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FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
NBBS1203PROFESSIONALISM AND ISSUES IN NURSING B
MAY 2012
ASSIGNMENT TITLE : Critically discuss issues related to empowerment in nursing that you identify in your area of practice.
Name: MAIZATUL AKMAR BT IBRAHIM
Matric number: 720618145398001
NRIC: 720618145398
Telephone number: 0123817871
E-mail address: [email protected]
Tutor’s name: PUAN JAMILAH ITHNIN
Learning Centre: JOHOR BAHRU
MAY 2012 Semester
CONTENT
1.0 INTRODUCTION……………………………………………………………………………page 2
1.1 POWER IN NURSING..................................................................................................page 2 – page 3
1.2 EPMPOWERMENT IN NURSING…………………………………………………… .page 4 – page 5
2.0 THE IMPORTANCE OF EMPOWERMENT ...................................................... page 6 – page 7
3.0 IMPLICATION ………………………………………………………………………………page 8 – page 9
4.0 CONCLUSION………………………………………………………………………………...page 9 – page 10
REFERENCES……………………………………………………………………………………….page 11
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 1
1.0 INTRODUCTION
The new millennium is upon us. Many advances in technology and health care
indeed make this a brave new world. However, relatively little has changed in nursing, where
almost 95% of all nurses are still women (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2000).
Even now, years after the feminist movement, many nurses do not feel empowered, and what we
do ”as nurses does not seem to be working” (Fletcher, 2006). Initially, nursing was a domestic
role women, were expected to fulfill in the home. In addition, a lot of nursing work is done in
private, behind drawn curtains. The persistent invisibility of a lot of nursing work decreases
nursing’ social status and perceived value, contributing to powerlessness.
1.1 POWER IN NURSING
A historical review of nurses’ power over nursing practice should include social,
cultural and educational factor influence nurses’ power over their practice. Social and cultural
factors that influence nursing power have their roots in view of nursing as women’s work.
Although the feminist movement of the 1960s did much to bring women in other professions on
equal footing with men, nursing’s low status in the health care hierarchy remains. Educational
factors contribute to this situation, and they are twofold. First, nursing has historically been
taught in hospitals, perpetuating nursing’s low status in relation to physicians and other health
care providers. Second, the multiple entry levels into nursing practice further dissipate whatever
influence, nursing may able to generate. Nurses’ lack power may be rooted in societal reluctant
in general to discuss power openly. Nurses may be more reluctant than most to discuss power
because 95% of all nurses are women, and women have not been socialized to exert power.
Historically nurses have had difficulty acknowledging their own power. This reluctance to
acknowledge and subsequently use one’s power as a nurse may in part explain many nurses’
inability to control their practice.
Power in Nursing has been defined as having control, influence, or domination over
something or someone (Chandler, 1992). Another definition views power as “ability to get
things done, to mobilize resources, to get and use whatever it is that a person needs for the goals
she is attempting to meet” (Kanter, 1993). Power is necessary to be able to influence an
individual or group. Nurses need power to be able to influence patients, physicians and other
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 2
health care professionals, as well as each other. Powerless nurses are ineffective nurses, and the
consequences of nurses’ lack of power has only recently come to light (Page, 2004). Powerless
nurses are less satisfied with their jobs (Manojlovich & Laschinger, 2002), and more susceptible
to burnout and depersonalization (Leiter & Laschinger, 2006). Lack of nursing power may also
contribute to poorer patient outcomes (Manojlovich & DeCicco, in review). For Benner, power
includes caring practices by nurses which are used to empower patients. Power may also viewed
as positive, infinite force that helps to establish the possibility that people can free themselves
from oppression. Benner has described qualities of power associated with caring provided by
nurses such as transformative and healing power. Transformative and healing power contribute
to the power of caring, which in central to the profession of nursing. According to Kanter (1977,
1993), defines power as the ability to mobilize information, resources and support to get things
done in an organization. The role of management is to provide employees with the ‘power
tools’ that power them to maximize their ability to accomplish their work in meaningful way.
