However, it may be that nurses are frequently unable to use their professional preparation, which focuses on autonomous practice and independent decision making, because they are powerless relative to organizational administrators and medical staff Manojlovich. Having control over the content of nursing practice may not be enough to provide power for nurses. Besides control over the content of nursing practice, which represents one type of power, a related type of control is known as control over the context of practice, and represents another type of power that nurses need Laschinger et al.
The positive findings of the magnet hospital research may be attributed to empowering organizational social structures, although they were not identified as such. Hospital characteristics which were found to attract and retain qualified staff nurses included decentralization and participatory decision making. All of the magnet hospital studies have also consistently demonstrated positive benefits for nursing and patients when nurses control both the content and the context of their practice.
The original magnet hospital study also recognized that the power base of staff nurses emerged from nursing leadership, whose power came from staff, hospital administrators, and boards of trustees McClure et al. A more recent study has validated the magnet hospital findings, demonstrating that strong nursing leadership strengthens the effect of empowerment on nursing practice behaviors Manojlovich, c.
In multiple studies, patient outcomes were improved when the hospital organization was supportive of autonomous nursing practice Aiken et al.
Women Rising: The Unseen Barriers
In these studies, autonomous nursing practice was operationalized as control over the practice environment, decision-making ability, and collegial relationships with physicians, suggesting an important link between power and patient outcomes. Power is maintained through knowledge development Rafael, , which is acquired through education and expertise. Expertise is not the same as experience, nor can expertise be acquired on nursing units with high turnover Benner, 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. There may be additional benefits for hospitals that promote nursing power. Bednash reported on a study indicating 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 another study patient satisfaction improved when there was more organizational control by staff nurses Aiken et al. Part of the difficulty many nurses have in being powerful may be due to their inability to develop the types of power described in the previous section. 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. An examination of the two major areas of empowerment literature in nursing, as well as a third area not yet embraced by nursing, may help inform future directions for the development of power and empowerment for nurses.
Empowerment in nursing has largely been studied from two perspectives. Therefore a third perspective on empowerment, not yet embraced by nursing, is gender specific. Women develop empathy and empowerment through relationships, although the mutual processes of empathy and empowerment are largely invisible Fletcher et al. The answer to increasing nursing empowerment may lie in understanding workplace sources of power, expanding the view of empowerment to include the notion of empowerment as a motivational construct, and finally making more explicit growth fostering relationships which also contribute to power.
The theory of structural empowerment states that opportunity and power in organizations are essential to empowerment, and must be available to all employees for maximal organizational effectiveness and success. There are four structural conditions identified by Kanter as being the key contributors to empowerment. Empowerment is on a continuum, because the environment will provide 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.
Therefore, the qualities of a job and its context evoke behaviors from those in a job position that determine the likelihood of success Kanter, However evidence of the essence of structural empowerment, if not the name, appears in other research as well. Kramer and Schmalenberg identified organizational strategies necessary before individuals could act in an empowered manner.
Other than the magnet program there is additional support for configuring work environments in a way that promotes empowerment. Aiken and colleagues conducted an international study in five countries to compare nurse staffing, work environments, and patient outcomes. Even in countries with vastly different health care systems nurses reported similarities in workplace empowerment elements. The results of this international study further suggest that the relative presence or absence of specific environmental factors associated with structural empowerment may contribute to variation in nursing and patient outcomes in multiple countries.
There is evidence in the literature that structural empowerment contributes to higher levels of job satisfaction Manojlovich, d , and is interrelated with nursing leadership Upenieks, a. In fact, nursing leaders must empower themselves by first accessing empowering work environment structures before moving forward to offer these same empowering work conditions to their staff Upenieks, b. Thus empowerment, as provided by the environment, tells part of the story, but alone it is not enough. Some environments are empowering because they allow workers to do what it is the workers feel is necessary to get the job done.
