“work empowerment as perceived by nurses and...

“Work Empowerment as Perceived by Nurses and Physicians Working

at National Heart Institute”

By

Dr. / Fatma Hamdy Hassan

Professor of Nursing Administration

Faculty of Nursing; Ain Shams University

2

The present study was derived from the M.Sc. thesis done by Mrs.

/Enayat Thabet Yakob under supervision of the author and Dr. Samia

Adam; Lecturer of Nursing Administration.

Introduction & Review of Literatures

Nowadays, many seek power but few possess it. Nurses are not

exception (Marquis and Huston, 2000). In health care settings, an unequal

power base exists among administrator, physicians, and nurses as a result

of the competing goals of administration and the coexistence of multiple

lines of authority (Sabiston and Laschinger, 1995). The rigidity of

hierarchical rule-bound structures has been specifically blamed for nurses’

inability to sufficiently control the content of their practice (Laschinger and

Havens, 1996).

Kanter (1993) proposed that an individual’s effectiveness on the job

is influenced largely by organizational aspects of the work environment.

This author identified power and access to opportunities to learn and grow,

as structural determinants affecting the behavior of the individual. This

power is derived from the ability to mobilize information, support, and

resources necessary for getting the job done.

Access to these empowering structures is influenced by the degree of

formal and informal power an employee has in the organization (Kanter,

1993). Formal power evolves from having a defined job that affords

flexibility, visibility and centrality to organizational purpose and goals.

Informal power is determined by the extent of employee’s networks and

alliances with sponsors, peers, and subordinates within the organization.

3

Access to these empowering structures has a positive impact on

employees, resulting in increasing their job satisfaction, level of

organizational commitment of and feelings of autonomy. Consequently,

employees are more productive and effective in meeting organizational

goals (Dutcher and Adams, 1994; Laschinger et. al., 1999).

Nurses’ autonomy or control over work was seriously limited by

unequal power relationships with medical staff, which enhanced physician

power and restricted the nurses’ freedom, and consequently hindered their

empowerment (Skelton, 1994; Fulton, 1997; McParland et al., 2000).

To achieve excellence in nursing requires empowered staff nurses in

order to be effective in their roles, and to be more autonomous (Marquis

and Huston, 2000). Nurses who perceive themselves to be empowered are

more likely to enhance client care through more effective work practice.

Thus by providing the sources of job-related empowerment and autonomy,

work methods and outcomes could be improved (Kanter, 1993; Sabiston

and Laschinger, 1995).

Empowerment

In the view of Hawks (1992), empowerment is the interpersonal

process of providing the proper information, support, resources and

environment to build, develop and increase the ability and effectiveness of

individuals to set and achieve organizational goals. It occurs between two

or more people, the person who empowers i.e. the manager, and the person

(s) who is (are) empowered, i.e. employee (s).

Baker and Young (1994) have claimed that empowerment occurs

when leaders communicate their vision, employees are given the

4

opportunity to make the most of their talents, and learning, creativity and

exploration are encouraged.

In simple terms, empowerment would appear to be the process of

enabling or imparting power transfer from one individual or group to

another. It includes the elements of power, authority, choice and

permission (Rodwell, 1996).

To feel empowered, in the context of new employment relationship,

means to understand the purpose and contribution of our work, and to

believe that we are ultimately responsible for the work we do, the service

we provide, and our own continual development and growth, personally

and professionally (Cassidy and Koroll, 1994).

Empowerment connotes sharing influence and power rather than

striving to enhance one’s power by taking it from others (Mason, et. al.,

1991). Empowerment focuses more on solutions than on problems. It

includes enabling people to recognize their strength, rights, abilities and

personal power (Rissel, 1994). In organizational settings, empowerment is

creating and sustaining a work environment that facilitates the employee’s

choice to invest in and own personal actions and behaviors resulting in

positive contributions to the organization’s mission (Cassidy and Koroll,

1994; Marquis and Huston, 2000).

Job Related Empowerment Factors

According to Kanter (1993), people are empowered to reach

organizational goals if their work environments are structural in ways that

provide access to information, support and resources necessary to getting

the job done, as well as opportunities to learn and grow. These

organizational structures are important determinants that affect behavior of

5

the individual. The author considers them as job related empowerment

factors.

