1. Describe the organizational characteristics of the facility in which you currently have a clinical assignment. Include the following:
a. Type of organization
b. Overall climate of the facility
c. How the organization is structured
d. Formal and informal goals and processes of the organization
2. Why is the work climate of an organization important to nurse leaders and managers?
3. What are the ways in which a nurse can enhance his or her expertise?
4. Explain “shared governance,” and describe how it can affect the power structure of a health-care organization.
5. Why is it important for staff nurses to understand the culture and real goals of the organization in which they work?
1. Describe your ideal organization. Explain each feature and why you think it is important.
2. Interview one of the staff nurses on your unit. Find out what practices within the organization help to empower the nurses. Compare this list of practices with those discussed in the textbook.
3. Recall the last time you walked into a hospital, clinic, or physician’s office for the first time. What was your first impression? Did you feel comfortable and welcome? Why or why not? If you could change the first impression this facility makes, what would you do?
4-What changes could be made at a very low cost? What changes would be expensive?Finally, discuss why it is important for a health-care facility to make a good first impression.
Chapter 5
Organizations, Power, and
Empowerment
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Understanding Organizations
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Types of Health-Care Organizations
• Private not-for-profit
• Publicly supported
• Private for-profit
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Understanding Organizational Culture
• Artifact level
• Espoused beliefs
• Underlying assumptions
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Culture of Safety
• Acknowledge mistakes.
• Detect error-prone situations.
• Change aspects of systems that are error-producing.
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Care Environments
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Collegial relationships
Skilled nurse managers
Staff development
Quality of care
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Organizational Goals
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Survival
Growth
Profit
Status
Dominance
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Organizational Structures
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Traditional
• Hierarchical
• Employees are ranked from top to bottom.
• The number of people on the bottom is usually
greater than the number on the top.
• Authority resides at the top.
• Power is distributed.
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The Organizational Hierarchy
CEO
Administrators
Managers
Staff nurses
Technicians (including LPNs)
Aides, housekeeping, maintenance
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Innovative
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Organic structure
Emphasizes flexibility
Less centralized
Decisions are made by the individuals who will
implement them.
• Emphasizes autonomy
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Processes
• A way to get things done within an organization
• Two mechanisms
– Formal
– Informal
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Power
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Definition
• Power is the ability to influence other people
despite resistance.
• Power may be actual or potential.
• Power may be intended or unintended.
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Sources of Power
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Authority
Reward
Expertise/control of information
Coercion
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Who Has the Power?
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Managers
Clients
Assistants
Nurses
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Empowering Nurses
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What Feeling Empowered Includes
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Self-determination
Meaning
Competence
Impact
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Contributors to Empowerment
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Participation in decision-making autonomy
Manageable workload
Reward and recognition
Fairness
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Shared Governance
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Practice councils
Unit budgeting, scheduling
Committees
Peer review
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Professional Organizations
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Collegiality
Advocacy
Representation
Enhancing competence
Recognition of achievements
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Collective Bargaining
• Uses the power of numbers for a common cause
• Employee protection
• Employee benefits
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Enhancing Expertise
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Participate in team conferences.
Take advantage of CEU offerings.
Attend conferences.
Keep your reading up-to-date.
Participate in nursing research.
Observe experienced nurses and nurse leaders.
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Conclusion
• Becoming and remaining empowered requires
active participation.
• Seek organizations whose organizational
cultures are a fit with your professional goals.
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