Additional Learning Exercises and Applications
DISPLAY 13.3 Action Plan for Increasing the Power of the Nursing Profession
office.
Become better informed about all health-care policy efforts. This means becoming involved with grassroots knowledge building and becoming better informed consumers and providers of health care with a commitment to collective strength. This is difficult because no one can do this but nurses. Cardillo (2016) argues that every nurse can and should learn the ABCs of politics and power as a first step to personal and professional empowerment. She suggests that nurses should develop relationships with their legislators and contact their Assemblypersons, Congresspersons, and Senators by phone or e-mail.
Introduce yourself as a nurse in their district and offer to be a resource on nursing and health-care issues.
Cardillo (2016) goes on to suggest that every step an RN takes toward political awareness and activism benefits the entire profession. It is also one more way to impact the greater good and advocate for better health care for all. O’Connor (2014) agrees, suggesting that the privileged intimacy the nursing role affords carries with it responsibilities beyond practice and professional responsibilities. It carries political responsibilities as well.
Build coalitions inside and outside of nursing. Health policy takes place in a virtual network of participants, professions, and organizations, both locally and nationally. Nurses have not always done well in building political coalitions with other interdisciplinary professionals with similar challenges. In addition to belonging to nursing professional organizations, nurses need to reach out to other nonnursing groups with the same concerns and goals. This interdependence and strength in numbers is what will ultimately help the profession achieve its goals.
In addition, nurses must build positive relationships with other health-care professionals in order to develop and maintain a sense of power in regard to providing effective care for patients (Fackler, Chambers, & Bourbonniere, 2015). Thus, “being on the same page” as the rest of the interprofessional team is important in building personal power (Fackler et al., 2015, p. 267).
Conduct more research to strengthen evidence-based practice. Great strides have been made in researching what it is that nurses do that makes a difference in patient outcomes (research on nursing sensitivity), but more needs to be done. Nurses must use research to present the case that nursing skills are vital to competent health care. In addition, building and sustaining evidence-based practice in nursing will require far greater numbers of master’s- and doctorally prepared nurses as well as entry into practice at an educational level similar to other professions (Huston, 2017).
Support nursing leaders. Rather than supporting their leaders’ efforts to lead, nurses have often viewed their leaders as deviants, and this has occurred at a high personal cost to the innovator. In addition, nurses often resist change from their leaders and instead look to leaders in medicine or other health-related disciplines. Thus, the division in nursing often comes from within the profession itself (Huston, 2017).
Mentor future nurse-leaders and plan for leadership succession. Female-dominated professions such as nursing often exemplify the queen bee syndrome. The queen bee is a woman who has struggled to become successful, but once successful, she refuses to help other women reach the same success. This leads to inadequate empowering of new leaders by the older, more established leaders. Increased and adequate empowering of others, mentoring the young, and ensuring leadership succession are clearly needed to advance nursing leadership. Remember that the profession is responsible for ensuring leadership succession and is morally bound to do it with the brightest, most highly qualified individuals (Huston, 2017).
Stop acting like victims. Unhappy nurses tend to look like victims. That is not to say that nurses are never victimized, but nurses need to address the cause of their unhappiness and attempt to alleviate the problem.
They can confront situations, change jobs, or move into a different career path. Motivated people who care about their profession will help bring power to nursing.
2. Increase level of nurses’ understanding regarding all health-care policy efforts.
3. Build coalitions within and outside of nursing.
4. Promote greater research to strengthen evidence-based practice.
5. Support nursing leaders.
6. Pay attention to mentoring future nurse-leaders and leadership succession.
7. Stop nurses from acting like victims.
Source: Huston, C. (2017). The nursing profession’s historic struggle to increase its power base. In C. Huston (Ed.), Professional issues in nursing: Challenges & opportunities (4th ed., pp. 332–346). Philadelphia, PA: Wolters Kluwer.
Changing nurse’s view of both power and politics is perhaps the most significant key to proactive rather than reactive participation in policy setting.
