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Keywords:

  • empowerment;
  • leadership;
  • nursing;
  • rural

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

Aim

To provide insight into the perceptions of structural empowerment of nurse leaders working in rural and regional Victoria, Australia.

Background

Fostering nurse leadership in rural health services may be informed by gaining insight into rural nurse leaders' perceptions of structural empowerment.

Method

A sample of nurse executives (= 45) from hospitals throughout rural Victoria, Australia completed the Conditions of Work Effectiveness Questionnaire II (CWEQ-II) aimed to measure structural empowerment.

Results

Rural nurse leaders' perceive themselves to be moderately empowered.

Conclusion

The concept of structural empowerment may be useful to inform rural leadership practices.

Implications for nursing management

Acknowledgement of structural empowerment by nurse leaders may assist in the process of formulating strategies to facilitate an open, honest and responsive culture of patient safety, removing silos, departmental turf issues, and professional territoriality in healthcare services.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

Hierarchical structures and leadership techniques, which have traditionally dominated management practices, should be complemented with empowering leadership concepts such as participative management, self-leadership and employee empowerment (Dewettinck & van Ameijde 2011). By encompassing broader leadership concepts, nurse leaders may be better prepared to tackle the persistent internal problems of contemporary health care systems. The problems in the Australian context include role definition for doctors and nurses, inequities in health access and outcomes, variable levels of quality and safety, inequitable resource allocation, and technical inefficiencies, related to workforce composition and distribution (Duckett 2008, National Health & Hospitals Reform Commission (Australia) 2009). These issues resonate internationally as research focuses on quality of life improvement, health information services and health care consumption (Zhou & Tian 2011). These problems are further compounded in the rural context due to geographic isolation, extreme climatic conditions, an ageing population, socioeconomic and resource inequality, and major health workforce maldistribution (Smith et al. 2008).

Australia, like many other developed nations, has endured a prolonged and difficult health care reform process (Banks 2010). The focus on reform is in response to the growing burden of chronic disease, economic constraints that are dictating a downsi-zing of health care infrastructure, increasing use of advanced technologies in care delivery and increasing concerns about risk, quality and safety (Dignam et al. 2012: 65). The Australian rural health care system is characterized by a heavy reliance on the nursing workforce, with most rural health services essentially nurse led. Medical care is generally provided by on-call community based general practitioners (Kenny & Duckett 2004). Australian hospitals are extremely diverse in terms of ownership size and the range of services offered (Duckett & Willcox 2011: 185) however, it is publically funded hospitals that continue to delivery the majority of care. While hospital capacity has declined with a reduction in available beds, rates of hospital utilization have increased driven by changes such as the impact of technology on reducing length of stay (Duckett & Willcox 2011: 185). The release of the first National Primary Health Care Strategy (Duckett & Willcox 2011) suggests that a shift in the foundation of the Australian health care system is imminent. In this context, nurse leaders must be responsive to localized issues and outwardly focused on the broader issues of the health care system.

Overview of the literature

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

Working in a context of high pressure, rapid change and uncertainty, Australian nurse leaders face exceptional challenges on a daily basis (Dignam et al. 2012: 69). The ability to contribute to policy development, manage a workforce with varying skill mix, maintain clinical currency and understand the culture of the wider rural community are significant in the role of nurse leaders in the provision of health care in rural and remote areas (Mills et al. 2010). The preparedness of nurses to deal with increasingly complex roles is supported by the move to university based education and the continuing refinement of curricula (Duckett & Willcox 2011: 98). Australian researchers (Mills et al. 2010) have suggested that the ability of nurse leaders to respond to the challenges of the rural context may be dependent on their perceptions of their own power, level of job satisfaction and perceived ability to drive change.

