Journal of Nursing Education

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RESEARCH BRIEF 

Cultivating Empowerment in Nursing Today for a Strong Profession Tomorrow

Sara L Campbell, DNS, RN, CNAA, BC

Abstract

ABSTRACT

The ongoing nursing shortage requires careful consideration by those in nursing education to determine causes of the shortage and best approaches to countering the supply issue predicted to last far into the future. A grounded theory approach was used to conduct a pilot study to explore processes related to empowerment and disempowerment among 16 participants from a baccalaureate nursing program. Participants included nursing school administrators, faculty, and students. Cultivating was the basic core process constructed that appeared to influence empowering and disempowering experiences in nursing education. Findings suggest collaborative efforts between nursing education and clinical practice are necessary.

Abstract

ABSTRACT

The ongoing nursing shortage requires careful consideration by those in nursing education to determine causes of the shortage and best approaches to countering the supply issue predicted to last far into the future. A grounded theory approach was used to conduct a pilot study to explore processes related to empowerment and disempowerment among 16 participants from a baccalaureate nursing program. Participants included nursing school administrators, faculty, and students. Cultivating was the basic core process constructed that appeared to influence empowering and disempowering experiences in nursing education. Findings suggest collaborative efforts between nursing education and clinical practice are necessary.

The public sector is being inundated with profound concerns related to the current and future nursing shortage. As leaders in legislative circles and hospitalbased arenas attempt to create ways to bring individuals into the profession at a faster rate, it becomes evident that moving nurses through the educational process at an increasingly rapid pace will not solve inherent professional problems that relate to functioning as nurses in society. Rather than allowing others to determine the destiny of future nurses, a leadership stance must be assumed within nursing education that involves a commitment spanning from the education of nursing students to the practice and work environments in which they are employed as graduates. Individuals in the nursing profession, whether in nursing education or service, must not fall prey to increasing pressures that result in simply moving nursing students through educational programs quickly and depositing them in the practice arena. In contrast, it is time to rise to the challenges that will exist for future nurses because of the nursing shortage.

It can be postulated that nurses historically have not seized opportunities of independence and autonomy because individually and collectively they have continued to possess disempowering beliefs, attitudes, and behaviors (Ashley, 1997). Based on this speculation, empowerment has been suggested to be a concept worthy of exploration and application within nursing (Ellis-Stoll & PopkessVawter, 1998; Kuokkanen & LeinoKilpi, 2000). Use of empowerment, in the context of understanding the cultural and organizational aspects of the nursing education environment, is paramount because this setting has the potential to influence individuals* beginning perspectives of nursing as a career. Exploration of nursing students' initial conceptual formation of the roles of nurses and the nursing profession is key to creating changes that lead away from oppression and toward empowerment (Hawks, 1999). In addition, behaviors reflective of empowerment or disempowerment that may be exhibited by nurse educators and administrators can provide insight into the possibility of observing continued oppressive behaviors in the next generation of nurses.

This qualitative pilot study explored processes related to empowerment and disempowerment that occur among nursing faculty members, administrators, and students.

Method

Sample

Theoretical sampling, as described by Glaser and Strauss (1967), Strauss and Corbin (1990), and Glaser (1992), guided this pilot study. The final sample consisted of 16 participants from a baccalaureate nursing program who engaged in semistructured, audiotaped interviews ranging in length from 25 to 75 minutes. Four female senior-level nursing students, 6 female nursing faculty members, and 6 female administrators participated in the study.

Design

A grounded theory approach, adapted from Streubert and Carpenter (1995), was used for this study. Data were gathered, coded, and analyzed simultaneously in a circular, ongoing manner. Coding, concept formation, and thematic analysis were performed to identify the core variable as recommended by Streubert and Carpenter (1995).

Results

Cultivating

Cultivating was constructed as the basic core process in this study, which appeared to influence occurrences of empowering and disempowering experiences in nursing education. Cultivating was developed using an analogy of a gardener tending to a garden. The gardener's intent may be to foster the development of a thriving garden, but the intent may or may not produce such a garden. Many other factors influence the development of the garden, such as the surrounding environment, the hardiness of the plants, and the gardening tools and techniques.

Data analysis from this study suggested nursing faculty and administrators do not have the intent of disempowering others. Rather, their intent is often to prepare, improve, refine, foster, and develop others. However, intent does not necessarily produce the desired results. Any interaction that occurs among individuals is subject to many interpretations. In this pilot study, it was evident the experience of empowerment was dependent not only on the individual, but also on the environment at the time and individuals' past experiences and current interactions with others.

Empowerment does not exist "out there" for the taking. Instead, it is an exchange that occurs at various times and levels among individuals. Empowerment is a continuous and ever-changing process throughout individuals' lives, with individuals often moving back and forth between experiencing feelings of empowerment and disempowennent. The fluid nature of cultivating and the various perspectives elicited within the process are discussed as themes of seeding, grafting, grounding, and transforming.

Seeding

Seeding was identified as the first theme and refers to experiences that occur early in individuals' lives or careers that affect how they perceive empowering and disempowering events in their lives. Ellis-Stoll and Popkess-Va wter ( 1998) suggested necessary antecedent conditions must exist before empowerment can occur, and findings from this study supported that belief. All of the participants talked about factors that influenced their later experiences of empowerment and disempowennent. These factors related to childhood or early career experiences that planted the "seeds" of self-esteem, selfresponsibility, and self-growth. One participant talked about her mother whom she viewed as being empowered. Despite a physical disability, the participant's mother never let the disability keep her from being who she wanted to be in life. The participant viewed these experiences as vital to her own development of selfempowerment. She stated, "It was an unspoken lesson for my sisters and me."

Grafting

While seeding refers to planting seeds for future empowerment experiences, the second theme, grafting, refers to an exchange that occurs between individuals. Grafting is not an exclusive exchange of empowerment or disempowennent. The individuals who initially facilitate the feelings are not left empty vessels, as though giving away their own empowerment or disempowennent. For example, one nurse administrator described the exchange process of empowerment as "An organic, reciprocal, mutual exchange. It is not like a milk bottle that you just put things into."

One faculty member also described aspects of grafting when she stated that faculty members need to help students early in their nursing program to understand they do not have to feel "victimized." This participant stated:

We talk about working together as a team and what you bring to the table and to that team. If we don't help them understand that they have something unique to bring to the table, then we've set them up to feel that they dont have something to offer, and they are being controlled by other forces.

Grounding

Grounding, the third theme, occurred for most individuals as they made decisions about their involvement in situations. Individuals "ground" themselves in a particular direction, which leads to a behavior or action and serves as a way of surviving or coping. For example, one student described how she coped with an instructor who felt her clinical work was unsatisfactory. She stated, "I wasn't able to change it, so I just waited until the end." She wrote a letter to the administration at the end of the semester, and although she did not know whether her letter had any effect, she felt empowered by her action.

In contrast to the ease with which students commented on disempowering situations reflective of grounding, faculty members had difficulty describing similar situations. For example, one faculty member reported never feeling disempowered because when she makes a decision and takes action, she feels empowered. Faculty members were more likely to deny ever feeling disempowered and focused on the empowerment of taking action, while students identified with the disempowering feelings first and then described the empowering feelings that resulted from taking action.

Transforming

The fourth theme of cultivating was coined transforming, which indicates change. Transformation may be positive and indicative of new growth, such as with branching that occurs upwards and outward. It also may be negative, such as with noted lack of growth. In this study, transforming referred to the transforming of female nursing students, faculty members, and administrators as they experienced episodes of empowerment and disempowerment throughout their nursing careers. One administrator discussed how she believed she unconsciously facilitated empowerment for others because of her caring desire for others to grow in personal and professional manners. She stated:

One's basic life philosophy contributes a great deal to facilitating others to feel empowered. A person needs to care deeply about the growth and development of others, and the development of relationships, whether they are one-to-one or organizational.

Discussion and Implications

The findings of this study indicate an encircled process of empowerment and disempowerment that individuals experience throughout their lives. Experiences of empowerment were described somewhat differently, depending on the context and individuals' perceptions of the events. For example, students were more likely to refer to empowering and disempowering experiences as external to themselves, whereas leaders in nursing, such as faculty members and administrators, were more internally focused. An external focus was apparent in how students, in particular, discussed disempowering experiences they directly related to interactions with nursing faculty and staff nurses. An internal focus was evident among faculty members because they were more likely to deny having disempowering experiences, with the implication that the nature of the experience was determined by the individual. Nursing administrators discussed empowerment and disempowerment in a more balanced manner, giving credit to both internal and external factors.

Findings indicated the empowerment-disempowerment cycle reflects much more than what occurs in nursing education. Although nursing schools' cultural and organizational aspects can be designed to offer avenues leading to experiences of empowerment, other aspects, such as interactions between student nurses and staff nurses, also are crucial to the formation of beginning nursing students' perceptions of nurses' role and the nursing profession. The responsibility for empowering nurses does not belong exclusively to nursing education, and some exploratory research has been conducted that focuses on use of empowerment or related concepts in the clinical practice environment (Erbin-Roesemann & Simms, 1997; Finegan & Shamian, 2001; Fullam, Lando, Johansen, Reyes, & Smaloczy, 1998; Laechinger, Finegan, Shamian, & WiIk, 2001; Laechinger & Wong, 1999).

Embedded in the issue of the work environment is the reason faculty members decide to move from the bedside to academia. Faculty members who participated in this study hinted that a career in nursing education was preferable to them because of the autonomous role available in education, as opposed to a more constricting and less empowering clinical practice role. In academia, faculty members possess a certain level of status and autonomy that possibly leads to denial of identification with staff nurses.

Findings from this study also demonstrate individuals' inherent denial of themselves as oppressors and as victims of oppression. Catalano (1994) claimed that when nurses obtain advanced degrees, they displace their own feelings of increased power onto nurses who do not have the privileges associated with advanced degrees. If Catalano's assertion is correct, there may be lack of congruency between bedside nurses' and nursing faculty members' perceptions of the role of professional nurses.

In these times of health care change and uncertainty, unity of profession members is crucial to empowerment. Although nurses embrace the concept of empowerment and teamwork, in this study, the concept of "individualness" permeated participants' stories. Especially for nursing faculty members and administrators, experiences of empowerment and disempowerment seemed to consciously occur at the individual level, without regard for the relationships among other people, the institutional culture, and the profession. They did not appear to want to attribute the influence or facilitation of empowerment or disempowerment to others. This individualness was demonstrated again with noted silence in data examples in which faculty members or administrators were asked to recall situations when they disempowered nursing students.

A disconnection was apparent in participants' discussion of the need for teamwork, collaboration, and interdependence on one another as nurses, and their separation of themselves from the group. For example, one administrator stated that faculty members tend to gravitate away from group efforts and center on individual goals that could benefit their own careers. This administrator believed faculty members were more likely to experience personal empowerment than group empowerment. The concept of group empowerment versus personal empowerment was also echoed by nursing students as they discussed not wanting to work together with, and be dependent on, others and described struggling with the idea of empowering others because they would prefer to complete tasks themselves, rather than allow others to complete them. From a curricular perspective, oppression, empowerment, and group and teamwork issues should be addressed by teaching related content. However, content alone is not empowering for studente if associated behaviors are not included in the learning process.

Conclusion

Throughout this study, one prominent idea persisted although there has been improvement over time, nurses continue to treat one another negatively. As Roberts (2000) noted, it is time for nurses to move away from focusing on blame for the current state of oppression and move toward healing. The nursing profession must assume responsibility for mentoring and bringing those behind them "with them." Future research conducted in the area of empowerment should include an expanded context, increased participant diversity, and exploration of the effects of nursing staff empowerment on client outcomes.

All nurses must consciously decide to facilitate empowering experiences for the nursing students with whom they interact. We can no longer afford to believe we do not have the power to facilitate such experiences for others.

References

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10.3928/0148-4834-20030901-10

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