Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
1
Chapter 6: Acute Care Organizations: An Example of a Healthcare Organization
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
Critique the development of U.S. hospitals and the role they play in the healthcare
delivery system.
Suggestions and Strategies for Classroom Experience
• Ask students to investigate what types of multi-provider healthcare delivery
systems exist in their community, or to find one described on the Internet.
Suggestions and Strategies for Clinical Experience
• Students can be asked about the relevance of standards, and what standards apply
to their clinical sites.
LEARNING OUTCOME 2
Differentiate the key methods for classifying hospitals.
Suggestions and Strategies for Classroom Experience
• Students identify the types of hospitals that are in their community.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 3
Compare the key departments found in most hospitals.
Suggestions and Strategies for Classroom Experience
• Representatives from a variety of hospital departments can be invited to do a short
Suggestions and Strategies for Clinical Experience
• As students work with assigned patients, ask them what departments in the
LEARNING OUTCOME 4
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Apply committee process.
Suggestions and Strategies for Classroom Experience
• Ask students if they have had experience on committees (can be any type of
Suggestions and Strategies for Clinical Experience
• Assign students to attend a committee meeting in the hospital and to critique the
experience.
• Students can review the hospital’s policy and procedure process, examples of
policies and procedures, and how the hospital evaluates and revises policies and
procedures. The students can focus on the unit they are on to review policies and
procedures that might be relevant to their patients. Ask students to select one and
to find evidence to support the approach taken. If there is no such evidence, what
should be changed that would be supported by evidence (evidence-based
practice)?
LEARNING OUTCOME 5
Analyze major changes that are occurring in hospitals and their impact on nursing.
Suggestions and Strategies for Classroom Experience
• Assign students to select an article about one of the examples of key concerns,
Suggestions and Strategies for Clinical Experience
• If any of the following positions are used in a unit where students are having
clinical, ask students to describe the role and impact it has on care: hospitalists,
advanced practice registered nurses, clinical nurse specialists, certified registered
nurse anesthetists, and certified nurse–midwives.
• Based on patient assignments, are there alternative/complementary therapies that
might be used for the patient? Students can research the therapy and discuss in
LEARNING OUTCOME 7
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Discuss the implications of the Nurse Manager Engagement Project to healthcare
delivery, nurse mangers, and staff nurses in acute care.
Suggestions and Strategies for Classroom Experience
• Ask students to search for more information about the Nurse Manager
Engagement Project and then summarize all the class knows about the project.
Suggestions and Strategies for Clinical Experience
• Consider the elements of this project and how they would apply in the clinical
setting in which the students are assigned for clinical experience.
KEY CHAPTER CONCEPTS
1. Historically, the focus of the healthcare delivery system in the U.S. has been on the
acute care hospital; though this is changing, it is still the key unit. Acute care hospitals
deliver patient care, both diagnostic and therapeutic. They are complex organizations
with medical and nursing providers that use standards that are established by law,
regulations, and accreditation. Consumers are playing more of a role. There is greater
emphasis today on public/community health; however, most new graduates first work in
acute care settings.
3. The system has become a multi-provider healthcare delivery system (see Box 6-1).
4. The medical staff organization has great power in any hospital. The medical staff is
5. Hospitals are classified according to public access, ownership, number of beds, length
of stay, accreditation, licensure, teaching, and hospital systems.
Public access—Describes hospitals as community or non-community hospitals,
determined by the amount of access that the public has to the hospital. Community
hospitals are nonfederal, short-term, or other special hospitals, which the public may use.
Non-community hospitals are characterized as federal, long-term, hospital units of
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30 days). Length of stay has been decreasing for acute care hospitals and specialty
hospitals such as psychiatric hospitals.
Accreditation—A healthcare organization uses its accreditation status in marketing and
communicating to consumers that it provides quality care, although accreditation does not
guarantee quality.
Licensure—Licensure of hospitals is done by states when the hospital meets certain state
standards and requirements.