Information

Information refers to the data, technical knowledge, and expertise

required to function effectively in one’s position (Laschinger and Havens,

1996). Information is defined as knowledge about work goals, plans,

organizational decisions, and changes in policies, environmental

relationships, and future decisions in an organization (Kanter, 1993;

Schermerhorn,1999).

Access to information is accomplished by providing staff members

with information beyond what is required to carry out specific patient care

on their unit, and becoming more familiar with the issues that affect them

and their jobs (Farley, 1989; Bruhn and Chesney, 1995). Access to

information represents an important source of power (Mintzberg, 1990). In

popular terms, “information is power”.

Support

Support is described by Kanter (1993) as the feedback and guidance

received from superiors, peers, and subordinates. Longest (1996) has

added that support is backing, acknowledgment of achievements,

endorsement, legitimacy, approval, advice, and problem solving of the

work environment.

According to Champan (1993), support can be divided into two

broad categories: material and psychosocial. Material support includes

money, equipment, supplies and the physical environment. Psychosocial

support is primarily in terms of expert cognitive advice from the manager.

6

Such structure helps the work group to do the job and share responsibilities

(Coffey and Coleman, 2001).

Interaction is necessary for support, and usually involves reciprocity

expectations (Stichler, 1995). For these reasons, support occurs with stable

or continuing relationships developed with co-workers. Although

managers are responsible for supporting employees, the strongest support

relationships may be among co-workers (Huddleston, 1999).

Resources

According to Carbonu and Soares (1997), the success of

empowerment is linked to resources. Access to resources is the most

critical empowerment factor (Marquis and Huston, 2000). Access to

resources refers to the ability to exert influence in the organization to bring

in needed materials. Examples of these are equipment, supplies, space, and

human resources necessary to do the job. They also include financial

resources such as funds, time, budget allocation, recognition for work, etc.,

and other supplies needed to do the job

efficiently and effectively in the organization (Chandler, 1991;

Sabiston and Laschinger, 1995).

Opportunities

The structure of opportunity is described by Kanter (1993) as the

chances for growth and mobility in the organization. It involves chances to

increase knowledge and skills, competencies of individuals, give them

recognition and rewards, provide possibilities for their growth and

advancement in their positions, and to participate on committees, task

forces, and interdepartmental work groups (Dibert and Goldenberg, 1995;

Soeren et al., 2000).

7

Managers empower subordinates when they delegate assignments to

provide learning opportunities and allow employees to share in the

satisfaction derived from achievement (Marsick and Watkins, 1996).

Managers are responsible for developing, upgrading employee’s

knowledge, skills and attitudes, to improve work methods and outcomes

that create productive work environments (Gillies, 1994). This can be

achieved through planning, development and implementation of

educational programs

(Lehmann, 1994). Provision of educational opportunities to expand

knowledge and skills has become a reward function that supports

motivation, and positively reinforces the employee’s autonomy, job

satisfaction and organizational commitment (Wiles et al., 2001).

Formal and Informal Power

Power is the ability to exert influence over others. Kanter (1993) has

stated that access to job-related empowerment factors, is facilitated by

formal and informal systems of power in the organization.

Formal Power

Formal power pertains to the authority inherent in the job position.

Formal power is the result of performance of job activities that are extra-

ordinary,

visible and relevant to the organizational problems and evolves from

positions that allow flexibility, creativity, and innovation (Kanter, 1993;

Stahl, 1995).

8

Extra-Ordinary Activities

Hoelzel (1989) and Gordon (1993) emphasize that if tasks are non-

routine and must be continually adjusted; those who make decisions

concerning these tasks have control over work and thereby acquire power.

Nursing administrators should examine the implications of task

routinaization in order to assign routine tasks to less skilled personnel

(Edward, 1994; Kreitner and Kinicki, 1998)

Visibility

For activities to enhance power, they have to be visible, and to attract

the notice of other people (Kanter, 1993; Smith, 1997). It is also possible

to gain visibility through increasing the relationships nurses have

throughout the organization by creating opportunities for staff nurses to

participate on interdepartmental committees and task forces. Furthermore,

recognition of employee achievements is an important component of

maintaining successful work teams that improves staff quality of work life

in current work environments, thus leading to improved productivity

(Sohier, 1992; Rocchiccioli and Tilbury, 1998).

