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Empowerment for the ophthalmic nurse
Empowerment
for the ophthalmic
nurse
Frances Annand,
Se/f-empowerment
is the means by which nurses can take
charge of their own professional determine
nursing’s
organizations, cooperation toward
development
future. Becoming
taking
political
action,
of health care consumers
this goal that can be attained
achieves personal
RN, MEd, CACS
power
through
involved
and help in nursing
and enlisting
the
are major steps when a nurse
personal
growth.
(Insight
7996;21:89-97) ursing as a profession has undergone many changes. It has traversed the spectrum from being purely technical to N being a professional practice. Nursing now harmoniously blends scientific principles with human behavioral responses into a holistic approach to high-quality patient care. Despite this advancement, nurses are still fighting the image of handmaiden passed down to them from their Victorian predecessors. Today’s ophthalmic nurses are especially frustrated with their lack of autonomy and fearful that the changes in health care and the shrinking work force could result in even less defined roles and increased use of unlicensed assistive personnel and ophthalmic technicians. It is true that a tightened economy could hinder nursing’s goal for professionalism and autonomy. However, this pressure could be the driving force that assists nurses to take charge of their professional development and empowerment. Two hundred twenty-eight nurses participated in a 1993 study conducted by Hospitals and Health Networks and Premier Hospitals Alliance of Illinois.’ Nurses responding to the survey indicated a belief that they will be leaders in nearly every aspect of patient care. Most important, they will be the leaders in the coordination of care delivery. Nurses will become INSIGHT
The Journal
of the American
increasingly accountable for cost containment and are in the best position to move patients through a cumbersome health care system in a high-quality and costeffective manner. These times require nurses to identify the responsibilities that are unique to nursing. This can be done through individual and collective efforts of selfempowerment. To understand empowerment we must first understand the concept of power. According to Madden and Manthey,z there are different types of power. The first is positional power, which carries with it three other forms of power: reward, coercive, and legitimate power. The second type of power is the one most applicable to empowerment of nurses, that is, personal power or the ability to influence other people. With this type of power come five other forms: l Expert power-based on knowledge, skill, expertise, and a person’s ability to express himself or herself in a way that achieves a professional recognition l Referent power-based on the ability to display traits that are valued and that inspire trust l Information power-based on reporting accurately, being informed, and being approachable l Withdrawal power-based on withholding support and predications of obstacles
Society of Ophthalmic
Registered Nurses, Inc.
Volume
Frances Annand is director of nursing education at the Massachusetts Eye and Ear Infirmary, Boston. She has been a member of ASORN since 7 992.
Reprint requests: Frances Annand, RN, MEd, CAGS, Director of Nursing Education, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 027 74. Copyright 0 7 996 by the American Society of Ophthalmic Registered Nurses.
7060- 735X/96 SS.00 + 0 72/l/73982
XXI, No. 3, September
1996
89
Annand Sabotage power-based on destroying, undermining, or discrediting others I believe that personal powerlessness has sometimes led nurses to exert the latter two types of power. The type of power that has most affected nursing is gender related. Women have dominated the profession of nursing but have felt powerless in a society that is male dominated. Nurses have always felt the need to do battle. Unfortunately, the enemies have often been other nurses. There has often been dissent, complaining, and infighting. The feeling of powerlessness resulted in frustration, which nurses often focused on each other.3 l
Key points in empowerment nurse
for the ophthalmic
l
Participate actively in practice issues
l
Avoid negativism
l
Enhance documentation to clearly demonstrate what nursing’s role is
l
Attend courses and professional workshops
l
Develop standards of care and teaching
l
Mentor and support colleagues
l
Believe in yourself
It is time to acknowledge and deal with feelings of powerlessness and direct frustrations toward the positive aim of selfempowerment. Nurses must overcome the image of them depicted in soap operas and movies. They must work toward achieving the reputation of competent, knowledgeable professionals. If nurses are to achieve this status they must abolish negative and disinterested attitudes, take an organized approach, and direct future courses of action. Nurses must stop allowing others to determine nursing’s future. One of the first steps to take is an active involvement in alumni and other nursing organizations. Nurses must take a proactive role in determining the educational requirements necessary 90
Volume
XXI, No. 3, September
1996
INSIGHT
The journal
for a beginning practitioner. No longer can they accept the present wide range of educational preparation. It has led to unclear expectation of practices.4 The next step is even more difficult because it involves accomplishing this by becoming politically active, not only in places of employment but statewide and nationally. Kalisch” states that nurses have typically been apolitical. She further states that the critical challenge facing nursing will be to build a sound resource and power base on which to move the profession forward. Ever since the beginning of the profession, the absence of such a base has been the most crucially limiting force in nursing’s march toward achieving its potential. It is absolutely essential that nurses become considerably involved in the political arena. If these tasks sound overwhelming, take heart! Nursing has allies, who will assist willingly. They are your patients. Now is the time to align with the consumer. They are no longer captives in a world they do not understand. A heightened awareness has precipitated demands for high-quality care. Consumers have always believed that nurses care. Help them now to recognize the scientific knowledge and clinical expertise that you possess. Nurses coordinate care, and the consumer must be assisted to recognize that, because of this, nurses are the sole provider of services that are indispensable to society. There must be a day-to-day effort that demonstrates clearly to all what the nurse’s role is. Covey’9 definition of power reaffirms the fact that achieving empowerment requires the cooperation and acceptance of others. He states that power should enable people to act far beyond their own resources, encouraging highly developed levels of interdependence. They become self-aware, knowledgeable, proactive individuals, unrestricted by attitudes, behaviors, or actions of others, with the ability to capitalize on their own abilities and assets and those of others-finding an interdependent freedom.” Keiffer’ concurs and defines empowerment as the achievement of a multidimensional participatory competence. This concept is important to nursing because it is
of the American
Society of Ophthalmic
Registered Nurses, Inc.
