Chapter 12: Organizational Structure

16. A nurse-manager is chairing a workplace committee. What should the manager prioritize in this role?A) Keeping members on task and promoting productivityB) Promoting members' career developmentC) Resolving interpersonal conflicts and preventing groupthinkD) Providing information on each agenda item

Ans: A Feedback: Although all the items may be something the chairperson does, the primary responsibility is to keep members on task so that committee work gets completed. This is prioritized because it best reflects the main purpose of a committee, which is to collectively address specific tasks and challenges in the workplace.

21. Which components are considered a part of an organizational structure? Select all that apply. A)The individuals included in the group B)Lines of communication C)Decision-making process D)Channels of legitimate authority E)Organizational culture

Ans: A, B, C, D Feedback: Organizational structure refers to the way in which a group is formed (membership), its lines of communication, and its means for channeling authority and making decisions. Organizational culture is an important aspect of every organization but this is not conveyed in the organizational structure.

22. The leadership of a large health-care organization has arranged a series of meetings with stakeholders. What individuals or groups would be included in this category? Select all that apply. A) A community group that advocates for the rights of people addicted to drugs B) Representatives from the labor union that represents many staff members, an external organization, or individual C) A community group that promotes client safety in health care D) Members of the local mediaE) The surgeons and anesthetists who work in the operating room

Ans: A, B, C, EFeedback: Stakeholders are those entities in an organization's environment that play a role in the organization's health and performance or that are affected by the organization. Stakeholders may be both internal and external, they may include groups. As a result, groups that focus on client safety or a particular vulnerable population would be considered stakeholders. As well, staff members or the organizations representing their interests would be considered stakeholders. The media would not normally play a role in the organization's health and performance or be affected by the organization.

25. Which statements are true concerning a bureaucratic organization? Select all that apply. A) It is commonly referred to as a line organization. B) It is typically found in large health-care organizations. C) It is rooted in individual personalities. D) They resemble Weber's original design of organization. E) Its authority is represented by its staff organizational chart.

Ans: A, B, D, EFeedback: Bureaucratic organizational designs are commonly called line structures or line organizations. Their structure is illustrated by an organizational chart. These designs are common in large health-care organizations and are based on Weber's original conceptualization. Policies and rules govern the organization rather than individual personalities.

2. Max Weber, as part of the scientific management era, contributed immensely to the development of organizational theory. Which statements are representative of his beliefs? Select all that apply. A) Bureaucracy could provide a rational basis for administrative decisions. B) Worker satisfaction was integral to productivity. C) Organization charts could depict the hierarchy of authority. D) Impersonality of relationships should exist in organizations. E) Advancement and placement should be based on relationships.

Ans: A, C, DFeedback: Weber emphasized the impersonality of work relationships, the ability of bureaucracy to provide rational decisions, and the role of organizational charts. Max Weber's theories did not address worker satisfaction. Weber advocated promotions based on competence, not relationships.

1. After starting a new job, a nurse-manager has been surprised at the amount of grapevine communication that happens. The manager should recognize what characteristic of this type of communication? A) It is difficult to control or stop. B) It always involves verbal, face-to-face communication. C) It consists of negative and subversive messages. D) Strong organizations have policies that prohibit it.

Ans: AFeedback: "Grapevine" communication is informal and is difficult to control or stop. Consequently, policies that aim to ban it are unrealistic. This type of communication can involve all types of content, not just negative messages. The spread of easy, instant electronic communication means that it is not always verbal.

7. A health-care organization utilizes decentralized decision making. What will most likely happen when there is need for decisions to be made in the organization? A) A decision can be made at the lowest practical managerial level.B) The decision will be made by top-level managers.C) There is a potential that the decision will be made too quickly.D) It will be unclear who is ultimately accountable for the decision.

Ans: AFeedback: Decentralized organizational structure allows decision making to be made at the level at which problems occur. Decision making by top managers is more likely when decision making is centralized. Decentralized decision making does not necessarily lead to rash decisions or unclear accountability.

12. A nurse-manager is working with a committee that is showing evidence of groupthink. What characteristic of the committee would show evidence of this phenomenon? A) Members of the committee are unwilling to take risks with new ideas. B) The committee prefers to make decisions by consensus. C) The committee members want to take turns chairing the meetings. D) Membership in the committee is frequently changing.

