In this modern day and age, there are many challenges in healthcare. These challenges include new types of disease or re-emergence of old diseases. However with the advancement of the healthcare and technology, life can be saved and life prolonged. Furthermore the length of hospitalization can be shortened. In present modern era of technology, patients are more educated and have accessibility to information in the internet. Hence, demand for quality care is higher. They have led to great changes in the nursing career. “Nursing began as women’s work and was a domestic role where women were expected to fulfill in the home.” (Manojlovich. 2007, Chong and Labong, 2011). But today, nursing is different from those days. It has progressed from doctors’ “handmaiden” to being a healthcare professional. The responsibility hence, is greater to provide a more complex nursing care. So, it is important for a nurse to be empowered and have the empowerment on her duty. This can improve in health care and patient outcome.
2. Definition of empowerment
Empowerment means is a positive concept of a power or authority is given on doing something. This is also a dynamic concept that can be shared, taken or given to others. “An individual is vested with power or authority legally or formally to perform certain tasks”. (Chong & Labong, 2011). It is also associated with growth and development of a person or an organization. Critical thinking on own thought, feeling and reason for action and in the pattern of activity are also in the empowerment process. Empowerment also refers to uniting people to achieve a common goal in the community.
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The importance of empowerment in nursing is that nurses will feel that they have the power to authorize their job, satisfaction in their job and feel appreciated. Besides, they will feel less worn-out also in their work. It will also enhance the care of patient outcomes. A powerless nurse is an ineffective nurse. Powerless nurses have more job strain compare to empowered nurses. this is the cause of burnout in work. According to Manojlovich (2007) and Laschinger (2006) powerless nurses are less satisfied with their jobs, and more susceptible to burnout and depersonalization (Leiter & Laschinger, 2006). “Lack of nursing power may also contribute to poorer patient outcomes” (Manojlovich, 2007). Alternatively, “disempowerment, or the inability to act, creates feelings of frustration and failure in staff nurses, even though they may still be accountable on their job”. (Laschinger & Havens, 2006). Styles and Hall maintained that power is central to nursing’s development as a profession (Hall, 1982 & Styles, 1982 cited from Manojlovich 2007).
3. Author would like to discuss on the issues related to empowerment in nursing in author’s area of practice.
3.1 Nursing empowerment among organization and management.
Empowerment in working place provides the chances to learn and grow through the access of information sharing, support, opportunity for advancement and resources. All staff nurses in author’s working hospital are given chance to develop knowledge and skills.
Formal power
In author’s working hospital, the organization and management theories are practiced. It means that powers in the organization are distribute in a top-down manner. Staff nurses in author’s working hospital are given the formal power to promote participating in the management and autonomous work unit. For example a senior staff nurse has the opportunity to be a Charge Nurse in each ward. She helps the management of the ward. Besides that, the ward staff nurses are also given chance to be promoted as a link nurse for the infection control team and so on to share out the responsibility to improve the organization. In formal power, the staff nurses are given chance to negotiate a mutually agreeable schedule of duty roster with the ward sister. Besides that, the opportunities are available for staff nurses to develop new skills via the multidisciplinary tasks assigned by the ward sister. For example the ward sister in author’s practice area can interchange staff nurses from surgical unit to medical unit and vice versa in a ward. This will enhance the skills of staff nurses with the opportunity to take care various medical, surgical, gynecology and dermatology problems. According to Patrick and Laschinger (2006) formal power had the strongest positive relationship with perceived organization support and increase role satisfaction.
Informal power
For the informal power, author’s area of practice is providing the opportunities on the networking with colleagues. For example, we are giving the chance to interact with other colleagues from different department or different units to exchange knowledge and skills. Networking skills can develop in the unit through the team building exercises. Furthermore, the collaborative relationship the nurses and the physician will enhance patient care. Besides that, the interdisciplinary networking opportunities also can be developed. According to Almost and Laschinger’s model, structural empowerment for NPs influences levels of collaboration with physicians and managers, communication, autonomy, and feelings of trust and respect. When structural empowerment is high, increased levels of collaboration and autonomy occur, thereby resulting in lower levels of job strain.
