Understanding and Working in Organizations

04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC

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Understanding and Working in Organizations


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Understanding Organizations Organizations

Formally constituted groups of people who work together; with identified tasks to achieve a specific purpose defined by the organization

Defined by unique purpose and structure

Organizational structure How the group is formed Chain of command Lines of communication How decision-making occurs Max Weber, the

Father of Organizational Theory!

http://www.faculty.rsu.edu/~felwell/Theorists/Weber/Whome.htm


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Understanding Organizations

Organizational function: is it parallel to organization structure?

Structure of organization Must accomplish its purpose in

effective way…make money!


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The Mission Statement Purpose or a reason for existing Reflects the basic nature of the

institution Critical element in the strategic

planning Often followed by a:

Vision statement Statement of values Listing of strategic goals


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Statement of Philosophy Nursing departments often have separate

statements

Flows from the purpose or mission statement

Provides a statement of beliefs and values that are basic to the delivery of nursing care

Can be identified by statements of values and goals or objectives


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Nursing Philosophy Statement Sets the standard of nursing care

that promotes a coordinated health care system and ensures quality across the continuum of care


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Types of Organizational Structure Tall

Also called centralized Nursing position would be that of the

chief nursing officer Each person who has some authority is

responsible for only a few subordinates


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Types of Organizational Structure (cont'd) Flat

– Decentralized organization – Few levels and a broad span of control – Decision making commonly spread among

many people – Those closest to the situation is given

wide latitude in determining appropriate actions

– Operates less expensively


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Types of Organizational Structure (cont'd)• Matrix

– Organization of areas around product lines and service lines

– Most often found in very large, multifaceted organizations

– Resources needed to offer complete care in the chosen area are brought together under one administrator

– Underlying structure that is either tall or flat and is thought of as the functional structure


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Understanding Organizations -Relationships

Authority Official power from top down; earned

Responsibility Ethical and legal obligation

Accountability Involves liability (Delegation)


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Relationships within Organizations Chain of Command

Also known as “organizational hierarchy”

Identifies path of authority and accountability!

Channels of Communication Formal and informal

pathways Span of Control


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Question A chain of command can also be called what?

A. Organizational structure

B. Organizational hierarchy

C. Organizational oversight

D. Organizational chart


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AnswerOrganizational hierarchy

Rationale: a chain of command exists in all organizations. It is also referred to as organizational hierarchy.


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Relationships within Organizations

Job Descriptions Written statements Provides general guidelines for

function Outlines scope of authority,

responsibility, and accountability

Basis for evaluation Found in policy manual


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Understanding Organizational Charts Provides graphic description of roles

and patterns of interactions among parts of the system

Shows formal structure of organization Solid lines: communication relationships Vertical lines: lines of authority; chain of

command Dotted lines: advisory Hospital Organizational Charts

http://www.bhhs.org/general/gi_organization.php4


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Organizational Chart


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Understanding Organizational Charts cont Tall or centralized structure

Has “core” individuals; few in power “Narrow” area of responsibility Problems in communication

Flat or de-centralized structure Decision-making “spread-out” Simplification of communication “Charge person” with broad span of

control


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Understanding Organizational Charts cont Matrix Structure*

Secondary lines of authority Typical of large organizational

structures• Characterized by having individuals with

expertise as resources• Team approach to problem solving! • Involves a two directions for lines of authority,

accountability and communication


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Guiding Organizational Function

Policy Plan or course of action for specific situation Found in a policy manual

Protocols Procedures

“How” a specific activity is to be carried out, the steps Standards of Care

Authoritative statement to describe acceptable level of care


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Understanding Organizational Charts cont Shared governance

Professional practice model Increasing importance (Porter-O-

Grady) Various models, widely used in

nursing, facilitates nursing input


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Question What kind of model is shared

governance?A. Nurses model their practice after their

manager.B. Nurses have control over their practice. C. Nursing practice is decided by the

organization.D. Nursing practice is unit specific.


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AnswerB. Nurses have control over their practice.

Rationale: implicit in this approach to governance is the fact that nurses have control over their practice and have input into broader areas of unit management and other decision-making processes involving patient care.


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Question Is the following statement is true or false?

As a nurse on a special care unit, it is important for you to know where the policy and procedure manual is kept as you expect to refer to it often.


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AnswerTrue.

Rationale: depending on the nature of the unit on which you are working, you may have greater or lesser need to refer to the policies. Special care units, such as birthing rooms and emergency departments, have more need to refer to policies than areas in which care is more standardized.


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Consider these questions

1. Why would a nurse find it useful to understand organizational structure?

2. Give one example of a situation in which a nurse might find it helpful to understand organizational structure.

3. Give one example of how a nurse participates in shared governance..


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Review your answers:

1. Why would a nurse find it useful to understand organizational structure?1. Work more effectively within organization

2. Give an example of a situation in which a nurse might find it helpful to understand organizational structure.1. A nurse identifies a need to change a procedure;

would need to know the organizational structure to determine “who” has authority to make changes and how change occurs.