Ans: AFeedback: Groupthink occurs when group members fail to take adequate risks by disagreeing, being challenged, or assessing discussion carefully. A preference for a rotating meeting chair does not necessarily indicate groupthink, nor does a preference for working by consensus. Unstable membership is not a desirable characteristic of a committee, but this does not directly indicate groupthink.

13. The nurse is working on a unit whose culture has become firmly entrenched? What solution should the nurses on the unit best propose? A) New leadership B) A decrease in workload C) Collaboration with a unit that is not entrenched D) Increased administration support

Ans: AFeedback: It is extremely difficult to change a unit culture without new leadership. A change in administrative support or even a reduction in workload will not necessarily challenge the established culture. Collaboration with a unit that is not entrenched may be beneficial, but new leadership is likely the most effective solution.

28. A nurse-manager is reviewing the organizational chart of a health-care facility before accepting a job offer. When reviewing the organizational chart, the nurse should:A) be aware that the informal structure of the organization cannot be discerned from the chart. B) confirm the accuracy of the chart with the human resources department. C) try to meet with the people at the top of the chart, if possible. D) review the qualifications of each person on the chart.

Ans: AFeedback: Organizational charts convey the formal structure of an organization, but they do not include informal structures. It is impractical and unnecessary to review every individual's qualifications. Unless there are reasons to doubt the accuracy of the chart, it is unnecessary to confirm with the human resources department. Unless the manager is applying for a top-level position, it is often unnecessary and impossible to meet with the people at the top of the chart.

26. A nursing supervisor has been given the responsibility for increasing the frequency and thoroughness of nursing assessments on a hospital unit. However, the supervisor does not have the authority to enforce new guidelines for assessment or assign consequences for noncompliance. What is the most likely outcome of this scenario?A) The desired outcome will not be achieved.B) The assessments will improve, but the nurses will be resentful.C) The supervisor will need to use unauthorized enforcement.D) The assessments will improve as a result of collaboration.

Ans: AFeedback: Responsibility without authority often causes role confusion and makes it difficult for a manager to enforce a necessary change. This is likely to cause the failure of the initiative. Without binding incentives and disincentives, it is unlikely that change will occur. Spontaneous collaboration is possible, but role confusion is more likely. The use of unauthorized enforcement could be problematic for the manager and would be most likely avoided due to the associated risk.

10. The nurse-manager is chairing a committee, most of whose members are subordinates. When communicating with the members during meetings, the manager should:A) ensure their contributions are recorded for performance appraisal purposes. B) avoid overt demonstrations of power or authority.C) reserve the right to impose decisions on the committee.D) avoid informality in speech or writing.

Ans: B Feedback: During committee work, encouraging interaction that is free of status and power is important. Recording for performance appraisal purposes is likely to be intimidating for committee members. There is no reason for all communication to be formal in a committee setting.

14. Which characteristic of an organization would suggest that flattening is occurring?A) There is a collective spirit.B) There is reduction in the administration levels.C) There are shared work goals across units.D) There are formal and informal systems are in place to address conflicts.

Ans: B Feedback: Reducing the numbers of administration levels is called flattening the organization. A collective spirit, shared work goals, and adequate structures for conflict resolution are not related to organizational flattening.

20. The nurse-manager works in a health-care facility that has applied for Magnet status. What characteristics of the organization will support the application? Select all that apply. A) Centralized decision-making environment B) Open, participatory management C) Improved patient outcomes D) High staff nurse satisfaction E) Large number of registered nurses and an absence of practical nurses

Ans: B, C, DFeedback: Magnet designation is conferred by the ANCC to health-care organizations exemplifying well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management. Magnet-designated organizations demonstrate improved patient outcomes and higher staff nurse satisfaction than organizations that do not have Magnet status. Magnet status is not dependent of registered nurses performing roles that are otherwise performed by practical nurses.

30. The top-level managers of a hospital have chosen to apply for magnet designation. The decision to grant this designation will be largely based on what factor?A) Input from local nursing educators and academicsB) The findings from an onsite visit by assessorsC) The results of a local public opinion surveyD) Review of the organizational chart

Ans: BFeedback: A detailed onsite visit is a major component of the magnet accreditation process. Nurse educators from outside the organization would not normally be consulted, and a public opinion survey is not normally taken. Accreditors would review the organizational chart, but this is a lesser piece of data compared with the results of a site visit.