Access to information
Open communication are practiced in the area of practice. Timely information are provided and shared among the colleagues. The intranet is created in author’s area of practice to provide information and communication between all personnel in the hospital. The information about values of management or goals of organizations is updated to each staff through intranet or announcement from ward sister.
Access to support
Mentoring system is use for guiding the new staff nurses in author’s area of practice. Collaboration and collegiality are encouraged among the staffs in the hospital in all departments. Provide recognition and applaud achievements to the staff nurses by giving the extra allowance. Encourage autonomy of staff nurses to control over the professional practices. “Autonomy represents one kind of power nurses need, and has been defined as the freedom to act on what one knows” (Kramer & Schmalenberg, 1993 cited in Manojlovich, 2007).
Access to resources
Nurses are involved in evaluation of supplies to assure the quality of the items. The plan for equipment replacement and preventative maintenance strategies are developed such as terumo infusion pump, glucometer set, pulse oximetry set and etc. Ward supplies and equipment are accessible and responsibly used. Staff nurses are encouraged to interpret workload data as a necessary part in decision making. Staff nurses are given the adequate time and resources to accomplish work. Sufficient manpower is provided in each shift.
Access to opportunity to learn and grow
There are in-service educators in author’s area of practice. The training is plan throughout the year to update the staff nurses knowledge and skills. And the nurses are encouraged to participate in training and development sessions. The organization is encourage the staff to facilitate advanced educational such as encourage in taking post basic, degree and so on. Reshuffling the staff nurses to different department to expands the skills and knowledge. The staff nurses can negotiate in expanded role or function in current job. The staff nurses are encouraged participating in special task force or important organizational committee. The career ladders are established based on the skills rather than status.
According to Armstrong-Stassen & Cameron (2003), Patrick & Laschinger (2006), found that nurses’ perceptions of support from their immediate supervisors, control over their work, and control over organizational decisions is affecting the future of their jobs.
“When employees do not have access to resources, information, support and opportunity for advancement, they experience powerless” (Kanter, 1979 & Manojlovich, 2007). These individual will feel less job satisfaction, often feel stuck in their jobs, and feel burnout and low patient satisfaction. This will affect their performance of their job and image of an organization. O’Brien (2011) found that the consequences of nurse burnout have been associated with high rates of nurse absenteeism, interference with process of care, low patient satisfaction, and intend of nurses to leave their job. This will result in more shortage of nurses in the country.
3.2 Nursing empowerment among patient
According to Kanter’s (1993) work empowerment theory are conceptually consistent with the nursing care process and can be logically extended to nurses’ interactions with their patients and the outcomes of nursing care. (Cited from Laschinger et al., 2010).
Formal power
The nurses have a great influence on patients’ acquisition of the aspect of the empowerment by assisting the patient to achieve mastery in managing their health. Patient is given the authority to negotiate on nursing care schedule such as the time for bed making, when to eat and drink, and what activities to take part in. patient will get informed before the procedures are perform. Patients are encouraged to make decision on their own care. Patients are acknowledged on there is more than one way to accomplish mutually defined goals. Laschinger et al., (2010) proposed that as patients gain formal power in the management of their health concerns, achievement of collaborative health goals becomes a focus of nursing care. In this way, the nurse/patient relationship functions are act as an empowering process. Thus, nurse and patient are collaborate to create optimal care in patient health.
Informal power
“Nurses can work with patients to identify strategies for developing supportive alliances, as establishing relationship to work on collaborative goals is an important empowering behavior of health care professionals”. (Funnell & Anderson,2004, Laschinger et al., 2010). Work with patient in identifying their strategies for developing supportive alliances in patient care. Establish a partnership with patient family in taking care of patient. Patients are viewed as important allies in the health producing process. Nurses also can promote the development of strong alliances patient and other health care members such as physiotherapist, radiologist, and laboratory technician and so on.
