Nursing Organization Master Plan: A New Executive's Guide

Introduction and Core Principles

This report lays out a master plan for a nursing and medical organization, written from the standpoint of a new nursing executive. The plan encompasses six major sections: contextual information, nursing strategic planning, culture and image, physical setting and technology, nursing's role in interdisciplinary care, and quality and success metrics. While crafting such a plan is a complex and daunting task, a few core principles should guide everything within it.

The mission statement, vision statement, and organizational assessments of the organization will all center on three basic ideals: integrity, quality of care, and the utilization and realization of human capital. In short, the nursing wing of the organization will be run with the utmost ethics and integrity, operated as efficiently and effectively as possible without compromising quality of care, and structured so that the people working within it are allowed to blossom and grow — in their careers, in their professional culture, and in the way they treat patients.

The hospital's nursing staff must be equipped with the latest standard equipment from reputable suppliers and vendors such as McKesson, Cerner, and GE Health. Best practices must be instilled in all nurses so that procedures are performed correctly the first time, every time. Immediate disposal and absolutely no reuse of sharps, and the prevention of all avoidable patient harm, are just the beginning. That said, nurses should not be intimidated into compliance or micromanaged. Instead, they should be empowered to thrive, but when they stray from required practices, correction must be swift and clear.

Strategic Planning and Workforce Development

In terms of organizational structure, the organization should follow a clear chain of command, but the organizational chart should be as flat as possible — more horizontal than vertical. Even so, lines of responsibility must be unambiguous: it should never be unclear who is responsible for what and by when. Checklists and best practices should be followed to the letter. When something does not fit neatly into a given procedure, management should assess whether a policy revision is warranted rather than allowing improvised exceptions to become the norm.

Strategic planning is critically important in the nursing profession. The nursing population is aging, and many industry experts place the average age of a working nurse in the fifties — a figure that underscores the urgency of pipeline development (Average age of nurses increases, 2010). New generations of nurses need to be encouraged, cultivated, and advanced through the ranks. However, this must never come at the expense of the educational and certification standards required to produce competent, safe practitioners. Releasing underprepared nurses into practice will ultimately harm both the nurses themselves and the patients they serve.

Parallel to workforce development is the importance of selecting and grooming the right people for leadership roles. Nursing managers and executives should, without exception, be registered nurses themselves — not simply individuals who are considered skilled at managing people. There are industries where non-expert managers can be effective, but the nursing and medical field is not one of them. All nurses and executives must understand in fine detail how to handle crises, what their personnel face each day, and what resources nurses need to do their jobs well.

Nurses will respect managers who understand the intricacies of the profession far more than they will respect those whose expertise lies primarily in public relations or financial administration (Germain & Cummings, 2010; George & Haag-Heitman, 2011). Regardless of rank, all nursing staff should be treated with respect, given access to resources that support their career goals, and afforded the opportunity to work with the best available technology.

Organizational Culture and Professional Image

Relying on clipboards and paper records should be replaced by electronic medical records and tablet technology from providers such as Apple and Samsung. These tools represent the future of healthcare documentation, regardless of what critics may argue (Angst & Agarwal, 2009; Gillum, 2013). It is true that a profit must be made, but this can be achieved through measures that do not affect quality of care — such as offering private rooms as an optional upgrade, and operating gift shops and cafeterias on-site. Every patient, regardless of their ability to pay or their socioeconomic background, should receive the same standard of clinical care unless the condition is non-life-threatening and entirely discretionary.

Nurses occupy a distinct niche within the broader culture of a hospital, just as professionals in other departments — such as information technology — have their own subcultures. What must be actively avoided is cliquish behavior, in which nurses fragment into small, insular groups that replicate the exclusionary social dynamics seen in adolescent peer groups. Some staff will naturally form friendships with coworkers, while others will maintain a firm boundary between their professional and personal lives. Both approaches are acceptable and entirely up to the individual.

However, bullying, sabotage, and subterfuge must be met with firm disciplinary action against any nurse or group of nurses who behaves in an obtuse or unprofessional manner. Managers or executives who engage in such behavior — or who allow it to fester without intervention — should be removed from their posts if they fail to immediately correct the situation (Katrinli, Atabay, Gunay, & Guneri Cangarli, 2010). A professional, respectful workplace culture is not optional; it is foundational to patient safety and staff retention.