What does this have to do with nursing? Let’s follow this sequence for a few questions that are relevant for nursing today.
Do nurses have power?
Whether nurses have power will depend on their beliefs about themselves their work and their profession. History plays a part in nurses’ beliefs even if those perceptions are at a subconscious level. Traditionally nursing was seen as women’s work and as assisting doctors. Nursing’s unique role in the health care system has been unacknowledged. The fact that the majority of nurses are female has a definite influence nurses’ beliefs about themselves and their beliefs about their ability to be powerful. Remember it has been less than 100 years since women won the right to vote in the United States.
Nurses’ beliefs about the nature of power will also determine how powerful they are. Although power is in itself neutral, does it carry a negative connotation, especially for women, and therefore nurses? Also because one of the fundamental values of nursing is caring do many nurses see caring and power as antithetical? Are caring and power unable to co exist in a set of professional values?
Power is a blanket term whose ultimate definition is the ability to influence change. Nurses however, have access to several types of power. They have the power of numbers as they are the most numerous of health care professionals. They have referent power which is based on the respect, trust, and admiration of others. They also have technical knowledge, skills and expertise which gives nurses expert power. Finally they have legitimate power which they acquire when they become licensed.
Nurses’ beliefs about their own power is a part of the medical paradigm but the organizational structure of a nurse’s workplace will also empower individual nurses. There are several factors that contribute to nurses being empowered. They are: Access to support for the responsibilities of the position, and access to resources and information about the medical center, as well as opportunities for advancement. An organization that involves staff in decision making, has a participative management style, and works towards a meaningful mission statement will also empower nurses.
A medical center that lacks these characteristics means nurses must strive to create them.
Several authors have noted that nurses have power because of the relationships they have with patients and family. Through effective communication nurses determine medical outcomes and that also is a source of power. Interpersonal interaction be it with patients, peer and colleagues are guided by values and principles to create a perspective that is sought by others.
There have been discussions about nursing and its potential power. The authors’ aim in writing these articles is to generate ideas among nurses as the beginning steps towards the realization of power of one nurse, many nurses, and nursing as a profession. Even if an individual nurse has no extra time to be a political advocate she or he is still powerful by asking questions be they in person, by email or blog. Membership in a professional organization definitely contributes to nursing power, as is voting is elections. Maybe these actions seem very small and insignificant but many small actions by committed professionals can effect a big change. Conversely inaction by many allows the continuation of the status quo.
So what are some examples of successfully demonstrated nursing power? What were the actions taken and the outcomes that resulted? We can start with the beginning of modern nursing and its founder Florence Nightingale. Nursing was elevated to a profession with credibility and respect, because of the formal education of nurses.
From 1996 to 2006 Georgia’s APNs persisted in their bid to acquire prescriptive authority. There was concerted opposition from the medical community and many roadblocks. The APNs formed a coalition, and the Georgia Nurses Association lobbied on their behalf. One strategy the nurses used to get the attention of legislators was to get the citizens of Georgia involved by writing letters. After 10 years a bill was passed and prescriptive authority was granted. Even after the bill became law the Board of Medical Examiners applied extra rules to it to restrict what was rightfully gained.
Another example is Lois Capps RN who is also a Congresswoman. She is on the Committee on Energy and Commerce, and its subcommittee of Health, Energy and Air quality, Environment and Hazardous Material. She is also part of the House Budget Committee and is founder and co chair of the Congressional Nursing Caucus a non partisan body.
In conclusion, can the words powerful and nurse be used in the same sentence? Powerful nurses can advance their personal practice and career goals. They will advance their profession and influence health care organizations thereby contributing to a better health care system. It has already been proven that empowered nurses create better care outcomes. The beginning of the journey to that ideal situation is to better quantify and measure nursing work.
Nurses need to gain more control over practice content. For instance, groups outside nursing can control practice content or context by hiring unlicensed staff to perform nursing duties, or veto NPs as PCP. Nurses need to participate and have input into the design and organization of health care, which is control over practice context.. Nurses should gain more control over nursing education. One author mentioned that since most nurses are trained in hospitals this detracts from their empowerment because of the vertical hierarchical structures of hospitals.
The full realization of the various manifestations of power through interpersonal, expertise, professional development, numbers, and referent power build on each other and creates a sum greater than its parts. The power of nursing as a profession starts with the practice of individual nurses. It is the value on one nurse creating a better health care system for all.
- Sources:
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32ntr16088.aspx
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.aspx
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_316092.aspx
Online Journal of Issues in Nursing Vol. 12 No.1 2007
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