UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
One way to assess the organizational environment is to evaluate the qualities of those hired for key positions in the organization. An organization in which nursing leaders are in- novative, creative, and energetic will tend to operate in a fast-moving, goal-oriented fashion. If humanistic, interpersonal skills are sought in candidates for leadership positions, the or- ganization will focus on human resources, employees, and patient advocacy (Hersey, 2011).
Organizational culture, on the other hand, are the basic assumptions and values held by members of the organization (Sullivan, 2013). These are often known as the unstated “rules of the game.” For example, who wears a lab coat? When is report given? To whom? Is tardiness tolerated? How late is acceptable?
Like environment, organizational culture varies from one institution to the next and subcul- tures and even countercultures, groups whose values and goals differ significantly from those of the dominant organization, may exist. A subculture is a group that has shared experiences or like interests and values. Nurses form a subculture within health care environments. They share a common language, rules, rituals, dress, and have their own unstated rules. Individual units also can become subcultures.
Systems involving participatory management and shared governance create organizational environments that reward decision making, creativity, independence, and autonomy (Kramer, Schmalenberg, & Maguire, 2010). These organizations retain and recruit independent, ac- countable professionals. Organizations that empower nurses to make decisions will better meet consumer requests. As the health care environment continues to evolve, more and more organi- zations are adopting consumer-sensitive cultures that require accountability and decision mak- ing from nurses.
What You Know Now • The schools of organizational theory include classical theory, humanistic theory, systems theory, contin-
gency theory, chaos theory, and complexity theory. • Organizations can be viewed as social systems consisting of people working in a predetermined pattern of
relationships who strive toward a goal. The goal of health care organizations is to provide a particular mix of health services.
• Traditional organizational structures include functional, hybrid, matrix, and parallel structures. • Service-line structures organize clinical services around specific patient conditions. • Shared governance provides the framework for empowerment and partnership within the health care
organization. • Accountable care organizations are recent additions to health care design. They can contract with a payer
to provide care to a specific group of patients. • The medical home is one of the patient-centered models where all services are provided by a group of
health care professionals. • Strategic planning is a process used by organizations to focus their resources on a limited number of
activities. • Organizational environment and culture affect the internal conditions of the work setting.
Questions to Challenge You 1. Secure a copy of the organizational chart from your employment or clinical site. Would you describe
the organization the same way the chart depicts it? If not, redraw a chart to illustrate how you see the organization.
2. What organizational structure would you prefer? Think about how you might go about finding an organization that meets your criteria.
3. Organizational theories explain how organizations function. Which theory or theories describes your organization’s functioning? Do you think it is the same theory your organization’s administrators would use to describe it? Explain.