Lesson 5: Organizational Structure, Power and the Role of the Nurse Leader

• 
  
  • Discuss in your blog, “reflective Journal”, the patient care models used in the organization where you are employed. What works well in the model? What doesn’t work so well?
  •  I work under a functional method to deliver nursing care. I work in a team with a Patient Care Tech (PCT). On days, the RN is assigned 1 PCT to help deliver care. The PCT is responsible for bringing me vitals, doing I/Os, hygiene, ADLs, etc. What works well is that this is cheaper. It is nice to have to 2 people assigned to the team, to help reposition/walk often takes 2. What doesn't work so well, is if the PCT is not very good. For example, if they do not tell the nurse that a BP is low or high/the RN does not find out about it until later, which can be problematic. Overall, I really like this team approach.
  • In your blog, “reflective Journal”, Differentiate among the different types of power and identify strategies to increase your personal power base. What are your thoughts about power and how it is used? 
  • Reward power is gained by grant favors/rewards. Coercive power is punishment power,  which is based on the fear of punishment (transfer, layoff, demotion, or dismissal). Legitimate (authority) power is obtained by a title or official position within an organization. Expert power is power through knowledge, expertise, or experience. Referent power is gained when others identify with that leader or with what that leader symbolizes. Charismatic is personal power. Informational power is gained when people have information that others must have to accomplish their goals.  Self-power (feminist power) is the power a person gains over his or her own life, which comes from maturity, ego integration, security in relationships, and confidence in one's impulse.
  • The five driving forces to increase nursing's power base are: timing, size of the nursing profession, increasing knowledge base and education for nurses, nursing's unique perspective,  and desire of consumers and providers for change. Strategies to increase my personal power base include stop acting like a victim, build coalitions within and outside of nursing, support nursing leaders, pay attention to mentoring future nurse-leaders and leadership succession, and promote greater research to strengthen evidence-based practice. Personally I can maintain my personal energy, increase professional skills and knowledge, use experts and seek counsel, be flexible, maintain a sense of humor, empower others, & learn the language and symbols of the organization.
  • I have a hard time under an authoritarian power. I need to know the why before I am willing to follow. I do not do well under the I told you so regime. I need a manager who is good at empowerment; luckily my manager is!I thought that the struggle over power is a major cause of burnout in the nursing field. The power struggle is between the doctor, the nurse, the patient, and time. They often conflict at times. The best way I can increase my power base is to number one have confidence in myself, two stay up on my education, three laugh when it becomes overwhelmingly stressful, etc. No one thrives when they feel complete suppressive power. The best to increase your power/confidence is by empowering others. It will also build you up. Power hungry people often eat up power unnecessarily. Power must be used appropriately!!!
  
  Clinical Update:
  
  Started my clinicals this week. I got to sit in on interviews and help pick who to hire. It was very difficult but a good experience! I do not envy the manager's job of hiring! I also got to see how she forms schedules and comes up with the masters. We also got to play around with schedules to try to work up to the employee's ideal schedule.