Aim: To describe how organizational context and restructuring influenced nurse leaders' use of evidence in decision-making in their management practice.

Method: Qualitative descriptive study. Fifteen leaders at executive and front-line manager levels in one organization were interviewed using a semi-structured format.

Findings: Inductive content analysis generated five main themes: leaders strove to keep relationships that preserve best decision-making ability; and sought the best knowledge to inform their decisions. However, a context of constant change; more scope; less autonomy; and decisional inertia in a sea of change had profound effects on their ability to employ evidence in decision-making.

Implications: Evidence-informed decision-making is a dynamic social process highly influenced by political instability in work environments. Organizational restructuring creates threats to common decision-making strategies, including information flow, relationships and priority setting. Healthcare restructuring is now a global constant, and there is a need for hospital leaders to understand and mitigate the effect restructuring has on the ability of leaders to engage in evidence-informed decision-making. Strategies are proposed to manage uncertainty and support nurse leaders in their evidence-informed decision-making to deliver quality health services. This research provides an in-depth examination of how evidence-informed decision-making is influenced in the context of instability and uncertainty due to ever-present organizational restructuring.

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