Unit VI:

Empowerment and
Powerlessness
Facilitator:
Tanzeel Ul Rahman
Nursing Instructor
BSN, RN, M.Phil Public health
 Objectives
By the end of the presentation participants will be able to:
• Define empowerment and its dimensions.
• Describe the factors influencing empowerment .
• List the barriers to nursing empowerment.
• Discuss the intervention to empower nurses.
• Compare the approaches to empowerment of nursing profession .
• Define power, powerlessness and influence .
• List the types and sources of power.
• Describe how to use power.
• Discuss politics in nursing.
Empowerment
 Empowerment
• Empowerment refers to increasing the spiritual, political, social,
educational, gender or economic strength of individuals and
communities.
• Empowerment is referred to an interactive process through which
people experience personal and social change, enabling them to
take action to achieve influence over the organizations which
affect their lives and the communities in which they lives.
• Empowerment is the process of enabling employees to set their
own work- related goals, make decisions and solve problems
within their spheres of responsibility and authority
• “Empowerment is the process of sharing power with employees”.
• Empowerment- sharing of power
 Empowerment- Benefits
• Empowerment as a mean to strengthening the capabilities
and commitment of employees is one of the most
important challenges faced by nurse managers today.
• Itis needed in day to day practice as nurses meet the
needs of patient in hospitals in the community and in
home settings
• Staffwho experience empowerment feel that they are
respected and trusted to be active participants .
• The empowered staff also demonstrate a positive image to
other healthcare team members, patients and their
families also to public.
 Empowerment- Benefits

• Enhances beliefs of employees that they are influential

contributors to the organizational success.
• Employees perceive meaning of work.
• Employees feel competent.
• Employees derive a sense of self-determination.
• Employees believe that they have an impact on
important decisions.
 Disadvantages of empowerment

• Increased arrogance
• Confidential & security risk
• Lack of experience
 07 Dimensions of empowerment
• Power
• Decision making
• Information
• Responsibility
• Creativity and initiative
• Knowledge and skills
• Autonomy
 Indicators of Empowerment

Following are some anecdotal possible indicators that is

considered as useful:
• Confidence and understanding:
• Skills in analysis and communication:
• Trust, Caring and tolerance
• Cooperation
• Access to information
 Empowerment in Nursing
• 1. Personal Empowerment:
• Professional knowledge and skills
• Self confidence
• Having authority
• 2. Collective Empowerment:
• Unity among nurses
• Supportive management
• Job related
• Financial
• Emotional support
 Why some managers do not
empower their subordinates ?
Why Empowerment is not universally embraced?

• Managers fear the loss of power, control and authority.

• Employees are not able to make responsible decisions.
• Previous failure of empowerment.
• Sharing proprietary information means leaking ideas, plans and
knowledge to competitors.
• Not every one wants to be empowered.
Barriers to empowerment in Nursing
• Image of nursing profession in public
• Nursing as oppressed group
• Lack of competency (knowledge, skills and leadership etc)
• Health profession is physician oriented
• Shortage of nurses
• Punitive management style
• The structure of nursing services
• Poor quality of education
• Lack of continual education
• Lack of financial resources
• Heavy workload
 Barriers to empowerment in Nursing Students

• The standard of entrance in profession

• The curriculum content are poorly managed
• Shortage of expert faculty
 Approaches to empowerment in Nursing

• A continuing investment of resources in the nursing education.

• Describe the well defined roles to nurses within in organization.
• Access to more post gradate specialized nurses
• Delegate responsibility with authority.
• Information sharing
• Training opportunities
• Performance feedback
 Power and
Powerlessness
 Power
• Power is potential ability of a person, team or organization to
influence others
• Potential to achieve goals
• Capability to get someone to do something
• Having control, influence, or domination over something or
someone
• The ability to get things done to mobilize resources, to get and
use whatever it is that a person needs for the goals he or she is
attempting to meet
• Power can be symmetrical when two parties have equal and
reciprocal power, or it may be asymmetrical with one person
or group having more control than another
 Influence

• The exerciseof ones capability to get someone

to do something.
• It is the process in which person B is induced by
person A to behave in a certain way
• Simply it is power in action
Types/Modes/Sources of Power

1. Reward power
2. Punishment power
3. Legitimate power
4. Expert power
5. Referent power
6. Information power
7. Connection power
8. Position power
9. Personal power
 Classification