Relevance

In the view of Rocchiccioli et al. (1998), relevance or centrality is

the degree to which activities are connected within a system. A subunit is

seen central if the activities performed are linked with the other activities of

the organization. Furthermore, Hoelzel (1989) emphasized that because

nursing participates in all aspects of patient care; the nursing department is

centrally linked with other hospital departments, and is critical to the

workflow of the organization.

9

Informal Power

Power is not automatic with the designation of authority, and is often

strengthened through the informal power (Kanter, 1993). The informal

social network plays a significant role in the exercise of power. It is almost

a necessity for power to come from social connections, especially those

outside of the immediate work group (Thompson, Melia and Boyd, 1995;

Catalano, 1996). Informal power results from alliances with sponsors,

peers and subordinates in the organization (Laschinger and Havens, 1996).

Sponsors

Sponsors have been found to be important in the careers of managers

and professionals in many settings. They are higher in the hierarchy than

those sponsored, and act as teachers or coaches whose functions are

enabling a young person to move effectively through the organizational

system (Gordon, 1993; Kanter, 1993).

Sponsors often provide the occasion for lower level organization

members to bypass the hierarchy; to get inside information, or to cut red

tapes. This could be very important to formal job success (Kelly and Joel,

1996; Hein, 1998).

Peers

According to Richard (1990) and Dutcher and Adams (1994) peer

alliances means the relationship between colleagues. This relationship can

be collaborative and supportive. Turning to colleagues for advice and

support empowers them, and expands one’s own power base at the same

time.

10

Beyers (1999) identified the components of collegial

communications as confidence, trust, mutual support, friendliness,

enjoyment, and team efforts toward goal achievement, creativity, open

communication, freedom from threat and the amount of interpersonal

contact in the job. Higher peer acceptance is necessary to any power base

or career success. Furthermore, it facilitates coordination among

interdependent units, and also can be used for joint problem solving

(Sullivan and Decker, 1997).

Subordinates

Alliances with subordinates are important when a supportive team is

required to carry out the mission of the organization or department (Kanter,

1993). The manager needs to provide subordinates with enough

information about organizational and unit goals, so that they understand

how their efforts and those of their manager are contributing to goal

attainment. This can be done by being a source and role model to

subordinates (Fitzpatrick, 1997; Marquis and Huston, 2000). These

alliances are effective method to coordinate activities among personnel,

and to use resources of time and abilities effectively (Sullivan and Decker,

1992; Griffin, 1994).

Autonomy

According to Stahl (1996) and Ellis and Hartely (2000), professional

employees indicate they want autonomy for practicing their profession, and

for making decisions about their work. They do not want their decisions

made for them by hospital administrators, physicians, or others.

Gillon (1995) has mentioned that autonomy is “the capacity to think,

decide, and act on the basis of such thought and decision freely and

11

independently and without hindrance”. Autonomy involves the right of the

individual to take independent action based upon his/her unique values and

desires. Additionally, it involves the right of self determination, and

freedom (Blegen et al., 1993; Aiken, 1994).

Autonomy does not mean the nurse will have total control, but the

autonomous nurse is free to choose when control should be abdicated or

retained. More simply stated, autonomy is the freedom to act on what one

knows (Kramer and Schmalenberg, 1993; Castledine, 1999). It means self-

directed clinical practice for individual nurses (Cassidy and Oddi 1991 and

Chitty, 1993). Professional nurse autonomy is the belief in the centrality of

the client when making responsible discretionary decisions. It reflects

advocacy for the client (Wade, 1999).

Kelly and Joel (1999) have emphasized that the keys to autonomy as

applied to nursing care are that no other profession or administrative force

can control nursing practice and that the nurse has latitude in making

judgment in patient care with the scope of nursing practice defined by the

profession.

Subjects and methods

Present study aims at investigating nurse’s and physicians’

perception of work empowerment available to nurses at work through: (1)

Identifying nurses and physicians perception of empowerment factors

available at work. (2) Describing nurses and physicians perceptions of

autonomy. (3) Examining the relationship between nurses’ perceptions of

job related empowerment and their perception of autonomy.

12

Setting

The study was conducted in different units at the National Heart

Institute, Imbaba-Giza, affiliated to the General Organization for Teaching

Hospitals and Institutes. The study units included open heart intensive care,

coronary care, medical/surgical, outpatient, emergency units and operating

theatres.

