| Various factors that an ideal span of control in an organization depends on | o nature of the job
o the manager’s abilities
o the employees’ maturity
o the task complexity
o the level in the organization at which the work occurs
o geographic location |
| involves a body of people where relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned. | Organizing |
| involves establishing a formal structure that provides the best possible coordination or use of resources to accomplish unit objectives | Organizing |
| Types of Organizing | Formal & Informal Structure |
| How are roles and functions defines in formal structure | defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident. |
| fills in the gaps with connections and relationships that illustrate how employees’ network with one another to get work done. | Informal Structure |
| German social scientist; Father of Organizational theory | Max Weber |
| What did Max Weber do? | Weber saw the growth of the large-scale organization and correctly predicted that this growth required a more formalized set of procedures for administrators |
| Reasons for organizing | - Having a purpose to achieve
- Defines our roles and functions in the organization
- Coordinates activities, no duplication
- Activities can be defined
- Reduces confusion |
| Characteristics of Bureaucracy by Max Weber | Division of labor/work, Hierarchy of authority, Rules and interpersonal relationships, system of procedures, system of rules, selection of employment and promotion is based on technical competence |
| all work must be divided into units that can be undertaken by individuals or groups of individuals competent to perform those tasks | Division of labor or work |
| must exist in which superiors are separated from subordinates; based on this hierarchy, remuneration for work is dispensed, authority is recognized, privileges are allotted, and promotions are awarded | Hierarchy of authority |
| bureaucrats are not free to act in any way they please. Bureaucratic rules provide superiors systematic control over subordinates, thus limiting the opportunities for arbitrary behavior and personal favoritism | Rules and impersonality of interpersonal relationships |
| Used for dealing with work situations | System of procedures |
| covering the rights and duties of each position must be
in place. | System of rules |
| defines formal relationships within the institution | organizational chart |
| - Formal relationships, lines of communication, and authority are depicted
- Coordinating communication | Unbroken lines (solid lines) |
| represent communication between people with similar spheres of responsibility and power but different functions. | Solid horizontal lines |
| between positions denote the official chain of command, the formal paths of communication and authority | Solid vertical lines |
| Represent staff positions | Dotted or borken lines |
| a staff member provides information and assistance to the manager but has limited organizational authority | Advisory |
| Do advisory staff positions have legitimate authority? | No |
| Unity of command | Chain of command |
| Effect of chain of command | greatly simplifies the manager–employee relationship because the employee needs to maintain only a minimum number of relationships and accept the influence of only one person as his or her immediate supervisor. |
| number of people directly reporting to any one manager represents that manager’s span of control and determines the number of interactions expected of him or her. | Span of control |
| Various factors that an ideal span of control in an organization depends on | o nature of the job
o the manager’s abilities
o the employees’ maturity
o the task complexity
o the level in the organization at which the work occurs
o geographic location |
| Components of Organizational structure | Chain of command, Span of control, Managerial levels, Centrality, Scalar chain |
| determining the organizational philosophy, setting policy, and creating goals and priorities for resource allocation. | Top - level managers |
| Sample of top level managers | CEO, highest level nursing officer |
| coordinate the efforts of lower levels of the hierarchy and are the conduit between lower and top-level managers | Middle-level managers |
| are concerned with their specific unit’s workflow | First-level managers |
| referst to the location where a position falls on the organizational chart, | Centrality |
| often has a broader view of the organization than other levels of management. | Middle managers |
| Why does a middle manager have a large degree of centrality? | this manager receives information upward, downward and horizontally |
| decision making hierarchy; chain of command | scalar chain |
| Each position has general authority over the lower
position in the hierarchy | Line organization/bureaucratic |
| What does line organizational design procude? | monotony, alienate workers, and make adjusting rapidly to altered circumstances difficult |
| designed to focus on both product and function. | Matrix Structure |
| What does matrix structure produce? | confusion and frustration |
| effort to remove hierarchical layers by flattening the chain of command and decentralizing the organization | Flat design |
| a system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common | Organizational culture |
| those few things present in an institution that are not open to discussion or change | Sacred Cows |
| what contributes to the unique social and psychological environment of an organization? | value and behavior |
| how employees perceive an organization | organizational climate |
| How to bridge an authority power gap? | build a personal power base, and minimize the negative politics of the organization |
| Suggestions to bridge authority - power gap? | 1. provide information to the organizational and unit goals
2. genuine effort to know and care for the workers
3. consider perceptions of the subordinates
4. credibility of the manager
5. empowering subordinates |
| creates and sustains a work environment that speaks to values, such as facilitating the employee’s choice to invest in and own personal actions and behaviors that result in positive contributions to the organization’s mission | Empowerment |
| Components empowerment | Professional traits, Continuing education, Effective leadership style |
| Building a Personal Base | a. Maintain personal energy
b. Present a powerful picture to others
c. Pay the entry fee
d. Determine the powerful in the organization
e. Learn the language and symbols of the organization
