Respond to Chisom and Arianne Chisom O  RE: Discussion - Week 3 Top of Form Organizational Structures and 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 uni.

1. Respond to Chisom and Arianne
Chisom O
RE: Discussion - Week 3
Top of Form
Organizational Structures and 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

2. 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.
References
Downey, M., Parslow, S., & Smart, M. (2018). The hidden

3. 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 Nursing, 11(4), 219–226.
doi:10.1111/wvn.12044
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20 hours ago
Arianne Saden
RE: Discussion - Week 3
Top of Form
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).

4. 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.
References
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 research, 14,
249. https://doi.org/10.1186/1472-6963-14-249
Van den Oetelaar, W. F., van Stel, H. F., van Rhenen, W.,
Stellato, R. K., & Grolman, W.

5. (2016). Balancing nurses' workload in hospital wards: study
protocol of developing a method to manage workload. BMJ
open, 6(11), e012148. https://doi.org/10.1136/bmjopen-2016-
012148
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