Page 74 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch05_057-070.qxd 11/6/09 5:56 PM Page 61
chapter 5 | Organizations, Power, and Empowerment 61 CikguOnline
and to avoid slipping into too much debt. This problem was that Hazel had to be paid overtime for
is sometimes difficult to accomplish. this work according to the union contract, and this
■ Status. The leaders or owners of many health- reduced the amount of overtime pay the nurse man-
care organizations also want to be known as the ager had available when the patient care load was
best in their field; for example, by having the especially high. “The corporation is very strict about
best open-heart surgeon, providing “the best staying within the budget,” she said. “In fact, my
nursing care in the world” (Frusti, Niesen, & rating is higher when I don’t use up all of my
Campion, 2003, p. 34), providing gourmet budgeted overtime hours.” When Hazel asked what
meals, or having the most attractive birthing she could do to improve her rating, the nurse man-
rooms in town. ager offered to help her streamline the care plans and
■ Dominance. Some organizations also want to manage her time better so that the care plans could
drive others out of the health-care business or be done during her shift.
acquire them, surpassing the goal of survival
and moving toward dominance of a particular Structure
market by driving out the competition. The Traditional Approach
These additional goals are not discussed in public as Almost all health-care organizations have a hier-
often as the first, more lofty statement of goals in the archical structure of some kind (Box 5-1). In a
true-or-false question. However, they still drive an traditional hierarchical structure, employees are
organization, especially the way an organization ranked from the top to the bottom, as if they were
handles its finances and treats its employees. on the steps of a ladder (Fig. 5.1). The number of
These goals may have profound effects on every people on the bottom rungs of the ladder is
one of the organization’s employees, nurses included. almost always much greater than the number at
For example, return to the story of Hazel Rivera. the top. The president or CEO is usually at the
Why did she receive a less favorable rating than her top of this ladder; the housekeeping and mainte-
friend Carla? nance crews are usually at the bottom. Nurses fall
After comparing ratings with those of her friend somewhere in the middle of most health-care
Carla, Hazel asked for a meeting with her nurse organizations, higher than the cleaning people,
manager to discuss her evaluation. The nurse man- aides, and technicians, but lower than physicians
ager explained the rating: Hazel’s care plans were and administrators. The organizational structure
very well done, and the nurse manager genuinely of a small ambulatory care center in a horizontal
appreciated Hazel’s efforts to make them so. The form is illustrated in Figure 5.2.

box 5-1
What Is a Bureaucracy?
Although it seems as if everyone complains about “the bureaucracy,”not everyone is clear about what a bureaucracy really is.
Max Weber defined a bureaucratic organization as having the following characteristics:
• Division of labor. Specific parts of the job to be done are assigned to different individuals or groups. For example, nurses,
physicians, therapists, dietitians, and social workers all provide portions of the health care needed by an individual.
• Hierarchy. All employees are organized and ranked according to their level of authority within the organization. For
example, administrators and directors are at the top of most hospital hierarchies, whereas aides and maintenance workers
are at the bottom.
• Rules and regulations. Acceptable and unacceptable behavior and the proper way to carry out various tasks are defined,
often in writing. For example, procedure books, policy manuals, bylaws, statements, and memos prescribe many types of
behavior, from acceptable isolation techniques to vacation policies.
• Emphasis on technical competence. People with certain skills and knowledge are hired to carry out specific parts of the
total work of the organization. For example, a community mental health center has psychiatrists, social workers, and nurses
to provide different kinds of therapies and clerical staff to do the typing and filing. Some bureaucracy is characteristic of the
formal operation of every organization, even the most deliberately informal, because it promotes smooth operations within
a large and complex group of people.
Adapted from Weber, M. (1969). Bureaucratic organization. In Etzioni, A. (ed.). Readings on Modern Organizations. Englewood
Cliffs, N.J.: Prentice-Hall.