Organizational Structures and Leadership

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Respond to the discussions

RE: Discussion – Week 3

Organizational Structures & Leadership

Nurse leaders and management must have organizing skills when working in any hospital setting.  According to Marquis & Huston (2015), “In the organizing phase, relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned” (p. 261).  The current hospital I am at runs like a corporation. The Hospital Corporation of America (HCA) is large hospital system that takes pride in being run like a business. That means that every hospital has CEO, COO, CFO, etc., just like in a corporation. The hospital is run like a line organization. According to Marquis & Huston (2015), ” In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships” (p. 271). Anyone that works at HCA must sign a contract that lists the job responsibilities and duties. This agreement serves as legal documentation that everyone understands their role in the organization.

Decision Making

The organization uses a centralized decision-making hierarchy.  Upper management makes all the important decisions and will inform nurse supervisors and management of any changes that must be implemented. All the main issues in the hospital are decided by upper management and must be expedited fast (Marquis & Huston, 2015).  The hospital is relatively large with multiple units and specialties.  The problem with centralized decision making is that upper management must implement any changes. The current unit I’m on has significant issues related to the nurse supervisor and director. Most of the problems stem from a lack of communication with management and staff. Staff has spoken up a lot about the problem but has realized nothing is getting done. Since the upper management makes decisions for the whole hospital, it has been hard to explain the problems of the unit.

Informal and Formal Leadership

Formal and informal nurse leaders are relevant to each unit. A formal leader on the unit is the Director of Nursing (DON). The DON has a formal position in the organization. Right now, the DON functions as a manager. The DON is in charge of all the staff on the unit and works closely with the Director of the unit. As stated before, there have been numerous issues with the DON and staff. Due to many changes with the director of the unit changing to different people in the span of a few months, more tasks have been pushed onto the DON. This has caused distention amongst the staff. Staff morale is low due to not having clear and concise responsibilities and duties. The DON as a nurse leader must use evidence-based practice (EBP) to push for better quality of care and safety of staff and patients on the unit. The nurse leader must lead changes in the organization and EBP paves the way for the changes needed (Stetle, Ritchie, Rycroft-Malone, & Charns, 2017). Informal leaders are essential to any unit. Informal leaders have leadership qualities without a formal title in the organizations (Downey, Parslow, & Smart, 2018). Many of the senior nurses on the unit have taken it upon themselves to help with keeping staff uplifted throughout the many changes that have happened. Although informal nurse leaders are underused, it can be known that those leaders can change the organizational culture to be more positive (Downey, Parslow, & Smart, 2018). These informal leaders are making an impact on other nurses by being the listening ear for any problems that may arise.


Downey, M., Parslow, S., & Smart, M. (2018). The hidden treasure in nursing leadership: Informal leaders. Journal of Nursing Management, 19(4), 517–521.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th Ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2017). Leadership for evidence-based practice: strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence-Based Nursing11(4), 219–226. doi:10.1111/wvn.12044

RE: Discussion – Week 3

Nurses are continuously battling to give quality nursing care while sacrificing their energy, pride, and capacity to deliver comprehensive healthcare. The competing needs of cost-efficiency and improvement of patient care directly affect nurses and satisfaction related to burnout. There is a link between the amount of work a nurse performs and patient outcomes regarding the quality of nursing care. Managing workloads for nurses can have a positive impact because the high workload is a predictor for burnout and absenteeism. There is a positive two-way relation between the nursing shortage and oncology registered nurses’ job dissatisfaction, stress, and exhaustion. They were looking at the workload in three-dimension such as; the level of responsibility, level in position, and department workloads. Each type of workload can influence burnout, job satisfaction, and medication errors. The workload for nurses is dependent on how much is given to staff. Smaller loads of work mean improved patient outcomes (Van Den Oetelaar, Stel, Rhenen, Stellato, & Grolman, 2016).

Many nurses feel that certain elements would improve patient experiences, such as; having a clinically skilled nurse, cooperative occupational relationships, independent nursing practice, enough staffing, authority over nursing practice, management assistance, and a patient-centered environment. However, nurses feel that there is pressure to increase efficiency and have a high workload, all while impeding factors of cost-effectiveness and transparency of goals prevent effective outcomes (Kieft, de Brouwer, Francke, & Delnij, 2014).

Changes in healthcare over the past few decades have gone from a treat-heal care model to more of a corporate business model with an emphasis on performance.  There is an attitude of “accept risky situations and to just suck it up and deal with how it is.” Many nurses who are presented with these types of situations become frustrated, unhappy, and disheartened. It can result in a sense of isolation, migraines, sleeplessness, and even gi upset (Kelly & Porr, 2018).

Organizations need to work with nurses to help create a positive workspace that encourages well-being and healthy mindsets as well as decreasing workload so nurses can take care of patients efficiently and with proper care. Changing the culture of burnout and unsafe working conditions can help reduce turnover and help organizations reduce costs. It is a win-win for everyone.


Kelly, P., Porr, C., (2018) “Ethical Nursing Care Versus Cost Containment:

Considerations to Enhance RN Practice” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 6.

Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their

work environment affect patient experiences of the quality of care: a qualitative study. BMC health services research14, 249.

Van den Oetelaar, W. F., van Stel, H. F., van Rhenen, W., Stellato, R. K., & Grolman, W.

(2016). Balancing nurses’ workload in hospital wards: study protocol of developing a method to manage workload. BMJ open6(11), e012148.


Last Updated on March 11, 2020