Malloch and Porter-O'Grady point out that organizations "work from the inside out" and not from top to bottom.It is significant for staff nurses to participate fully in the decision-making processes of their health-care organizations and they can best do this by:

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Empowering themselves and other nurses to negotiate for their patients is the best choice because it suggests that nurses should take an active role in decision-making and advocate for their patients. This approach is aligned with the authors' assertion that organizations work from the inside out, meaning that change must come from within the organization rather than being imposed from above. Shadowing physicians (option A) may be informative but does not directly empower nurses to participate in decision-making. Compromising (option B) implies that nursing is in competition with other healthcare workers, which may not always be the case. Ignoring administrators (option D) is not productive or professional.

Malloch and Porter-O'Grady Point Out That Organizations "Work from the Inside