Strategies for Building a Personal Power Base
In addition to assisting with empowering the profession, nurse-leaders and nurse-managers must build a personal power base to further organizational goals, fulfill the leadership role, carry out management functions, and meet personal goals. Even a novice manager or newly graduated nurse can begin to build a power base in many ways. Habitual behaviors resulting from early lessons, passivity, and focusing on wrong targets can be replaced with new power-gaining behaviors. The following are suggested strategies for enhancing power.
Maintain Personal Energy
Power and energy go hand in hand. To take care of others you must first take care of yourself. Effective leaders take sufficient time to unwind, reflect, rest, and have fun when they feel tired. Leader-managers who do not take care of themselves begin to make mistakes in judgment that may result in terrible political consequences. Taking time for significant relationships and developing outside interests are important so that other resources are available for sustenance when political forces in the organization drain energy.
You must take care of yourself before you can take care of others.
Present a Powerful Picture to Others
How people look, act, and talk influence whether others view them as powerful or powerless. The nurse who stands tall and is poised, assertive, articulate, and well-groomed presents a picture of personal control and power. The manager who looks like a victim will undoubtedly become one. When individuals take the time for self-care, they exude confidence. This is apparent in not only how they dress and act but also how they interact with others.
Work Hard and Be a Team Player
Newcomers who stand out and appear powerful are those who do more, work harder, and contribute to the organization. They attend meetings and in-service opportunities; they do committee work and take their share of night shifts and weekend and holiday assignments without complaining. A power base is not achieved by slick, easy, or quick maneuvers but through hard work. It is also important to be a team player. Showing a genuine interest in others, being considerate of other people’s needs and wants, and offering others support whenever possible are all part of a successful team building. These interpersonal skills are part of emotional intelligence.
Determine the Powerful in the Organization
Understanding and working successfully within both formal and informal power structures are important
strategies for building a personal power base. Individuals must be cognizant of their limitations and seek counsel appropriately. One should know the names and faces of those with both formal power and informal power. The powerful people in the informal structure are often more difficult to identify than those in the formal structure. When working with powerful people, look for similarities and shared values and avoid focusing on differences.
Learn the Language and Symbols of the Organization
Each organization has its own culture and value system. New members must understand this culture and be socialized into the organization if they are to build a power base. Being unaware of institutional taboos often results in embarrassment for the newcomer.
Learn How to Use the Organization’s Priorities
Every group has its own goals and priorities for achieving those goals. Those seeking to build a power base must be cognizant of organizational goals and use those priorities and goals to meet management needs. For example, a need for a new manager in a community health service might be to develop educational programs on chemotherapy because some of the new patient caseload includes this nursing function. If fiscal
management is a high priority, the manager needs to show superiors how the cost of these educational programs will be offset by additional revenues. If public relations with physicians and patients are a priority, the manager would justify the same request in terms of additional services to patients and physicians.
Increase Professional Skills and Knowledge
Because employees are expected to perform their jobs well, one’s performance must be extraordinary to enhance power. One method of being extraordinary is to increase professional skills and knowledge to an expert level. Having knowledge and skill that others lack greatly augments a person’s power base. Excellence that reflects knowledge and demonstrates skill enhances a nurse’s credibility and determines how others view him or her.
Maintain a Broad Vision
Vision is one of the most powerful tools that a leader has in his or her toolbox. Because workers are assigned to a unit or department, they often develop a narrow view of the total organization. Power builders always look upward and outward. The successful leader recognizes not only how the individual unit fits within the larger organization but also how the institution as a whole fits into the scheme of the total community. People without vision rarely become very powerful.
Use Experts and Seek Counsel
Newcomers should seek out role models. Role models are experienced, competent individuals an individual wishes to emulate. Even though there may be no significant interpersonal relationship, one can learn a great deal about successful leadership, management, and decision making by observing and imitating positive role models. By looking to others for advice and counsel, people demonstrate that they are willing to be team players, that they are cautious and want expert opinion before proceeding, and that they are not rash newcomers who think they have all the answers. Aligning oneself with appropriate veterans in the organization is excellent for building power.