In other words, these environments provide the sources of power. Other work environments may not be as empowering, yet there will still be a few hardy individuals who manage to do whatever it takes to be effective on the job. It may be that these people are able to recognize what few empowering social structures in the environment are present, and manipulate them, since it is only in recognition that the structures can be used.
An alternative theoretical perspective on empowerment acknowledges the fact that empowerment is also a psychological experience. Conger and Kanungo viewed empowerment as a motivational construct, while maintaining that it is still a personal attribute. Spreitzer developed this version of empowerment further. According to Spreitzer, the process of psychological empowerment is a motivational construct which manifests as a set of four cognitions that are shaped by a work environment.
The four cognitions are: meaning, competence, self-determination, and impact Spreitzer, Self-efficacy for nursing practice one of the psychological empowerment cognitions was recently found to contribute to professional nursing practice behaviors Manojlovich, b. In fact, this study demonstrated that structural empowerment contributed to professional practice behaviors through self efficacy, consistent with the notion that both forms of empowerment may be necessary to sustain professional practice behaviors Manojlovich.
In addition to accessing workplace structures to garner structural empowerment, and developing power through psychological empowerment, yet one more perspective on empowerment may be required. Viewing empowerment through a feminist lens may help explain persistent findings of disempowerment. Most feminist scholarship on nursing focuses on overcoming oppressive working conditions brought on by the patriarchal structure of medicine and the health care industry Chinn, ; Sampselle, Feminist theory that focuses on eliminating oppression and seeking equal status for women is known as liberal feminism Wuest, An alternative feminist perspective argues for a relational context to empowerment: one that values and rewards interactive relationships Chandler, ; Rafael, This perspective falls under the broad umbrella of socialist feminist theory, and emphasizes the development of relationships through interactions with one another Wuest, Relational theory comes from the school of social feminism, and posits that women engage in growth fostering and nurturance relationships, which maintain society Fletcher et al.
Women foster growth and nurture others, deriving strength from the relationships and bonds that develop as a result of these activities Fletcher et al. Relational theory may have greater relevance to the development of empowerment in nursing than either workplace or motivational views of empowerment because of the nature of nursing work. As Chandler has argued:. Fletcher suggests a relational theory approach when she asserts that nurses need to focus on relationships to build power.
Fletcher maintains that relationships are built through dialogue and self-awareness and that the development of self-awareness "can begin to break the cycle of oppression and lead to changes in the structures that oppress nurses" Fletcher, , p. Benner also argues for power through relationships and caring: the core of nursing practice.
When nursing embraces caring, empathy, and compassion as components of power, nurses will be more likely to adopt and accept power as part of their practice Benner. 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. 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.
Manojlovich has written numerous publications describing the relationship of empowerment to nursing variables and works closely with Dr. Heather Laschinger, one of the foremost experts on nursing empowerment. Aiken , L. Hospital restructuring: Does it adversely affect care and outcomes? JONA, 30 10 , Nurses' reports on hospital care in five countries. Health Affairs, 20 3 , Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.
JAMA, 16 , Organization and outcomes of inpatient AIDS care. Medical Care, 37 8 , Apker , J. Predicting nurses' organizational and professional identification: The effect of nursing roles, professional autonomy, and supportive communication. Nursing Economics, 21 5 , Bednash , G. The decreasing supply of registered nurses: Inevitable future or call to action? JAMA, 22 , Benner , P. From novice to expert: Excellence and power in clinical nursing practice commemorative edition.
Boudrias , J. Testing the structure of psychological empowerment: Does gender make a difference? Educational and Psychological Measurement, 64 5 , Brewer , C. Nursing recruitment and retention in New York State: A qualitative workforce needs assessment. Chandler , G. The source and process of empowerment. Nursing Administration Quarterly, 16 3 , The relationship of nursing work environment to empowerment and powerlessness. University of Utah Editor.
