60 unit 1 | Professional Considerations
■Openness to questioning existing systems and to
changing them to prevent errors (Armstrong &
Laschinger, 2006; Vogus & Sutcliffe, 2007).
It is not easy to change an organization’s culture. In
fact, Hinshaw (2008) points out we are trying to cre-
ate a culture of safety at a particularly difficult time,
given the shortages of nurses and other resources
within the health-care system (Connaughton &
Hassinger, 2007). Nurses who are not well prepared,
not valued by their employer or colleagues, not
involved in decisions about organizing patient care,
and are fatigued due to excessive workloads are cer-
tainly more likely to be error-prone. For example,
increased workload and stress have been found
to increase adverse events by as much as 28%
(Weissman, et al., 2007; Redman, 2008). Clearly,
organizational factors can contribute either to an
increase in errors or to protecting patient safety.
Care Environments
There is also much concern about the environment
in which care is provided, an issue that is closely
related to patient safety. Patients have lower risk of
failure to rescue and death in better care environ-
ments (see Aiken, et al., 2008). What constitutes a
better care environment? Collegial relationships
with physicians, skilled nurse managers with high
levels of leadership ability, emphasis on staff devel-
opment, and quality of care are important factors.
Mackoff and Triolo (2008) offer a similar list of
factors that contribute to excellence and longevity
(low turnover) of nurse managers:
■Excellence:always striving to be better, refusing
to accept mediocrity
■Meaningfulness:being very clear about the pur-
pose of the organization (for example, serving
the poor, healing the environment, protecting
abused women)
■Regard:understanding the work people do and
valuing it
■Learning and growth:providing mentors, guid-
ance, opportunities to grow and develop
Identifying an Organization’s Culture
The culture of an organization is intangible; you
cannot see it or touch it, but you will recognize it
when you bump up against it. To find out what
the culture of an organization is when you are
applying for a new position or trying to familiarize
yourself with your new workplace, you can ask
several people who work there or are familiar with
the organization to describe it in just a few words.
You can also ask about workload and decision mak-
ing, and you can ask for examples of nursing impact
on patient safety.
Does it matter in what type of organization you
work? The answer, emphatically, is yes. For exam-
ple, the extreme value placed on “busyness” in hos-
pitals, i.e., being seen doing something at all times,
leads to manager actions such as floating a staff
member to a “busier” unit if she or he is found read-
ing new research or looking up information on the
Web (Scott-Findley & Golden-Biddle, 2005).
Even more important, a hospital with a positive
work environment is not only a better place for
nurses to work but also safer for patients.
Once you have grasped the totality of an orga-
nization in terms of its overall culture, you are ready
to analyze it in a little more detail, particularly its
goals, structure, and processes.Organizational Goals
Try answering the following question:
Question:The primary goal of any health-care
organization is to keep people healthy, restore them
to health, or assist them in dying as comfortably as
possible. True or false?
Answer:False. The statement is only partially
correct. Most health-care organizations have several
goals.
What other goals might a health-care organiza-
tion have? Following are some examples:■Survival.Organizations have to maintain
their own existence. Many health-care organi-
zations are cash-strapped, causing them to
limit hiring, streamline work, and reduce costs,
putting enormous pressure on remaining
staff (Roark, 2005). The survival goal is
threatened when, for example, reimbursements
are reduced, competition increases, the
organization fails to meet standards, or
patients are unable to pay their bills (Trinh
& O’Connor, 2002).
■Growth.Chief executive officers (CEOs)
typically want their organizations to grow by
expanding into new territories, adding new
services, and bringing in new patients.
■Profit.For-profit organizations are expected to
return some profit to their owners. Not-for-profit
organizations have to be able to pay their bills