NURS 446 leadership Latest Set Final Exam 2026

NURS 446 leadership Latest Set Final Exam 2026 Formal structure Highly planned, visible, provides framework for defining managerial authority, responsibility and accountability. Roles and functions are defined systematically arranged, different people have differing roles and rank and hierarchy are evident. Informal structure Unplanned, often hidden, generally naturally forming social network of employees, typically based on camaraderie, resulting in more immediate response from individuals, which saves peoples time and effort. Chain of command Formal paths of communication and authority; those with the greatest decision making authority are at the top, those with the least are at the bottom; level of position signifies status and power. Span of control Number of people directly reporting to any one manager represents that managers span of control and determines the number of interactions expected of him or her. Inverse relation between the span of control and the number of levels in hierarchy in an organization. Levels of managers Top level, middle level, and first line Examples of top level managers Chief nursing officer, chief executive officer, chief financial officer Examples of middle level managers Unit supervisor, dept. Head, director Examples of first level managers Charge nurse, team leader, primary nurse. Scope responsibility of top level managers NURS 446 NURS 446 Look at organization as a WHOLE as well as external influences. Scope responsibility of middle level managers Focus is on integrating unit level day to day needs with organizational needs. Scope responsibility of first level managers Focus primarily on day to day needs at unit levels. Centrality Where a position falls on the organizational chart, determined by organizational distance. Refers to the location of a position on an organization chart where frequent and various types of communication occur. Matrix structure Designed to focus on both product and function. Example of matrix structure Good patient outcomes are the product, and staff education and adequate staffing may be the functions necessary to produce the outcome. Service line Can be used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations. Also called care-centered organizations. Example of service line Overall goals would be determined by the larger organization, but the service line would decide on the process to be used to achieve the goals. Flat design An effort to remove hierarchical layers by flattening the chain of command and decentralizing the organization. Continues to be line authority because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out. Stakeholders Those entities in an organizations environment that play a role in the organizations health and performance or that are affected by the organizations. Can be internal (nurse in hospital or dietitian in nursing home) or external (local school of nursing, home health agencies). Patient satisfaction, quality outcomes, fiscal accountability. Organizational culture NURS 446 NURS 446 The total of an organizations values, language, traditions, customs, and sacred vows, those few things present an institution that are not open to discussion or change. System of symbols and interactions unique to each organization, its way of thinking, behaving, and believing that members of a unit have in common. Example of organizational culture Hospital logo that had been designed by the original board of trustees is an item that may not be considered for updating or change. Shared governance Innovative and empowering. Alternative to traditional bureaucratic organizational structure. Organizations governance is shared among board members, nurses, physicians, and management. Magnet Used to denote organizations that were able to attract and retain professional nurses. Only about 7% achieve this recognition. 5 model components required to achieve magnet status Transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation, and improvements, and empirical quality results. 14 foundational forces of magnetism for magnet hospital status Quality of nursing leadership, organizational structure, management style, personnel policies and programs, professional models of care, quality of care, quality improvement, consultation and resources, autonomy, community in the hospital, nurses and teachers, image of nursing, interdisciplinary relationships, and professional development Types of power Reward, punishment or coercive, legitimate, expert, referent, charismatic, and informational. Reward power Obtained by the ability to grant favors or reward others with whatever they value. Positive leadership through rewards tends to develop a great deal of loyalty and devotion toward leaders. Punishment or coercive power NURS 446 NURS 446 Opposite of reward, based on fear of punishment if the managers expectations are not met, may obtain compliance through threats. Legitimate power The power a person receives as a result of his or her position in the formal hierarchy of an organization Expert power Gained through knowledge, expertise, or experience; critical knowledge allows a manager to gain power over others who need that knowledge. Referent power Power that a person has because others identify with that leader or with what that leader symbolizes, also occurs when one person gives another person feelings of acceptance or approval. Charismatic power An intense form of referent power that stems from an individual's personality or physical or other abilities, which induce others to believe in and follow that person Informational power Power derived from control over information Empowerment Occurs when leaders communicate their vision, employees are given the opportunity to make the most of their talents; and learning, creativity, and exploration are encouraged Authority power gap Gap that sometimes exists between a position of authority and subordinate response Negative effects of wide gap Organizational chaos may develop, there should be little productivity if every order were questioned. Narrow gap Reinforce dependency and obedience by emphasizing extreme consequences, including the death of a patient Six driving forces to increase nursings power base 1. The timing is right 2. The size of the nursing profession NURS 446 NURS 446 3. Nursing's referent power 4. Increasing knowledge base and education for nurses 5. Nursing's unique perspective 6. Desire of consumers and providers for change Total patient care The oldest mode of organizing patient care; Nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty. Also called case method of assignment because patient may be assigned as cases. Functional model Created when there was a shortage of nurses after WWII. Personnel were assigned to complete certain tasks rather than care for specific patients. Team nursing Created to reduce the fragmented care that accompanied fragmented nursing. A