Chinn , P. Feminism and nursing. Annual Review of Nursing Research pp. Conger , J. The empowerment process: Integrating theory and practice. Academy of Management Review, 13 3 , Fletcher , K. Beyond dualism: Leading out of oppression. Nursing Forum, 41 2 , Fletcher, J.
Women and the workplace: Applications of a psychodynamic theory. The American Journal of Psychoanalysis, 60 3 , Gibson , C. A concept analysis of empowerment.
Journal of Advanced Nursing, 16 3 , Hall , R. The professions, employed professionals, and the professional association. Professionalism and the empowerment of nursing: Papers presented at the 53rd convention pp. Washington D. Kalisch , B. The promise of power. Nursing Outlook, Jan , Kanter , R. Men and women of the corporation. Power failure in management circuits.
Feminist Perspectives on Power
Harvard Business Review. Kramer , M. Learning from success: Autonomy and empowerment.
Nursing Management, 24 5 , Kubsch , S. Conflict, enactment, empowerment: Conditions of independent therapeutic nursing intervention. Journal of Advanced Nursing, 23 , Kuokkanen , L. Promoting or impeding empowerment? JONA, 33 4 , Laschinger , H. Promoting nurses' health: Effect of empowerment on job strain and work satisfaction. Laschinger, H. Testing Karasek's demands-control model in restructured healthcare settings: Effects of job strain on staff nurses' quality of work life.
JONA, 31 5 , Workplace empowerment as a predictor of nurse burnout in restructured healthcare settings. Mental health professionals often complain that their clients have poor skills and cannot seem to learn new ones. At the same time, the skills that professionals define as important are often not the ones that clients themselves find interesting or important e.
When clients are given the opportunity to learn things that they want to learn, they often surprise professionals and sometimes themselves by being able to learn them well. People with psychiatric diagnoses are widely assumed to be unable to know their own needs or to act on them. People with devalued social statuses who can hide that fact often quite wisely choose to do so. However, this decision takes its toll in the form of decreased self-esteem and fear of discovery.
Individuals who reach the point where they can reveal their identity are displaying self-confidence. We wanted to emphasize in this element that empowerment is not a destination, but a journey; that no one reached a final stage in which further growth and change is unnecessary. As a person becomes more empowered, he or she begins to feel more confident and capable.
Within the research project, the definition was the starting point for the development of a measurement instrument. This concept is particularly important within psychiatric rehabilitation programs, since these programs often claim that they are promoting independence, autonomy, and other ideas related to empowerment. It would be extremely useful to find out, for example, whether rehabilitation practitioners believed their programs were promoting empowerment in their clients, and whether clients of those programs agreed. An increase in empowerment scores following participation in a program would be a positive indicator about that program.
If scores did not increase, practitioners and program clients should try to identify those program elements that interfere with clients becoming empowered. Operating an empowerment-oriented program has risks, as does becoming empowered. The desire to protect and to be protected is a strong one; nonetheless, there are genuine benefits when clients begin to control their own lives, and when practitioners become guides and coaches in this process, rather than assuming the long-term, paternalistic role of supervisors.
Such a shift of roles and practices would make rehabilitation services truly transformative in the lives of their clients.
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She is affiliated with the center for psychiatric rehabilitation, Boston University, and with the National Empowerment Center, Lawrence, Massachusetts. After much discussion, we defined empowerment as having a number of qualities, as follows: Having decision-making power. Having access to information and resources. A feeling that the individual can make a difference being hopeful. Learning to think critically; learning the conditioning; seeing things differently; e. Learning to redefine what we can do. Learning to redefine our relationships to institutionalized power. Learning about and expressing anger.
Not feeling alone; feeling part of a group. Understanding that people have rights. Learning skills e. Coming out of the closet. Growth and change that is never ending and self-initiated. Having a range of options from which to make choices. A feeling that the individual can make a difference.
Learning to think critically; unlearning the conditioning; seeing things differently. Learning skills that the individual defines as important. Related Posts. October 19, 0 Comments. Developing a Sense of Purpose. May 30, 0 Comments.