There are at least three types of power that nurses need to be able to make their
optimum contribution, three domains types of power are; control over the content of practice,
control over the context of practice, and control over competence. The continue lack of control
over both the content and context of nursing work suggests that power remains an elusive
attribute for many nurses ( Manojlovich, 2005). Power is an attribute that nurses must cultivate
in order to practice more autonomously because it is through power that members of occupation
are able to rise their status, define their area of expertise, and achieve and maintain autonomy
and influence (Hall, 1982). Autonomy represents one kind of power nurses need, and has
defined as “the freedom to act on what one knows” (Kramer & Schmalenberg, 1993). Therefore
a key element of empowerment is nurses’ control over their practice (Page, 2004). The ability to
act according to one’s knowledge and judgment is known as control over the content of nursing
practice. A related type of control is known as control over the context of practice, and
represent another type of power that nurses need (Laschinger et al., 1997).
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 3
1.2 EMPOWERMENT IN NURSING
Antecedents to empowerment are: trust, openness, honesty, genuineness,
communication and interpersonal skills, acceptance of people as they are, mutual respect, value
of others courtesy, and shared vision. The concept of empowerment emerged in the late 1960s
and early 1970s as a result of the self-help and political awareness movements. Since the early
1990’s increased attention has been given to the concept of empowerment. Empowerment is
multidisciplinary concept used in management, psychology, social anthropology, sociology,
political science and nursing. Although power has been discussed in nursing literature since the
1970s, Chandler (1992), was among the first to describe the process of empowerment in nursing.
Chandler also distinguished between power and empowerment, nothing that empowerment
enables one to act, whereas power connotes having control, influence, or domination.
In Nursing, empowerment can be defined as an interpersonal process between nurse
and the patient intended to facilitate healthy behaviors. Empowerment is a way for nurses to
approach the individual patient on his or her conditions, according to his or her wishes. This may
seem basic to nearly all nursing ethical standards, but empowerment make a shift in perspective:
it has a revolutionary, rather than reformist approach to caring. It gives the patient an equal vote
and a loud voice. Hence, caring with an empowerment approach will always assume the patient’s
perspective. Empowerment is an important concept in nursing for both nurses and their patients.
In the health promotion field, empowerment refers to ensuring individuals have the resources
necessary for maintaining their health and well-being (Rappaport 1981, Wallersrein 1992,
Leino-Kipli et al. 1998, Faulkner 2001). A key aspect of the nurse manager role is to create
condition that empower nurses to provide the best possible care working relationships. It is
widely assumed that, if nurses are empowered within their workplace, they will provide better
care, which will result in better patient outcomes. We propose that empowered nurses are better
able to empower their patients, which has a positive impact on patient’s feelings empowerment
and better health outcomes.
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 4
Kanter (1977) describes two primary empowerment structure in organizations: the
structure of opportunity and the structure of power. The theory of structural empowerment states
that opportunity an power in organizations are essential to empowerment, and must be available
to all employees for maximal organizational effectiveness and success. Kanter saw employees’
work behavior as arising from condition and situations in the workplace, and not from personal
attributes. There are four structural conditions identified by Kanter as being key contributors to
empowerment. They are: having opportunity for advancement or opportunity to be involved in
activities beyond one’s job description; access to information about all facets of the
organization; access to support for one’s job responsibilities and decision making; and access to
resources as needed by the employee. Empowerment is on a continuum, because the
environment will provided relatively more or less empowerment, depending on how many of the
four structures are present in the work setting. The theory of structural empowerment places the
focus of causative factors of behavior fully on the organization, in effect maintaining that
powerless individuals have not been exposed enough to the four empowering workplace
structures.
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 5
2.0 THE IMPORTANCE OF EMPOWERMENT IN NURSING
Nurse managers’ role are the importance in ensuring access to empowerment
working conditions that support professional nursing practice. Strong leadership also influenced
nurses’ involvement in unit decision, effective nurses and doctor collaboration, and staff
adequacy. These three factors influenced the extent to which the predominant approach to patient
care had a nursing focus which, in turn, was related to staffing adequacy an ultimately higher
quality-of-care perceptions and job satisfaction. The impact of leadership on these components
of supportive profesional practice environments makes sense given the power of the manager to
put empowering structures in place. It is reasonable to expect that when work conditions provide
support of nurses’ participation in decision making and control over their practice, nurses are
better able to provide high-quality care, thereby increasing job satisfaction.
