| Course | NUR-6320 Nursing Administration Standards and Structures |
|---|---|
| Module | Module 4 |
| Paper type | Organizational structure analysis |
| Length | About 1,012 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S., Nursing Administration Concentration |
| Updated | October 2026 |
Free sample paper for NUR 6320 Module 4
Who Decides What: Mapping Decision Rights and Shared Governance in the Nursing Structure of a Critical Access Hospital
Student Name
M.S., Nursing Administration Concentration, Thomas Edison State University
NUR-6320: Nursing Administration: Standards and Structures
Mentor Name
Month Day, Year
Who Decides What: Mapping Decision Rights and Shared Governance in the Nursing Structure of a Critical Access Hospital
Boxes and lines tell a reader where each job sits; they say little about where decisions are made. The hospital's nursing chart has only a few boxes: the director answering to the chief executive officer, two charge nurse leads, a half-time educator, and a mixed staff of RNs, LPNs and aides spread over the emergency department, the inpatient and swing-bed unit and the infusion room. The real structure lies in how decisions are made. This paper describes the nursing structure in terms of decision rights, explains the shared governance model the director has strengthened, presents a matrix assigning each decision an owner and listing whose views are sought and who hears the result, and discusses how the structure will be evaluated.
Formal Structure and Its Limits
Small hospitals tend to have flat structures, with few management layers between the bedside and the executive team. Flatness can speed decisions and keep leaders close to practice, but it can also concentrate decisions in one person. Before the current director arrived, almost every decision, from schedule changes to the choice of IV start kits, went to the director of nursing, and staff described the culture as waiting for permission. A structure in which one person decides everything is fragile: it slows decisions, discourages initiative and leaves the department exposed when that person leaves.
The ANA's description of nursing administration, applied in the first module, assigns the director responsibility for creating structures in which nurses control their practice. The question for the director was not how to draw a different chart but how to distribute decisions.
Shared Governance as a Decision Structure
Shared governance is a structure in which nurses at the point of care hold authority over decisions about their practice, while managers hold authority over resources and operations, and the two are linked through councils. Hess (1998) developed the Index of Professional Nursing Governance to measure how governance is distributed in hospitals and found that its scores differed significantly between hospitals with shared and traditional governance. The index covers areas such as control over personnel, access to information, influence over resources, participation structures, control over practice and the setting of goals and resolution of conflict. Those areas are a useful checklist for a director deciding which rights to share.
Evidence links shared governance to better practice environments. Clavelle et al. (2013) surveyed chief nursing officers and practice council leaders in Magnet organizations and found that governance was mainly shared and that higher governance scores were positively correlated with scores on the Nursing Work Index practice environment measure. Lake (2002) developed the practice environment scale from that index and showed that nurses in Magnet hospitals rated their environments more highly, and Kutney-Lee et al. (2015) found that hospitals that achieved Magnet recognition improved their work environments and some patient outcomes more than hospitals that did not. Our hospital is not seeking Magnet recognition, but the structural features the research links to better environments do not depend on it.
Decision Rights in Practice
In a small hospital, a single nursing practice council replaces the several councils a large system would have. Ours includes eight staff nurses from every department and shift, the educator and the director as a nonvoting member, with a charter that states the council's decision rights. The table below summarizes the main decisions. The council decides on nursing practice policies and procedures, consulting pharmacy and the medical staff where orders are affected, and sets the competency standards for floating with the educator. Charge nurses decide shift assignments and floats within those standards, consulting the floating nurse's competency profile. A self-scheduling committee builds the monthly schedule within rules set by the director. The director retains decisions on hiring, the budget and positions, and purchases, but consults staff through peer interview panels and the council's priority list.
| Decision | Decides | Must be consulted | Informed |
|---|---|---|---|
| Nursing practice policies and procedures | Nursing practice council | Pharmacy, medical staff when orders are affected | All nursing staff |
| Competency standards for floating | Practice council with the educator | Charge nurses | Director, staff |
| Shift-by-shift assignments and floats | Charge nurse | Floating nurse (competency profile) | Director, next day |
| Monthly schedule | Self-scheduling committee within director's rules | Staff | Director |
| Hiring of nursing staff | Director | Peer interview panel | Practice council |
| Nursing budget and positions | Director with the chief financial officer | Practice council on priorities | Staff |
| Unit equipment under $5,000 | Director | Staff users | Finance |
Accountability and Conflict
Distributing decisions requires clear accountability. The council's charter states that when it adopts a practice change, it also owns the plan to implement and evaluate it, with support from the educator. When the council and the director disagree, the charter provides a route: the director explains the operational or financial constraint in writing, the council may revise its proposal, and unresolved issues go to the chief executive officer. In the first year, one such disagreement arose over a proposed change in night shift staffing that the budget could not support; the council revised the proposal into a pilot on weekend nights, which the director approved. Clear rights made the disagreement productive rather than personal.
