Nursing is a dynamic profession in which nurses are increasingly being given greater responsibility and providing more complex nursing care.
Due to the ongoing development of the nursing role, health care organizations have a duty to ensure that their workforce is providing the highest standards of care and meeting patients’ expectations. This is a task that often falls to nursing managers and empowerment is an effective tool that nursing leaders can utilize in order to increase the competence and confidence of their nursing staff.
Empowerment embraces the concepts of managing with dignity and mutual respect which produces strong, efficient nurses and leaders. When considering effective nursing management, Shaw (2002) describes that empowered staff are given greater control with a move towards self direction rather than autocracy.
Autocratic management styles may lead to nurses feeling undervalued and unable to properly utilize their skills and education to benefit their patients. Conversely, a management style that focusses on trust, mutual respect, open and honest communication, and consistent support is more likely to result in a skilled and confident nursing team who are involved in decision making and who actively promote clinical effectiveness.
Scott and Caress (2005) discuss the concept of shared governance, a system of management and leadership that empowers all staff involved in patient care.
In this system, empowering staff includes involving them in decision making, facilitating motivation and job satisfaction by appraisal and job incentives, encouraging creativity, supporting education and promoting interpersonal relationships. These strategies encourage a culture of openness, honesty and responsibility.
Nurses working a positive, empowered atmosphere are more likely to maximize on opportunities to gain further education credentials, and to be motivated by the prospect of promotional possibilities. In this way, nurses become more skilled, deliver better patient care and are less likely to seek employment opportunities elsewhere.
Staff that are involved in the decision making process are more likely to feel that they are directly contributing to strategies to improve the running of their unit, higher quality patient care and cost effectiveness. Kanter (1993) considers that empowered staff are more committed to incorporating and implementing new ideas and decisions into their daily work and thus develop a sense of ownership and responsibility.
Staff may also feel more motivated to deliver their best performance once they feel that management will acknowledge their hard work either by incentive schemes, such as bonuses, or by supporting nurses by furthering their education and cross training. In this way, the empowered workplace becomes dynamic, one in which management and staff work together to achieve the highest standards of care.
Managers can create an effective work environment by empowering nurses to utilize their professional knowledge and assume accountability for their own actions. Management can motivate staff to become change agents and to develop new ideas and creative ways to improve patient care.
Management, in turn, benefits from having input from staff that are most directly involved in patient care and is able to build a more cohesive team with common goals.
This sense of motivation, shared responsibility and mutual respect may assist greatly in staff retention, allowing management to spend more time and money on improving the quality of patient care rather than on recruitment. Empowerment ultimately benefits the organization by increased productivity and work effectiveness.
This differs greatly from a hierarchical system in which nurses are simply obliged to carry out the duties assigned to them by management without really being involved in the formulation of care objectives or unit goals.
Just as the nursing process itself involves a series of interrelated and dynamic steps, implementing empowerment on nursing units can pose a great challenge and requires careful assessment, planning and implementation of change at every level of the system.
Christie Hospital NHS Trust, a hospital in Manchester, England was one of the first hospitals in the United Kingdom to implement a shared governance system based on empowering its’ healthcare staff in order to improve standards of care. Christie Hospital followed a series of carefully planned steps which resulted in the successful implementation of empowering nurses which showed the nursing process at management level.
Their core policy highlighted the importance of allowing staff to develop professional autonomy and encouraging staff to begin being more proactive. A steering group was formed and a vision statement was identified that indicated that health care professionals would be involved in all decisions related to their clinical practice. They would be empowered to lead the decision making process and staff and management would work collaboratively to develop patient care standards.
The approach taken at Christie Hospital was a great success and followed the philosophy that professionals working closest with their patients are in the best position to make decisions relating to those patients. It is evident that in order to provide quality direct client care, nurses have to be given autonomy. Nursing professionals have for many years advocated for the creation of work environments that reflect the "true professional practice of registered nurses," (Ethridge, 1987, p.44.) Empowerment gives individuals the opportunity to grow in their work setting.
However, in order for management to foster an environment of empowerment, nurses must recognize the importance of accountability in the nursing profession. Nurses must have the education and ability to competently carry out their scope of practice and it is the responsibility of each nurse to make accountability a personal choice (Horsefall, 1996).
Accountability, autonomy and empowerment are closely linked. In shared governance models, the traditional controlling roles of management are replaced by a system in which management recognizes the importance of supporting nurses by ensuring that adequate resources are available to them in all aspects of their work.
Porter-O’Grady (1991) adds that nurses who rely solely on management to initiate action inhibit their scope of practice considerably. Access to resources and support result in well defined nursing roles and the provision of professional client care.
In order to effectively empower staff and improve organizational outcomes, managers need to reflect on respect, justice and trust in the workplace.
A recent study by Laschinger (2005) highlighted that only 38.3% of staff nurses felt that they were respected by management. It is imperative for management to foster a trusting relationship with employees which can be achieved by adopting an open door policy and including staff in the decision making process.
Staff that are treated fairly and with respect more readily trust that management are representing their best interests. Open communication, decisional involvement and the sharing of critical information are the foundations for creating responsible, autonomous and satisfied staff and increasing retention rates. In turn, staff retention not only serves to decrease recruitment costs, but dedicated staff are more likely to be positive spokespersons for their organization, thereby attracting potential employees.
It is important to remember that the patient is the primary focus of empowered nursing and nurses who feel respected, supported and autonomous are more likely to provide higher standards of patient care.
The effort that management puts into empowering their staff will likely be rewarded by greater patient satisfaction and an improved image of the hospital as a quality care organization. Empowerment can therefore serve as a highly effective tool for hospitals seeking to gain Magnet status or to improve the quality of their overall care.
The current nursing shortage should serve as an impetus for managers to work on more effective staff retention and recruitment strategies.
Managers working on creating conditions that empower nurses foster a dynamic and independent atmosphere, where mutual trust and respect enable nurses to provide quality nursing care