15. A manager is participating in introducing a shared governance model to a health-care organization. What is the manager's best action? A) Remove lines of authority. B) Form joint practice committees. C) Eliminate performance appraisals. D) Increase the number of first-level managers.

Ans: BFeedback: In shared governance, the organization's governance is shared among board members, nurses, physicians, and management. Joint practice committees are developed to assume the power and accountability for decision making, and professional communication is egalitarian rather than hierarchical. Shared governance does not require a complete removal of lines of authority or the elimination of performance appraisals. Shared governance would not require more first-level managers.

11. A manager has accepted a new position and there are more than 20 people who directly report to the manager. What description of this manager's role is most accurate? A) The manager's workload is unrealistic. B) The manager has a large span of control. C) The manager has a top-level management position. D) The manager is working in a poorly designed organization.

Ans: BFeedback: The number of people directly reporting to any one manager represents that manager's span of control and determines the number of interactions expected of him or her. Without knowing more about the manager's role, there is no way of knowing if the workload is unrealistic or if this is a top-level position. This manager's large span of control is not necessarily a marker of a poorly designed organization.

17. A nurse-manager has been commissioned to create a new workplace committee that will focus on client safety issues. When forming this committee, the manager should: A) meet at least twice per week for the first month to create momentum. B) aim for diversity of genders and cultures among the membership. C) ensure that half of the members are the manager's subordinates and half are the manager's superiors.D) give members permission to attend meetings as often or as rarely as they wish in order to accommodate their schedules.

Ans: BFeedback: When assigning members to committees, cultural and gender diversity should always be a goal. The manager should make efforts to accommodate members' schedules, but giving members' permission to attend as rarely as they wish will compromise the group's cohesion and effectiveness. Momentum must be created after the committee is formed, but this does not necessarily require twice-weekly meetings. It is unnecessary and unrealistic to split the membership between the manager's subordinates and superiors.

27. An organization has proposed a policy stating that no more than five people should report to any single manager in the organization. What is the most likely outcome of this change in organizational structure? A) Decision making will become unpredictable. B) Workplace satisfaction will increase. C) Efficiency will decrease in the organization. D) Worker autonomy and empowerment will increase.

Ans: C Feedback: Having too few people report to a manager creates an inefficient and top-heavy organization. Decision making is likely to become similarly inefficient, although it may not become more unpredictable. This change in structure will not necessarily increase the autonomy or satisfaction of employees who may be under closer scrutiny.

8. A middle-manager who oversees the operations of several nursing units has a high degree of organizational centrality. What is most likely true about this manager? A) The manager is isolated from top-level managers. B) The manager interacts with a comparatively small number of coworkers. C) The manager receives much communication from varied directions. D) There are more middle-level managers than first-level managers in the organization.

Ans: CFeedback: Centrality is a position on an organizational chart where it is possible to have many different types of communication (upward, downward, lateral, and diagonal). This does not suggest that there are more middle-level managers than lower level managers or that this manager is isolated from his or her superiors.

19. During a strategic planning committee meeting to develop technology goals, several unit managers spend a considerable amount of time discussing current staffing problems. What is the primary action of the chairperson of this committee? A) Take the remainder of the meeting time to discuss staffing with all members. B) Adjourn the meeting and reschedule at a time when there are no staffing problems.C) Request that committee members return to discussing items on the agenda. D) Excuse those discussing staffing from the remainder of the meeting.

Ans: CFeedback: Committee time is wasted when agendas are not adhered to. The chairperson should avoid facilitating discussion of peripheral issues. It is unrealistic to put the committee's work "on hold" pending resolution of this problem. Dismissing the members who are discussing irrelevant issues is a heavy-handed approach that is unnecessary and which would be disruptive.

23. A health-care organization has undergone an organizational restructure that increases nurses' autonomy and empowerment. What effect is most likely? A) Increased interdisciplinary collaboration B) Increased communication C) Increased effectiveness of client care D) Increased client autonomy

Ans: CFeedback: Current research suggests that changing an organization's structure in a manner that increases autonomy and work empowerment for nurses will lead to more effective client care. There is no evidence that increasing the autonomy of nurses causes enhanced communication or collaboration, or that it has an effect on client autonomy.

