Valuing and empowering nurses


The March issue of the Journal of Nursing Management featured a paper by Faulkner and Laschinger entitled The effects of structural and psychological empowerment on perceived respect in acute care nurses. In it, they suggest that ‘many nurses feel they do not receive the respect they deserve in hospital settings’. They conclude that ‘nurse managers have the influence and resources to facilitate empowering work conditions that can increase nurses’ feelings of being respected’. The collection of papers in this issue provides diverse examples of where nurse managers can both empower nurses and identify aspects within the working environment that can be improved to enable nurses to feel more valued at work.

Recruitment to nursing and continuing employment once qualified is a choice to be made from an ever-increasing variety of occupations and careers worldwide. Recruits to the profession, still predominantly women, no longer have to choose from such limited career options as were available to our mothers and grandmothers. Those students entering nursing in the modern world, whether they are school/college leavers or mature entrants, have experienced educational opportunities and approaches which equip them to make deliberative choices for their future rather than following the well-beaten paths of their predecessors. These recruits, once qualified, are more discerning about the quality of their work environment and how they are valued within it; moreover, they are aware of opportunities for career change and redevelopment and not reluctant to avail themselves of this choice.

One good example of this trend is the development and visibility of nursing in middle-Eastern countries on the worldwide stage. I start this issue with three papers which consider: predictors of career commitment in Jordan (Mrayyan and Al-Faouri); voluntary turnover among nurses in Kuwaiti hospitals (Alotaibi); and job stress, recognition, performance and intention to stay in nursing in Jordan (Abualrub and Al-zaru). The last paper identifies a buffering effect of the recognition of nurses’ performance on both job stress and intention to stay in the job, and suggests that nurse managers focus on identifying and implementing strategies to recognize and acknowledge outstanding performance to improve retention. Alotaibi places responsibility for turnover rates in the hands of nurse managers, identifying the need for improved two-way communication with a commitment to listening to staff’s views; encouraging participation in decision-making; implementing logical grading systems and fair systems of financial rewards. Particular attention is drawn to the effect that abusive supervisors have on their staff, and a suggestion made that action to identify and remove them is crucial to staff morale. Finally, Mrayyan identifies the complex link between career commitment and job performance, suggesting that nurse managers focus on developing strategies for retention, staff development and quality of care in order to increase career commitment through increased job satisfaction.

The issues raised in the previous three papers are not new, and make regular appearances in the pages of this journal. What is new and significant perhaps is the emergence of these issues in countries where career opportunities for women have not been as diverse as in other parts of the world in the past, and that a voice is being given to nurses, as well as choice and control over this part of their lives. Nursing worldwide is dependent on the female workforce – issues of empowerment originating in middle eastern countries provide a clear sign that the present nursing shortage may reach catastrophic levels if steps are not taken, on a global scale, to ensure that career opportunities and working conditions are commensurate with alternative avenues of employment available to those having a choice of where to sell their labour.

Faulkner and Laschinger (2008) suggest that respect in the workplace is a key to nurses feeling empowered. One illustration of the notion of respect is the degree to which nurses feel involved in decision-making and respected for the contribution they can make. The next five papers provide clear examples of how involvement can be achieved in a diversity of settings. Hayman et al. suggest that empowerment, and self-empowerment, is essential for effective change to occur; where the change process involves all stakeholders and considers characteristics such as context, workload, the skills required and measures such as patient and staff satisfaction and health outcomes. Marchionni and Ritchie, and Van Krogh and Nåden both address the organizational and environmental factors that need to considered when implementing change, which include how transformational leadership and involving staff are key to success.

Yoshioka-Maeda, presenting a study that explored Japanese public health nurses’ strategies for assessing the feasibility of developing new services, demonstrates that nurses are empowered at grass-roots levels to directly impact on the services they provide. Moreover, they employ five main strategies to evaluate feasibility of new projects, suggesting that decision-making has been successfully devolved down to levels where services are designed to meet the needs of the local population. Finally, Liu, in a study of Taiwanese nurses, draws attention to the need for nurse managers to be aware of cultural and social influences on levels of participation in decision-making. He suggests that nurses with different cultural backgrounds have differing expectations and styles of engagement and that managers need to be creative in devising strategies to enable engagement from all nurses.

As a group, these five papers demonstrate that effective planning by nurse managers that considers how staff can be involved in the process, and how organizational, environmental and cultural considerations need to be factored into the process prior to introducing any sort of change are more likely to be successful in empowering the workforce and result in success. Five further papers explore nurses’ participation in research, research utilization and research capacity – another area where nurses can be further empowered to be involved in the decision-making about care and care delivery.

Planning for success also includes a consideration of factors that may inhibit change and interfere with empowerment. One of these is identified by St-Pierre and Holmes in their analysis of workplace violence. They suggest, from a Foucauldian perspective, that ‘power, surveillance and disciplinary techniques are used at all levels of hospital management to control and contain both human resources and costs’. They conclude that ‘by associating common workplace practices with institutional violence, employers who have a policy of zero tolerance towards workplace violence will need to re-examine their current ways of operating’. Another factor is identified by Rice et al. as ‘moral stress’ which negatively contributes to job satisfaction and staff retention.

The final paper by Kirk provides an evaluation of Nurse Executive Director effectiveness through a systematic literature review, drawing attention to the limited information available on which to base judgements but suggesting nevertheless that there are ‘sufficient recurring themes to inform current practice and to investigate in new research’. Nurse executive directors are an example of empowerment for nurses as ‘ubiquitous members of the leadership of healthcare organisations providing professional leadership to nursing and contributing more broadly to the senior leadership of all services’. It is worrying, however, that there is limited evidence on which to evaluate their success and that much of what is available is anecdotal and opinion.

Workplace empowerment is a complicated concept involving structural and psychological features as well as respect (Faulkner & Laschinger 2008). Workforce empowerment is critical in enabling able recruits and graduates to fulfil their potential as nurses, and for the system to retain their skills and expertise in a rapidly changing environment of healthcare. Without nurses’ empowerment, the future of the profession and its development as a significant influence on the world population’s health and wellbeing is in jeopardy.