Essentials of Nursing Leadership and Management, 5th Edition

64 unit 1 | Professional Considerations

Processes

Organizations have formal processes for getting
things done and informal ways to get around the
formal processes (Perrow, 1969). The formal
processes are the written policies and procedures
that all health-care organizations have. The infor-
mal processes are neither written nor discussed
most of the time. They exist in organizations as a
kind of “shadow” organization that is harder to see
but equally important to recognize and understand
(Purser & Cabana, 1999).
The informal process is often much simpler and
faster than the formal one. Because the informal
ways of getting things done are seldom discussed
(and certainly not a part of a new employee’s orien-
tation), it may take some time for you to figure out
what they are and how to use them. Once you
know they exist, they may be easier for you to iden-
tify. The following is an example:

Jocylene noticed that Harold seemed to get STAT

laboratory results on his patients faster than she did.

At lunch one day, Jocylene asked Harold why that

happened. “That’s easy,” he said. “The people in our

lab feel unappreciated. I always tell them how help-

ful they are. Also, if you call and let them know that

the specimens are coming, they will get to them faster.

They can’t monitor their e-mail constantly.” Harold

has just explained an informal process to Jocylene.

Sometimes, people are unwilling to discuss the

informal processes. However, careful observation

of the most experienced “system-wise” individuals

in an organization will eventually reveal these

processes. This will help you do things as efficient-

ly as they do.

Power

There are times when one’s attempts to influence

others are overwhelmed by other forces or individ-

uals. Where does this power come from? Who has

it? Who does not?

In the earlier section on hierarchy, it was noted

that, although people at the top of the hierarchy

have most of the authorityin the organization, they

do not have all of the power. In fact, the people at

the bottom of the hierarchy also have some sources

of power. This section explains how this can be

true. First, power is defined, and then the sources of

power available to people on the lower rungs of the

ladder are considered.

Definition

Power is the ability to influence other people

despite their resistance. Using power, one person or

group can impose its will on another person or

group (Haslam, 2001). The use of power can be

positive, as when the nurse manager gives a staff

member an extra day off in exchange for working

during the weekend, or negative, as when a nurse

administrator transfers a “bothersome” staff nurse

to another unit after the staff nurse pointed out a

physician error (Talarico, 2004).

Sources

There are numerous sources of power. Many of

them are readily available to nurses, but some of

them are not. The following is a list derived primar-

ily from the work of French, Raven, and Etzioni

(Barraclough & Stewart, 1992):

■Authority.The power granted to an individual

or a group by virtue of position (within the

organizational hierarchy, for example)

■Reward.The promise of money, goods, services,

recognition, or other benefits

■Expertise.The special knowledge an individual

is believed to possess; as Sir Francis Bacon said,

“Knowledge is power” (Bacon, 1597, quoted in

Fitton, 1997, p. 150)

Health and

Wellness

Care

Exercise and

Massage

Group

Relaxation

and

Meditation

Group

Nutrition

Group

Aromatherapy

and Imagery

Group

Figure 5.3An organic organizational structure for a non-
traditional wellness center. (Based on Morgan, A. [1993].
Imaginization: The Art of Creative Management.Newbury
Park, Calif.: Sage.)