N108: Transition to the Registered Professional Nurse

N108: Transition to the Registered Professional Nurse Role Study Guide Organizational Relatio hips Most organizations have several ways of expressing and defining the relationship of one worker to another. Organizational charts, chains of commands, channels of communications, job descriptions, policies, and procedures provide different views of organizational relationships. The structure of any large group comprises both formal and an informal organization. The formal organization can be seen on an organizational chart. • Organizational chart: The organizational chart is a graphic, pictorial means of portraying roles and patterns of interaction among parts of a system. It describes the span of control that each manager has within the organization. It identifies formal chains of command, communication channels, and the authority for decision making. • Chain of command: This represents the path of authority and accountability from individuals at the top of the organization to those at the base of the organization. It is often referred to as the organizational hierarchy because it refers to the lines of authority. • Channels of communication: This refers to the flow of communication between individuals, referring to the patterns through which messages are delivered within an organization. The channels of communication usually reflect the chain of command; they run up and down the organizational chart, moving from one level of responsibility and authority to the next. The flow of communication between individuals is formal or informal. Formal follows the chain of command and informal is often referred to as grapevine or “chit chat.” • Job description: These are written statements, usually found in policy manuals, that specify the duties and functions of various jobs within the organization and the scope of authority, responsibility, and accountability in each position. o Job descriptions should explain the role of each individual working for the company and organization, from the chief executive officer to the housekeeper. Job descriptions provide the foundation for performance standards for each position and should provide a basis for evaluation. Job descriptions may also include competencies expected of employees and can provide the basis for competency-based orientation. o Job descriptions may be used when cross-training is used in the organization. Cross- training requires that a person hired to perform functions of one position in the healthcare team be trained in the skills needed to perform those of another position. o Job descriptions may also be used to describe clinical ladders, which differentiates and defines the skills and performance expected of nurses in terms of advancing levels. • Standards of care: These are authoritative statements that describe a common or acceptable level of client care or performance and define professional practice. In 1973, the ANA first formulated general standards and guidelines for nursing practice. These standards and guidelines were revised in 1991 and again in 2004. These standards apply across the nation, are broad and general in nature, and have the purpose of establishing the best practice and eliminating as much variation as possible. Some agencies may develop standards of care for patients with selected healthcare problems. These are more detailed, and specific standards may take the form of standard nursing care plans. Some standards are incorporated into documents termed care pathways, critical pathways, or clinical pathways, which are intended to serve as guides to direct the healthcare team in daily care. The individual standard organizes and sequences the care and describes the care required for a patient at specific times in the

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