Kanter's (1977) seminal work on structural empowerment has applicability to Australian rural nurse leaders. Researchers have drawn on Kanter's theory and argued that the structure of the work environment and perceived access to power and opportunity has a direct impact on people's attitudes and behaviours in the workplace (Faulkner & Laschinger 2008, Hauck et al. 2011). For nurse leaders, opportunity to access empowerment structures such as resources, information and support, facilitates growth and development, and ensures power acquisition. This leads to flexible, creative, visible professionals capable of managing and responding to complex and unstable environments and creating work settings where empowerment is evident at all levels of the organisation (Stewart et al. 2010). Creating an environment where there are high levels of structural empowerment at all levels is important as numerous studies have demonstrated the link with work and cost effectiveness (Stewart et al. 2010), psychological well being, workforce retention, patient satisfaction (Donahue et al. 2008) and quality nursing care (Matheson & Bobay 2007, Bradbury-Jones et al. 2008).

While there is a growing body of research on rural nursing in Australia and internationally (Molinari & Monserud 2009, Mills et al. 2010), studies focusing on nurse leadership in the rural context have attracted less interest. Much of the research on nurse leadership development has been undertaken in urban hospitals (Krebs et al. 2008), where contextual differences limit its transferability and applicability. As researchers, we are interested in the development of rural nurse leaders as responsive change agents, with the capacity to empower their workforce. We argue that understanding rural nurse leaders' own levels of structural empowerment is an important first step. Hence, this study is focused on measuring nurse leaders' perceptions of access to structural empowerment in the Australian rural context.

Conceptual framework

Kanter's theory (1977) of organisational behaviour has been used to guide this study. Based on a five year study at a large industrial corporation, Kanter's (1993) position regarding the origin of empowerment is that it begins from three separate sources; formal power, informal power and access to particular organisational structures. Formal power exists in visible positions that are central to the organisation's goals and that cater for employee flexibility (Kanter 1993). Informal power can be identified by looking at the various alliances an individual has with superiors, peers and subordinates within the organisation and cross-functional groups both within and outside the organisation (Kanter 1993). The organisational empowerment structures described by Kanter include: access to information, support, resources needed to do the job and opportunities to learn and grow. Access to information refers to an employee being equipped with the knowledge of organisational decisions, policies and goals as well as data, technical knowledge and expertise required to be effective within the broader context of the organisation. Access to support includes feedback and guidance received from superiors, peers and subordinates. This may consist of emotional support, helpful advice, or hands-on assistance. Access to resources refers to the capacity of an individual to access materials, money, supplies, time and equipment to achieve organisational goals. The opportunity for mobility and growth for an individual entails access to challenges, rewards and professional development opportunities to increase knowledge and skills.

Research using Kanter's theory as a conceptual framework has supported the development of a knowledge base regarding work structures that empower nurses (Hauck et al. 2011). Several nursing studies (Manojlovich & Laschinger 2007, Matheson & Bobay 2007, Bradbury-Jones et al. 2008, Laschinger et al. 2008) have linked Kanter's concept of empowerment to important organisational outcomes such as job autonomy, participation in organisational decision making, perceived control over nursing practice, job satisfaction and lower levels of burnout. Kanter (1977) argues that conditions for work effectiveness must be created that ensure employees have access to the supports necessary to accomplish their work, including information, resources and ongoing opportunities for personal development. As a consequence of higher levels of empowerment, employees experience positive feelings about their work and are more effective in meeting organisational goals (Baird & Wang 2010).

Nurse leadership supported by structural empowerment

Having attracted much interest within international literature (Avey et al. 2008, Alimo-Metcalfe 2010, Baird & Wang 2010), the concept of empowerment has been referenced in a wide variety of contexts and disciplines including sociology, social work, nursing, psychology and political science (Aujoulat et al. 2007). With a tendency to be studied separately, two distinct perspectives on empowerment, structural and psychological have evolved. Structural empowerment refers to organisational policies, practices and structures that provide organisational leaders with a greater degree of latitude to make decisions and exert influence. This construct relates to the notion of power sharing between employers and their employees (Greasley et al. 2007: 41). Emerging as a popular managerial rhetoric, structural empowerment is described as a socio-structural phenomenon, that focuses on a set of organisational policies and practices initiated by management, with the goal of addressing conditions that foster the development of power, and support the delegation of decision making authority and responsibility through the organisational hierarchy (Biron & Bamberger 2010: 165). This description of structural empowerment provides the context for this investigation.