Subjects

Study subjects included two main groups; nurses and physicians.

They were all fulfilling the criteria of being fulltime employed in the

setting for a period of at least one year.

1. The Nurses Group

The nurses group included two different groups of nurses; staff

nurses and head nurses. Each represents a different level and category of

personnel in the nursing department organizational chart.

Staff Nurses Group

A consecutive sample of 117 staff nurses were selected from a total

number of 202 nurses working in the above mentioned study units. Their

work responsibilities included the provision of total nursing care to patients

in the study units.

Head Nurses Group

A total number of 17 head nurses were included. They represent all

available head nurses in charge of management of above mentioned study

units.

13

2. Physicians Group

Consecutive samples of 58 physicians were selected from a total

number of 82 physicians who have been working in the above mentioned

units as residents, assistant specialists and specialists.

Tools of Data Collection

The data for this study were colleted by using two types of

questionnaire sheets, one for nurses groups and the other for physicians

group. Both questionnaires aim to assess respondent’s perception of nurses’

empowerment. The questionnaire was divided into four main sections.

The first section is the condition of work effectiveness questionnaire

adopted from Chandler (1986). It contains 35 statements about job related

empowerment factors available to nurses at work. These were categorized

under the four subsections namely; opportunities (8 statements),

information (8 statements), support (10 statements) and resources (9

statements).

The second section was the job activities scale developed by

Laschinger et al. (1993). The scale includes 12 statements related to formal

power characteristics (jobs that provide recognition, relevance, and

discretion).

The third section was the organizational relationships scale

developed by Laschinger et al (1993). This instrument included 24

statements for assessing informal power or political and social alliances in

a job setting.

The fourth section was the job description questionnaire developed

by Sabiston and Lascginger (1995). This instrument includes “10”

14

statement about respondents perception of autonomy defined as control

over work.

Respondents were asked to indicate their opinion on a 5 points Likert

scale ranging from “1” (none) to “5” (a lot). The job related empowerment

score was obtained by adding the means for the four subsections with a

possible range from 4 to 20, denoting availability of evidence. Theses

scores were linearly converted into a percent score by dividing the obtained

score by the maximum attainable score, and multiplying by 100. These

percent scores were expressed in mean. The higher the mean score, the

more empowered the respondents perceived work empowerment. For

individual items of the scale, a score of <=3 on the Likert scale was

considered disagree with the item, while a score of >3 was considered

agree with the item.

Results & Discussion

Table (1) shows scores related to work empowerment factors, power

and autonomy as reported by nursing and physicians groups. According to

the table all the studied groups generally reported low level scores related

to nurses’ access to work empowerment, power or autonomy. Difference

between scores was statistically significant (p<0.05).

The lowest scores in relation to all empowerment factors were

reported by staff nurses. However, physicians had their highest scores in

the two variables; job-related empowerment and power. Meanwhile, head

nurses had the highest scores (59.3) of autonomy.

physicians point of view denoting that nurses have more access to

both the work empowerment factors and power, than do nurses themselves

15

might reflect a lack of familiarity and clarity on the part of medical staff

with the extend of having these factors available to nurses.

Study findings suggest that head nurses perceive themselves as

having greater access to empowering factors than do staff nurses. It is

known that higher level in the hierarchy which head nurses possess provide

them with more power as well as, better chances for access to available

work empowerment factors (Kanter, 1993).

It is evident that the nursing and physicians groups perceived certain

factors as more empowering than others. For access to support in nurse’s

current jobs, both nursing and physicians groups rated it as the highest

empowering factors, followed by access to opportunities, then availability

of resources, while access to information was rated as the least empowering

factor.

Among items denoting access to support (table 2), majority of the

studied physicians, (96.6%) compared to slightly more than one half (53%)

of the staff nurses, reported that nurses are having the chance to work

closely with their direct bosses. Conversely, none of the staff nurses and

6.9% of the studied physicians agreed that the nurse was getting rewards

and recognition for well-done work.

Table (3) was concerned with opportunities as an empowerment

factor in nurses’ work. Findings revealed that the highest percentage of the

staff nurses and physicians (62.4% and 91.4%; respectively) agreed that the

nurse was having the chance to work closely with her direct supervisor.