5. There is one vertical, solid line connecting a middle manager and a top-level manager on a clinic's organizational chart. What should a nurse conclude from this aspect of the organizational chart? A) The middle- and top-level manager share equal authority. B) The middle manager is in a permanent position. C) The middle manager has only one boss. D) The top-level manager was originally promoted from being a middle-manager.

Ans: CFeedback: Unity of command means one immediate boss per employee and is denoted by a single vertical line. This does not suggest equal authority among the two managers or that the top-level manager was promoted from the position below him or her. This portion of the chart does not indicate that the middle manager's position is permanent.

9. A nurse-manager has established a new committee and will be chairing the committee. The committee consists of six representatives from various departments, at various levels within the organization. What goal should the committee members set? A) Creating a new organizational chart B) Adding four to six new members C) Emphasizing formal communication D) Implementing shared decision making

Ans: DFeedback: A shared decision making is a desirable goal in most committees. This maximizes productivity and input. Communication does not necessarily need to be formal and a committee does not necessarily have to consist of 10 to 12 members. It would unusual for a committee to be charged with creating an entirely new organizational chart.

6. Which employee of a health-care organization would likely be considered a middle-level manager? A) An experienced primary care nurse who mentors other nurses B) The team leader of the hospital's wound care specialists C) The charge nurse who oversees day shifts on a medical unit D) The hospital's nursing supervisor

Ans: DFeedback: Nursing supervisors are middle-level managers. All the other listed nurses are first-level managers.

3. A nurse has begun working in a new health-care facility and is beginning to understand the organizational culture. When seeking to understand the organizational culture, the nurse should: A) carefully examine the demographic characteristics of the workforce. B) ask the middle- and upper level managers about the potential for advancement.C) ask coworkers at various levels to interpret the organizational chart.D) try to perceive the dominant values, traditions, and beliefs in the organization.

Ans: DFeedback: Organizational culture is the symbols and beliefs, values, history, and communication patterns of the organization. It differs from organizational climate, which is how the employees perceive the organization. Employees may not be able to articulate the organizational culture due to their proximity to it. Culture does not determine the potential for advancement and is not solely a reflection of demographics.

4. A clinical nurse specialist (CNS) is included on a hospital department's organizational chart. However, there are no solid lines leading to or from the nurse's position on the chart. What does this imply? A) The CNS lacks productive relationships with colleagues. B) Any member of staff may exercise authority over the CNS. C) The CNS is not accountable for his or her practice. D) The CNS does not have formal authority over other staff members.

Ans: DFeedback: The absence of a "line position" denotes an absence of formal decision-making authority. This is often the case for an advisory (staff) position such as CNS. However, this does not suggest that every other staff member holds authority over the CNS or that the CNS is not accountable for his or her safe practice and adherence to standards. Line positions do not represent personal relationships.

18. What should the leader remember when forming committees?A) Committees work best when there is an adequate supply of workers, with 10 members being the minimum. B) Willingness to work hard is the most important criterion for appointment.C) Written agendas provide excessive structure and stifle committee creativity. D) There should be sufficient expertise among committee members to accomplish the assigned task.

Ans: DFeedback: The most important criterion for committee selection is overall adequate expertise to accomplish the agenda. Effort is an important criterion for membership, but this quality is not productive unless it is accompanied by expertise. There is no absolute minimum of 10 members. Written agendas provide structure and focus for committee meetings and the manager should provide these.

29. A rural hospital is considering a sharp reduction in the range and availability of the services it provides. Before making this change, the hospital's leadership should: A) decentralize its decision-making model. B) implement shared governance. C) review its organizational chart. D) consult with local stakeholders.

Ans: DFeedback: The stakeholders are all the internal and external individuals and groups that have an interest in an organization's operations. In a rural community where few options for health care exist, it would be prudent to consult with local stakeholders before a major change in service. There is no obvious need for this organization to decentralize, implement shared governance, or review its organizational chart.

24. The organization of work in a large health-care facility reflects Weber's theories around bureaucracies. What characteristic is most likely to exist in this facility? A) High flexibility in the way that work is structured B) Promotion and advancement on the basis of relationships C) Absolute autonomy of each employee D) A clear division of labor among employees

Ans: DFeedback: Weber emphasized the need for a clear division of labor. Advancement was to be based on competence, not relationships. A high degree of accountability was to exist rather than absolute autonomy. The flow of work is more structured than flexible.