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Review your answers:

3. Give one example of how a nurse participates in shared governance.

Mary, RN, was elected as Medical-surg floor representative to the Shared Governance committee; nurses have complained that the new rotation schedule is not satisfactory; staff is dissatisfied and are leaving. What are the options besides everyone having to work every other weekend?


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Consider this question Which statement BEST describes a

“Matrix” organization?1. Decision-making by a few people “at the top”2. Lines of communication and accountability highly

structured3. Authority and accountability widely dispersed

within organization; not one person in charge4. Involves a secondary structure with two

directions for lines of authority, accountability and communication


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Consider this question Which statement BEST describes a

“Matrix” organization?1. Decision-making by a few people “at the top”2. Lines of communication and accountability highly

structured3. Authority and accountability widely dispersed

within organization; not one person in charge4. Involves a secondary structure with two

directions for lines of authority, accountability and communication


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Try another question! 1. As a recent graduate, you are

seeking information on “criteria for promotion and advancement through the clinical ladder”. Where will you go to find this information? a. ask your charge nurse b. contact the hospital

administrator c. ask another nurse d. consult the policy manual e. consult the procedure manual


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Try another question!

1. As a recent graduate, you are seeking information on “criteria for promotion and advancement through the clinical ladder”. Where will you go to find this information? a. ask your charge nurse b. contact the hospital

administrator c. ask another nurse d. consult the policy manual e. consult the procedure manual


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Organizational Effectiveness and Magnet Status How well an organization

accomplishes the purposes for which it exists

Criteria for recognition as a magnet hospital- Seton is one


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Structuring Nursing Care Delivery Systems A wide variety of systems used for nursing care

delivery The registered nurse remains responsible for

assessing the patient, identifying nursing care problems, planning and providing care, and evaluating care in all these systems

No one form is suitable for every setting Analyzing a care delivery system


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Structuring Delivery of Nursing Care

Case Method 1st type; hired for individual patient; provide all

care; “home health” Functional Method

1930’s model; task assignment such as one nurse do all medications or treatments; used in nursing homes

Team Nursing 1950’s model; use of RN, LPN, UAP. Team leader gives assignments; have team

conference Variation emerging today


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Structuring Delivery of Nursing Care cont

Modular Care variation of team nursing Total Patient Care

1970’s-1980’s RN, LPN assigned to give all care to group of 4-6 patients

Holistic care 1930’s model; task assignment such as one nurse do all medications or treatments; used in nursing homes

Primary Nursing 1980’s replacement for Total Patient Care Model “Primary” nurse develop, update care plans, plan

discharge Considered “too” expensive; required decision-

making skills; need for BSN’s


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Structuring Delivery of Nursing Care cont

Case Management Method Monitors individual patient needs to achieve best

outcome Beyond primary care; works with multiple

disciplines No “direct” care; education and experience

required Partnership Model

Also called “care pairs” Care provided by RN working with LVN or UAP

(usually) to groups of patients RN has accountability and responsibility


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Culture and Climate of the Organization

Informal organization and YOU! Social Needs Organizational goals met, even informally Communication

• Share information• Job information

Preserving group values Leadership development (skills and abilities;

changing) Informal organization: why a risk?

Undermine authority Have “outsiders” “Grapevine messages”


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Question What impact on communication might the

informal organization have?A. Meets the needs of the organizationB. Communication follows the chain of commandC. Communication comes only from the topD. Meets the needs of the individual


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AnswerD. Meets the needs of the individual

Rationale: some formal channels are inadequate for the information needs of individuals; thus, the needs are met through the informal organization.


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Organizational Culture and Climate

Culture based on: Interaction of the official policies and

procedures of the organization Behavior of supervisors Behavior of coworkers within the informal

organization Feedback provided within the organization

Your role as a new nurse within the organization


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Organizational Culture and Climate (cont'd) Climate:

The way in which the recurring patterns of behavior that are part of the every day activity of the organization are experienced, understood, and interpreted by those working within the organization.


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Changing the Organizational Culture and Climate They can be changed Why would you want to change the

climate of an organization? Once you know where you are and

where you want to go, you can begin planning the actions that will get you to your goal


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Test Your Knowledge Which of these is a function of the informal

organization?1. Establishing lines of authority2. Perpetuating cultural values and norms3. Making organizational decisions4. Evaluating performance

Which form of health care delivery has a nurse monitor the patient’s interaction with the entire health care system?

1. Primary nursing2. Case method3. Total patient care4. Case management


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Test Your Knowledge Which of these is a function of the informal

organization?1. Establishing lines of authority2. Perpetuating cultural values and norms*3. Making organizational decisions4. Evaluating performance

Which form of health care delivery has a nurse monitor the patient’s interaction with the entire health care system?

1. Primary nursing2. Case method3. Total patient care4. Case management*

Documents

Understanding and Working in Organizations