Be Flexible
Great leaders understand the power of flexibility. Anyone wishing to acquire power should develop a reputation as someone who can compromise. The rigid, uncompromising newcomer is viewed as being insensitive to the organization’s needs.
Develop Visibility and a Voice in the Organization
Newcomers to an organization must become active in committees or groups that are recognized by the organization as having clout. When working in groups, the newcomer must not monopolize committee time.
In addition, novice leaders and managers must develop observational, listening, and verbal skills. Their spoken contributions to the committee should be valuable and articulated well.
Experienced leader-managers must strive for visibility and voice as well. Managers who are too far removed from workers in the organization hierarchy can have a view that is cloudy or distorted. If workers do not know their managers, they will not trust them.
Learn to Accept Compliments
Accepting compliments is an art. One should be gracious but certainly not passive when praised for extraordinary effort. In addition, people should let others know when some special professional recognition has been achieved. This should be done in a manner that is not bragging but reflects the self-respect of one who is talented and unique.
Maintain a Sense of Humor
Appropriate humor is very effective. The ability to laugh at oneself and not take oneself too seriously is a most important power builder. Humor allows the leader to relax so that he or she can step away from the challenge and look at the circumstance in a different perspective.
Empower Others
Leaders need to empower others, and followers must empower their leaders. When nurses empower each other, they gain referent power. Individual nurses and the profession as a whole do not gain their share of power because they allow others to divide them and weaken them. Nurses can empower other nurses by sharing knowledge, maintaining cohesiveness, valuing the profession, and supporting each other. Power building and political strategies are summarized in Table 13.2.
LEARNING EXERCISE
13.5
Building Power as the New Nurse
Y
ou have been an RN for 3 years. Six months ago, you left your position as a day charge nurse at one of the local hospitals to accept a position at the public health agency. You really miss your friends at the hospital and find most of the public health nurses older and aloof. However, you love working with yourpatients and have decided that this is where you want to build a lifetime career. Although you believe that you have some good ideas, you are aware that because you are new, your ability to act as a change agent will be limited. Eventually, you would like to be promoted to agency supervisor and become a powerful force for stimulating growth within the agency. You decide that you can do a few things to build a power base. You spend a weekend designing a personal power-building plan.
A S S I G N M E N T:
Make a power-building plan. Give 6 to 10 specific examples of things you would do to build a power base in the new organization. Provide rationale for each selection. (Do not merely select from the general lists in the text. Outline specific actions that you would take.) It might be helpful to consider your own community and personal strengths when solving this learning exercise.
The Politics of Power
Politics is the art of using legitimate power wisely. It requires clear decision making, assertiveness, accountability, and the willingness to express one’s own views. It also requires being proactive rather than reactive and demands decisiveness. Leader-managers in power positions in today’s health-care settings are more likely to recognize their innate abilities that support the effective use of power.
It is important for managers to understand politics within the context of their employing organization. After the employee has built a power base through hard work, increased personal power, and knowledge of the organization, developing skills in the politics of power is necessary. After all, power may not be gained indefinitely; it may be fleeting. For example, people often lose hard-earned power in an organization because they make political mistakes. Even seasoned leaders occasionally blunder in this arena.
Although power is a universally available resource, it does not have a finite quality and can be lost as well as gained.
It is useless to argue the ethics or value of politics in an organization, because politics exists in every organization. Thus, nurses waste energy and remain powerless when they refuse to learn the art and skill of political maneuvers. Politics becomes divisive only whenever gossip, rumor, or unethical strategies occur.
Much attention is given to improving competence, but little time is spent in learning the intricacies of political behavior. The most important strategy is to learn to “read the environment” (e.g., understand relationships within the organization) through observation, listening, reading, detachment, and analysis.
Because power implies interdependence, nurses must not only understand the organizational structure in which they work but also be able to function effectively within that structure, including dealing effectively with the institution’s inherent politics. Only when managers understand power and politics will they be capable of recognizing limitations and potential for change.
