Power and Power Dynamics in Nursing Leadership

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Activity #1

Read the paper by Manojlovich (2007).

 

Power and Power Dynamics in Nursing Leadership

In nursing, power is associated with having control, influence and domination over something and someone (Chandler, 1992). Power may also be conceptualized as “one’s ability to get things done through mobilizing resources and to get and use whatever it is that a person needs for the goals he or she is attempting to meet” (Kanter, 1993, p.166). There are multiple types of power depending on its source. Leaders are in a position of power and are expected to use strategies to empower their staff. In nursing, these strategies are classified into three empowerment theories: structural empowerment, psychological empowerment, and leader empowering behaviours, which will be discussed later in this section.

 

Here is an excerpt from Manojlovich’s (2007) paper:

Historically nurses have had difficulty acknowledging their own power (Falk Rafael, 1996). This reluctance to acknowledge and subsequently use one’s power as a nurse may in part explain many nurses’ inability to control their practice.

 

Some scholars consider nursing an “oppressed” minority, because nurses, themselves, believe that they are powerless–ceding control to their oppressors (Roberts, DeMarco & Griffin, 2009).

 

Types of Power and Power Accessibility

The table below contains some common types of power and has been adapted from a book by Sullivan (2004), entitled Becoming Influential: A Guide for Nurses.

Type of Power Definition
Legitimate/Formal/Positional Based on formal authority and position within an organization
Knowledge/Information Based on access to critical information
Expert Based on professional knowledge and expertise
Personal Based on authenticity, trust, integrity
Connection Based on formal and informal connections to people with influence (e.g., extensive social network)
Symbolic Based on the reputation of one’s workplace, profession. Nursing, for example, has a lot of symbolic power because of the trust the public puts in nurses.

Sullivan and others make the case that nurses have access to many types of power, but often ignore or under-utilize power. As mentioned in Monojlivich’s paper, one reason for this may be because nurses don’t think it is appropriate or professional to seek out or acknowledge their sources of power. Nurse empowerment begins by recognizing how powerful you are, and how you can grow power to use for the betterment of the profession and your clients. For example, you are growing your knowledge power and your expert power by taking this course. You are building your connection power through this course and your peer/faculty network. You hold a great deal of symbolic power by being a nurse. A symbolic power litmus test: How often do you state, up front and with pride, that you are a nurse?

 

Learning Activity: Assess your Personal Power

Think about your current power base. For each type of power, provide examples of how you are using your personal power. What are some ways you can ‘grow’ each type of power?

  1. Legitimate power = formal authority.
    • How do you currently use this type of power? How can you increase this type of power?
  2. Information power = critical information.
    • How do you currently use this type of power? How can you increase this type of power?
  3. Expert power = knowledge and skills.
    • How do you currently use this type of power? How can you increase this type of power?
  4. Personal power = authenticity, trust, integrity.
    • How do you currently use this type of power? How can you increase this type of power?
  5. Connection power = who you know, your network.
    • How do you currently use this type of power? How can you increase this type of power?
  6. Symbolic power = what you symbolize.
    • How do you currently use this type of power? How can you increase this type of power?

 

Empowerment Theories

There are different theories related to empowerment: the key ones are structural empowerment theory (Kanter, 1993) and psychological empowerment theory (Conger & Kanungo, 1998). Dr. Heather Spence Laschinger, one of Canada’s great nurse researchers, devoted her research career to the study of nurse empowerment.

 

A basic definition for empowerment is feeling empowered. Some scholars say that you can’t empower someone else—it must come from an individual’s personal sense of control and awareness of power. We believe that is possible to raise others’ awareness of power; to enable others to recognize and use their sources of power more effectively. Spence Laschinger referred to these enabling behaviours as leader empowering behaviours, which we will discuss later on.

 

Structural empowerment is a theory developed by a business professor from Harvard University, Rosabeth Moss Kanter. Kanter conducted a detailed ethnography of men and women within their work environments, to better understand their organizational sources of power. Kanter found access to certain structures in the workplace is empowering to employees. These empowering structures include a) critical information, b) needed resources, c) opportunities for advancement or professional development, and d) supports to enhance job autonomy and decision-making power. Although access to these empowerment structures can be obtained through formal and informal routes within an organization, typically, formal authorities/leaders act as gatekeepers. Leaders play an integral role in developing these empowering structures in the workplace and in promoting access to them.

 

Psychological empowerment is another theory developed by psychologists Conger and Kanungo, and refined by Spreitzer (1995; 1997), a positive organizational psychologist. Psychological empowerment represents the sense of power individuals derive from their work and their work experience: “an intrinsic sense of motivation”. In other words, psychologically empowered individuals are self-motivated at work. Spreitzer identified “four cognitions” that represent individuals’ sense of psychological empowerment: a) meaning, b) competence, c) self-determination, and d) impact. A psychologically empowered person attaches great value or meaning to their work; they have a sense of competence or confidence that they can do their work well; they acknowledge that they have professional control and autonomy over their work; and they believe that they are making important contributions through their work—that they can change their work decisions and outcomes.

 

Activity #2

Before moving on to the next section, read the paper by Laschinger, Finegan and Wilk (2009). The authors discuss the important role of nurse leaders at the unit level. This is a complex paper to follow, although it provides excellent descriptions of structural and psychological empowerment.

 

The Role of Nurse Leaders

On page 229, Spence Laschinger et al. describe the link between structural empowerment and psychological empowerment. A systematic review by other Canadian nurse researchers (Wagner et al., 2010) also demonstrates the linkage, known as a “mediating effect,” between structural empowerment and psychological empowerment. This relationship can be represented as:

 

  • Structural empowerment (SE)→psychological empowerment (PE)→positive outcomes.

