04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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Understanding and Working in Organizations
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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!
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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!
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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Understanding Organizations -Relationships
Authority Official power from top down; earned
Responsibility Ethical and legal obligation
Accountability Involves liability (Delegation)
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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AnswerOrganizational hierarchy
Rationale: a chain of command exists in all organizations. It is also referred to as organizational hierarchy.
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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.
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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.
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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..
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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.
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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?
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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”
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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.
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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
04/22/23 Carolyn Morse Jacobs, Rn, MSN, ONC
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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*