The aforementioned result could be expected because more than one

half of the nursing subjects in the present study were employed in the

critical care units. Traditionally, critical care areas have offered nurses

16

excellent opportunities challenging work either in their contact with patient

or with the health team members. Moreover, nurses working in these units

have opportunities to learn new skills and knowledge.

As regards to availability of resources as an empowerment factor

(table 4), the percentages of agreement of staff nurses on availability

resources for wok were very low, with a maximum of 21.4% and minimum

of 0%. Physicians reported a higher agreement level; that was significantly

or high significantly different. Agreement related to availability of time for

nurses to accomplish required tasks was reported by majority (93.1%) of

physicians compared to about one fifth of the staff nurses.

On the same line, Raatikainen (1994) has emphasized that

unavailability of resources limits nurses’ capacity to work properly.

Besides, it could create problems among nurses and between nurses and

other members of the health team. It could also negatively affect patients’

perception of nurses as competent professionals. Therefore nurses cannot

perform their work effectively and efficiently without resources.

The lower access to information (table, 5) reported by studied nurses

and physicians groups could be attributed to lack of communication. On the

same line, Wilson and Laschinger (1994) mentioned that the place of staff

nurses at the bottom of the hierarchy could result in limited opportunities to

access communication channels available within the organization.

Table (6) demonstrates agreement related to items of formal power

available to nurses at work. As shown in the table the percentages of

agreement reported by staff nurses and physicians were very low. On one

hand, the item with the highest rate of agreement among staff nurses (41%)

and physicians (93.1%) was that related to the current hospital problems

17

affecting nurse’s job functions. On the other hand, none of the staff nurses

agreed that the nurse was getting incentives for extraordinary work. The

lowest agreement in the physician group was in relation to the item of

clarity of activities related to the nurse work in the hospital (1.7%).

Table (7) clarifies the agreement related to items of informal power

as reported by the studied nurses and physicians. The figures in the table

indicate that staff nurses had very low percentages of agreement about all

items, with exception of that related to “collaborating with physicians in

patient care”. The later, had the highest percent of agreement both among

staff nurses (81.2%) and physicians (98.3%). Meanwhile, the item of

having opportunity to increase nurse’s efficiency outside her unit was the

item with lowest agreement in the two groups. Only 0.9% of the staff

nurses and none of the physicians have agreed upon it.

According to table (11) low level of perceived nurses’ autonomy was

reported by both nurses and physicians. The highest percent of staff nurses

agreement was related to having control over the pace of her work, whereas

the highest percentage of studied physicians (70.7%) agreed that the nurse

was having the freedom to perform her job functions independently of her

supervisor. Alternatively, it was noticed that only 4.3% of the staff nurses

and none of the studied physicians agreed that the nurses’ job allows her to

make decisions on her own.

Moreover, the results show that the studied physicians had

statistically significantly higher percentage of agreement (p<0.05) on the

statements such as: “the nurse left on her own to accomplish her work’,

“the nurse having the freedom to perform her job functions independent of

her supervisor”, and “the nurses’ job allows her to express her opinions at

work”.

18

Recommendations

• Nurse managers must provide staff nurses by sources of job-related

empowerment, namely access to opportunities, information,

support and resources.

• Nurses should be allowed to participate in decision making to

empower them, as well as increasing their feeling of autonomy.

• Committees should be established to allow nurses to form new

relationships, learn new skills, and gain recognition by having the

opportunity to demonstrate their abilities.

• Increasing the level of nursing education may be another key to

boosting the level of autonomy perceived nurses.

19

References

• Baker, A.M. and Young, C.E. (1994): Transformational

Leadership: The Feminist Connection in Postmodern

Organizations. Holistic Nursing Practice. 9 (1) 16-25.

• Bruhn , J.G. and Chesney, A.P. (1995): Organizational Moles,

Information Control and the Acquisition of Power. Health Care

Supervisor. 14 (1) 24-31.

• Carbonu, D.M. and Soares, J.M. (1997): Forensic Nursing in

Pakistan Bridging the Gap between Victimized Women and

Health Care Delivery System. Journal of Psychology in Nursing.

35 (6) 19-26.

• Cassidy, V.R. and Koroll, C.J. 91994): Ethical Aspects of

Transformal Leadership. Holistic Nursing Practice. 9 (1) 41-47.

