Chapter 5: Organizations, Power, And Empowerment

Question 0

Traditional organization

Answer 0

Most healthcare organizations have a hierarchal structure of some kind. CEO, administrators, managers and medical staff, staff nurses, technicians including LPNs, aides housekeeping and maintenance.
§Hierarchical
§Employees are ranked from top to bottom
§Number of people on the bottom usually greater than the number on the top
§Authority resides at the top
§Power is distributed
Some amount of bureaucracy

Question 1

Coersion

Answer 1

The threat of pain or of harm, which may be physical, economic, or psychological.

Question 2

Empowerment

Answer 2

Power: is the actual or potential ability.
Empowerment: refers to feeling of competence, control, and entitlement.
Power refers to ability and empowerment refers to feeling.
It is possible to be powerful and yet not feel empowered.
§Self-determination: Feeling free to decide how to do your work.
§Meaning: Caring about your work, enjoying it and taking seriously.
§Competence: Confidence in your ability to do your work well.
§Impact: Feeling that people listen to your ideas, that you can make a difference.

Question 3

Contributors to empowerment

Answer 3

§Decision-making: Control of nursing practice within an organization
§Manageable workload: Reasonable work assignments.
§Reward and recognition: Appreciation of a job well done.
§Fairness: Consistent, equitable treatment of all staff.
Autonomy: ability to act on the basis of one’s knowledge and expertise

Question 4

Group level empowerment

Answer 4

§Professional organizations: A collective voice, can be stronger and more easily heard than one individual voice.
§Collective bargaining: Like professional organizations, uses power in numbers to equalize the poser of employees and employer to improve working conditions. Downside encourage conflict rather than cooperation.
§Shared governance: Staff nurses are included in the highest levels of decision making within the nursing department through representation on various councils that govern practice and management issues.

Question 5

Shared governance

Answer 5

§Shared governance: Staff nurses are included in the highest levels of decision making within the nursing department through representation on various councils that govern practice and management issues.

Managers are reluctant to relinquish control to their staff. Ideas may not meet organizational goals.

Question 6

Types of healthcare organizations

Answer 6

§Private not-for-profit: Many health-care organizations were founded by civic, charitable, or religious groups. Hospitals, long-term care, home-health services began this way.
§Publicly supported: Government operated such as county public health and Veteran’s hospital.
§Private for-profit: Operate for profit.
§Slight differences, all compete for patients particularly insurance, all experience effects of cost containment, all may provide services eligible for Medicaid and Medicare.

Question 7

Organizational culture

Answer 7

People seek stability, consistency, and meaning in their work. To achieve this, some type of culture will develop within an organization (Schein, 2004).
§Artifact level: visible characteristics such a patient room, patient forms etc.
§Espoused beliefs: state, often written, goals; philosophy of the organization.
§Underlying assumptions: unconscious but powerful beliefs and feelings, such as a commitment to cure every patient, no matter the cost.

Question 8

Organizational goals

Answer 8

§Survival: Organizations need to maintain their own existence. Many cash strapped and limited to hiring, updating equipment, pressure to reduce costs and do more with less.
Survival is threatened when reimbursement reduced, competition increases or fails to meet standards, and patients fail to pay bills.
§Growth: CEO’s typically want their organizations to grow by expanding into new territories.
§Profit: For-profit organizations are expected to return some profit to their owners. Not-for-profit organizations have to pay their bills and avoid too much debt.
§Status: Leaders and owners of many health care organizations want to be known as the best in their field.
§Dominance: Some organizations want to drive others out of the health-care business or acquire to reduce competition.

Question 9

Innovative structure

Answer 9

§Organic structure
§Emphasizes flexibility
§Less centralized
§Decisions are made by the individuals who will implement them
§Emphasizes autonomy
Teams: IV, infection, child
Supervisors are planners and resource people, coordinators.

Question 10

Processes

Answer 10

§A way to get things done within an organization
§Two mechanisms
§Formal: Are the written policies and procedures that all health-care organizations have.
§Informal: are neither written nor discussed most of the time. They exist in organizations as a kind of “shadow” organization that is harder to see but equally important to recognize and understand.

Question 11

Power

Answer 11

§Power is the ability to influence other people despite resistance
§Power may be actual or potential
§Power may be intended or unintended
Positive or negative

Question 12

Sources of power

Answer 12

§Authority: The power granted to an individual or a group by virtue of position within an organization.
§Reward: The promise of money, goods, services, recognition, or other benefits.
§Expertise: The special knowledge an individual is believed to possess.
§Coercion: The threat of pain or of harm, which may be physical, economic, or psychological.