To optimize the health of patients in need of long-term nursing pose a challenge for
nurses, today and in the future. The present illness panorama in the industrialized world poses
challenges to health care providers to facilitate healthy behaviors. The nursing profession must
develop tools to make this happen. Empowerment might be such a tool. Empowerment can be
used in many different settings and applied to different types of diagnosis. Organizational
systems aimed at promoting nurses’ power so that, they can use their profesional skills may
provide an attractive and rewarding career choice for today’s sophisticated students. There may
be additional benefits for hospitals that promote nursing power. A study indicated that, hospitals
that allowed their staff autonomy over their own practice and active participation in decision
making about patient care issues were the most successful in recruiting and retaining nurses. In
other study, patient satisfaction improved when there was more organizational control by staff
nurses. Nurse leaders recognize that understanding and acknowledging power and learning to
seek and wield it appropriately in critical in nurses’ efforts to shape their own practice and the
broader health care environment are to be successful.
Understanding characteristics of power held by individual nurses and finding ways
to help nurses achieve power is important, since individual power translates into greater power
for nursing departments and for nursing as a profesion. In addition, understanding the
characteristics of profesional practice that associated with power and developing ways to help
novice and experienced nurse adopt these practices offers nurse leaders in health care institutions
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 6
and academia a way to promote the career advancement of individual nurses, advance nursing as
a profession, and ultimately improve patient and family centered care and patient outcomes.
The characteristics of powerful nursing practice are; Nurses with a powerful practice
acknowledge their unique role in the provision of patient centered and family centered; nurses
with powerful practice commit to continuous learning through education, skill development, and
evidence-based practice; nurses with a powerful practice demonstrate profesional comportment
and recognize the critical nature of presence; nurses with a powerful practice value collaboration
and partner effectively with colleagues in nursing and other disciplines; nurses with a powerful
practice position themselves to influence decisions and resource allocation; nurses with a
powerful practice strive to develop an impeccable character; to be inspirational, compassionate,
and to have a credible, sough-after perspective; nurses with a powerful practice recognize that
the role of the nurse leader is to pave the way for nurses’ voices to be heard and to help novice
nurses develop into powerful professionals; and, nurses with a powerful practice evaluate the
power of nursing and the nursing department in organizations they enter by assessing the
organization’s mission and values and its commitment to enhancing the power of diverse
perspectives.
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 7
3.0 IMPLICATIONS OF EMPOWERMENT IN NURSING
Power is maintained through knowledge development (Rafael, 1996) which is
enquired through education and expertise. The multiple entry levels into nursing practice, as well
as the low educational level of nurses relative to other health care professionals may contribute
to nurses’ powerlessness. Part of the difficulty many nurses have in being powerful may be due
to their inability to develop the types of power described, power over the content, context and
competence of nursing practice contributes to feelings of empowerment, but control in these
three domains may not be enough. Another contributor to nurses’ lack of power may be that they
don’t understand how power can develop from relationship, as proposed by Chandler (1992).
According to Kanter (1997), when employees do not have access to resources,
information, support and opportunity, they experience powerlessness. These individuals often
feel stuck in their jobs, lacking in opportunities for growth and mobility and excluded from
organizational decision-making. They feel frustrated, hopeless and may disengage from
organizational life beyond the essentials of their job activities. In contrast, empowered
employees have control over conditions that make their work possible, which results in improved
overall organizational functioning. Those with access to the power and opportunity structures
within an organization are highly motivated and able to motivate and empower others by sharing
the sources of power (Kanter, 1979). The extent of control people feel they have over the
conditions of their work has been linked to individual health and- being (Karasek & Theorell
1990, Kelloway & Barling 1991, Thomas & Ganster 1995).
