58 unit 1 | Professional Considerations
The subjects of this chapter—organizations, power,
and empowerment—are not as remote from a
nurse’s everyday experience as you may first think.
It is difficult to focus on these “big picture” factors
when caught up in the busy day-to-day work of a
staff nurse, but they have an effect on your practice
as you will see in this chapter. Consider two scenar-
ios, which are analyzed later in the chapter.
Were the disappointments experienced by
Hazel Rivera and the critical care department staff
predictable? Could they have been avoided?
Without a basic understanding of organizations
and of the part that power plays in health-care
institutions, people are doomed to be continually
surprised by the responses to their well-intentioned
efforts. As you read this chapter, you will learn why
Hazel Rivera and the critical care department staff
were disappointed.
This chapter begins by looking at some of the
characteristics of the organizations in which nurses
work and how these organizations operate. Then it
focuses on the subject of power within organizations:
what it is, how it is obtained, and how nurses can
become empowered.Understanding Organizations
One of the attractive features of nursing as a career
is the wide variety of settings in which nurses can
work. From rural migrant health clinics to organ
transplant units, nurses’ skills are needed wherever
there are concerns about people’s health.
Relationships with patients may extend for months
or years, as they do in school health or in nursing
homes, or they may be brief and never repeated, as
often happens in doctors’ offices, operating rooms,
and emergency departments.Types of Health-Care Organizations
Although some nurses work as independent prac-
titioners, as consultants, or in the corporate
world, most nurses are employed by health-careIn school, Hazel Rivera had always
received high praise for the quality
of her nursing care plans. “Thorough, comprehen-
sive, systematic, holistic—beautiful!” was the com-
ment she received on the last one she wrote before
graduation.
Now Hazel is a staff nurse on a busy orthopedic
unit. Although her time to write comprehensive
care plans during the day is limited, Hazel often
stays after work to complete them. Her friend
Carla refuses to stay late with her. “If I can’t com-
plete my work during the shift, then they have
given me too much to do,” she said.
At the end of their 3-month probationary period,
Hazel and Carla received written evaluations of their
progress and comments about their value to the
organization. To Hazel’s surprise, her friend Carla
received a higher rating than she did. Why?■Scenario
1
The nursing staff of the critical care
department of a large urban hospi-
tal formed an evidence-based practice group about
a year ago. They had made many changes in their
practice based on reviews of the research on sever-
al different procedures, and they were quite pleased
with the results.
“Let’s look at the bigger picture next month,” their
nurse manager suggested. “We should consider the
research on different models of patient care. We
might get some good ideas for our unit.” The staff
nurses agreed. It would be a nice change to look at the
way they organized patient care in their department.
The nurse manager found a wealth of informa-
tion on different models for organizing nursing
care. One research study about a model for caring
for the chronically critically ill (Rudy, et al., 1995)
particularly interested them because they had had
many patients in that category.
Several nurses volunteered to form an ad hoc
committee to design a similar unit for chronically
critically ill patients within their critical care
department. When the plan was presented, both
the nurse manager and the staff thought it was
excellent. The nurse manager offered to present the
plan to the vice president for nursing. The staff
eagerly awaited the vice president’s response.
The nurse manager returned with discouraging
news. The vice president did not support their concept
and said that, although they were free to continue
developing the idea, they should not assume that it
would ever be implemented. What happened? ■Scenario
2