Organizational Structure and Nursing Leadership - Essay Example

Organizational structure and nursing leadership/management Nursing and the importance of organization: Nursing in its best could be described as a putting into practice the clinical judgment with the aim of providing care to enable people to improve, maintain and recover in their health. Nurses strive hard to help people to cope up with their heath problems and to achieve the best quality of life, unaltered by the nature of the disease or disability until death. The nursing employs intellectual, physical, emotional and moral processes as interventions, by providing personal care advocacy, information, emotional and spiritual support to patients. Apart from providing patient care, the nursing practice also includes management teaching policy and knowledge development. Thus nurses work in partnership with the patients and in collaboration other medical team members. Thus it becomes essential for nurses to be properly organized to give a effective quality of care. But it is a well known fact that unlike the physicians circle, nurses unit in hospital is rarely effectively organized. (International Council of Nurses ,1992) The number of investigation carried out in the light of relationship of nurses to the patients’ outcome defended on the number of nurse’s ratio of nurses to patients, organization of nursing care delivery, organization culture stress, work load and qualification of nurses. This essay would describe the organizational chart, structure, culture and climate of my particular organizational unit. Generally the nursing is divided into main sub units that work in different environment namely intensive care, medical, surgical, psychiatric, auxiliary, rehabilitation, rural, pediatric and obstetrical. The effective function of these depends on the organization of each unit. (Oberle K and Allen M ,2001) Organizational Chart: Organizational chart may be defined as a graphical or pictorial way of portraying the roles and patterns of interaction among the system. The organization chart of the organization that I am involved is Oregon Health and Science University. The overall nursing organization includes council and team. At the outset the hospital has medical director followed by executive director , under whom would be the heads of clinical , educational, community service, hospital management in charge etc. the nursing comes under the clinical director. Again the nursing in broader sense would include hospital based service team, nursing area management team, shared governance, staff council, and co- ordination and management. This in turn involves the nursing units organization involves, the nursing administrator at the top position who guides and commands the assistance administrator, they in turn direct and evaluate the nursing unit manger. Similarly a registered nurse directs the vocational nurses and nursing assistant. The salary commanded increases with increase in hierarchy. As seen the organization consists of both healthcare practice and educational unit. The mission of them unit as such is to act as a comprehensive public academic health center. Its fundamental aim is to improve the health and well being of people in and beyond the state. As part of its multifaceted public mission, the organization strives for excellence in education, research and scholarship, clinical practice and community service. Through its dynamic interdisciplinary environment, the organization encourages inquiry, initiative, and cooperation among staff. Thus the organization tries to deliver excellent health care, emphasizing the creation and implementation of new knowledge and cutting-edge technologies. The nursing research team aims to organize and prioritize nursing evidence, to support research activity, to assist grant research proposal. The education council tries to coordinate education and practice. The quality committee tries to set in high quality and communicate with nursing education.  The nursing models of care delivery or the organizational model includes patient focused care, primary or total nursing care, team or functional nursing care, magnet hospital or environment shared governance. Our organization follows environment shared governance that is characterized as "good places for nurses to work" as it employs a high degree of Registered Nurse autonomy, Medical Director and RN collaboration, and RN control of practice; allows for shared decision-making by RNs and managers. Many studies have shown that magnet hospital organization model has better results on patient care. A study by Aiken etal showed that magnet hospital had lesser mortality rate, another study showed the magnet type of organization had greater patient satisfaction. A study done on ICU organization showed that organization of magnet type had lower nurse turn over.  (Oregon Health & Science University) Organizational structure, culture and climate: As could be seen from the management theories any organization has in itself a concept called organizational culture and organizational climate, which are in its own ways different from each other. At the outset the organization can be defined as the group of living people who have several of entities as common feature among them. Thus they are coordinated unit that are linked to external environments, designed to meet specific goals. Thus the organization is usually structured so as to obtain the maximum of goals. When describing the organizational structure, two components are important as structural dimension and contextual dimension. The structural dimension describes the internal characteristics whereas the contextual describes the relationship of it to, the external environment. Thus any organization has its own culture which exhibits its own set of values, beliefs, understandings and rules that are shared by the employees as nurses of that unit. The organizations culture exhibits itself as various characteristics or features. The observable part of the organizational culture could be described as the organizational climate. Thus in a area like