The relationship between structural empowerment and key nursing issues has been explored through research focusing on job satisfaction, respect (Faulkner & Laschinger 2008), organisational commitment (DeCicco et al. 2006) and staff turnover (Hauck et al. 2011). Structurally empowering work environments are a likely outcome of leadership practices that foster employees' respect and trust (Laschinger & Finegan 2005b).

Structurally empowered rural nurse leaders are important in driving change within their own organisations and contributing to broader health reform. They must be capable of leading and developing an open, honest and responsive culture that supports quality and safe patient care, multidisciplinary and interprofessional practice, more equitable resource allocation, and retention of a highly skilled and professional workforce. These achievements are consistent with Australia's health reform agenda (National Health and Hospitals Reform Commission (Australia) (2009). Given that greater collective organisational empowerment and improved organisational success are a logical result of empowering leadership practices (Faulkner & Laschinger 2008) the aim of this study was to identify rural nurse leaders' perceptions of their own structural empowerment.

Method

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

Research design

The study utilized a descriptive, non experimental design, with the administration of the Conditions of Work Effectiveness Questionnaire II (CWEQ-II) to a sample of 45 nurse leaders in rural Victoria, Australia.

Setting and sample

The study was conducted in rural Victoria, Australia. For the purposes of this study, rural was defined as areas outside a metropolitan city and rural nurse leaders were at Director of Nursing or equivalent level. After approval for the study was attained from the La Trobe University Ethics Committee, an e-mail was sent to all rural Victorian hospitals (= 75) with a link to the online questionnaire. This was a convenience sample as it was sent to all Directors of Nursing in the rural regions of the state of Victoria. The response rate was 60%, with 45 surveys completed from 45 health services.

Instrument: the Conditions of Work Effectiveness Questionnaire II (CWEQ-II)

Developed by Laschinger, Finegan, Shamian and Wilk in 2001, the CWEQ-II is designed to specifically measure perceptions of access to structural empowerment. Used in international nursing research (Laschinger et al. 2001, 2007, Laschinger & Finegan 2005a), the self-administered instrument has been used primarily within urban hospital settings, but has been applied in other health care services (Krebs et al. 2008).

The questionnaire is a validated tool that consists of 19 items that measure the six components of structural empowerment and a 2-item global empowerment scale which is used for construct validation purposes. Items are rated on five-point Likert scale (1 = none, 5 = a lot) measuring structural empowerment through rural nurse leaders' perceptions of access to opportunity, information, support and resources. The job activities scale is a three item sub scale to measure formal power. The organisational relationship scale is a four item measure of informal power. Items on each of the six subscales are summed and averaged to provide a score for each subscale ranging from 1 to 5. The scores of the six subscales are then summed to create the total empowerment score (score range: 6–30). Higher scores represent higher perceptions of empowerment. The two-item global empowerment scale is not included in the structural empowerment score. The correlation between this score and the total structural empowerment score provides evidence of construct validity for the structural empowerment measure (Laschinger et al. 2007). In a previous study the CWEQ-II has a high correlation with the global measurement of empowerment (= 0.56), demonstrating additional evidence of construct validity (Hauck et al. 2011). The Cronbach alpha reliabilities for the instrument in previous studies have been reported as 0.79 to 0.89 (Krebs et al. 2008, Casey et al. 2010).

Data collection

Nurse leaders were invited to participate in the study via e-mail in March 2011. The main text of the e-mail provided the background, aims of the investigation, potential risks, withdrawal, confidentiality, the use of data and correspondence details should they require further information. A link was provided to the web based questionnaire, hosted by Survey Monkey, a site that uses advanced technology for Internet security through server authentication and data encryption. The rationale for an online questionnaire was based on the practical advantages of wide geographic coverage, effective data inputting, reduced turnaround times and cost saving (Denscombe 2009).

Control over the presentation of the survey questions was important to maximize the ease of use for respondents. Survey Monkey design features were used to present the questionnaire in a manner that was aligned as closely as possible with the original CWEQ-II format. Each question was presented with a rating scale that had five options. Parameters were set for participants to only provide one answer per question. Clear headings were used to alert respondents to the three sections of the questionnaire; four scales referring to Kanter's empowerment structures, two subscales; job activities scale (JAS) and the organisational relationships scale (ORS) and the two-item global empowerment subscale. It was expected that the questionnaire could be completed in approximately 7 minutes.

