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

[color=#995522]overview and summary:

power to influence patient care: who holds the keys?

fran beall, aprn, bc

in 2007 nurses continue to comprise the largest group of health care professionals in the united states, but our numbers have failed to result in a corresponding ability to shape and direct health care policy in a way that empowers both nurses and health care consumers.

in her 1988 address to the ana house of delegates, president margretta madden styles issued this clarion call:

march! there are no bunkers, no sidelines for nursing today. we find ourselves the center of attention. as the government and corporate america fight escalating health care costs, aids is wreaking havoc and technology swells unchecked. underpaid, overworked and overstressed nurses are in the midst of a conflagration. nursing is in far greater demand than ever before. remember scutari. we must organize, unite, go on the offensive.

her charge to nurses in 1988 is as true today as it was two decades ago; and many of the issues she addressed in that speech have grown, multiplied, and intensified with the passage of time and the aging of both the general population and the nursing workforce. 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....

the introductory articles in this ojin topic look at power from different perspectives.

manojlovich discusses the various concepts and definitions of power, both in nursing and in other settings and disciplines, providing the historical framework in which to study the evolution of power in nursing practice over the years. she compares the positive outcomes of empowerment on nursing status and professional autonomy with the negative impact of nurses' failing to understand and embrace power. positive patient outcomes, as well as increased satisfaction for nurses themselves, are inextricably linked to nursing power, as has been repeatedly demonstrated in research on magnet hospitals. manojlovich further discusses the organizational characteristics which are key contributors to the nurses' power to influence patient care in the current work setting.

abood looks at nursing power in the context of political and legislative advocacy in a health care system badly in need of change. this article points out the symbiotic relationship which exists between the practice setting and the legislative arena, and the ways in which political advocacy can enhance nursing practice in the work setting. after outlining the historical perspective of nursing advocacy, abood defines the sources from which nurses can derive power. such an understanding, along with knowledge of the policy-making process and the political forces which govern it, is vital to effective nursing advocacy. she provides specific examples of nurses who have identified problems within the health care system, and who were able to bring about needed change by developing and utilizing political skills. abood makes the very important point that most policy changes require sustained group effort over many months, which should highlight the importance to nurses of their professional organization as the vehicle for such changes.

ponte describes a partnering project between the dana farber/harvard cancer center nursing departments and the university of massachusetts boston school of nursing and health sciences, which included a unique mentoring project designed to enable doctoral nursing students to develop powerful professional practices. ponte and her colleagues share how they interviewed 11 nurse leaders to identify how practicing nurses achieve and maintain power in their practices. they present what was learned through these interviews about the properties of a powerful nursing practice and the characteristics of the nurses working in these practices. while the immediate focus of the project was on doctorally prepared nurses, ponte's findings have relevance for nurses in all settings who aspire to be powerful professionals.

hakesley-brown and malone provide a more global perspective by comparing similarities and differences between nursing in the uk and in the us. they use a poem to explore clinical power vis à vis the nurse-patient partnership, and describe the various forms of clinical power, including charismatic clinical power. while core values are the same for nurses in both countries, there are significant differences related to educational preparation, private vs. public health care delivery systems, underlying assumptions, and the degree of diversity of the nursing population. ultimately, the authors believe that the common bond of caring in nursing is a form of empowerment which cuts across all lines of education, delivery systems, and diversity. ...

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there is power in our minds, mouths and hands. i challenge each bb member to look within themselves, find the key and unleash the power within. karen

[OC_An Khe]

Thank you for posting the links to these articles. Although it takes some time I would strongly recommend these articles to all RNs and students. Change within the health care delivery system and by extension in the Nursing profession is taking place. This will happen whether Nursing has a seat at the table or not. We have IMO a professional responsibility to be involved in this change and assure that Nursing has a seat at the table and on the Board of Directors of all health care organizations.