healthcare the at various level there may be various cultures coexisting as one in executive level, one in the middle line and on among nursing but overall it should possess the fit and proper communication with the external environment. Depending on the dimension and set the organization culture of a organization may fall in any one category. (Robert A. Zorowitz,2007) The organization I that represents follows a clan culture among other types as market or mission culture, adhocracy or adaptability culture, and hierarchy or bureaucratic culture. Basically the clan Culture focuses on the happiness and well-being of its employees apart from maintaining an internal orientation with a flexible approach to the competitive environment. Here the governing factors are not policies or procedures as could be expected but it is loyalty, and tradition and sense of oneness. The organization culture is very important as many studies have proven that there is a close link between the culture and performance. Another study has shown that these culture traits affected strongly the quality, employee satisfaction and overall performance. Thus it becomes clear that the organization culture apart from being strong and strategically appropriate, it should also be an adaptive culture that allows for continued fit with both the organization’s strategy and innovation and change in a fluid external environment. (Aiken & Patrician, 2000) Thus the organizational culture seen in this slight is important as it is highly found to influence and have effect on the employee’s beliefs and norms, with a say on the employee perceptions, behaviors, and emotional responses at the workplace. It is based on the culture is set the other attributes as organizational climate, work attitudes etc. On simply put in term the climate is usually either constructive culture or defensive culture Constructive cultures occurs when the organizational norms of supportiveness and individualism enhances the positive interactions with others and exist in a environment were the staff has high satisfaction. Defensive cultures, on the other hand, are characterized the features of conformity and submissiveness that allows self protective interaction. (Schein,1990). Organizational climate on the other hand is combination of characteristics that mirrors the personality of the organization. The organizational climate is a outcome of interactions, which take place between the organization’s culture, leader behavior, systems, structure, etc. It is a strong indicator of the organization’s individual’s views and feelings about the problems and working nature of the establishment. Thus the climate is an important meter to measure the performance. Thus to put in nutshell the Organizational climate actually is the reflection of feeling of working in a particular work environment, being one of the factor on which is the performance of a particular organization or work team is dependent on. Thus the organizational climate is a indicator of the individual’s work behaviors and job-related attitudes. The Organizational climate may be of two types as positive organizational climates that is characterized by low levels of emotional exhaustion – the fatigue felt by employee due to the work demand and depersonalization- the extent of distance the employee feels from his organization. (Gibson &Barsade,2003) Thus the organizational culture and climate that are e distinct, multi-dimensional constructs are proposed to influence individual level attitudes (e.g., work attitudes) and behavior (e.g., turnover). Here the Work attitudes describe the employee evaluations and opinions of jobs and the amount of commitment to the organization. The work commitment in turn is reflection of job satisfaction – internal appraisal of job; and organizational commitment – the measure of amount of commitment of the employee to the organization.. The work attitudes are further seen to be associated with organizational culture and climate, employee behaviors, and turnover. Especially, job satisfaction and organizational commitment are the significant determinants of turnover. Thus now it becomes clear that the constructive culture results in more positive work attitudes with employees being more satisfied with their jobs and more committed to their organizations and, hence, should be less likely to leave. (Daft,1998) This becomes more important that a recent survey shows that more that 30% of RN leave jobs in a year, 70% reporting the reason to be of poor working condition, though the nurses were highly qualified. The main reason that was stated was the organizational climate. Thus the culture and climate affects the behavior, attitudes and motivation that in turn affect the quality of process and outcomes. But generally it is well known that nursing staffs are more likely to be satisfied, committed, and stable in health care organizations that support and empower nurses. A more satisfied and stable nursing staffs are naturally found to contribute to patient satisfaction, with reduced occurrence of errors, and assist in the implementation of other steps toward improving health care quality. (McMurray ,2003) From the above study it could be understood that the clan culture followed in the hospital, in turn creates a positive or constructive climate that has lead to great job satisfaction among nurses, increased quality of work and less turnout. The motivational and organizational climate leads to increased job satisfaction, empowerment, and organizational commitment. Thus the organizational climate is very conducive and is aimed as a pathway to achieve the mission of providing best healthcare, patient’s satisfaction and best of employee’s satisfaction. (Schein, 1996) Effect of the organization structure, climate and culture over communication, leadership and nursing care delivery system: Communication: It is well known that the communication is solid base of any interpersonal relationship, obviously in the field of nursing. The communication skill is very essential for effective organization success and patient care. Thus within an organization