04/19/23Carolyn Morse Jacobs, Rn,

MSN, ONC 1

Understanding and Working in Organizations

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Understanding OrganizationsDefined

Organizations Formally constituted groups

of people who work together Have identified tasks to

achieve a specific purpose defined by the organization

Defined by unique purpose and structure

Organizational structure includes

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

Father of Organizational Theory!

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To understand 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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Understanding Organizational Structure (know definitions/ advantages/ disadvantages)

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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Understanding Organizations

Adhocracy Bureaucracy and “adhoc” type structure

using teams as specialists; has director Special projects

Shared governance Professional practice model Increasing importance Various models, widely used in nursing,

facilitates nursing input

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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

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Organizational Chart

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Answer these questions

What do the vertical lines represent on an organizational chart?

What do the horizontal lines represent?

A dotted (or broken) line in an organizational chart indicates what type of relationship among individuals?

Lines of authority and accountability= chain of command

Communication among individuals with similar levels of authority; no authority, same “work” level

A communication relationship…not an authority relationship!

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More on understanding organizations…defining characteristics

Authority Official power from top down; earned

Responsibility Ethical and legal obligation

Accountability Involves liability (Delegation)

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Answer this question! When the RN “delegates a

task to a UAP…who is accountable for performance of that task?? (see p 48)

When the nurse delegates (assigns) a task to a UAP (unlicensed assistive personnel) the nurse is still accountable/responsible for performance of that task!

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Relationships within Organizations

Chain of Command Also known as “organizational

hierarchy” Identifies path of authority and

accountability! Span of control

Number of individuals a person is responsible for

The greater the # the more authority and responsibility & greater span of control

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Channels of Communication Formal and informal pathways

Think about advantages/disadvantages of each and effect on clinical work!

Formal Informal

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Understanding Organizations

Mission Statement “Why” of existence Describes what the organization plans to

accomplish, aims or function Generally very brief

Philosophy Results from “mission” statement Generally a listing of beliefs and values Promotes quality care Sets “Benchmark” to evaluate the

organization’s performance

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Understanding Organizations

Policy Plan or course of action for specific

situation (such handling rape victims) Found in policy manual

Procedure “How” a specific activity is to be

carried out, the actual steps Found in a procedure manual

Standard of Care Authoritative statement to describe

acceptable level of care

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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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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 structured

3. Authority and accountability widely dispersed within organization; not one person in charge

4. 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 structured

3. Authority and accountability widely dispersed within organization; not one person in charge

4. 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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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

Primary Nursing 1970’s-1980’s “Primary” nurse develops, update care plans, plan

discharge. RN has 24 hour responsibility for patient’s care for duration of stay in hospital.

Considered “too” expensive; required decision-making skills; need for BSN’s

Total Patient Care 1980’s replacement for Primary Care Model. RN, LPN

assigned to give all care to group of 4-6 patients. Assigned nurse has responsibility for care only during his/her shift.

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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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Organizational Culture and Climate

Organizational climate Perceptions held by employees Influenced by organizational culture Multiple factors influence

• Should be positive, compatible values• Sum total of values, formal and informal

communications• Not static

Your role as a new nurse within the organization

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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*