AIM:

The aim of this study was to investigate how restricted decision making autonomy and conflicting demands impact operational managers' work performance and health.

BACKGROUND:

Managers at operational level (first and second-line managers') in health care organizations are commonly exposed to strain in their work situation with high demands and a challenging work context. Although they play an important role, the knowledge about the causal associations between stressful job demands and their consequences is limited.

METHODS:

A prospective design with questionnaire data collected at two points in time, one year apart, from a sample of operational managers (N = 162) at five Swedish hospitals was used to conduct a structural equation model (SEM) analysis with cross-lagged paths.

RESULTS:

Restricted decision making autonomy was negatively associated with both the managers' health and their managerial work performance over time.

CONCLUSIONS:

Health care managers' work performance and health may be sustained by the top management allowing them a higher degree of autonomy in their decision making.

IMPLICATIONS FOR NURSING MANAGEMENT:

This study suggests that nursing leaders should create the circumstances for operational managers' to have higher levels of autonomy in their area of responsibility and the freedom to prioritize their managerial workload.