• Champan, J. (1993): Collegial Support Linked to Reduction Job

Stress. Nursing Management. 24 (5) 52-55.

• Chandler, G. (1991): Creating an Environment to Empower

Nurses. Nursing Management. 22 (8) 20-23.

• Coffey, M., and Coleman, M. (2001): The Relationship between

Support and Stress in Forensic Community Mental Health

Nursing. Journal of Advanced Nursing. 34 (3) 397-407.

• Dibert, C. and Goldenberg, D. (1995): Preceptor’s Perceptions of

Benefits, Reward, Support and Commitment to the Preceptor

Role. Journal of Advanced Nursing. 7 (21) 1144-1151.

20

• Dutcher, L.A. and Adam, C.E. (1994): Work Environment

Perception of Staff Nurses and Aids in Home Health Agencies.

Journal of Nursing Administration. 24 (10) 24-30.

• Farley, M.J. (1989): Assessing Communication in Organization.


• Fulton, Y. (1997): Nurses’ View of Empowerment; a Critical

Social Theory Perceptive. Journal of Advanced Nursing. 26:

529-534.

• Gillies, D.A. (1994): Nursing Management; A System Approach.

2nd. ed. Philadelphia. W.B. Saunders Co. PP. 119, 407.

• Hawks, H.J. (1992): Empowerment in Nursing Education;

Concept Analysis and Application to Philosophy, Learning and

Instruction. Journal of Advanced Nursing. 17 (5) 609-618.

• Huddleston, D. (1999): Empowerment in Nursing Staff for

Optimal Job Performance. Journal of Nursing Administration.

29 (12) 5-16.

• Kanter, R.M. (1993): In: Sabiston, J.A. and Laschinger, H.k.

(1995): Staff Nurse Work Empowerment and Perceived

Autonomy; Testing Kanter’s Theory of Structural Power in

Organizations. Journal of Nursing Administration. 25 (9) 42-50.

• Kanter, R.M. (1993): Men and Women of the Corporation. 2nd.

ed., New York: Basic Books. PP. 166-174.

• Laschinger, H.K. and Havens, D.S. (1996): Staff Nurse Work

Empowerment and Perceived Control Over Nursing Practice;

21

Conditions for Work Effectiveness. Journal of Nursing

Administration. 26 (9) 27-35.

• Laschinger, H.K., Wong, C., Macmahon, L. and Kaufmann, C.

(1999): Leader Behavior Impact on Staff Nurse Empowerment,

Job Tension, and Work Effectiveness. Journal of Nursing


• Lehmann, R.S. (1994): Nursing Management Desk Reference

Concepts; Skills and Strategies. Philadelphia. W.B. Saunders Co.

PP. 198-210.

• Longst, B.B. (1996): Health Professionals in Managements.

Philadelphia. A Simon and Schuler Co., P. 40.

• Marquis, B.L. and Huston, C.J. (2000): Leadership Roles and

Management Functions in Nursing; Theory and Application. 3rd

ed., Philadelphia. Lippincott Co., PP. 34, 139.

• Marsick, V.J. and Watkins, K.E. (1996): Adult Educators and

The Challenge of The Learning Organization. Adult Learning. 7

(4) 18.

• Mason, D.J., Backer, B.A. and Georges, C.A. (1991): Toward a

Feminist Model for Political Empowerment of Nurses Image.

Journal of Nurses Scholarship. 23 (2) 72-77.

• McParland, J., Scott, P.A., Arndt, M., Dassen, T., Gasull, M. and

Lemonidou, C. (2000): Autonomy and Clinical Practice; 1;

Identifying Areas of Concern. British Journal of Nursing. 9 (8)

507.

22

• Mintzberg, H. (1990): The Power in and Around Organizations.


• Rissel, C. (1994): Empowerment: The Holy Grail of Health

Promotion? Health Promotion International. 9 (1) 39-47.

• Rodwell, C.M. (1996): An Analysis of the Concept of

Empowerment. Journal of Advanced Nursing. 23:305-313.

• Sabiston, J.A. and Laschinger, H.K. (1995): Staff Nurse Work

Empowerment and Perceived Autonomy; Testing Kanter’s

Theory of Structural Power in Organizations. Journal of Nursing


• Schermerhorn, J.R. (1999): Management. 6th ed. New York.,

John Wiley and Sons Co., PP. 262-267.