Understanding one’s own power can be frightening, especially when one considers that “attacks” (or opposition) from various fronts may reduce that power. When these attacks occur, people who hold powerful positions may undermine themselves by regressing rather than progressing and by being reactive rather than proactive. The following political strategies will help the novice manager to negate the negative effects of organizational politics:
Become an expert handler of information and communication. Beware that facts can be presented seductively and out of context. Be cautious in accepting facts as presented, because information is often changed to fit others’ needs. Managers must become artful at acquiring information and questioning others. Delay decisions until adequate and accurate information has been gathered and reviewed. Failing to do the necessary homework may lead to decisions with damaging political consequences.
Managers must not trap themselves by discussing something about which they know very little.
Political astuteness in communication is a skill to be mastered, and the politically astute manager says, “I
don’t know” when adequate information is unavailable. Grave consequences can result from sharing the wrong information with the wrong people at the wrong time. Determining who should know, how much they should know, and when they should know requires great finesse.
One of the most politically serious errors that one can make is lying to others within the organization.
Unlike withholding and refusing to divulge information, which may be good political strategies, lying destroys trust, and leaders must never underestimate the power of trust.
Be a proactive decision maker. Nurses have had such a long history of being reactive that they have had little time to learn how to be proactive. Although being reactive is better than being passive, being proactive means getting the job done better, faster, and more efficiently. Proactive leaders prepare for the future instead of waiting for it. Seeing changes approaching in the health-care system, they prepare to meet them, not fight them.
Assuming authority is one way that nurses can become proactive. Part of power is the image of power;
a powerful political strategy also involves image. Instead of asking, “May I?” leaders assume that they may. When people ask permission, they are really asking someone to take responsibility for them. If something is not expressly prohibited in an organization or a job description, the powerful leader assumes that it may be done. Politically astute nurses have been known to create new positions or new roles within a position simply by gradually assuming that they could do things that no one else was doing. In other words, they saw a need in the organization and started meeting it. The organization, through default, allowed expansion of the role. People need to be aware, however, that if they assume authority and something goes wrong, they will be held accountable, so this strategy is not without risk.
Expand personal resources. Because organizations are dynamic and the future is impossible to predict, the proactive nurse prepares for the future by expanding personal resources. Personal resources include economic stability, higher education, and a broadened skill base. Some call this the political strategy of
“having maneuverability,” that is, the person avoids having limited options. People with “money in the bank and gas in the tank” have a political freedom of maneuverability that others do not. People lose power if others within the organization know that they cannot afford to make a job change or lack the necessary skills to do so. Those who become economically dependent on a position lose political clout.
Likewise, the nurse who has not developed additional skills or sought further education loses the political strength that comes from being able to find quality employment elsewhere.
Develop political alliances and coalitions. Nurses often can increase their power and influence by forming coalitions and alliances (networking) with other groups, be they peers, sponsors, or subordinates, especially when these alliances are with peers outside the organization. In this manner, the manager keeps abreast of current happenings and consults others for advice and counsel. Although networking works among many groups, for the nurse-manager, few groups are as valuable as local and state nursing associations. More power and political clout result from working together rather than alone. When a person faces political opposition from others in the organization, group power is very useful.
Nurses must be represented in mass, in some way, before they will be able to significantly impact the decisions that directly influence their own profession.
Be sensitive to timing. Successful leaders are sensitive to the appropriateness and timing of their actions.
The person who presents a request to attend an expensive nursing conference on the same afternoon that his or her supervisor just had extensive dental work typifies someone who is insensitive to timing.
Besides being able to choose the right moment, the effective manager should develop skill in other areas of timing, such as knowing when it is appropriate to do nothing. For example, in the case of a problem employee who is 3 months from retirement, time itself will resolve the situation. The sensitive manager also learns when to stop requesting something. That time is before a superior issues a firm “no,” at which point continuing to press the issue is politically unwise.
Promote subordinate identification. A manager can promote the identification of subordinates in many ways. A simple “thank you” for a job well done works well when spoken in front of someone else.
Calling attention to the extra efforts of subordinates says in effect, “Look what a good job we are capable of doing.” Sending subordinates sincere notes of appreciation is another way of praising and promoting.