it is expected that the communication climate would be in harmony to the corporate culture, ultimately encouraging quality independence, objectivity and client service. Thus the communication could be used as an important tool in achieving the vision and mission of nursing organization that in turn would be a certificate for nursing quality. Many nursing literature points out that nurse generally desire for autonomy. They expect the nurse management through make and conducive climate that will support the autonomy, thus nursing would remain free of political constraints. Though it may be a fact that even the organization culture is not so positive many studies have proven that with little managerial effort and skill it can be achieved. Thus both formal and informal structures of nursing are both expected to be a good base for communication, else it might turn destructive. (Denison, 1996) The organization that I work is very encouraging in the concept of communication, where communication in the reversal order of hierarchy of roles are possible with only aim of achieving the mission. Cultural agenda are used to communicate the mission and also for developing personal bonding like by communicating new hires, marriage, death, etc through news letters, memorandums, etc. Leadership role: Organizational cultures of any organization revolve around an entrepreneurial leader or founder around whom the employees revolve. The leaders are expected to inspire and empower other employees to take initiatives on their own for bringing in any successful transformation in organization the leadership should have the capacity to establish a sense of urgency, form collation, create and communicate vision , empower others, plan and create and in turn consolidates the improvement. Thus intellectual stimulation could be brought around only through collective leadership between formal nursing management and staff nurse that would in end point results in supporting the professional growth of the organization as well as individuals. To achieve this continues mentoring education and training opportunities are to be integrated in the working environment. This will provide the forum for skill training, exchange of practice, feedbacks, evaluation, problem solving and creativity. Thus the teaching act helps in establishing a relationship between mentor and men tee but enhance the interest, commitment, personal and organizational growth. Thus the development of nursing leadership is important for improving patient outcome. The OHUS permits and encourages leadership roll in nursing. They encourage many training, seminars and workshop, and at corporate level encourage by providing funds.( Schein, 1985) Nursing Care delivery system : A health care system at the outset can be divided into 4 levels as individual patient, care tea, organization and political and economic environment. The individual patients need and preference defines the patient centered health care systems. This has changed the perceptive of the organization and they induce them to treat the patients and the family as partners and also to involve them in decision making. This demands the patients care team to have access to educational decision support information and communication tool. So this in turn demands a formal training of team work techniques and autonomy to give positive results. From many research studies it is seen that high efficiency hospital care is achieved by employing proper integration strategies. The OHUS organization culture and climate encourages efficient delivery of nursing care. Many studies have shown that increased educational intervention lead to changes in nursing factors that in turn lead to improved patient outcome. (Scott etal.,2003) Strategies that could improve the organization climate: Improving professional practice in work environment, clinical competency of nurses and supporting new hires may help to reduce the turn over problem that in turn will lead to good organizational climate. The size and work load of nurses is an important factor that when balanced properly could result in a good organization. Also deployment of an recruitment and retention team, revamping compensation system, ensuring effective communication and offering leadership development still more may convert the organizational climate conducive. (Srivastav, 2006). References: 1. International Council of Nurses (1992) Guidelines on specialisation in nursing.Geneva: ICN. 2. Oberle K and Allen M (2001) The nature of advanced practice nursing. Nursing Outlook. 49:3, 148- 153. 3. Oregon Health & Science University, Portland, Oregon , www.ohus.edu. 4. Robert A. Zorowitz, Leading Culture Change in Health Care Organizations: Leadership Strategies and Lessons Learned, AGS 2007 Annual Scientific Meeting. 5. Aiken, L. H., & Patrician, P. A. (2000). Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research, 49, 146–153. 6. Schein, E. (1990). Organizational culture. American Psychologist, 45, 109-119. 7. Gibson DE,Barsade SG. Managing Organizational Culture Change: The Case of Long-Term Care. J Soc Work LTC 2003;2: 8. Daft RL. Organization Theory and Design. Sixth Edition, SouthWestern Publishing Company, Cincinnati, 1998. 9. McMurray A. The Relationship Between Organizational Climate and Organizational Culture. J American Academy of Business 2003;3(1/2):1-8. 10. Schein EH. Three Cultures of Management: The Key to Organizational Learning. Sloan Management Rev 1996:38(1):9-19. 11. Denison, D. (1996). What IS the difference between organizational culture and organizational climate? A native’s point of view on a decade of paradigm wars. Academy of Management Review, 21, 619–654. 12. Schein, E. (1985). Organizational culture and leadership. San Francisco: Jossey-Bass. 13. Scott, T., Mannion, R., Marshall, M., & Davies, H. (2003). Does organisational culture influence healthcare performance? A review of the evidence. Journal of Health Services Research and Policy, 8, 105–117. 14. Srivastav, A. K. (2006). Organizational climate as a dependent variable. Journal Of Management Research, 6(3), 125-136. Read More