Access to information
Open communication are use during communicate with patients. Relevant information is provided with clear answer to patient questions. Explanations are given to patients before giving medication or treatment to patients. Orientation to patients are provided when admitted to the ward to allow the patient to be familiar with the surrounding and ward routine. Timely information is given to update the patient and relatives on his/her condition and progress. According to Faulkner (2001) & Laschinger et al., 2010) providing relevant information about an illness, coupled with clear answer to patients questions, is an example of empowering behavior on the part of nurses.
“Nurses often have knowledge of potential sources of information that patient may be able to access as they try to manage their health issues” (Pellino et. al, 1998 & Laschinger et al., 2010).
Access to support
Providing access to support for patient can produce positive outcomes to patient. Nurses can maintain a conducive environment and restful atmosphere to promote healing and recovery. Determine what patient beliefs are, thoughts, and feeling that might hinder recovery, so as it is easier to give them support on related issues. Respecting their choices is important. Explained to patients regarding the role of caregiver and support patients’ right on giving them to be the decision-maker. Nurses are to attend to the patients’ complaint and call bell trigger quickly. According to Leino-Kilpi et al (1999), & Laschinger et al. (2010), nurses can create a supportive healing environment by maintaining a restful atmosphere, addressing patient complaints promptly, by respecting patient choices and offer encouraging remarks for achieving specific health goals.
Access to resources
Nurses can facilitate the resources of clinical and the community to the patient for their needs, such as where to get a colostomy bag for those patients who have colostomy and provide information on the stoma care. Nurses also can help patient to identify their own resources and also can help them to identify their self care ability and inner strengths. Nurses are facilitate patients access to interdisciplinary team members as this can help patient to communicate well with other health care provider and can have more satisfaction towards the care that provided. Nurses should provide patients enough time to accomplish personal activities such as eating, personal hygiene. “By not rushing patients through these activities, patients’ sense of control may be enhanced, therein enhancing their overall sense of empowerment” (Laschinger et al. 2010). According to Laschinger et al. (2010), ensuring patients have access to the resources necessary to achieve optimal health is an essential element in the empowerment process.
Access to opportunity to learn and grow
Nurses can help patient and family to gain new knowledge and skills on managing patient care on personal health and well being. According to Laschinger et al. (2010) in helping families transfer existing knowledge to new situations helps build family self efficacy for managing their health. Nurses need to use simple words and not the jargon words while explaining to patient and relatives and according to their level of comprehension. Nurses are also can have a scenario on an issue such as skin excoriation in stoma patient to help patient in practicing a new skills on stoma care and health education can be given at the same time.
3.3 The implications of empowerment issues identified are:
The nursing manager need to identify and recognized the contributions of the staff nurses. When the staff nurses feel appreciated, it enhance in psychological empowerment. Thus, it will have more job satisfaction and reduced in job strain. Besides that, it is important to identify the factors on the work environment for staff nurses towards patients to improve the work effectiveness, cost effectiveness, and quality in patient care. “Providing access to structurally empowering elements can affect staff nurses perceptions of caring for patients, which can add to feelings of overall empowerment” (Steward et. al 2006). Besides that, it is important to supply efficient staffing in each shift to provide a quality care to the patients and it also can reduce the job strain. Laschinger, Almost, & Tuer-Hodes (2003) also commented that adequate staffing makes it possible to have the time to deliver the quality care to patients. Nurses will feel frustrated and betrayed by the management if there is inadequate staff in a hectic ward environment. Besides that, teamwork among the staffs is important in providing a quality care to the patients.
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As a conclusion, in today’s rapidly changing in healthcare environment, empowerment is very important for an organization. A good organization will empower their staffs to enhancing grow and improving in an organization to improve the quality of health care. While there are practicing structural empowerment in working environment, it will increases work engagement among colleagues and reduces burnout. “As the mandate of nursing management is to create workplaces that promote the health and well-being of both nurses and patients” (Laschinger et al. 2010). Aujoulat et al. (2007) & Laschinger et al. (2010) also commented that empowerment is a health enhancing process. Besides that, Laschinger et al. (2010) also proposed that nurse/patient empowerment could be used as a guide for creating high-quality practice environments in nursing workplaces that ensure positive outcomes for both nurses and their patients.
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