Interpersonal Power:
• Organisational Power:
• Legitimate Power • Structural Power:
• Reward Power • Resources
• Coercive • Decision-Making Power

• Personal Power: • Information Power

• Expert Power
• Referent Power
1. Reward power is based on the inducements the manager can offer
group members in exchange for cooperation and contributions that
advance the manager’s objectives. The degree of compliance depends
on how much the follower values the expected benefits. For example, a
nurse manager may grant paid educational leave as a way of rewarding
a staff nurse who agreed to work overtime. Reward power often is used
in relation to a manager’s formal job responsibilities.
2. Coercive power is based on the penalties a manager might impose
on an individual or a group. Motivation to comply is based on fear of
punishment (coercive power) or withholding of rewards. For example,
the nurse manager might make undesirable job assignments, mete out
a formal reprimand, or recommend termination for a nurse who
engages in disruptive behavior. Coercion is used in relation to a
manager’s perceived authority to determine employment status.
3. Legitimate power stems from the manager’s right to make a request
because of the authority associated with job and rank in an organizational
hierarchy. Followers comply because they accept a manager’s prerogative to
impose requirements, sanctions, and rewards in keeping with the
organization’s mission and aims. For instance, staff nurses will comply with a
nurse manager’s directive to take time off without pay when the workload has
dropped below projected levels because they know that the manager is
charged with maintaining unit expenses within budget limitations.
4. Expert power is based on possession of unique skills, knowledge, and
competence. Nurse managers, by virtue of experience and advanced
education, are often the best qualified to determine what to do in a given
situation. Employees are motivated to comply because they respect the
manager’s expertise. Expert power relates to the development of personal
abilities through education and experience. Newly graduated nurses might ask
the nurse manager for advice in learning clinical procedures or how to resolve
conflicts with coworkers or other health professionals.
5. Referent power is based on admiration and respect for an
individual. Followers comply because they like and identify with the
manager. Referent power relates to the manager’s likeability and
success. For example, a new graduate might ask the advice of a
more experienced and admired nurse about career planning.
6. Information power is based on access to valued data.
Followers comply because they want the information for their own
needs. Information power depends on a manager’s organizational
position, connections, and communication skills. For example, the
nurse manager is frequently privy to information about pending
organizational changes that affect employees’ work situations. A
nurse manager may exercise information power by sharing
significant information at staff meetings, thereby improving
attendance.
7. Connection power is based on an individual’s formal and
informal links to influential or prestigious persons within and
outside an area or organization. Followers comply because they
want to be linked to influential individuals. Connection power also
relates to the status and visibility of the individual as well. If, for
example, a nurse manager is a neighbor of an organization’s
board member, followers may believe that connection will protect
or advance their work situation.
8. Position Power: it is determined by the job description,
assigned responsibilities, recognition, advancement, authority, the
ability to withdraw money and decision making
• Legitimate,coercive, and reward power are positional because
they relate to the “right” to influence others based on rank or
role. The extent to which managers mete out rewards and
punishment is usually dictated by organizational policy.
Information and legitimate power are directly related to the
manager’s role in the organizational structure.
9. Personal Power: referred to ones credibility, reputation,
experience, control of resources or information and ability to build
trust.
• Expert,referent, information, and connection power are based,
for the most part, on personal traits.
Subordinate Responses to Different Sources interpersonal of Power

• The use of legitimate or reward power will typically result in

compliance
• Subordinates will obey your requests but are unlikely to exert more than
the minimal effort necessary

• The use of coercive power may result in resistance

• Subordinates may only pretend to comply with your requests and they
may not openly resist

