The organization chart for this university-associated teaching hospital is a very flat organizational structure with respect to the nursing practice organization. Essentially, the Chief Nursing Officer (CNO) heads a group of divisions that report to her. These divisions, all of which directly report to the CNO include the Associate Directors for each of: Adult critical care nursing, Advanced practice nursing, Ambulatory care nursing, Behavioral health nursing, Cancer center nursing, Cardio-vascular & thoracic nursing, Emergency nursing, Medical/surgical nursing, Ob/gyn nursing, Pediatric nursing, and Peri-operative nursing. In addition to the associate directors for each of those nursing units the CNO also has three other direct reports to her: the Director of Clinical nursing/research, the Manager of Financial management & reporting (for the nursing practice), and the Associate Director for Nursing support operations. Although both Financial management and Nursing support operations have subsidiary departments underneath these headings, in all of the nursing departments there is no formal structure below the Associate Director level.

This does not quite accurately reflect the actual structure of the organization because it does not include the shift supervisors for each of the nursing units. However, even taking the chart to that additional level of detail this is a remarkably flat structure. From an individual nurse, the managerial levels go to: shift supervisor, Associate Director (say, of the Medical/surgical unit), the CNO, who reports to the Chief Medical Officer, who in turn reports directly to the General Director and CEO of the hospital. Thus, there are only five layers of management between a typical nurse on the floor and the CEO of the entire hospital.

This type of very flat organization is good to work with in many ways because it seems much more personal than an organization that has many layers of management. It makes it easy for anyone to talk to someone “in authority” when a problem arises. No doubt it also makes the managerial positions more challenging, but it does seem like a good type of organization for the individual nurses. It is as if everyone potentially has the ear of even “high level” managers throughout the organization.