Chapter 08: Understanding and Designing Organizational Structures


Chapter 08: Understanding and Designing Organizational Structures
Yoder-Wise: Leading and Managing in Nursing, 6th Edition


1. Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. This position is termed a(n):
a. Hierarchical position.
b. Ancillary.
c. Line position.
d. Staff position.
Line personnel have authority for decision making, whereas personnel in staff positions provide education, support, advice, and counsel. The nurse in the advanced practice is providing advice and support through education as well as consultation.

REF: Page 144 TOP: AONE competency: Business Skills

2. A hospital is working toward becoming a Magnet™ hospital. The chief nursing officer is aware that professional nursing departments of the future will:
a. Not be directed by nurses.
b. Be virtual organizations.
c. Be designed to maintain nursing standards of practice.
d. Be entitled to have client care departments.
Hospitals that are successful in recruiting and retaining nurses have found that the major contributing characteristic to success is a nursing department that is structured to provide nurses the opportunity to be accountable for their own practice. Accountability is guided by nursing standards of practice and thus, successful nursing departments emphasize maintenance of these standards.

REF: Page 149 TOP: AONE competency: Knowledge of the Health Care Environment

3. The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment, this partnership will:
a. Promote professional medical authority, autonomy, and responsibility.
b. Need a degree of flexibility to engender success.
c. Be essential for self-governance.
d. Provide for the establishment of medical committees.
Bureaucratic structures have a centralized command structure (chain of command). with a clear division of labor and well-articulated and commonly accepted expectations for performance. Rules, standards, and protocols ensure uniform actions and limit individualization of services and variance in workers’ performance. Although bureaucracy enhances consistency, by nature, it limits employees’ autonomy and thus the potential for innovations.

REF: Page 143 TOP: AONE competency: Leadership

4. In matrix organizational structures, a nurse manager understands that this type of structure:
a. Is a simplified organizational structure.
b. Has both a functional manager and a service or product-line manager.
c. Arranges departments strictly according to function.
d. Promotes harmony in organizational decision making.
Matrix structures are complex, integrated organizational structures that involve both functional and service or product-line managers. In this structure, team members or teams from various functional departments may combine to complete a project or program, thereby becoming responsible to both their functional department manager and their product-line manager.

REF: Page 147 TOP: AONE competency: Business Skills

5. Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure:
a. Has many divisions of labor.
b. Best fits long-term care units.
c. Has a mixture of the characteristics of various organizational types.
d. Places the authority for decision making closest to the places where workers perform.
Hybrid structures include characteristics of various organizational types and reflect the needs of the situation and the environment.

REF: Page 148 TOP: AONE competency: Knowledge of the Health Care Environment

6. In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to:
a. Reflect the culture of the unit and its values.
b. Be developed by the nursing manager on the unit.
c. Identify the clients that will be served on the unit.
d. Replicate the organization’s philosophy.
A philosophy expresses the values and beliefs that members of the organization hold about the nature of their work, about the people to whom they provide service, and about themselves and others providing the services.

REF: Page 137 TOP: AONE competency: Knowledge of the Health Care Environment

7. The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to:
a. Function through influence.
b. Take complete responsibility for the care of clients.
c. Interview and hire staff nurses for designated nursing units.
d. Be granted functional authority to determine standards of nursing care and enforce them.
Staff positions provide support to line positions but have no direct accountability for staff or patient outcomes and therefore function through influence.

REF: Page 143 | Page 144
TOP: AONE competency: Knowledge of the Health Care Environment

8. A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated:
a. Bureaucratic
b. Decentralized
c. Delegated authority and responsibility
d. Delegated responsibility but no authority
In traditional structures, decision-making authority (right to act) is held by a centralized decision-making body, so that staff members have responsibility for certain functions but do not participate in decisions related to those functions.

REF: Page 142 TOP: AONE competency: Knowledge of the Health Care Environment

9. The chief nursing officer is given the task of reviewing and revising the organization’s mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in:
a. The organizational structure.
b. Line and staff responsibilities.
c. The policies and procedures.
d. Government regulations.
The mission statement is an important foundation for the organizational structure and defines technology and human resources required for the organization.

REF: Page 138 TOP: AONE competency: Knowledge of the Health Care Environment

10. The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you:
a. Know that this challenge is their issue and that it has nothing to do with your unit.
b. Understand that such events are localized and do not have an impact on the organizational culture.
c. Know that the nature of challenges and reorganization in facilities will have an impact on other areas.
d. Anticipate that your prior experiences with facilities have no effect on the current situation.
By nature, a system such as an organization is an interacting collection of parts that together make up the whole. Changes to one part will affect other parts and the system as a whole.

REF: Page 138 TOP: AONE competency: Leadership

11. “Georgia Hospital will provide care that is a national example of consumer service” is a:
a. Vision statement.
b. Statement of philosophy.
c. Mission statement.
d. Rationale for care.
A vision statement is an articulated goal that provides an inspirational target to which the organization aspires at some future time. A statement of philosophy expresses values and beliefs, and a mission statement provides the reason for the existence of the organization.

REF: Page 137 TOP: AONE competency: Knowledge of the Health Care Environment

12. “At Thoroughcare, we provide health care for women and children in transition” is an example of a:
a. Vision statement.
b. Mission statement.
c. Goal statement.
d. Statement of philosophy.
Mission statements provide a reason or rationale for the existence of the organization and are indicative of the structure of the organization and of who consumes the services provided.

REF: Page 137 TOP: AONE competency: Knowledge of the Health Care Environment

13. Which of the following would be the most appropriate mission statement for a nursing center?
a. “At Plentyville, we provide rehabilitative services for addicted adolescents.”
b. “Georgiatown provides treatment and prevention services for county residents.”
c. “At Heart, our aim is to provide services that lead the nation in health education and research.”
d. “At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain.”
The mission statements of nursing centers are oriented toward achieving optimal health status for a defined group of patients or consumers rather than being treatment or maintenance or social-support oriented.

