Page 71 - Essentials of Nursing Leadership and Management, 5th Edition

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58 unit 1 | Professional Considerations CikguOnline
The subjects of this chapter—organizations, power, focuses on the subject of power within organizations:
and empowerment—are not as remote from a what it is, how it is obtained, and how nurses can
nurse’s everyday experience as you may first think. become empowered.
It is difficult to focus on these “big picture” factors
when caught up in the busy day-to-day work of a Understanding Organizations
staff nurse, but they have an effect on your practice
as you will see in this chapter. Consider two scenar- One of the attractive features of nursing as a career
ios, which are analyzed later in the chapter. is the wide variety of settings in which nurses can
Were the disappointments experienced by work. From rural migrant health clinics to organ
Hazel Rivera and the critical care department staff transplant units, nurses’ skills are needed wherever
predictable? Could they have been avoided? there are concerns about people’s health.
Without a basic understanding of organizations Relationships with patients may extend for months
and of the part that power plays in health-care or years, as they do in school health or in nursing
institutions, people are doomed to be continually homes, or they may be brief and never repeated, as
surprised by the responses to their well-intentioned often happens in doctors’ offices, operating rooms,
efforts. As you read this chapter, you will learn why and emergency departments.
Hazel Rivera and the critical care department staff
were disappointed. Types of Health-Care Organizations
This chapter begins by looking at some of the Although some nurses work as independent prac-
characteristics of the organizations in which nurses titioners, as consultants, or in the corporate
work and how these organizations operate. Then it world, most nurses are employed by health-care

1 In school, Hazel Rivera had always stays after work to complete them. Her friend
Scenario
received high praise for the quality Carla refuses to stay late with her. “If I can’t com-
of her nursing care plans. “Thorough, comprehen- plete my work during the shift, then they have
sive, systematic, holistic—beautiful!” was the com- given me too much to do,” she said.
ment she received on the last one she wrote before At the end of their 3-month probationary period,
graduation. Hazel and Carla received written evaluations of their
Now Hazel is a staff nurse on a busy orthopedic progress and comments about their value to the
unit. Although her time to write comprehensive organization. To Hazel’s surprise, her friend Carla
care plans during the day is limited, Hazel often received a higher rating than she did. Why? ■

Scenario
2 The nursing staff of the critical care for the chronically critically ill (Rudy, et al., 1995)
department of a large urban hospi- particularly interested them because they had had
tal formed an evidence-based practice group about many patients in that category.
a year ago. They had made many changes in their Several nurses volunteered to form an ad hoc
practice based on reviews of the research on sever- committee to design a similar unit for chronically
al different procedures, and they were quite pleased critically ill patients within their critical care
with the results. department. When the plan was presented, both
“Let’s look at the bigger picture next month,”their the nurse manager and the staff thought it was
nurse manager suggested. “We should consider the excellent.The nurse manager offered to present the
research on different models of patient care. We plan to the vice president for nursing. The staff
might get some good ideas for our unit.” The staff eagerly awaited the vice president’s response.
nurses agreed.It would be a nice change to look at the The nurse manager returned with discouraging
way they organized patient care in their department. news.The vice president did not support their concept
The nurse manager found a wealth of informa- and said that, although they were free to continue
tion on different models for organizing nursing developing the idea, they should not assume that it
care. One research study about a model for caring would ever be implemented.What happened? ■