Page 73 - Essentials of Nursing Leadership and Management, 5th Edition

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60 unit 1 | Professional Considerations CikguOnline
■ Openness to questioning existing systems and to several people who work there or are familiar with
changing them to prevent errors (Armstrong & the organization to describe it in just a few words.
Laschinger, 2006; Vogus & Sutcliffe, 2007). You can also ask about workload and decision mak-
ing, and you can ask for examples of nursing impact
It is not easy to change an organization’s culture. In
on patient safety.
fact,Hinshaw (2008) points out we are trying to cre-
Does it matter in what type of organization you
ate a culture of safety at a particularly difficult time,
work? The answer, emphatically, is yes. For exam-
given the shortages of nurses and other resources
ple, the extreme value placed on “busyness” in hos-
within the health-care system (Connaughton &
pitals, i.e., being seen doing something at all times,
Hassinger, 2007). Nurses who are not well prepared,
leads to manager actions such as floating a staff
not valued by their employer or colleagues, not
member to a “busier”unit if she or he is found read-
involved in decisions about organizing patient care,
ing new research or looking up information on the
and are fatigued due to excessive workloads are cer-
Web (Scott-Findley & Golden-Biddle, 2005).
tainly more likely to be error-prone. For example,
Even more important, a hospital with a positive
increased workload and stress have been found
work environment is not only a better place for
to increase adverse events by as much as 28%
nurses to work but also safer for patients.
(Weissman, et al., 2007; Redman, 2008). Clearly,
Once you have grasped the totality of an orga-
organizational factors can contribute either to an
nization in terms of its overall culture, you are ready
increase in errors or to protecting patient safety.
to analyze it in a little more detail, particularly its
Care Environments goals, structure, and processes.
There is also much concern about the environment
Organizational Goals
in which care is provided, an issue that is closely
related to patient safety. Patients have lower risk of Try answering the following question:
failure to rescue and death in better care environ- Question: The primary goal of any health-care
ments (see Aiken, et al., 2008). What constitutes a organization is to keep people healthy, restore them
better care environment? Collegial relationships to health, or assist them in dying as comfortably as
with physicians, skilled nurse managers with high possible. True or false?
levels of leadership ability, emphasis on staff devel- Answer: False. The statement is only partially
opment, and quality of care are important factors. correct. Most health-care organizations have several
Mackoff and Triolo (2008) offer a similar list of goals.
factors that contribute to excellence and longevity What other goals might a health-care organiza-
(low turnover) of nurse managers: tion have? Following are some examples:
■ Excellence: always striving to be better, refusing ■ Survival. Organizations have to maintain
to accept mediocrity their own existence. Many health-care organi-
■ Meaningfulness: being very clear about the pur- zations are cash-strapped, causing them to
pose of the organization (for example, serving limit hiring, streamline work, and reduce costs,
the poor, healing the environment, protecting putting enormous pressure on remaining
abused women) staff (Roark, 2005). The survival goal is
■ Regard: understanding the work people do and threatened when, for example, reimbursements
valuing it are reduced, competition increases, the
■ Learning and growth: providing mentors, guid- organization fails to meet standards, or
ance, opportunities to grow and develop patients are unable to pay their bills (Trinh
& O’Connor, 2002).
Identifying an Organization’s Culture ■ Growth. Chief executive officers (CEOs)
The culture of an organization is intangible; you typically want their organizations to grow by
cannot see it or touch it, but you will recognize it expanding into new territories, adding new
when you bump up against it. To find out what services, and bringing in new patients.
the culture of an organization is when you are ■ Profit. For-profit organizations are expected to
applying for a new position or trying to familiarize return some profit to their owners. Not-for-profit
yourself with your new workplace, you can ask organizations have to be able to pay their bills