REF: Page 138 TOP: AONE competency: Knowledge of the Health Care Environment

14. A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as:
a. Hierarchical.
b. Bureaucratic.
c. Service-line.
d. Matrix
In service-line structures (sometimes called product lines), the functions necessary to produce a specific service or product are brought together into an integrated organizational unit under the control of a single manager or executive.

REF: Page 145 TOP: AONE competency: Knowledge of the Health Care Environment

15. In which of the following situations would you expect low morale and frustration?
a. Statement of philosophy indicates “We value our staff.” When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees.
b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding.
c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships.
d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.
Although frustration may occur with external factors that affect ability to act on values and aspirations, lack of congruence between what is espoused as a value within the organization (such as promising advancement as an incentive to join the organization) and what is actually done (such as restricting advancement to internal candidates with much organizational history) can cause low morale and confusion.

REF: Page 139 | Page 140
TOP: AONE competency: Communication and Relationship-Building

16. At Orangetown Hospital, the nursing department is developing a mission statement for nursing. Which would be a suitable mission statement?
a. “Nursing provides services for patients admitted to Orangetown Hospital.”
b. “To participate fully in the professional services offered by Orangetown Hospital.”
c. “To lead by the lamp; services for seniors.”
d. “At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration.”
A nursing mission statement within an organization needs to establish the reason for nursing within the organization and lays out relationships with clients, the community, and other disciplines.

REF: Page 139 TOP: AONE competency: Knowledge of the Health Care Environment

17. At Hospital XYZ, staff members on Y3 have dealt with the third head nurse in three years. Donna, the current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna’s effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that “open, transparent communication between staff and management is desired and supported,” and that “innovation and creative thinking are the foundation of the organization’s progress.” In assessing this situation as a newly hired senior executive, you anticipate that:
a. Staff members will resolve the conflict on their own.
b. The situation will lead to ongoing disgruntlement and attrition.
c. No further discussion or concerns will come out of the situation.
d. The head nurse will be able to resolve the conflict on her own.
Lack of congruence between the stated philosophy of the hospital and the experienced organizational culture does not support either the staff or the head nurse and likely will result in ongoing frustration, confusion, and morale, which could result in increased attrition.

REF: Page 139 | Page 140
TOP: AONE competency: Communication and Relationship-Building

18. A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place ten years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents:
a. Chaos theory.
b. Organizational redesign.
c. Organizational reengineering.
d. Restructuring.
Reengineering involves a total overhaul of an organizational structure. It is a radical reorganization of the totality of an organization’s structure and work processes. In reengineering, fundamentally new organizational expectations and relationships are created. Redesign is a technique to analyze tasks to improve efficiency, and restructuring is a technique to enhance organizational productivity.

REF: Page 140 | Page 141
TOP: AONE competency: Knowledge of the Health Care Environment

19. With revenue reductions and cost-saving measures, the number of managers has been reduced, which has increased the number of team leaders supervised by managers by as many as three. This change may result in:
a. Decreased patient satisfaction.
b. Increased efficiency in costs.
c. A more positive perception of managers.
d. Little change to manager-staff relationships.
When a span of control becomes too large, supervision can become less effective, which can have a negative effect on staff-manager relationships and on the overall quality of patient care.

REF: Page 141 | Page 142
TOP: AONE competency: Knowledge of the Health Care Environment

20. Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is:
a. Breakdown in function and communication across specialties.
b. Lack of congruence in culture and organizational values.
c. Highly centralized decision making and authority.
d. Wide span of control.
In a functional organizational structure, departments and services function according to specialty. This model supports professional expertise but can lead to silos in communication and decision making and discontinuity in patient services.

REF: Page 145 TOP: AONE competency: Knowledge of the Health Care Environment

21. In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies:
a. Transformational leadership.
b. Transactional leadership.
c. Bureaucratic organization.
d. Chaos theory.
Organizational structure refers to the organization of a work group, rather than to its leadership, and includes where decisions are made and what the relationships are between groups. In the example given, power is centrally located, with all decisions regarding policies and procedures flowing from this central location, which is characteristic of bureaucratic organizations.

REF: Page 143 TOP: AONE competency: Knowledge of the Health Care Environment

22. In the Unity Healthcare organization, communication flows:
a. Laterally.
b. Bottom to top.
c. Top to bottom.
d. Intermittently.
In a bureaucratic organization, communication flows vertically top to bottom.

REF: Page 143 TOP: AONE competency: Knowledge of the Health Care Environment

23. Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has:
a. Direct responsibility for patient care.
b. Direct accountability for patient outcomes.
c. An authority relationship to staff.
d. An influence over patient outcomes.
In a staff position, Sarah supports line positions in accomplishing the primary goals and objectives of the unit and provides support, counsel, and advice, but she has limited or no authority for decision making.

REF: Page 143 | Page 144
TOP: AONE competency: Knowledge of the Health Care Environment

24. A statement such as “We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs” is a _____ statement.
a. Mission
b. Goal
c. Vision
d. Philosophy
Philosophy statements capture significant beliefs and values of the organization.

REF: Page 137 TOP: AONE competency: Knowledge of the Health Care Environment


1. Organizational culture includes (select all that apply):
a. Norms.
b. Traditions.
c. Behaviors.
d. Values.
ANS: A, B, C, D
Organizational culture, the reflection of the norms or traditions of the organization, is exemplified in behaviors that illustrate values and beliefs.

REF: Page 139 | Page 140
TOP: AONE competency: Knowledge of the Health Care Environment