• Skelton, R. (1994): Nursing and Empowerment; Concepts and

Strategies. Journal of Advanced Nursing. 19:415-423.

• Soeren, V.M., Anderusyszyn, M.A., Laschinger, H.K.,

Goldenberg, D., and Dicenso, A. (2000): Consortium Approach

for Nurse Practioner Education. Journal of Advanced Nursing.

32 (4) 825.

• Stichler, J.F. (1995): In: Hojat, M; Nasca, T.J.; Cohen, M.J. and

Fields, S.K. (2001): Attitudes toward Physicians-Nurse

Collaboration; A Cross-Cultural Study of Male and Female

Physicians and Nurses in the United States and Mexico. Nursing

Research. 50 (2) 123.

23

• Wiles, R., Postle, K., Steiner, A., and Walsh, B. (2001): Nurse-

Led Intermediate Care; An Opportunity to Develop Enhanced

Roles for Nurses? Journal of Advanced Nursing. 34 (6) 818.

24

Table (1): Scores Related to Empowerment Factors, Power, and Autonomy

as Reported Nursing and Physicians Groups in the Study.

Study Subjects

Staff

Nurses

(n=117)

Head

nurses

(n=17)

Physicians

(n=58)

Study

Variables

X +-- X S.D. X S.D

ANOVA p-value

Job related empowerment factors

Opportunities

Information

Support

Resources Total

Empowerment

36.3+13.9

26.6+12.2

38.6+14.7

35.4+10.6

33.5+9.5

47.1+13.9

33.5+11.7

52.8+ 12.5

42.2+10.4

44.3+10.1

56.5+11.4

52.8+ 8.0

59.7+12.0

56.0+9.6

56.5+8.46

46.6

108.9

47.7

77.5

114.3

<0.001*

<0.001*

<0.001*

<0.001*

<0.001*

Power

- Formal

- Informal

23.6+9.3

37.0+11.6

35.7+12.6

48.7+12.1

53.1+11.4

55.3+8.5

160.1

58.2

<0.001*

<0.001*

Autonomy 39.2+18.5 59.3+16.9 52.9+11.5 20.0 <0.001*

* Statistically significant at P<0.05

25

Table (2): Staff Nurses and Physicians Agreement Related to Items of

Support as an Empowerment Factor. Groups

Items of Support

Staff Nurses (n=117) No. %

Physicians (n=58) No. %

Chi- square

P-value

Having specific information that help her perform efficiently

43 36.8 26 44.8 1.06 >0.05

Having suggestions that could improve work

23 19.7 13 22.4 0.18 >0.05

Having helpful hints for solving some problems

7 6.0 17 29.3 17.83 >0.001*

Having information /suggestions about job potentials

16 13.7 12 20.7 1.42 >0.05

Demands for more training/education are acceptable

6 5.1 16 27.6 17.79 <0.001*

Finding help in case of job crisis 23 19.7 41 70.7 43.53 <0.001* Finding help in getting more people to get the job done

13 11.1 39 67.2 58.50 <0.001*

Finding help in getting materials / supplies needed to get job done

19 16.2 43 74.1 56.82 <0.001*

Having chance for obtaining support of direct boss

62 53.0 56 96.6 33.50 <0.001*

Getting rewards and recognition for well-done work

0 0.0 4 6.9

Fisher <0.01*


Agree: score of 60% or more Disagree: score of <60%

26


Opportunities as an Empowerment Factor.

Groups

Items of Opportunities

Staff

Nurses

(n=117)

No. %

Physicians

(n=58)

