FACULTY OF NURSING AND ALLIED HEALTH SCIENCES

NBBS1203 PROFESSIONALISM 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: akmar1972@yahoo.com

Tutors name: PUAN JAMILAH ITHNIN Learning Centre: JOHOR BAHRU

MAY 2012 Semester

CONTENT

1.0 INTRODUCTIONpage 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 womens work. Although the feminist movement of the 1960s did much to bring women in other professions on equal footing with men, nursings 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 nursings 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 ones 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 ones 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 1990s 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 patients 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 patients 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 ones job description; access to information about all facets of the organization; access to support for ones 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 todays 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 organizations 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 dont 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
Page 9

MAIZATUL AKMAR IBRAHIM/ KP 720618145398/NBBS1203

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 ones 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 Kanters 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