Empowerment also has implications for the relationship between nurse and
patient. Nurses wishing to empower clients must understand the complexity of this approach
because failure to do so could result in the nurse not recognizing the need for an individual
approach which takes into account patients' differing circumstances. This could result in patients
being overloaded with information, creating unnecessary anxiety, rather than the nurse using his
or her skills to assess and address individual needs.
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 8
Nurses' power may arise from three components: a workplace that has the requisite
structures that promote empowerment; a psychological belief in one's ability to be empowered;
and acknowledgement that there is power in the relationships and caring that nurses provide.
Nursing research has been able to demonstrate the relationship between the first two components
and empowerment; yet there remains a need for research to examine the power that exists in
relationships. Nursing research from a relational theory perspective may help make nurses'
power more explicit and more visible, moving our understanding of power in nursing further
than has previously been possible. A more thorough understanding of these three components
may help nurses to become empowered and use their power for their practice and for better
patient care. Nursing expertise is a related source of power that has a transformative effect on
patients' lives. Expertise is not the same as experience, nor can expertise be acquired on nursing
units with high turnover. This suggests a complex relationship between organizational factors
that contribute to nursing turnover and the development of nursing expertise. Educational
preparation and expertise represent two additional types of power nurses need to make their
optimal contribution to patient care.
4.0 CONCLUSION
Acorn, Ratner, and Crawford (1997) found that "providing nurse managers with
autonomy over decisions that affect the work at the unit level," affects nurse managers'
organizational commitment. Concomitantly, "the nurse manager has to feel empowered and
influential not only in her current role but also as a clinical nurse" in order to empower and
influence staff nurses (Aroian et al., 1997). Three processes were described by the managers:
building relationships, sharing decision making, and sharing knowledge (Arioan et al., 1997).
The current nursing shortage is multifactorial. On the supply side, it results from an aging
nursing workforce, decreased interest in a nursing career resulting from expanding opportunities
for women, and slow growth of minority nurses. The singular finding of most studies of hospital
nurses is that nurses love their work but hate their jobs. Nurses’ job dissatisfaction is associated
highly ranked support from family and friends outside of work, as well as support from other
new nurses. Although support from managers was reasonably high, it was the lowest area of
support. This could be related to management support often not being visible to the new
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 9
employee. Nursing leaders are challenged by this shortage to look for innovative approaches to
develop a long-term increase in the nursing workforce. Although financial incentives are
important, work environment and content have a stronger relationship with job satisfaction than
economic or individual factors. To attract and retain a continual supply of new nurses and keep
experienced nurses, nursing leaders are striving to create dynamic, rewarding, and supportive
work environments.
In conclusion, nurses’ power may arise from three components: a workplace that
has the requisite structures that promote empowerment; a psychological belief in one’s ability to
be empowered; and acknowledgement that there is power in the relationships and caring that
nurses provide. Nursing research has been able to demonstrate the relationship between the first
two components and empowerment; yet there remains a need for research to examine the power
that exists in relationships. Nursing research from a relational theory perspective may help make
nurses’ power more explicit and more visible, moving our understanding of power in nursing
further than has previously been possible. A more thorough understanding of these three
components may help nurses to become empowered and use their power for their practice and
for better patient care.
Words: 2,816
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 10
REFERENCES
1) Heather, K at el. (2010) Towards a comprehensive theory of nurse/patient empowerment:
applying Kanter’s empowerment theory to patient care. Journal of Nursing Management,18,4-13.
2) Medscape, (n.d) Power and Empowerment in Nursing: Looking Backward to inform the
Future (Online). Available: http://www.medscape.com/viewarticle/5533403_4. (2012 July 4).
3) Manojlovich, M., (n.d) Power and Empowerment in Nursing: Looking Backward to Inform
the Future (Online). Available:
http://www.nursingworld.org/mainmenucategories/ANAMarketplace/ANAPeriodicals/OJIN/
tableofcontent/volume122007/N01Jan07/Lookingbackwardtoinformthefuture. (2012 July 4).
MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203 Page 11