Annand impossible for nurses to provide highquality care on their own. They must work with patients and other health care disciplines in a collaborative effort toward providing care with built-in quality. This result can occur only through understanding differences, problem solving, unifying thinking, and a high level of interdependence. Nurses must continuously keep in mind that power is necessary to obtain professional goals and work towards selfempowerment. The following steps to self-empowerment can help. They are not all-inclusive and can be modified by your own individuality and creativity. Give yourself the gift of power: . Actively involve yourself in issues that
affect entry-level preparation and practice (including legislation) . Participate in research unique to the concerns of nursing . Align professionally with colleagues . View yourself and your colleagues as strong and powerful with the ability to work together toward a common goal . Exhibit flexibility . Embrace change . Avoid participation in negative discussions with coworkers . Build alternatives to either/or situations that are not acceptable . Practice win-win negotiation . Look for more than the easy answers . Use abilities to the fullest . Do things when you would rather not . Be a positive role model for others . Support nursing . Instill confidence and trust . Cross-train, broaden the scientific knowledge base, acquire new knowledge surrounding practice . Protect yourself and your practice by being the best you can be . Assume responsibility and accountability . Function on values . Act with integrityZ,‘-‘” According to Hersey and Duldt,” the opposite of empowerment-powerlessness-is unacceptable. It means to be without choice, influence, and accountability. It means merely reacting to events.
INSIGHT
Nurses have functioned too long in an environment where they are not empowered to control their practices. Conflict has followed, and fuzzy lines of authority, accountability, and power can block the effective delivery of nursing care. A major problem for patients, nursing, and society can be the result.lz I agree with Carl Rogers that power is a personal attribute, which through humanistic approaches can be expanded upon. Empowerment is resultant of personal power, which arises from personal growth. For a person to remain empowered, power must be earned every day. It can be measured by the extent to which a person gains the confidence and respect of others and his or her ability to generate cohesiveness and commitment among patients and colleagues. Empowered nurses are self-actualized. They do not practice excellent nursing because of positive rewards from others, but rather because it is what they stand for and believe in. Empowerment for nurses can only occur and be maintained if nurses capitalize on their inherent personal power and accept the responsibility within it. References 1. Sherer JL. Next steps for nursing. Hosp Health Netw 1993;67(16):26-8. 2. Madden JJ, Manthey M. Manual for nurse managers. Minneapolis: Creative Nursing Management, 1987. 3. Parker B, McFarlane J. Feminist theory and nursing: an empowerment model for research. ANS 1991;13(3):59-67. 4. Leddy S, Pepper JM. Conceptual bases of professional nursing. Philadelphia: JB Lippincott, 1989. 5. Kalisch BJ. The promise of power. In: Hein EC, Nicholson MJ, editors. Contemporary leadership behavior: selected readings. Boston: Little, Brown, 1982:172-3. 6. Covey SR. The 7 habits of highly effective people. New York: Simon &r Schuster, 1990. 7. Keiffer CH. Citizen empowerment, a developmental perspective. Prevention in Human Services 1984;3:201-26. 8. Gilbert T. Nursing: empowerment and the problem of power. J Adv Nurs 1995;21:865-71. 9. Roatikainen R. Power or the lack of it in nursing care. J Adv Nurs 1994;19:424-32. 10. Shelton R. Nursing and empowerment: concepts and strategies. J Adv Nurs 1994;19:415-23. 11. Hersey P, Duldt BW. Situational leadership in nursing. Norwalk (CT): Appleton & Lange, 1989. 12. Moss MT. Perioperative nursing in the managed care era. Nurs Econ 199.5;13:112-4.
The Journal of the American Society of Ophthalmic
Registered Nurses, Inc.