f. Learn to know the organization’s priorities
g. Increase professional skills and knowledge
h. Maintain broad vision
i. Use experts and seek counsel
j. Be flexible
k. Develop visibility and voice in the organization
l. Learn to toot your horn
m. Maintain a sense of humor
n. Empower others |
| Modes of Organizing Patient Care/ Modalities of Nursing Care | Total Patient Care/ Case Method, Functional Method, Team Nursing, Modular Nursing, Primary Nursing/Relationship Based Nursing, Case Management |
| nurses assume total responsibility during their time on duty for meeting all the needs of assigned patients | Total Patient Care/ Case Method |
| Why is it referred to as case the case method of assignment? | patients may be assigned as cases, much like the way a duty nursing was historically carried out |
| What happesn in total patient care/ case method? | Assigning patient rivates is simple and direct and does not require the planning that other methods of patient care delivery require. |
| Are the lines of responsibility & accountability clear in case method? | Yes |
| How does total patient care affect the nurse? | provides nurses with high autonomy and responsibility |
| Advantages of total patient care | The patient theoretically receives holistic and unfragmented care during the nurse’s time on duty. |
| Disadvantages of total patient care | occurs when the nurse is inadequately prepared or too inexperienced to provide total care to the patient |
| Examples of functional nursing tasks | checking blood pressures, administering medication, changing linens, and bathing patients. |
| RNs became managers of care rather than direct care providers, and “care through others” became the phrase used to refer to this method of nursing care. | Functional Method |
| Advantage of functional method | - efficiency; tasks are completed quickly, with little confusion regarding responsibilities.
- does allow care to be provided with a minimal number
of RNs |
| Disadvantages of functional method | - may lead to fragmented care and the possibility of overlooking patient priority needs
- may result in low job satisfaction, e some workers feel unchallenged and understimulated in their roles
- may also not be cost-effective due to the need for many coordinators
- Employees often focus only on their own efforts, with less interest in overall results |
| What Modes of Organizing Patient Care is this? | Total Patient Care/Case Method |
| What Modes of Organizing Patient Care is this? | Functional Method |
| What Modes of Organizing Patient Care is this? | Team Nursing |
| What Modes of Organizing Patient Care is this? | Primary Nursing/Relationship Based Nursing |
| ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse | Team Nursing |
| What's the nurse's role as a team leader in team nursing? | As the team leader, the nurse is responsible for knowing the condition and needs of all the patients assigned to the team and for planning individual care. |
| What are the duties of a team leader in team nursing? | assisting team members, giving direct personal care to patients, teaching, and coordinating patient activities. |
| How many people should be in a team nursing? | A team should consist of not more than five people or it will revert to more functional lines of organization. |
| How can you provide a comprehensive care to patients with team nursing? | extensive team communication |
| Is team nursing related to democratic leadership? | Yes |
| How is responsibility & accountability in a team nursing? | Group members are given as much autonomy as possible when performing assigned tasks, although the team shares responsibility and accountability collectively. |
| Disadvantages of team nursing | - are associated primarily with improper implementation rather than with the philosophy itself
- can lead to blurred lines of responsibility, errors, and fragmented patient care
- the team leader must be an excellent practitioner and have good communication, organizational, management, and leadership skills |
| uses a mini team (two or three members with at least one member being an RN), with members of the modular nursing team sometimes being called care pairs. | Modular Nursing |
| How is modular nursing practiced? | - was never practiced in its purest form but was instead a combination of team and functional structure. |
| How are patient care units divided in modular nursing? | typically divided into modules or districts, and assignments are based on the geographical location of patients |
| How does modular nursing affect nurses? | allow the professional nurse more time for planning and coordinating team members |
| Advantage of modular nursing | a small team requires less communication, allowing members better use of their time for direct patient care activities |
| uses some of the concepts of total patient care and brings the RN back to the bedside to provide clinical care | primary nursing/relationship based nursing |
| Role of nurses in primary nursing | - the primary nurse assumes 24-hour responsibility for planning the care of one or more patients from admission or the start of treatment to discharge or the treatment’s end
- The primary nurse provides total direct care for that patient
- When the primary nurse is not on duty, associate nurses, who follow the care plan established by the primary nurse, provide care. |
| to this method, lie primarily in improper implementation. | disadvantage of primary nursing |
| Challenges in primary nursing | include “shorter lengths of stay, increasing numbers of part-time positions, and variable shift lengths, combined with the ongoing pragmatic need to provide holistic, coordinated care to human beings” |
| facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes | Case management |
| integrates utilization management and discharge planning functions an may be unit based, assigned by patient, disease based, or primary nurse case managed | Acute care case management |
| Role of case manager | - case manager helps patients access community resources, helps patients learn about their medication regimen and treatment plan, and ensures that they have recommended tests and procedures
- often manage care using critical pathways and multidisciplinary action plans (MAPs) to plan patient care |
| Is a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. | Patient classification system |
| Category 1 | self care minimal care patients |
| Category 2 | intermediate or moderate care |
| category 3 | total care patients |
| category 4 | intensive care patients |