6. The key departments found in a hospital are administration, admissions, ambulatory
care/outpatient services, clinical laboratory, clinical respiratory services, diagnostic
services, dietetic services, finance and budget, housekeeping/environmental services,
infection control program, infusion therapy services, information management,
Administration may not be an official department but rather a description of
administrative staff that supports the work of the organization.
Admissions department ensures that patients are admitted in a timely and efficient
manner, and reimbursement issues are resolved related to covered medical services.
Ambulatory care/outpatient services provide services to persons who generally do not
need the level of care associated with the more structured environment of an inpatient or
a residential program.
Clinical laboratory is equipped to examine material derived from the human body to
provide information for use in the diagnosis, prevention, or treatment of disease.
Clinical respiratory services provide goal-directed, purposeful activity to patients with
disorders of the cardiopulmonary system.
Diagnostic procedures provide laboratory and other invasive, diagnostic, and imaging
procedures.
Dietetic services deliver optimal nutrition and quality food services to individuals.
Occupational therapy services provide goal-directed, purposeful activity to evaluate,
assess, or treat persons whose function is impaired by physical illness or injury,
emotional disorder, congenital or developmental disability, or the aging process.
Pharmacy/pharmaceutical care and services are responsible for procuring, preparing,
dispensing, and distributing pharmaceutical products, and the ongoing monitoring of the
and economic stresses associated with illness or injury.
Staff development/education provides organized education designed to enhance skills
of staff members or teach new skills relevant to their responsibilities and disciplines.
Quality improvement performance department ensures that the hospital meets
standards (local, state, federal, and accrediting bodies) to ensure quality and safety of
8. Nurses are playing a more important role in committees. Differentiated practice can
assist nurses as they take on more leadership roles within the organization.
9. Effective care requires the development and implementation of standards, policies, and
10. The process for developing policies and procedures typically is carried out by a
11. Selection of the committee and how it functions are typically the same for most
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12. Policy and procedure development requires an understanding of the purpose of these
documents and decisions.
13. The steps in the development process are identification of need, development of
15. The healthcare delivery system has been undergoing major changes, such as closures
of hospitals, mergers, reduced reimbursement, and loss of services to rural areas. There
16. Several areas are of note when changes in the system are considered: (1) Emergency
service is one area that has been stressed with the changes, affecting the care hospitals
provide and when they can accept patients. Triage, medical evaluation and therapy, and
medical disposition and discharge all have been affected. (2) Patient access to services as
17. Staffing continues to be a top concern in acute care. Acute care hospitals are not only
adjusting staffing levels, but also the staffing mix to reduce costs.
18. The healthcare reform legislation of 2010 includes provisions about emergency and
trauma services, recognizing the need for changes. A new trauma center program is to be
managers and their activities.
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
Chapter identifies which Essentials apply to the chapter content. This information is
primarily for the instructor, but students should understand the how these nursing
record of their work per chapter and build on previous responses from one chapter of My
Hospital Unit experience to the next.
Applying AONE Competencies
The AONE competencies for nurse leaders are found in Appendix A. Ask students to
identify which of the AONE competencies apply to the content in the chapter.
Engaging in the Content: Critical Thinking and Clinical Reasoning and Judgment
See Discussion Questions and Application Exercises at the end of the chapter. Online
options are noted.
Chapter Features: Case Study and Applying Evidence-Based Practice
The Chapter Features: Case Study and Applying Evidence-Based Practice features may
ADDITIONAL CASE
This case is not found in the textbook. It may be used for individual or team assignments:
written assignment and classroom or online team discussions. It may also be used as an
essay question for exams.
Case:
You are part of 3-person team, all nurse managers, identifying nurses to chair various
nursing committees. The team is concerned about the outcomes of chairs as the past few
years many committee outcomes have not been reached. The discussion begins by
deciding on criteria to use in identifying nurses to serve as chairs of the following
committees: Nursing Policy and Procedures, Quality Improvement, Evidence-Based
Practice, and Staff Education.
Questions:
1. What criteria might be established to improve the choice of chairs?
2. How might the team approach the nurses to serve in these positions?
3. What do they need to emphasize with the nurses before they take a chair position?
4. How should new committee chairs be oriented?