Organizational Culture in Nursing
By T. Nadeau RN

Organizational Culture in Nursing:

Edward Schein , author of the book Organizational Culture and Leadership and first recipient of the Hughes Award ( award of the careers division of the Academy of Management) defines organizational culture as “ a pattern of basic assumptions – invented, discovered, or developed by a given group as it learns to cope with it’s problems of external adaptation and internal integration-that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think and feel in relation to those problems.”

Schein describes culture as a phenomenon that surrounds all of us. One must understand the culture in order to understand the organization. Organized culture includes the customs and rights as well as the norms, values, behaviors, rituals and traditions of the organization.

If a nurse manager wants to implement change it is important to analyze the values and trends of the work environment, the text gives the example of how an organization failed at grouping all long-term care clients together in one area of an institution. After a trial the project was not implemented. Another attempt was made five years later and was successful because the trend and values of the organization had changed. The organization felt at this present time that the change was the most cost effective and efficient way to run the organization. This change in values helped make the project succeed.

There are 2 types of clues for the nurse manager to assess organizational culture. 1) Explicit Clues: this includes formal contracts, written mission statements, policies and procedures, organizational charts and job descriptions. 2) Implicit Clues: this includes informal, unwritten rules and expectations ie dress code

The key players are considered those individuals or groups that will be impacted by the change that may be taking place. The positives and negatives must be identified regarding why a change is to be made as well as the strengths and goals of the key players.

Key players who are positive and support the change maybe considered resource people. The individuals or groups that do not support the change may cause conflict to arise. According to the text there are several ways of dealing with negative key players p. 285 in text 1) They can be avoided 2) Their impact can be minimized by identifying the specific area they oppose and trying to convince them either to support the goal or at least be neutral. 3) They can be confronted by developing arguments that demonstrate why the proposed goal is better.

Del Bueno (1986) offers some suggestions at managing conflict: 1) Building up a strong team 2) Choosing the second in command with great care 3) Establishing a strong partnership between management and staff 4) Being flexible 5) Project an impression of status and success

Governance is the establishment and maintenance of social, political, and economic arrangements by which practitioners control their own practice, their self discipline, their working conditions, and their professional affairs. ( p.8 Fundamentals of Nursing )

Governance of Hospitals:

Most hospitals in Canada are owned provincially or by either profit or not for profit groups. In general most of the hospitals use a board of directors to “govern” the affairs of the institution. Most people view having a board as being more objective and less self fulfilling than having just one person directing the organization. Having a board allows the institution a variety of opinion and expertise.

The board of directors are responsible for the activities that go on within the organization as well as managing the resources.

If a facility is for profit and small, often there is no board of directors but an owner and possibly someone to manage the facility. On the other hand if the institution is large and has several owners often there is a board to govern the facility.

Membership on health care boards is open to anyone who would like to participate. The board’s wishes are often to have a balance with equal men and women, various ages, professions and backgrounds. Individuals that have a strong history in fundraising are very desirable. The individuals interested in becoming members are selected according to the board’s constitution and voted in by the members.

Most of the boards are volunteers and have very few paid staff. There are exceptions in larger facilities where the board members may get an honoraria. The governance literature suggests that the most effective size of a board is between 15 and 20 members.

The non profit boards have a Cooperatives act and are required to have bylaws such as role of board, qualifications for membership, terms of office, methods of obtaining a seat and expectations.

The board of directors are legally responsible for not only their own decisions but also for the decisions and actions of all the staff and volunteers of the organization. The board can be held liable by parties that feel they have been wronged. Most boards take out liability insurance to protect themselves from lawsuits.

The fundamental responsibilities of the board are : defining the purposes, principles and objectives of the hospital, ensuring and monitoring the quality of hospital services, ensuring the fiscal and integrity and long term future of the hospital, arranging for and monitoring the effectiveness of the hospital’s management.

Shared Governance: “ Empowering nurses by giving them opportunities to play a significant role in decisions that affect their practice and by systematically sharing authority and accountability” (Monk , 1994 ) . Another definition from Nursing Foundations A Canadian Perspective is: a term used for the organization of hospital patient services in which the staff nurses have more autonomy and decision making authority than in the traditional structure. Another name for shared governance is participatory management. The primary focus is on nurses controlling their own professional practice usually through committees. The manager’s role usually shifts from one of controlling to one of facilitating and coaching.

Some examples of the committees formed might be: policy and procedure committees, nursing practice standard committees, nursing research committees and nursing education committees. The committees generally address issues such as practice, management, quality and education.

Shared governance during the cut backs in the 1990’s had major setbacks as it does tend to be expensive to form all these committees. From evidence based practice, shared governance is coming back into vogue as they are finding that giving nurses a sense of having control over their own practice may result in increased staff retention and job satisfaction.

References: Organizational Culture and Leadership by Edward Schein (

Nursing Management in Canada, second edition by Judith Hibberd and Donna Lynn Smith

From Bedside to Boardroom- Nursing Shared Governance.

Issues in the Governance of Canadian Hospitals, Part 1: Structure and Process by Mark Hundert and Robert Crawford ( from Canadian Journal of Nursing Leadership

Community Health Nursing fifth edition p. 371 by Stanhope and Lancaster

Nursing Foundations A Canadian Perspective 2nd edition p.93 by Beverly Dugas, Lynne Esson, Sharon Ronaldson

Fundamentals of Nursing Concepts Process and Practice 4th edition by Kozier, Erb and Olivieri p. 8

Building on Strength: Improving governance and Accountability in Canada’s Voluntary Sector by Anne Corbett ( from Canadian Journal of Nursing Leadership

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