Power: A Professional Responsibility

[MBar1, RN]

Power: A Professional Responsibility 

Power is both a necessary evil and a potential obstruction both fundamentally, and within the field of nursing. It is certainly a game of computational hierarchy and I think that we can all agree that nurses have their hands in most pots and come to understand almost every aspect of their patient’s lives. We become so involved, and with this level of invasiveness, as professionals, with knowledge of the human entity and its innumerable processes, we become a figure of power in some odd way. We understand, and with this understanding, we can act appropriately. So does this imply that knowledge is directly related to the outcome of power? So would argue yes, and some would contest this notion. An interesting perspective paper written on the topic of power and empowerment within the nurse-client relationship elucidates that power is self-identified.[2] Discerning between “power to” versus “power over” is what separates outcomes of empowerment and oppression through dominance hierarchies respectively.[2] It seems that a matter of balancing intention and outcome is predicated on our conceptualizations of power. Even more, power can be separated based on scale. Macro versus micro sources of power present a middle ground with respect to definition and context. Macro level power is defined as a system or societal power stemming from oppressed populations and perpetuated by those at the top of the dominance hierarchy.[2] While micro level power lives within interpersonal relationships and is perpetuated by transactional relations.[2] Regardless of definition or conceptualization with regards to morphology, it has been argued that the concept of power and one's understanding of it are determined from within.[2] 

 

As nurses, we carry knowledge from an array of domains. When we are conflicted with a medical dilemma, we recall our scientific understanding of human physiology and our capacity to change with illness. Our expansive knowledge base related to what is happening in our patient’s continuum of care is what separates us from them. It has to, or else our roles would be put up for review. The obvious exception being if our patient’s identify as medical professionals by trade, however this goes without saying. If a hospitalized patient of yours begins experiencing symptoms reflective of ACS, it is your duty to act upon what you notice through assessment and respond through coordination with multiple partners within the care team.[5] This process begins with noticing and ends with your reflection of the entire process, which includes, but is not limited to your action(s). And with our knowledge and sensibilities to act in an ethical manner, it seems that we are powerful beyond recognition. We can contribute to the change of disease states both expediently and long term. In fact, we can oftentimes lead our patients down a path that we feel to be the best for them, which guides their future thoughts and actions within their own lives.  But what is the cost? And is this power inherently “good” or “bad”? 

 

The example above reflects both the nurses ability to enact “power over” and “power to”. However, this example is far from perfect in execution. And as we know, the care of another person can oftentimes be far from perfect. Sometimes we are fooled by our patients' assumed docility based on hierarchical dogma that is predisposed from designation and knowledge base. But what would happen if our patient in the example above refused your interventions? This particular patient being of sound mind and body, decided not to pursue treatment for their coronary syndrome. What then? Well, the power you thought you had is no longer. A paradigm shift has occurred in your world, and you can either accept it or become resentful. The power you thought that you once had- power that you once thought was instantiated into the role that you assume as a nurse can sometimes be a guise or falsification of a perceived authoritative position because the patient allows it to happen.[3] Whether it be the image that you created of yourself, the patients acceptance of their lack of knowledge or level of understanding, or perhaps a combination of both - it is imperative that you ensure that you approach is not disempowering.[4] Power can easily become abused, especially when it becomes tied up within one’s identity both personally and professionally. It can undoubtedly become a game of status among health professionals and between nurse and the patient.[3] And when this becomes the case, the relationship crumbles and those involved become cynical and designations such as “uncooperative” or “stubborn” are irresponsibility ordained into the language of care.  

 

The idea that power somehow makes a nurse “whole” and therefore viewed as powerful within the healthcare regime is not a new one.[3] The literature on the topic of power is quite expansive and is investigated from multiple domains.[3] What complicates things more is the concept of “empowerment” that we spoke of previously. Attempting to define either topics has also proven to be a difficult one as both can be seen as interdependent and also mutually exclusive.[3] I am under the opinion that a “holier than God” approach is not good for anyone involved. Moreover, the literature shows us that the oppressed take on the attitude of the oppressor, which leads to poor outcomes.[3] On the flip side, an inherent disregard of the importance of empowered nurses and the effectiveness that said power brings about within the continuum of care is no different than the latter.[3]

 

So how do we balance the intention to do “good” with the potential to negatively impact the care we provide through the use of power? Surely both extremes of forgoing the power we hold inherently and total abuse of said power are not tenable alternatives. Perhaps taking a more lax approach to what we perceive as power socially, organizationally, and psychosocially as it relates to hierarchy and status, and adopting a more productive view of power is necessary to realize all that power truly can be is empowering yourself and the patients that you care for. Sharing is caring, and having the ability to share the power that both nurse and client possess is both a professional responsibility and moral obligation. [1] 

References

[1]College of Nurses of Ontario. (2006). Therapeutic Nurse-Client Relationship, Revised 2006. Retrieved from: https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf

 

[2]Du Plat-Jones, J. (1999) ‘Power and representation in nursing: A literature review. Nursing Standard, vol 13(49), 39–42. Retrieved from: https://search.proquest.com/openview/a72099bae6d634b6979e7d5bc03046f8/1?pq-origsite=gscholar&cbl=30130

 

[3]Jones, C. B. , Sambrook, S. , & Irvine, F. (2007). Power and empowerment in nursing: a fourth theoretical approach. Journal of Advanced Nursing, vol 62(2), 258-266. doi: 10.1111/j.1365-2648.2008.04598.x

 

[4]Oudshoorn, A. (2005). Power and empowerment: Critical concepts in the nurse-client relationship. Contemporary Nurse, vol 20(1), 57-65. DOI: 10.5172/conu.20.1.57

 

[5]Tanner, C.A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45 (6), 204-211. Retrieved from: http://www.healio.com/journals/jne

[GrumpyRN, NP]

Did you accidentally paste in an essay?

Curious what your reasoning behind writing this is? 

[DavidFR, BSN, MSN, RN]

Have you come accross this?

https://www.jstor.org/stable/42857837?seq=1

Sam Porter's excellent paper "Contra-Foucault: Soldiers, Nurses and Power"

Hasn't dated and remains the most pertinent analysis of power. Michel Foucault's post-structuralist perspective on power is easily applied to nurses (see The Birth of the Clinic, The History of Sexuality volumes 1, 2 and 3). With power goes surveillance, again Michel Foucault, Bentham's panopticon etc.

I am intrigued by this subject though I agree with Grumpy in that I don't quite get what your point is? You do just seem to have posted an essay without any prompt at a discussion point. Just what was your objective in starting this post? Is this your own essay? What  exactly do you want posters to pick up and expand on?