In accordance with the ethics application, the survey was programmed for anonymous collection. To ensure ample time was offered to access the questionnaire, it was left open for 6 weeks, and was available 24 hours a day, 7 days a week. The online program (Survey Monkey) automatically collates responses to provide an up to date response summary throughout the data collection timeframe. The capabilities of the software enabled the response rate and current analysis of results to be tracked in real time.

Data analysis

Data analysis may range from analyses encompassing very simplistic summary statistics to extremely complex multivariate analyses (Garfield & Ben-Zvi 2008). In this study descriptive statistical methods were used to describe the basic features of the data. It was deemed appropriate in accordance with the goal of the questionnaire to provide information that will further the understanding of rural nurse leader's perceptions of structural empowerment.

Data were extracted from Survey Monkey and descriptively analysed using the Statistical Package for Social Sciences (spss®) Windows version 19, IBM© NSW Australia 2010. The data were regarded as ordinal data, as the focus was on the frequency of responses that fell into each ordered rank of the scale (Polgar & Thomas 2008: 144). A description was created from the data set using the mean and standard deviation. Descriptive statistics do not allow for conclusions to be made beyond the data analysed or to reach conclusions regarding any hypotheses made (Polgar & Thomas 2008) but were deemed appropriate for the purposes of this study.

Consistent with the Conditions of Work Effectiveness Questionnaire II (CWEQ-II), the cohorts' level of structural empowerment was identified as low, moderate or high by using the score ranges (Laschinger 2010) identified in Table 1.

Table 1. Total structural empowerment scale
Score levelEmpowerment level
6–13Low
14–22Moderate
23–30High

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

The questionnaire was distributed to 75 services, with 45 questionnaires completed, resulting in a 60% response rate. All people who commenced the survey responded to every question providing a 100% completion rate. The mean total structural empowerment score for Victorian rural nurse leaders who completed the survey was 20.5. The score represents the perception of structural empowerment by the participants as moderate. As the questionnaire uses Likert scales, calculation and reporting of Cronbach alpha coefficient for internal consistency reliability was a priority. The Cronbach α, a coefficient for internal consistency reliability for the total CWEQ-II in this study was 0.88. For each of the subscales: opportunity α  =  0.87, information α  =  0.90, support α  =  0.84, resources α  =  0.76, formal power α  =  0.82 and informal power α  = 0.81. Alpha reliabilities are presented in Table 2 in direct comparison with recent American research using the CWEQ-II that identified nurse managers' structural empowerment, overall job satisfaction and intention to stay in their current position (Ellis 2011).

Table 2. Comparison of Cronbach's alpha with previous structural empowerment research
InstrumentThis studyEllis (2011)
  1. CWEQ-II, conditions of work effectiveness questionnaire-II; JAS, job activities scale; ORS, organisational relationship scale.

CWEQ-II (total score)0.880.88
Opportunity0.870.80
Information0.900.90
Support0.840.94
Resources0.760.86
Formal Power (JAS)0.820.73
Informal Power (ORS)0.810.79

The two subscales that measure Kanter's formal (job activities scale, JAS) and informal power (organisational relationships scale, ORS) have been included in the presentation of findings (see Table 3). To demonstrate the relevance of this study's findings, the mean and standard deviation have been presented with examples from previous research that has used the CWEQ-II; the first focusing on the rural nurse work environment and structural empowerment (Krebs et al. 2008), the second focusing on perceptions of nursing staff empowerment (Greco et al. 2006). The total score for structural empowerment in this study (mean 20.5, SD 3.41) is higher than both studies. A recent study (Hauck et al. 2011) that used the CWEQ-II has been included to provide additional comparison. Interestingly, the total empowerment mean of this investigation and the work of Hauck and colleagues is the same. A study undertaken with Canadian senior nurse leaders (Laschinger et al. 2008), where the total empowerment score mean (24.08) and standard deviation (2.91), rates higher than this study's findings. A possible reason for the decline in perception of empowerment by senior nurse leaders in a 4 year time frame may be due to the increase in expectation of performance in a difficult environment.

