8 In ad-
dition, it surveyed three constructs
of decision evaluation: value (ap-
propriate 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

10. content analysis and survey meth-
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 feed-
back. Member self-report methods
were implemented to discern per-
ceived improvement. Individual
session usefulness was evaluated
by asking: 1. Was this session inter-
esting to you? 2. Did this session
add new knowledge for you? 3. Do
you think the session informs di-
mensions of communication for col-
laborative decision making? 4. Was
the presenter effective? 5. Did you

11. attend session one, completing the
collaborative decision-making as-
sessment and the MBTI? This eval-
uation was completed after each
session using a 5-point Likert scale
(1 = “not at all”; 5 = “very much”)
to measure member buy-in and ap-
praisal of the presented materials.
Implementation
Session one began with an introduc-
tion 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?”

12. was administered. The MBTI was
given and results were revealed, fol-
lowed by a best-fit education mod-
ule to confirm personality type
through further explanation and
member self-report. Voluntarily dis-
closed 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 re-
view of personality type descriptors.
Group discussion enabled a safe en-
vironment for member feedback on
personality type comprehension,
self-awareness, and insight into
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Team Concepts
Copyright © 2016 Wolters Kluwer Health, Inc. All rights
reserved.
personality type propensities. Mem-
bers shared new understanding of
personal inclinations toward meth-
ods 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 de-

14. scribed: 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 Dis-
cussion incorporated the influence
of personality type on each step.
Four diverse activities were com-
pleted to explore personality type
influence on decision making per
scenario. Clear differences in ap-
proaches and priorities were noted
by type.
Figure 2: Members’ dichotomous personality types
8
7

15. 6
5
4
3
2
1
0
Extraversion/ Sensing/ Thinking/ Judging/
introversion intuition feeling perceiving
Figure 3: Nursing leadership constructs and
decision evaluation improvement
100
90
Session three explored the im- 80
pact of individual perception and 70
information processing on decision 60
making. A detailed illustration was
briefly presented. What the mem- Pe
rc
en
t 50
40

16. 30
bers recalled about the picture 20
was discussed to demonstrate 10
how differently people perceive 0
and interpret information, aligned
with personality type. Divided by
type dichotomy, members were
asked to resolve a nurse staffing
challenge.
Solution
s were com-
62.5
50
87.5
50
25 25 25

17. 62.5 62.5
0
Tr
us
t
A
pp
re
ci
at
io
n
an
d
un

18. de
rs
ta
nd
in
g
Co
lla
bo
ra
tio
n
Co
m
m
un
ic

19. at
io
n
Pr
of
es
si
on
al
gr
ow
th
Et
hi
ca
l c

20. on
du
ct
Ev
id
en
ce
-b
as
ed
pr
ac
tic
e
D
ec

21. is
io
n
va
lu
e
to
st
ak
eh
ol
de
rs
D
ec
is
io

22. n
pr
oc
es
s
ex
pe
di
en
cy
D
ec
is
io
n
pr

23. ag
m
at
is
m
pared, highlighting the influence
of person ality type.
Session four included recogniz-
ing team strengths and gaps by in-
creasing member understanding,
group trust, communication, and
collaboration. The decision-making
process was used to navigate a criti-

24. cal decision team scenario. Atten-
tion was given to personality type
preferences, outcomes, and stake-
holder 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 post-
intervention assessment tool was

25. administered.
Results
The MBTI and best-fit educa-
tion module disclosed member
self - report of personality type.
(See Figure 2.) Most members had
a preference for feeling over think-
ing. What draws individuals into
caring professions is typically an
empathetic, subjective viewpoint,
defined as feeling.4 More members
reported a preference for extraver-
sion over introversion, common

26. to groups and demonstrated by
participation degrees during dis-
cussions. 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.
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27. Copyright © 2016 Wolters Kluwer Health, Inc. All rights

28. reserved.
Team Concepts
(See Figure 3.) Individual improve-
ment ranged from 10% to 70%, ac-
cording to outcome comparison.
The greatest collective improve-
ment was reported in collaboration
at 87.5%. High improvement was
reported in group trust, decision
process expediency, and decision
pragmatism at 62.5%. Peer appreci-
ation and understanding, as well as
communication, revealed a 50% im-

29. provement. All other constructs re-
ported a 25% improvement, with
the exception of personal profes-
sional growth, which showed no
perceived change during the
4-month project. Group discussion
revealed that each member de-
clared an initial moderate-to-high
regard for this construct and didn’t
waiver.
All four sessions were evaluated
by member report. A cumulative
graph demonstrated the positive

30. trajectory of evaluation by session,
inclusive of interest; added knowl-
edge; 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

31. themes, see the Nursing Management
iPad app.) The project sample size
and supportive context created a
safe environment for personal dis-
closure of thoughts and reflections.
Understanding the MBTI helped
members define their actions, pro-
pensities, and inclinations. Com-
ments were categorized into the
common themes of personality type
self-awareness, impact on decision
making, awareness of other council
members’ personality types, under-

32. standing of MBTI application in the
workplace, and enhanced collabora-
tion with other healthcare disci-
plines. Productive and positive
feedback demonstrated substantial
benefits to self, peers, and the inter-
disciplinary team.
Acknowledged inherent limita-
tions of the study were the small
convenience sample, an investigator-
created tool, and self-reported data
collection.

33. The personality impact
Educating nurse leaders about per-
sonality types is increasingly signif-
icant to nursing practice. This study
exemplifies the prospective benefits
Figure 4: Session total mean scores
17.6
18.1
18.87
19.25
SESSION ONE SESSION TWO SESSION THREE SESSION
FOUR
of incorporating personality types

34. into the nurse leader decision-
making process. Heightened self-
awareness and peer appreciation of
the impact of personality types can
improve communication and col-
laboration within nursing and other
disciplines. Empowering nurses to
engage in decision-making forums
brings sage input from the bedside
to the boardroom. NM
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Linda S. Burkett was an RN-BSN program in-
structor. She’s currently pursuing other venues
to apply the components of this project.

37. The author has disclosed no financial rela-
tionships related to this article.
DOI-10.1097/01.NUMA.0000491131.60730.d3
10 September 2016 � Nursing Management
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https://DOI-10.1097/01.NUMA.0000491131.60730.d3