chapter 5 | Organizations, Power, and Empowerment 65■Coercion.The threat of pain or of harm, which
may be physical, economic, or psychological
There is power at the bottom of the organizational
ladder as well as at the top. Patients also have
sources of power (Bradbury-Jones, Sambrook, &
Irvine, 2007). Various groups of people in a health-
care organization have different types of power
available to them:
■Managersare able to reward people with salary
increases, promotions, and recognition. They can
also cause economic or psychological pain for the
people who work for them, particularly through
their authority to evaluate and fire people but
also through their responsibility for making
assignments, allowing days off, and so on.
■Patients at first appear to be relatively powerless
within the health-care organization. However, if
patients refused to use the services of a particular
organization, that organization would eventually
cease to exist. Patients can reward health-care
workers by praising them to their supervisors.
They can also cause problems by complaining
about them.
■Assistants and techniciansmay also appear
to be relatively powerless because of their
low positions in the hierarchy. Imagine, how-
ever, how the work of the organization (e.g.,
hospital, nursing home) would be impeded
if all the nursing aides failed to appear one
morning.
■Nurseshave expert power and authority over
licensed practical nurses, aides, and other per-
sonnel by virtue of their position in the hierar-
chy. They are critical to the operation of most
health-care organizations and could cause
considerable trouble if they refused to work,
another source of nurse power.
Fralic (2000) offered a good example of the power of
information that nurses have always had: Florence
Nightingale showed very graphically in the 1800s
that wherever her nurses were, far fewer died, and
wherever they were not, many more died. Think
of the power of that information. Immediately,
people were saying, “What would you like, Miss
Nightingale? Would you like more money? Would
you like a school of nursing? What else can we do for
you?” She had solid data, she knew how to collect it,
and she knew how to interpret and distribute it in
terms of things that people valued (p. 340).
Empowering Nurses
This final section looks at several ways in which
nurses, either individually or collectively, can maxi-
mize their power and increase their feelings of
empowerment.
Poweris the actual or potential actual ability to
“recognize one’s will even against the resistance of
others,” according to Max Weber (quoted in
Mondros & Wilson, 1994, p. 5).Empowermentis a
psychological state, a feeling of competence, con-
trol, and entitlement. Given these definitions, it is
possible to be powerful and yet not feel empow-
ered.Power refers to ability, and empowerment
refers to feelings. Both are of importance to nurs-
ing leaders and managers.
Feeling empowered includes the following:
■Self-determination.Feeling free to decide how
to do your work
■Meaning.Caring about your work, enjoying it,
and taking it seriously
■Competence.Confidence in your ability to do
your work well
■Impact.Feeling that people listen to your ideas,
that you can make a difference (Spreitzer &
Quinn, 2001)
The following contribute to nurse empowerment:
■Decision-making.Control of nursing practice
within an organization
■Autonomy.Ability to act on the basis of one’s
knowledge and experience (Manojlovich, 2007)
■Manageable workload.Reasonable work assign-
ments
■Reward and recognition.Appreciation received
for a job well done
■Fairness.Consistent, equitable treatment of all
staff (Spence, Laschinger, & Finegan, 2005)The opposite of empowerment is disempower-
ment. Inability to control one’s own practice leads
to frustration and sometimes failure. Work over-
load and lack of meaning, recognition, or reward
produce emotional exhaustion and burnout
(Spence, Laschinger, & Finegan, 2005). Nurses,
like most people, want to have some power and to
feel empowered. They want to be heard, to be
recognized, to be valued, and to be respected.
They do not want to feel unimportant or
insignificant to society or to the organization in
which they work.