Paradigms and nursing management, analysis of the current organizational structure in a large hospital.
Hospitals developed over the period of time when positivism become a predominant world view. Positivism was founded by four Western trends: preponderance of hierarchy and autocracy, popularization of bureaucracy, extensive application of a machine orientation to work and predominance of "scientific" inquiry. Organizational theory developed largely from quantitative research findings arising from a positivistic world view. A case study, analyzing a current nursing organizational structure at one large hospital, is presented. Nursing management was found to be based upon the positivistic paradigm. The predominance of a machine orientation, and an autocratic and bureaucratic structure are evidence of this. A change to shared governance had been attempted, indicating a shift to a more modern organizational structure based on a different paradigm. The article concludes by emphasizing that managers are largely responsible for facilitating change; change that will meet internal human resource needs and the cost-effectiveness crises of hospitals today through more effective use of human resources.
Wilson
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Faculty of Nursing, University of Alberta, Edmonton.
D000416:Alberta; D002170:Canada; D003659:Decision Making, Organizational; D006608:Hierarchy, Social; D006746:Hospital Bed Capacity, 500 and over; D015401:Nursing Administration Research; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation