The real power base in nursing begins and is actualized through the strength and performance of each nurse. Nurses who seek to effect change and mobilize the power potential of our profession, will need to have a strong theoretical and practical foundation.
Many nurses lack experience in dealing with power dynamics and mobilizing power resources. This inexperience is consistent with women in other female-dominated professions who have had little opportunity to participate in power politics and power mobilization strategies. If nurses are to transcend these limitations and learn to better utilize their power sources, we need to become more conversant with fundamental concepts of power.
Within the confines of this article, two concepts of power will be explored. These are Cavanaugh's "power orientations" (1979) and Hersey, Blanchard, and Natemeyer's "power bases" (1979). Three power exercises which allow the student to experience power, and to apply power concepts, are also presented.
According to Cavanaugh (1979), how an individual understands and values power determines his/her "power orientation." Based on social science literature and her research, Cavanaugh developed a category system delineating the six possible power orientations:
Power as Good: An individual ascribing to this power orientation believes that power is natural and will likely seek out a power position because such positions are felt to be desirable.
Power as Resource Dependency: An individual with this orientation believes that power is maintained by carefully monitoring resources (knowledge and information), and will weigh the pros and cons of surrendering valuable resources if she or he wishes to acquire or remain in a power position.
Power as Instinctive Drive: This orientation links the desire for power with an innate instinct, rather than a desire nurtured within a specific environment.
Power as Charisma: This perception assumes that certain people possess a special magnetism and therefore maintain power and influence over others.
Power as Political: This perception associates power with the ability to "wheel and deal" and play the system. To acquire and maintain power certain political in-roads must be made with key people.
Power as Control and Autonomy: A person viewing power in this manner, understands that to maintain his or her own autonomy and independence, other individuals must be controlled.
An individual or group derives power and influence from a specific source or base. In 1965, French and Raven identified five bases of power. Since that time, Hersey, Blanchard and Natemeyer went on to expand the original typology, indentifying a total of seven power bases (1979). The power bases are:
Coercive Power: This is a power based on fear and coercion The person being influenced feels forced to comply with the influencer s wishes, out of fear that to do otherwise will lead to punishment.
Reward Power: A position of power and influence over others is maintained because followers expect and hope the powerful person will bestow favors and rewards if his or her wishes are met.
Expert Power: An individual experiences power and influence over others when she or he possesses special knowledge, skills and expertise not shared by others in the group.
Legitimate Power: This source of power comes from the hierarchical position a person holds within the organizational structure. Persons in line positions are said to hold legitimate power over subordinates because of the authority inherent in their positions.
Referent power: This type of power is experienced when the follower identifies and is influenced by certain personal characteristics or traits shown by the "powerful" person.
Information Power: Power and influence occurs if one individual possesses (or is believed to possess) special information valued by another individual.
Connection Power: Power will be accorded to someone believed to have special connections with powerful persons or groups.
Integrating The Two Power Concepts
How a person uses available power sources will depend upon his or her specific power orientation(s). For example, an individual who believes that power is associated with "control and autonomy" will be inclined to use a number of power sources to see that goals are met. This individual will likely use combinations of coercive, information and connection power sources. On the other hand, an individual who believes that "power is good" will convey a positive attitude and will likely use reward, expertise and legitimate sources of power in order to accomplish goals.
The "resource dependent" individual can be expected to rely on information power, retaining and withholding it rather than sharing information freely.
Individuals believing that power is associated with the need to be political will rely on connection sources and may also be influenced by referent sources, i.e., if a health professional aspires to be in power, and is vying for the time and attention of a person in rank above him/her, the power seeker may try to emulate or be influenced by that individual.
Persons who attribute power to charismatic people will likely be influenced by individuals with such personality attributes. Similarly, an individual who knows he/she possesses certain charismatic qualities will be the recipient of referent power because others will emulate and identify with him or her.
Ib help learners more fully integrate the "power orientation" and "power bases" content, discussions of personal examples and vignettes will facilitate this process. Drawing upon these personal experiences, the nurse educator can apply the previously described concepts. In addition to discussions of personal examples, planned power exercises are useful with groups. Three exercises that we have used with some success are included here.
An excellent simulation which allows learners to interact with power dynamics, power orientations and power bases is "Starpower. " This simulation, developed by psychologist R.G. Shirts (1969), pits "powerful" and "powerless" participants against one another. As the game unfolds, participants are randomly assigned to groups. Through a series of structured events, the groups are transformed into opposing factions. The "powerless" group experiences the real meaning of impotence while the "powerful" group realizes that to be all-powerful is not always desirable.
The simulation can be played with 12 to 25 players. To allow sufficient time for processing the experience, one to three hours should be allotted. Participants will benefit from discussions about how power orientations influenced observed behaviors and emotions.
Videotaping the simulation adds another learning dimension. This audio-visual aid assists in linking power orientations with the observed behaviors. By reviewing the simulation on tape, participants are quickly able to recognize and apply concepts of "power orientation" and "power bases." For disbelieving participants, videotaping provides "hard" evidence that the behaviors did occur as described.
This exercise, developed by one of the authors, is easy to use with any size group and has the advantage of taking only 15-30 minutes. On 8 x 11-inch "cards," each of the main characters in the health care arena is listed and briefly described: e.g., patient, (age 32, female, housewife); staff nurse (psychiatric unit, age 23, female); staff physician (psychiatric unit, age 23, male); hospital director (age 60, male); physician's assistant (age 30, male); social worker (age 30, male). The number of cards and their types of characters can be as numerous and varied as the group leader desires.
The group is asked to line up the cards from most powerful to least powerful as they perceive the individuals to have power in a typical hospital setting. With a large enough class, some group members can assume the roles described on the cards and the group can line up their classmates. This adds an interesting, if somewhat hectic, dimension to the exercise. Those who assume the roles may misinterpret the power or powerlessness of the role due to their own power orientations.
Interesting discussion occurs around the reasons for the amount of power, e.g., the effect that age, sex, education, and profession have on power. A second set of cards which do not include personal information about each character is used to compare the effect of the setting on power. The group is asked to line up the characters (e.g., physician, director of nursing, staff nurse, patient, patient's spouse, nurse graduate student, physical therapist, dietician, social worker) first, according to their power in a hospital and, second, according to their power in a community agency.
This exercise, which allows the participants to experience power, was also developed by one of the authors. It is suggested for use with mature individuals and time is needed for debriefing as the exercise tends to cause strong emotional responses.
Any size group can participate. Approximately one hour should be used for the simulation and one hour for a debriefing discussion.
The simulation has two stages: preparation for debate and debate. After having done some previously assigned reading (for example, Ashley, 1973; Claus & Bailey, 1977; Garant, 1982; Grissum, 1976) or based on their own experiences, two groups are formed and are told that they will each have a half hour to prepare their side of the debate. One group is assigned to debate the side "nurses do not have power"; the other group is assigned to debate "nurses do have power." Both groups are told that the negative side will present first, that each side gets five to ten minutes to present its arguments and three minutes rebuttal time, and that the group can determine how many members of the side actually speak. Two to four members of the class should be assigned as observers, and can in addition act as judges of the debate.
The experiencing of power begins to happen when the instructor approaches the side assigned to debate "nurses do not have power," approximately five minutes after both sides have formed into circles on opposite sides of the room to prepare the debate. The instructor (in our case a faculty member working with graduate students enrolled in her course) gets the attention of members and quietly (out of hearing of the other group) but very forcefully says, "In my opinion this is the hardest side of the debate, yet, I expect you to win the debate. I suggest you consider using power to win the debate on power. I will grant you all my formal authority as class instructor to use as you wish. You may do as you like with the debate rules and with the physical structure of the classroom. I will go along with whatever you want."
The outcomes cannot be predicted as each group reacts differently. Some common responses though, have been noted. The powerful group (negative side) often uses some degree of coercive power; the powerless group either unites if there are some strong individuals who assume leadership or, without leadership, react ineffectively in individual ways; the content of the powerful group's debate is often lost in their exercise of power strategies. The exercise can be less threatening for the powerless group if they have previously been given some guidance in ways to react to power politics. As in the Starpower simulation, the powerful group realizes that having power and authority carries a heavy responsibility. All participants learn that the correct exercising of power requires practice.
Additional Teaching Strategies
Other skills are known to facilitate the use of power. These include expertise in interpersonal and group communication, use of negotiation practices, assertiveness behaviors, and knowledge and application of conflict resolution principles.
Specific classroom activities can be designed to help nurses develop their abilities with these skills. Integration of theory and practice in relation to each of these content areas will strengthen the nurse's ability to use available power resources.
Concepts and strategies presented here provide nurses with a new perspective from which to analyze and interact with power dynamics. Understanding fundamental concepts of power will help nurses enjoy a more equal status and bargaining position within the community of health professionale and in health care delivery systems. As nurses integrate and utilize this content for enhancing professional practices and client services, our public image will also continue to be strengthened. In so doing, our power base and sphere of influence will also be broadened.
- Ashley, J. (1973, October). This I believed about power in nursing. Nursing Outlook, pp. 637-641.
- Cavanaugh, M.S. (1979). A formulative investigation of power orientations and preliminary validation of relationships between power orientations and communication. Unpublished doctoral dissertation, University of Denver.
- Claus, K., & Bailey J. (1977). Power and influence in health care, St. Louis: CV. Mosby.
- French, J., & Raven, B. (1965). The bases of social power. In D. Cartwright and A Lander (Eds. ), Group Dynamics. Evaneton, IL: Row, Peterson and Company.
- Garant, CA. (1981). Power, leadership and nursing. Nursing Forum, 20(2), 183-199.
- Grieeum, M. (1976). Politics of power. In M. Griaeau & C. Spangler (Eds.), Vrbmanpower and health care. Boston: Little Brown Co.
- Hersey, P., Blanchard, K" & Natemeyer, W. (1979, December). Situational leadership, perception and impact of power. Group and Organizational Studies, 4(4), 418-428.
- Shirt«, R.G. (1969). Starpower. LaJolla.CA: Western Behavioral Sciences Institute.