 

What this means is that a leader can give their staff access to empowering structures in the workplace (SE) such as resources and support, but this source of unit-level empowerment is not sufficient in promoting sustainable positive outcomes, such as organizational commitment. Nurses, at an individual or personal level, need to believe that access to these resources will enable and motivate them to derive more meaning, impact, control (self-determination) and confidence over their work.

 

Spence Laschinger et al. (2009) studied some additional factors or variables in their empowerment model. They looked at the quality of leader-member exchanges (LMX) on staff (unit level) and they included personality or dispositional variables known as core self-evaluation variables (CSE) at the individual level. They found that positive organizational commitment is significantly influenced by two unit-level actions of leaders: providing access to organizational empowerment structures (SE) and the quality of leader-member exchanges (LMX). Does this seem familiar to you?

 

At the individual level, two variables of importance are nurses’ personal beliefs/cognitions in their power to make a difference at work (PE) and their personality dispositions (CSE).

Although personality influences can be fairly set, personal beliefs about one’s own power base (i.e., PE) can have a significant impact on nurse outcomes, including organizational commitment, retention, job satisfaction, and even joy at work.

 

Disempowerment

One reason you are learning about power and empowerment is so that you can be more empowered and enable those around you. Wagner and Spence Laschinger’s work shows that there are positive outcomes from being in an empowering environment, particularly positive feelings about work, enhanced job satisfaction, and organizational commitment. But, in the absence of empowerment structures and effective, empowering leaders, the opposite conditions typically exist in nurses’ work environments. What do nurses do when they are faced with disempowering work conditions?

 

Activity #3

Read Udod (2014): Seeking connectivity in nurses’ work environments: advancing nurse empowerment theory.  Dr. Sonia Udod is a Canadian nurse researcher who studies empowerment using qualitative methods.

Read the paper by Greco, Spence Laschinger and Wong (2006).

 

Leader Empowering Behaviours

To understand the model on page 51 of Greco et al. (2006), think of the connections between the variables as a chain link fence. They need to link together in the order shown to get the predicted or expected outcomes (engagement or burnout). Leader empowering behaviours are at the beginning of the chain link fence. Leaders demonstrating empowering behaviours are perceived by their staff as structurally empowering; they provide access to empowerment structures in the workplace. When SE (structural empowerment) is present, nurses report positive conditions in different areas of their work life and when nurses have positive perceptions of their work life, they are more engaged and at less risk for burnout.

 

Let’s look at the five categories of leader empowering behaviours (LEB). We have summarized them for you in the table below. These LEB categories were developed by psychologists Conger and Kanungo (1988), to complement the four conditions of psychological empowerment (PE). More work was done with LEB by psychologist Hui (1994), followed by Canadian nurse researchers Greco, Spence Laschinger and Wong (2006).

Leader Empowering Behaviours Definition/example
Enhancing the meaningfulness of work
  • Leaders frequently emphasize how nurses’ work is important and valued.
  • “Your work really makes a difference to the quality of patient care.”
Fostering participation in decision-making
  • Leaders regularly ask for staff input and follow through on collaborative staff decisions.
  • Nurse leaders have frequent formal and informal conversations with staff during daily huddles, staff meetings, walkabouts, and 1-on-1s.
  • “Tell me your ideas about this new technology.”
Facilitating goal accomplishment
  • Leaders provide resources, such as continuing education/certification opportunities for staff to accomplish their goals.
  • “You show a lot of aptitude in care of critically ill patients. Would you like to take critical care certification courses?”
Fostering confidence of staff
  • Leaders express a “you can do” attitude.
  • In the example above (goal accomplishment) the leader says:
  • “I think you can be very successful in this area of nursing.”
Promoting freedom from bureaucratic restraints
  • Leaders eliminate unit-level policies that are outdated, obsolete.
  • “Let’s form a governance council of nurses to review our unit policies and eliminate ones that are outdated.”

 

In the table examples, you will see that leaders do not require a lot of resources; they need to connect with staff and use transformational leader styles (e.g., idealized influence, inspirational motivation, individualized consideration, intellectual stimulation) to make a positive difference.

 

Learning Activity: Examples of Leader Empowering Behaviour

Create a table (as above) with one example of each type of LEB that you have experienced during your clinical placements. You should have five examples. If they don’t exist, give examples of disempowering leader behaviours (that need to be replaced by empowering ones!).

Leader Empowering Behaviour (LEB) Your clinical example
Enhancing the meaningfulness of work
Fostering participation in decision-making
Facilitating goal accomplishment
Fostering staff confidence
Promoting freedom form bureaucratic restraints

 

According to sociologists, nurses belong to an oppressed group. Oppressed groups believe that they have no power. Culturally and historically, nurses have been considered an oppressed or disempowered group. Traditional hierarchical chains of command have made it difficult for nurses to speak up and advocate for their professional standards and ethical principles in situations where they believe patient care is compromised. Nurses have the capacity, however, to build their own power bases using diverse sources of power, such as expert power (i.e., knowledge and skills acquisition). The good news is that each of us can continuously grow our power base by harnessing readily available sources of power—it’s up to us.

 

Check Your Understanding

 

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Leadership for Nurses in Clinical Settings by Dr. Kirsten Woodend, Dr. Catherine Thibeault, Dr. Manon Lemonde, Dr. Janet McCabe is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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