Evaluating the Structure
The structure will be evaluated in three ways. First, nursing staff will complete a governance measure annually, using a validated short form, to see whether perceived control over practice and participation increases. Second, staff will complete the practice environment scale, which allows comparison with published benchmarks. Third, the council will track its own work: the number of practice changes proposed and adopted, time from proposal to decision and staff participation in council meetings. Turnover and vacancy rates will be monitored alongside these measures, though many factors influence them in a rural labor market.
Conclusion
In a critical access hospital, the nursing organizational chart has few boxes, which makes it more important, not less, to be clear about who decides what. Mapping decision rights and strengthening a single shared governance council has given nurses authority over their practice and freed the director to focus on resources, relationships and strategy.
References
Clavelle, J. T., O'Grady, T. P., & Drenkard, K. (2013). Structural empowerment and the nursing practice environment in Magnet organizations. JONA: The Journal of Nursing Administration, 43(11), 566-573. https://doi.org/10.1097/01.nna.0000434512.81997.3f
Hess, R. G. (1998). Measuring nursing governance. Nursing Research, 47(1), 35-42. https://doi.org/10.1097/00006199-199801000-00007
Kutney-Lee, A., Stimpfel, A. W., Sloane, D. M., Cimiotti, J. P., Quinn, L. W., & Aiken, L. H. (2015). Changes in patient and nurse outcomes associated with Magnet hospital recognition. Medical Care, 53(6), 550-557. https://doi.org/10.1097/mlr.0000000000000355
Lake, E. T. (2002). Development of the practice environment scale of the Nursing Work Index. Research in Nursing & Health, 25(3), 176-188. https://doi.org/10.1002/nur.10032
What the NUR 6320 Module 4 instructions ask for
Module 4 of NUR-6320 often addresses organizational structure, design and governance in nursing services. Directions may ask you to describe and analyze the structure of your organization or department, evaluate its effectiveness, compare structural models such as centralized, decentralized, matrix or shared governance, and recommend changes. Some sections ask for an organizational chart; check whether one is required and how it should be presented. The TESU classroom gives length and source requirements. Avoid naming individuals in your organization; describe roles instead. Explain how decisions are made, not only how positions report. Describe roles by title, since mentors are interested in the design and not in particular people. A decision matrix may be accepted in place of, or alongside, a traditional chart.
How this NUR 6320 Module 4 example is built
The paper opens by contrasting reporting lines with decision-making and describes the small hospital's chart. The formal structure section explains the risks of concentrated decisions. Shared governance is defined as a decision structure, with research on governance measurement, practice environments and Magnet outcomes used carefully. The decision rights section describes a single practice council and presents a table showing, decision by decision, who holds the authority, who gives input and who simply hears the outcome. The accountability section shows how disagreements are resolved, with an example. The evaluation section names measures, and the conclusion links clarity of rights to the director's role. A worked disagreement between the council and the director shows the charter in use rather than on paper.
NUR 6320 Module 4 rubric: what earns full marks
Expect a structure paper to be judged first on how faithfully it describes the organization, then on analysis of strengths and weaknesses, correct use of structural concepts, application of evidence on governance and practice environments, practical recommendations and clear writing. Mentors reward analysis that goes beyond the chart to how authority and accountability work. Tables or matrices that show decision rights clearly add value. Evidence should be used for what it actually shows; claims that shared governance guarantees better outcomes overstate the research. A plan to evaluate the structure shows administrative thinking that mentors usually expect at this level. Showing how conflicts are resolved within the structure often separates strong papers from adequate ones.
NUR 6320 Module 4 help: mistakes that cost marks
Students frequently describe an organizational chart line by line and stop there. Explain who decides what and how conflicts are resolved. Another weakness is presenting shared governance as a set of meetings rather than a transfer of decision rights; state which decisions move to staff and which stay with managers. Avoid claiming that Magnet status or shared governance proves better outcomes; describe associations accurately. In a small organization, adapt models rather than copying a large system's council structure. The desk can analyze your organization's structure from your directions and the roles involved. Include one example of a decision that moved from management to staff, and what changed as a result.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 6320 Module 4 questions, answered
Where can I find a free NUR 6320 Module 4 sample paper?
This page carries the full decision rights paper; the matrix in the body and the comments beside each sheet show the method. Use its approach of mapping decisions, not boxes, for your own organization.
What is shared governance in nursing?
A structure in which staff nurses hold authority over decisions about their practice, while managers hold authority over resources and operations, linked through councils with defined decision rights.
How is nursing governance measured?
With instruments such as the Index of Professional Nursing Governance, which assesses how control over personnel, information, resources, participation, practice and goals is distributed among nurses and managers.
What is a decision rights matrix?
A grid that lists the main decisions and, for each, names the owner, the people whose input is required and the people told afterward. It makes authority and accountability explicit.
Does shared governance improve the practice environment?
Studies in Magnet organizations found that more shared governance was associated with better practice environment scores. Associations do not prove cause, but the pattern supports sharing decision rights.