Table 3. Comparison of means and standard deviations with previous research
InstrumentThis studyRural study (Krebs et al. 2008)Nursing staff study (Greco et al. 2006)Recent study using CWEQ-II
MSDMSDMSDMSD
  1. M, mean; SD, standard deviation; CWEQ-II, conditions of work effectiveness questionnaire-II; JAS, job activities scale; ORS, organisational relationship scale.

CWEQ-II (total score)20.53.4118.332.9918.433.4120.513.04
Opportunity3.880.753.930.823.980.814.170.78
Information3.950.842.800.882.940.873.250.77
Support3.460.812.770.652.700.923.310.78
Resources2.920.792.780.792.880.773.080.74
Formal power (JAS)3.370.852.770.752.490.852.970.65
Informal power (ORS)3.280.723.280.803.490.703.700.72

The respondents reported the lowest scores regarding the resources (mean 2.92, SD 0.97) and the highest scores regarding the information (mean 3.95, SD 0.84). The scores regarding opportunity (mean 3.88, SD 0.75) were lower in relation to the comparative studies used (see Table 3). The scores regarding support (mean 3.46, SD 0.81) were higher than the comparative studies.

The data from the two item global empowerment scale were combined and averaged to provide a mean score of 3.72. The global empowerment scale correlated strongly with the total empowerment score (= 0.61), providing evidence of the construct validity of the CWEQ-II.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

The results of this study identified Victorian rural nurse leaders' level of structural empowerment as moderate. This is an important finding, given the suggestion that excellence in nursing care will only happen by ensuring that nurse leaders are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice (McSherry et al. 2012: 7). The findings revealed that rural nurse leaders feel they have sufficient access to information (mean 3.95, SD 0.84), rating this highest in the subscales. In comparison with other studies (see Table 3) this result is significantly higher. This may be related to the seniority of a rural nurse leader within their organisation that demands they are knowledgeable across practice and management areas. The use and ability to translate the acquisition of information into actions may, however, be thwarted by rural nurse leaders' perceived limited access to resources (mean 2.92, SD 0.97) evidenced by the lowest score on the subscales. This perception may be generated from the inevitability of specialist services needing to be concentrated to achieve economies of scale and expertise only being available in limited tertiary hospitals (Duckett & Willcox 2011: 302).

The need for strong rural nursing leadership is crucial given the scrutiny that the nursing profession has faced in Victoria with recent industrial action. Not only is nursing a profession that operates in an environment that traditionally lacks power, but the ongoing state of crisis in hospital funding that seems to transcend whichever government is in power, has arguably intensified Australian communities' perception of powerlessness. It is noteworthy that the data from this study do not reflect the difficulty that nursing has historically had in achieving recognition as a profession (Clarke 2008), as rural nurse leaders' perceptions of their own level of formal power (mean 3.37, SD 0.85) is considerably higher when compared with other studies (refer to Table 3). This is not the case when considering the respondents' perception of informal power (mean 3.28, SD 0.72) as it is lower in comparison with other studies. This finding is interesting as rural nurses are known to use insider knowledge of the communities they live and work in to provide tailored care (Barber 2007: 23). Exploration into the rationale behind such results is warranted and is important for the promotion of nursing as a progressive, engaged profession that is capable of effecting positive change. The mechanisms to build formal and informal power may then be developed specific to the rural nursing context.