• The use of expert or referent power frequently results in

commitment
• Subordinates are likely to exert high level of effort to accomplish what
you ask perhaps even exceeding what you requested.
 Using Power Appropriately
• Using power not only affects what happens at the time, but also has a
lasting effect on your relationships. Therefore, it is best to use the least
amount of power necessary to accomplish your goals.
• Improper use of power can destroy a manager’s effectiveness. Power can
be overused or underused. Overusing power occurs when you use
excessive power relative to the situation. If you fail to use power when it is
needed, you are underusing your power. In addition to the immediate loss
of influence, you may lose credibility for the future.
• Power plays are another way that power is used inappropriately. Power
plays are attempts by others to diminish or demolish their opponents.
Typical power plays include:
• “Let’s be fair.”
• “Can you prove that?”
• “It’s either this or that; which is it? Take your pick.”
• “But you said . . . and now you say. . . .”
Review Box 7-1 in Sullivan N Decker for Guidelines for the Use of
Power in Organizations
General Guidelines for Using Power
• Use power in ethical ways.
• Understand and use all of the various type of power.
• Accept that influencing people is an important part of
the management job.
• Recognize the strategies and tactics through which
organizational power is developed and used.
• Understand that to get things done you must have
power and in the case of those who oppose you, you
must have more power than they do.
 How Nurses May Promote the Image of Power
• Appropriately introducing yourself by saying your name, making eye contact, and
shaking hands can immediately establish you as a powerful person.
• Attire can symbolize power and success
• Conveying a positive and energetic attitude sends the message that you are a
“doer” and someone to be sought out for involvement in important issues
• Pay attention to how you speak and how you act when you speak. Nonverbal signs
and signals say more about you than words
• Being Knowledgeable: Use facts and figures when you need to demonstrate your
point
• Being involve in policy making
• becoming part of power network: Make it a point to get to know the people who
matter in your sphere of influence.
• Develop a strategy for gaining access to power brokers through joining alliances
and coalitions.
• Achieving goals and objectives
 Politics: The Art of Influencing

• Politics is the art of influencing the allocation of scarce

resources, which includes money, time, personnel and material
•
 How to be Politically Savvy
• (Green and channey) suggested political skill is built on
relationship with others to improve political skills following
advise are followed:
• Learn self promotion- report your accomplishments properly
• Be honest and tell the truth
• Use compliments –
• Discourage gossips
• Learn and use quid pro que- do and ask for favour
• Appearance matters
• Use good manners and be courteous
 Types of Power over Nursing Care
Need for Nurses

Control over the content of nursing practice

• The ability to act according to one’s knowledge and judgment is
known as control over the content of judgment that is control
over content of nursing practice.
• Professionalsmust have understanding and control over the
entire spectrum of activities associated with the job at hand.
• Nurses frequently are unable to use their professional
preparation, which focuses on autonomous practice and
independent decision making.
 Types of Power over Nursing Care
Need for Nurses

Control over context of nursing practice

• Nurses should be more meaningfully involved In the hospital
affairs and decision making
• Hospitalcharacteristics of decentralization and participatory
decision making will attract and retain qualified staff nurses
• Strong nursing leadership strengthens the effect of
empowerment on nursing practice behaviours, thereby
increasing their control over the context of nursing practice
 Types of Power over Nursing Care
Need for Nurses

Control over the competence of nursing practice

•A necessary precursor for both autonomy and power is
competence which has its foundation in educational preparation
• Educational preparation and expertise represent a special type
of power that nurses need, to make their optimal contribution to
patient care.
• Nursing expertise is a related source of power that has a
transformative effect on patient lives
 Powerlessness

• To
feel like one is not listened to or not viewed positively can
make a person feel powerless
• At the individual level, powerlessness can be seen as the
perception of the person that his own action will be ineffective in
influencing the outcome of life events
• Many nurses feel that they cannot make an impact in clinical
setting and they are not listened to or sought out for their
opinion.
 Powerlessness

• Real powerlessness results from economic inequities and

oppressive control excised by systems and other people
• surplus powerlessness is an internalized belief that change
connot occur, a belief which results in apathy and unwillingness
to struggle for more control and influence
 Six ways of expressing
Powerlessness
• Individual Powerlessness
• I have no control, other makes decisions about me

• Normlessness
• There is no point doing things properly, the only thing that works in breaking
the rules

• Meaninglessness
• what is the point

• Self alienation
• I have not done as well as I should, I am failure

• Social isolation
• i feel so lonely no one wants to listen to or involve me, I am the odd one out
• People especially me do not matter any more the only thing matters Is money
 Factors Contributing to Nurses Powerlessness

• Educational factors (Less highly educated)

• Societal reluctance in general to discuss power openly because
95% of all nurses are women
• Nurses view power as a masculine attribute that is inconsistent
with their self identity as women
• Other groups continue to exert control over nurses professional
lives
 Consequences of powerlessness among nurses

• Feeling of powerlessness can generate alienation and

depression
• Nurses feeling powerless may withdraw from group membership
• Powerless nurses are ineffective in providing competent quality
care and thus contribute to poor patient outcome
• Less satisfied with their jobs.
• More susceptible to stress and burnout
• Page 181 to 182 Professional and interpersonal skills for nurses