Power to Influence Patient Care: Who Holds the Keys?

[NRSKarenRN, BSN, RN]

© 2007 ojin: the online journal of issues in nursing

article published january 31, 2007

power to influence patient care: who holds the keys?

[color=#995522]overview & summary by fran beall, aprn, bc

.... the extensive corporate takeover of health care delivery has brought with it additional challenges for both nursing and the health care system in general. if ever there were a time for 2.9 million nurses (united states department of health and human resources, 2004) to collectively exert their power to fix both a fractured health care system and a profession in crisis, the time is now.

despite the need, however, for nurses to assert their power both collectively and individually, many remain largely oblivious to the concept and relevancy of power in their daily lives. this failure to understand and to utilize power appropriately has its roots in many causes, including sexual stereotyping, role socialization, and negative images of power as a coercive or corrupting influence, rather than in what it is: the ability to "do" or to influence outcomes which we all want and need....

[color=#995522]the introductory articles in this ojin topic look at power from different perspectives.

[color=#995522]...all of this topic’s articles provide the opportunity for nurses to reflect on the meaning and importance of power in their own professional lives, and to contemplate how they can develop the skills necessary to practice powerfully for the benefit of themselves, their colleagues, and their patients. in 1985, dr. haifdan mahler, director general of the world health organization, spoke of his vision for nursing, stating:

if the millions of nurses in a thousand different places articulate the same ideas and convictions about primary health care, and come together as one force, then they could act as a powerhouse for change. i believe that such a change is coming, and that nurses around the globe, whose work touches each of us intimately, will greatly help to bring it about (

pg. 10

).

i believe that as well.

[color=#995522]power and empowerment in nursing: looking backward to inform the future

[color=#995522][color=#995522]

[color=#995522][color=#995522]abstract

there are compelling reasons to empower nurses. powerless nurses are ineffective nurses. powerless nurses are less satisfied with their jobs and more susceptible to burnout and depersonalization. this article will begin with an examination of the concept of power; move on to a historical review of nurses’ power over nursing practice; describe the kinds of power over nursing care needed for nurses to make their optimum contribution; and conclude with a discussion on the current state of nursing empowerment related to nursing care. empowerment for nurses may consist of three components: a workplace that has the requisite structures to 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. a more thorough understanding of these three components may help nurses to become empowered and use their power for better patient care

influencing health care in the legislative arena

[color=#995522]abstract

nurses are well aware that today’s health care system is in trouble and in need of change. the experiences of many nurses practicing in the real world of health care are motivating them to take on some form of an advocacy role in order to influence a change in policies, laws, or regulations that govern the larger health care system. this type of advocacy necessitates stepping beyond their own practice setting and into the less familiar world of policy and politics, a world in which many nurses do not feel prepared to operate effectively. successful policy advocacy depends on having the power, the will, the time, and the energy, along with the political skills needed to ‘play the game’ in the legislative arena. this article describes the role of the nurse as health care policy advocate, identifies the power bases available to nurses as they assume that role, discusses the policy process in the legislative arena, and presents strategies for effective action. a list of selected online resources is included to help readers learn more about shaping and influencing future health policy.

the power of professional nursing practice – an essential element of patient and family-centered care

[color=#995522]abstract

understanding power and learning how to use it is critical if nurses' efforts to shape their practice and work environments are to be successful. as part of our efforts to develop a fast-track bsn-to-phd nursing program, we met with nurse leaders from six organizations to explore what power means, how nurses acquire it, and how they demonstrate it in their practice. through these discussions, we identified eight characteristics of powerful nursing practice that, together, form a framework that can guide nurses’ efforts to develop a powerful practice and shape the health care delivery settings and academic institutions in which they work. in this article we review recent studies of organizational power and share discussions which helped us better understand nursing power and the ways in which it is manifested. we also reflect on what power means for individual nurses and the profession and discuss how our insights influenced our fast-track programm,..

table. properties of a powerful professional nursing practice

nurses who have developed a powerful nursing practice...

