Download - Empowerment

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


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).


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.


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.


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


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.


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.


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


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


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).