Volume XXI, No. 3, September 1996
91
for the ophthalmic
nurse
Frances Annand,
Se/f-empowerment
is the means by which nurses can take
charge of their own professional determine
nursing’s
organizations, cooperation toward
development
future. Becoming
taking
political
action,
of health care consumers
this goal that can be attained
achieves personal
RN, MEd, CACS
power
through
involved
and help in nursing
and enlisting
the
are major steps when a nurse
personal
growth.
(Insight
7996;21:89-97) ursing as a profession has undergone many changes. It has traversed the spectrum from being purely technical to N being a professional practice. Nursing now harmoniously blends scientific principles with human behavioral responses into a holistic approach to high-quality patient care. Despite this advancement, nurses are still fighting the image of handmaiden passed down to them from their Victorian predecessors. Today’s ophthalmic nurses are especially frustrated with their lack of autonomy and fearful that the changes in health care and the shrinking work force could result in even less defined roles and increased use of unlicensed assistive personnel and ophthalmic technicians. It is true that a tightened economy could hinder nursing’s goal for professionalism and autonomy. However, this pressure could be the driving force that assists nurses to take charge of their professional development and empowerment. Two hundred twenty-eight nurses participated in a 1993 study conducted by Hospitals and Health Networks and Premier Hospitals Alliance of Illinois.’ Nurses responding to the survey indicated a belief that they will be leaders in nearly every aspect of patient care. Most important, they will be the leaders in the coordination of care delivery. Nurses will become INSIGHT
The Journal
of the American
increasingly accountable for cost containment and are in the best position to move patients through a cumbersome health care system in a high-quality and costeffective manner. These times require nurses to identify the responsibilities that are unique to nursing. This can be done through individual and collective efforts of selfempowerment. To understand empowerment we must first understand the concept of power. According to Madden and Manthey,z there are different types of power. The first is positional power, which carries with it three other forms of power: reward, coercive, and legitimate power. The second type of power is the one most applicable to empowerment of nurses, that is, personal power or the ability to influence other people. With this type of power come five other forms: l Expert power-based on knowledge, skill, expertise, and a person’s ability to express himself or herself in a way that achieves a professional recognition l Referent power-based on the ability to display traits that are valued and that inspire trust l Information power-based on reporting accurately, being informed, and being approachable l Withdrawal power-based on withholding support and predications of obstacles
Society of Ophthalmic
Registered Nurses, Inc.
Volume
Frances Annand is director of nursing education at the Massachusetts Eye and Ear Infirmary, Boston. She has been a member of ASORN since 7 992.
Reprint requests: Frances Annand, RN, MEd, CAGS, Director of Nursing Education, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 027 74. Copyright 0 7 996 by the American Society of Ophthalmic Registered Nurses.
7060- 735X/96 SS.00 + 0 72/l/73982
XXI, No. 3, September
1996
89
Annand Sabotage power-based on destroying, undermining, or discrediting others I believe that personal powerlessness has sometimes led nurses to exert the latter two types of power. The type of power that has most affected nursing is gender related. Women have dominated the profession of nursing but have felt powerless in a society that is male dominated. Nurses have always felt the need to do battle. Unfortunately, the enemies have often been other nurses. There has often been dissent, complaining, and infighting. The feeling of powerlessness resulted in frustration, which nurses often focused on each other.3 l
Key points in empowerment nurse
for the ophthalmic
l
Participate actively in practice issues
l
Avoid negativism
l
Enhance documentation to clearly demonstrate what nursing’s role is
l
Attend courses and professional workshops
l
Develop standards of care and teaching
l
Mentor and support colleagues
l
Believe in yourself
It is time to acknowledge and deal with feelings of powerlessness and direct frustrations toward the positive aim of selfempowerment. Nurses must overcome the image of them depicted in soap operas and movies. They must work toward achieving the reputation of competent, knowledgeable professionals. If nurses are to achieve this status they must abolish negative and disinterested attitudes, take an organized approach, and direct future courses of action. Nurses must stop allowing others to determine nursing’s future. One of the first steps to take is an active involvement in alumni and other nursing organizations. Nurses must take a proactive role in determining the educational requirements necessary 90
Volume
XXI, No. 3, September
1996
INSIGHT
The journal
for a beginning practitioner. No longer can they accept the present wide range of educational preparation. It has led to unclear expectation of practices.4 The next step is even more difficult because it involves accomplishing this by becoming politically active, not only in places of employment but statewide and nationally. Kalisch” states that nurses have typically been apolitical. She further states that the critical challenge facing nursing will be to build a sound resource and power base on which to move the profession forward. Ever since the beginning of the profession, the absence of such a base has been the most crucially limiting force in nursing’s march toward achieving its potential. It is absolutely essential that nurses become considerably involved in the political arena. If these tasks sound overwhelming, take heart! Nursing has allies, who will assist willingly. They are your patients. Now is the time to align with the consumer. They are no longer captives in a world they do not understand. A heightened awareness has precipitated demands for high-quality care. Consumers have always believed that nurses care. Help them now to recognize the scientific knowledge and clinical expertise that you possess. Nurses coordinate care, and the consumer must be assisted to recognize that, because of this, nurses are the sole provider of services that are indispensable to society. There must be a day-to-day effort that demonstrates clearly to all what the nurse’s role is. Covey’9 definition of power reaffirms the fact that achieving empowerment requires the cooperation and acceptance of others. He states that power should enable people to act far beyond their own resources, encouraging highly developed levels of interdependence. They become self-aware, knowledgeable, proactive individuals, unrestricted by attitudes, behaviors, or actions of others, with the ability to capitalize on their own abilities and assets and those of others-finding an interdependent freedom.” Keiffer’ concurs and defines empowerment as the achievement of a multidimensional participatory competence. This concept is important to nursing because it is
of the American
Society of Ophthalmic
Registered Nurses, Inc.