Resources: the money, materials, and human help needed to accomplish work

support: authority to take action without having to obtain permission
information: patient care expertise and knowledge about the organizational’s goals and activities of other departments

Question 13

Who has the power

Answer 13

§Managers: Are able to reward people with salary increases, promotions, and recognition. They can cause economic or psychological pain for people who work for them.
§Patients: First appear powerless but if refused services could cause the organization to cease to exist. Patients can praise or complain about the care they receive.
§Assistants: Can appear powerless due to low positions, however can impede work if they fail to appear to work.
§Nurses: Have expert power and authority over LPN’s, aides and other personnel by virtue of their position in the hierarchy. Critical to the operation of most health-care organizations and can cause problems if they do not show up for work.

Question 14

Enhancing expertise

Answer 14

§Participate in team conferences
§CEU offerings
§Attend conferences
§Keep your reading up-to-date
§Participate in nursing research
§Observe experienced nurses and nurse leaders

Question 15

Dealing with conflict

Answer 15

§There are no conflict-free work groups (Van de Vliert & Jansssen, 2001).
§Small or large, conflicts are a daily occurrence in the life of nurses (McElhaney, 1996), and interfere with work.
§Serious conflicts can be very stressful for the people involved
§Conflict has a positive side, can learn how to manage conflict, people can develop more open, cooperative way of working together.

Question 16

Potential conflict generators

Answer 16

§Competition between groups such as nurse-physician relationships, unions, and gender based.
§Increased workload due to cost reductions or work intensification to do more with less.
§Multiple role demands such as inappropriate tasks assignments.
§Threats to safety and security such as layoffs
§Scarce resources to pay for raises, equipment, supplies can cause competition among units to grab their share of what little is available.
§Cultural differences in how hard a person works or productivity, or what it means to arrive to work on time.
§Invasion of personal space due to crowded conditions and constant interactions increase interpersonal tension.

Question 17

Conflict resolution myths

Answer 17

§Win-lose-draw: Is not like a football game where someone wins or loses. The loser feels bad about losing and will spend their time preparing to win the next round rather than their work.
§Fixed pie myth: “I get half and you get the other half.” The problem is one side gets everything and the other half nothing.
§Devaluation reaction: “If the other side is getting what they want, then it has to be bad for us.

Question 18

Problem resolution

Answer 18

§Identify the problem or issue
§Generate possible solutions
§Evaluate suggested solutions
§Choose the best solution
§Implement the solution chosen
§Is the problem resolved?
§If yes, end process; if not, repeat

Question 19

Negotiating an agreement informally

Answer 19

§Scope the situation
§Set the stage
§Conduct the negotiation
§Agree on a resolution

Question 20

Conducting a negotiation

Answer 20

§Manage emotions
§Set ground rules
§Clarify the problem
§Make an opening move
§Continue the negotiations
§Agree on a resolution

Question 21

Collective bargaining

Answer 21

Economic issues: Salaries, shift differentials, length of the workday, overtime, holidays, sick leave, breaks, health insurance, pensions, severance pay.
§Management issues: Promotions, layoffs, transfers, reprimands. Grievance procedures, hiring and firing procedures.
§Practice issues: Adequate staffing, standards of care, code of ethics, safe working environment, quality of care issues, and staff development.

There is power in the numbers, the more people you have to words a certain goal, the easier it is to obtain that goal.

Question 22

Pros for collective bargaining

Answer 22

Protects workers’ rights
§Grievance procedures available
§Higher pay
§Empowering

Question 23

Cons for collective bargaining

Answer 23

§Create management-staff barrier
§Adds rules and regulations
§Drain on manager time
Encourages conflict rather than cooperation
The effects of strike on the patient’s welfare and economic security

Question 24

Culture of safety

Answer 24

Willingness to acknowledge mistakes. Vigilance in detecting and eliminating error prone situations. Openness to questioning existing systems and changing them to prevent errors. Organizational factors can contribute either to increasing errors or protecting patient safety such as being overworked.

Question 25

Care environment

Answer 25

Collegial relationships with physicians, skilled nurse managers with high levels of leadership ability, emphasis on staff development, and quality care are important factors.

Excellence: always striving to be better, refusing to accept mediocrity.
Meaningfulness: being very clear about the purpose of the organization
Regard: understanding the work people do and valuing it
Learning and growth: providing mentors, guidance, opportunities to grow and develop

Question 26

Bureaucracy

Answer 26

Division of labor
hierarchy
rules and regulations: procedures, policy, by
laws, behavior
emphasis on technical competence, special in
your area