after 1990, nurse practitioners began treating patients more widely and gained authorization to prescribe medications. this trend allows more patients to be treated more quickly, but what is one of its unintended consequences?

An informal structure in a bureaucracy would be something like so-called "office politics". where there's a formal structure set up for the organization, but then an informal subculture as well that has a way of organizing the bureaucracy further. this can be positive because it sets up an added degree of organization, albeit informal, within the bureaucracy.