Annand impossible for nurses to provide highquality care on their own. They must work with patients and other health care disciplines in a collaborative effort toward providing care with built-in quality. This result can occur only through understanding differences, problem solving, unifying thinking, and a high level of interdependence. Nurses must continuously keep in mind that power is necessary to obtain professional goals and work towards selfempowerment. The following steps to self-empowerment can help. They are not all-inclusive and can be modified by your own individuality and creativity. Give yourself the gift of power: . Actively involve yourself in issues that
affect entry-level preparation and practice (including legislation) . Participate in research unique to the concerns of nursing . Align professionally with colleagues . View yourself and your colleagues as strong and powerful with the ability to work together toward a common goal . Exhibit flexibility . Embrace change . Avoid participation in negative discussions with coworkers . Build alternatives to either/or situations that are not acceptable . Practice win-win negotiation . Look for more than the easy answers . Use abilities to the fullest . Do things when you would rather not . Be a positive role model for others . Support nursing . Instill confidence and trust . Cross-train, broaden the scientific knowledge base, acquire new knowledge surrounding practice . Protect yourself and your practice by being the best you can be . Assume responsibility and accountability . Function on values . Act with integrityZ,‘-‘” According to Hersey and Duldt,” the opposite of empowerment-powerlessness-is unacceptable. It means to be without choice, influence, and accountability. It means merely reacting to events.
INSIGHT
Nurses have functioned too long in an environment where they are not empowered to control their practices. Conflict has followed, and fuzzy lines of authority, accountability, and power can block the effective delivery of nursing care. A major problem for patients, nursing, and society can be the result.lz I agree with Carl Rogers that power is a personal attribute, which through humanistic approaches can be expanded upon. Empowerment is resultant of personal power, which arises from personal growth. For a person to remain empowered, power must be earned every day. It can be measured by the extent to which a person gains the confidence and respect of others and his or her ability to generate cohesiveness and commitment among patients and colleagues. Empowered nurses are self-actualized. They do not practice excellent nursing because of positive rewards from others, but rather because it is what they stand for and believe in. Empowerment for nurses can only occur and be maintained if nurses capitalize on their inherent personal power and accept the responsibility within it. References 1. Sherer JL. Next steps for nursing. Hosp Health Netw 1993;67(16):26-8. 2. Madden JJ, Manthey M. Manual for nurse managers. Minneapolis: Creative Nursing Management, 1987. 3. Parker B, McFarlane J. Feminist theory and nursing: an empowerment model for research. ANS 1991;13(3):59-67. 4. Leddy S, Pepper JM. Conceptual bases of professional nursing. Philadelphia: JB Lippincott, 1989. 5. Kalisch BJ. The promise of power. In: Hein EC, Nicholson MJ, editors. Contemporary leadership behavior: selected readings. Boston: Little, Brown, 1982:172-3. 6. Covey SR. The 7 habits of highly effective people. New York: Simon &r Schuster, 1990. 7. Keiffer CH. Citizen empowerment, a developmental perspective. Prevention in Human Services 1984;3:201-26. 8. Gilbert T. Nursing: empowerment and the problem of power. J Adv Nurs 1995;21:865-71. 9. Roatikainen R. Power or the lack of it in nursing care. J Adv Nurs 1994;19:424-32. 10. Shelton R. Nursing and empowerment: concepts and strategies. J Adv Nurs 1994;19:415-23. 11. Hersey P, Duldt BW. Situational leadership in nursing. Norwalk (CT): Appleton & Lange, 1989. 12. Moss MT. Perioperative nursing in the managed care era. Nurs Econ 199.5;13:112-4.
The Journal of the American Society of Ophthalmic
Registered Nurses, Inc.
Volume XXI, No. 3, September 1996
91