• acknowledge their unique role in the provision of patient and family centered care

• 
  

commit to continuous learning through education, skill development, and evidence-based practice

• 
  

  
  

demonstrate professional comportment and recognize the critical nature of presence

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value collaboration and partner effectively with colleagues in nursing and other disciplines

• 
  

  
  

actively position themselves to influence decisions and resource allocation

• 
  

  
  

strive to develop an impeccable character; to be inspirational, compassionate, and have a credible, sought-after perspective (the antithesis of power as a coercive strategy)

• 
  

  
  

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

• 
  

  
  

evaluate the power of nursing and the nursing department in organizations they enter by assessing the organization’s mission and values and its commitment to enhancing the power of diverse perspectives

• 
  

patients and nurses: a powerful force

[color=#995522]abstract

quality of care is of paramount importance to both patients and nurses. this article examines how the existing patient/nurse partnership is the result of a variety of clinical, political, and organisational power paradigm shifts over time. the significance of this partnership on the quality of care, particularly in terms of the necessary power base required, is then considered. next the education, health care systems, and diversity issues found in the uk and the us are compared and contrasted. the conclusion focuses on a transatlantic vision for the future in the consolidation of the patient/nurse transaction for the achievement of negotiated, competent, compassionate care and as a continuing force for quality at policy, strategic, and operational levels.

[BBFRN, BSN, PhD]

Great articles- Thanks for taking the time to post these viewpoints. There is one thing that doesn't sit so well with me, though. In the "Power of Professional Nursing" article, it states that "Understanding power and learning how to use it is critical if nurses' efforts to shape their practice and work environments are to be successful."

The writers sought insight from "a clinical nurse specialist, nurse manager, vice president, program manager, nurse scientist, dean, chief retention officer, and a nurse faculty member."

I'm wondering how in touch the above nurses are with those nurses at the bedside (with a possible exception of the retention specialist). They were sought out because they were perceived to have a certain amount of power within their organizations, and within the profession. My guess is that they were given this power by their organizations for reasons that may have benefited the organization more than the profession.

In the article they are asked to describe a nurse's power, and explore what to do with it. Why weren't any bedside nurses asked? Why not ask someone in the trenches, since it is being stated that nurses need to be empowered to influence care? It just seems to me to be another example of leaders way off in the clouds dictating to us how healthcare should be run, and being benevolent enough to hand us our power, instead of going from the ground up. Isn't that one of the problems with healthcare today?

I hope this all made sense lol.

BTW Karen, I always love your posts- you always make me think. I do see you as a mentor from afar!

[NRSKarenRN, BSN, RN]

:icon_hug: thanks for the compliment.

i love to read ojin as presents peer reviewed + timely information, offering varying viewpoints in professional manor that is easy to understand and provokes your thinking.

you've brought up a great point and think you should submit your comments: submit letters to the editor

[BBFRN, BSN, PhD]

:icon_hug: thanks for the compliment.

i love to read ojin as presents peer reviewed + timely information, offering varying viewpoints in professional manor that is easy to understand and provokes your thinking.

you've brought up a great point and think you should submit your comments: submit letters to the editor

you're very welcome- and thanks for the link. i just sent the email. i'll let you know if they reply!

[BBFRN, BSN, PhD]

Uhhh...they're going to publish my question in the OJIN. What did I get myself into? :rotfl: :rotfl:

[Simplepleasures]

Well, I definatly advocate empowerment for the individual in all areas of their lives, work, family, social, etc. But that comes with a caveat, it is dangerous to apply those principals of empowerment, BUT OH SO WORTH IT as a human being. I have gotton myself in trouble several times throughout my carreer because of excersizing my right to empowerment and standing up to what I felt was improper, or unethical or even illegal. Saying this though, I would not have changed a thing, I can live with my decisions and sleep well at night knowing that I did what was morally correct. It cost me , still is costing me, BUT with the knowlege it was the CORRECT and JUST thing to do, it has all been worth it.Perhaps things may change for the better in LTC because of the stand I took.Again, for me personally it was worth the price.