Understanding and Working in Organizations

1. Understanding and Working in Organizations Carolyn Morse Jacobs, Rn, MSN, ONC

2. 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! Carolyn Morse Jacobs, Rn, MSN, ONC

3. Understanding Organizations • Organizational function: is it parallel to organization structure? • Structure of organization • Must accomplish its purpose in effective way…make money! Carolyn Morse Jacobs, Rn, MSN, ONC

4. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

5. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

6. Nursing Philosophy Statement • Sets the standard of nursing care that promotes a coordinated health care system and ensures quality across the continuum of care Carolyn Morse Jacobs, Rn, MSN, ONC

7. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

8. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

9. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

10. Understanding Organizations -Relationships • Authority • Official power from top down; earned • Responsibility • Ethical and legal obligation • Accountability • Involves liability • (Delegation) Carolyn Morse Jacobs, Rn, MSN, ONC

11. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

12. Question • A chain of command can also be called what? A. Organizational structure B. Organizational hierarchy C. Organizational oversight D. Organizational chart Carolyn Morse Jacobs, Rn, MSN, ONC

13. Answer Organizational hierarchy Rationale: a chain of command exists in all organizations. It is also referred to as organizational hierarchy. Carolyn Morse Jacobs, Rn, MSN, ONC

14. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

15. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

16. Organizational Chart Carolyn Morse Jacobs, Rn, MSN, ONC

17. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

18. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

19. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

20. Understanding Organizational Charts cont • Shared governance • Professional practice model • Increasing importance (Porter-O-Grady) • Various models, widely used in nursing, facilitates nursing input Carolyn Morse Jacobs, Rn, MSN, ONC

21. 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. Carolyn Morse Jacobs, Rn, MSN, ONC

22. Answer B. 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. Carolyn Morse Jacobs, Rn, MSN, ONC

23. 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. Carolyn Morse Jacobs, Rn, MSN, ONC

24. Answer True. 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. Carolyn Morse Jacobs, Rn, MSN, ONC

25. Consider these questions Why would a nurse find it useful tounderstand organizational structure? 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.. Carolyn Morse Jacobs, Rn, MSN, ONC

26. Review your answers: • Why would a nurse find it useful tounderstand organizational structure? • Work more effectively within organization • Give an example of a situation in which a nurse might find it helpful to understand organizational structure. • 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. Carolyn Morse Jacobs, Rn, MSN, ONC

27. 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? Carolyn Morse Jacobs, Rn, MSN, ONC

28. Consider this question • Which statement BEST describes a “Matrix” organization? • Decision-making by a few people “at the top” • Lines of communication and accountability highly structured • Authority and accountability widely dispersed within organization; not one person in charge • Involves a secondary structure with two directions for lines of authority, accountability and communication Carolyn Morse Jacobs, Rn, MSN, ONC

29. Consider this question • Which statement BEST describes a “Matrix” organization? • Decision-making by a few people “at the top” • Lines of communication and accountability highly structured • Authority and accountability widely dispersed within organization; not one person in charge • Involves a secondary structure with two directions for lines of authority, accountability and communication Carolyn Morse Jacobs, Rn, MSN, ONC

30. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

31. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

32. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

33. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

34. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

35. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

36. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

37. 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” Carolyn Morse Jacobs, Rn, MSN, ONC

38. Question • What impact on communication might the informal organization have? A. Meets the needs of the organization B. Communication follows the chain of command C. Communication comes only from the top D. Meets the needs of the individual Carolyn Morse Jacobs, Rn, MSN, ONC

39. Answer D. 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. Carolyn Morse Jacobs, Rn, MSN, ONC

40. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

41. 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. Carolyn Morse Jacobs, Rn, MSN, ONC

42. 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 Carolyn Morse Jacobs, Rn, MSN, ONC

43. Test Your Knowledge • Which of these is a function of the informal organization? • Establishing lines of authority • Perpetuating cultural values and norms • Making organizational decisions • Evaluating performance • Which form of health care delivery has a nurse monitor the patient’s interaction with the entire health care system? • Primary nursing • Case method • Total patient care • Case management Carolyn Morse Jacobs, Rn, MSN, ONC

44. Test Your Knowledge • Which of these is a function of the informal organization? • Establishing lines of authority • Perpetuating cultural values and norms* • Making organizational decisions • Evaluating performance • Which form of health care delivery has a nurse monitor the patient’s interaction with the entire health care system? • Primary nursing • Case method • Total patient care • Case management* Carolyn Morse Jacobs, Rn, MSN, ONC