No. %

Chi-

square

P-value

Good competition with peers 28 23.9 31 53.4 15.12 <0.001*

Chance to gain new skills and

knowledge at work

51 43.6 39 67.2 8.68 <0.005*

Access to training programs for

new learning

7 6.0 8 13.8 Fischer >0.05

Chance to work closely with

direct boss

37 62.4 53 91.4 16.16 <0.001*

Chance to learn how the hospital

works

2 1.7 4 6.9 Fisher >0.05

Tasks that need all of her skills

and knowledge

31 26.5 34 58.6 17.14 <0.001*

Chance of promotion at work 8 6.8 12 20.7 7.35 <0.01*

Getting incentive for tasks

achieved efficiently

0 0.0 5 8.6 Fisher <0.005*



27


Resources as an Empowerment Factor. Groups

Items of Resources



Chi- square

P-value

Availability of supplies necessary for the job

23 19.7 35 60.3 28.97 <0.001*

Time available to do necessary paperwork

1o 8.5 19 32.8 16.44 <0.001*

Time available to accomplish required tasks

25 21.4 54 93.1 80.58 <0.001*

Acquiring temporary help when needed

21 17.9 25 43.1 12.66 <0.001*

Sharing in choosing rewards for her colleagues at work

0 0.0 2 3.4 Fisher >0.05

Getting rewards for a job well done

1 0.9 5 8.6 Fisher <0.05*

Unit decisions are influential in obtaining permanent manpower

12 10.3 24 41.4 22.99 <0.001*

Unit decisions are influential in obtaining supplies

17 14.5 40 69.0 52.32 <0.001*

Unit decisions are influential in obtaining special equipment

13 11.1 35 60.3 47.22 <0.001*



28


Nurses’ Information as an Empowerment Factor.

Groups

Items of Nurses’ Information

about

Staff

Nurses

(n=117)

No. %

Physicians

(n=58)

No. %

Chi-

square

P-value

The relation of the work of her

unit to the hospital

14 12.0 26 44.8 23.75 <0.001*

How nursing colleagues perform

their work

27 23.1 49 84.5 59.51 <0.001*

Goals of top management 3 2.6 0 0.0 Fisher >0.05

This year’s plan of her unit 5 4.3 1 1.7 Fisher >0.05

Salaries of work colleagues 16 13.7 41 70.7 57.39 <0.001*

Other departments’ opinions

about her unit

9 7.7 43 74.1 81.97 <0.001*

What patients think of the work

in her unit

36 30.8 51 87.9 50.68 <0.001*

Current hospital ambiance 1 0.9 12 20.7 Fischer <0.001*



29


Formal Power Available to Nurses at Work. Groups

Items of Formal Power



Chi- square

P-value

Available bylaws regulating activities and job functions

5 4.3 30 51.7 54.57 <0.001*

Having a well-defined routine to accomplish her job

24 20.5 27 46.6 12.73 <0.001*

Having variability in the tasks related to her job

21 17.9 31 53.4 23.40 <0.001*

Getting incentives for extraordinary work

0 0.0 9 15.5 Fisher <0.001*

Getting incentives for outstanding work

2 1.7 9 15.5 Fisher <0.001*

Having flexibility in her job 13 11.1 15 25.9 6.28 <0.01* Availability of approvals for non-routine decisions

4 3.4 17 29.3 24.62 <0.001*

Declaring of nurses’ job activities 3 2.6 8 13.8 Fisher <0,01* Current hospital problems affect her job functions

48 41.0 54 93.1 43.25 <0.001*

Participation in educational programs in the hospital

1 0.9 11 19.0 Fisher <0.001*

Participation in solving problems 2 1.7 25 43.1 50.92 <0.001*Clarity of activities related her work in the hospital

2 1.7 1 1.7 Fisher 1.00



30


Informal Power Available to Nurses at Work.

Groups

Items of Support

Staff

Nurses

(n=117)

No. %

Physicians

(n=58)

No. %

Chi-

square

P-value

Collaborating with physicians on

patient care

95 81.2 57 98.3 9.91 <0.005*

Receiving positive feedback from

physicians about her work

55 47.0 50 86.2 24.83 <0.001*

Asking physicians for patients’

information

40 34.2 47 81.0 34.04 <0.001*

Having physicians appreciation 23 19.7 36 62.1 31.21 <0.001*

Physician use her opinions 11 9.4 11 19.0 3.23 >0.05

Giving opinions about

administrative aspects to her

supervisor

10 8.5 29 50.5 38.47 <0.001*

Direct supervisor makes use of

her opinions

14 12.0 33 56.9 39.85 <0.001*

Knows early about changes in

unit work from direct supervisor

22 18.8 33 56.9 26.11 <0.001*

Opportunity to increase her

efficiency outside her unit

1 0.9 0 0.0 Fisher 1.00



31


Nurses Autonomy.

Groups

Items of Support

Staff

Nurses

(n=117)

No. %

Physicians

(n=58)

No. %

Chi-

square

P-value

Left on her own to accomplish

her work



“work empowerment as perceived by nurses and...

Documents