Recognition exists for the need for self aware, effective empowering nurse leaders who can adopt a multi-agency approach to improving health care service delivery (Janes & Mullan 2007). It has been suggested that in service orientated organisations a selective approach to using structural empowerment may allow managers to enhance individual task performance without sacrificing either operational efficiency or individual well-being (Biron & Bamberger 2010), however, this statement does not recognize what the manager's perception of structural empowerment may be. The profile of Victorian rural nurse leaders' having a moderate level of empowerment is intrinsic knowledge that must inform the formulation of strategies and recommendations used to foster nurse leadership in rural health services. Further development of the capacity of rural nurse leadership is warranted as there are unique leadership challenges existing in the rural setting including: working in an isolated environment with limited peer support, working within small communities that may be highly politicized, leading teams across a distance where subordinate staff may be geographically separated and managing a ‘fly in fly out’ workforce (Crethar et al. 2011: 316). Strategies that may build the leadership capacity to address such challenges are available. Participation in workshops such as those offered in ‘The Better Workplaces Leadership Development Program’, utilized by Queensland Health; personal leadership qualities, coaching skills for leaders, energizing from conflict combined with accessing executive coaching and undertaking 360-degree feedback (Crethar et al. 2011: 316), may extend leadership capacity whilst reiterating the need for leaders to have a clear understanding of their level of structural empowerment.

Effective leadership is regarded as essential in contemporary health systems as evidenced by research in Australia (Garling 2007, Bennet 2009), New Zealand (Marinelli-Poole et al. 2011), Scotland (Edmonstone 2011), Sweden (Grill et al. 2011), and the USA (Borkowski et al. 2011) identifying the need for purposeful education for leadership in nursing. The content of educational programmes must be informed by an understanding of the skills and capabilities required of nurse leaders to ensure that educational initiatives foster and support the acquisition of these skills (Dignam et al. 2012: 69). The results of this study suggest that a greater understanding of the components of structural empowerment: opportunity, information, support and resources is required and through inclusion into formalized professional development offerings may positively impact on rural nurse leaders' performance. This impact may extend to the recruitment and retention of rural nurse leaders and in doing so promote stability in the rural nursing workforce and inform succession planning at a health service level.

Limitations of the study

Limiting the study to one Australian state resulted in a small sample size (= 45). Not requesting respondents' background variable data impacted on the findings as there was no opportunity to establish if the respondents' background variable data were associated with their perception of empowerment. Potential weaknesses with online questionnaires were acknowledged; perception as junk mail, respondents lack of online experience/expertise, impersonal and a potential for a low response rate (Evans & Mathur 2005: 197), but outweighed by the positives that accompany the process.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

The findings of this study extend the findings of earlier field investigations using a structural empowerment approach by indicating rural nurse leaders' perception of having a moderate level of empowerment, sufficient access to information and a perceived high level of formal power. The study confirms the need for robust theory development to support and promote viable nursing leadership for the future (Cummings et al. 2008). Additional research is necessary to develop knowledge that will effectively underpin strategies to inform the leadership practices of rural nurse leaders. Research that focuses on the concepts of structural empowerment: access to opportunity, information, support, resources, formal and informal power may provide specific results that may inform leadership practices. Cultivating nurse leadership requires the development of a broad skill set that extends beyond traditional hierarchical leadership structures and techniques. Structural empowerment may be a tool for rural nurse leaders to use selectively to equip nurses to continue to aim to deliver a high quality of patient care in rural health services and advocate for rural communities to be adequately resourced.

Implications for nursing management

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

If rural nurse leaders understand the value of structural empowerment, potential exists for the benefits of its application to filter through all levels of an organisation. This may assist with the process of formulating strategies to facilitate an open, honest and responsive culture of patient safety, removing silos, departmental turf issues and professional territoriality in health care services.

With a wider perspective, rural nurse leaders need to develop and refine their current capacity to represent the needs of smaller, geographically isolated health services through engaging in active lobbying across professional bodies, industrial bodies and in the political arena. The benefits that rural nurse leaders may have from having an understanding of the concept of structural empowerment are plentiful. Opportunity exists to draw on the six components as tools to enhance their ability to represent rural nursing in activities occurring at regional, state and national level. Adopting an approach informed by structural empowerment may see rural nurse leaders equipped with a greater sense of capability to participate in health reform and a greater preparedness to lead rural nursing in the future.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References

The authors would like to thank Heather Laschinger for granting permission for the use of the CWEQ-II tool and the participants for their contribution and support of nursing research.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Overview of the literature
  5. Method
  6. Results
  7. Discussion
  8. Conclusion
  9. Implications for nursing management
  10. Acknowledgements
  11. Sources of funding
  12. Ethical approval
  13. References
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