Additional Learning Exercises and Applications
DISPLAY 13.2 Six Driving Forces to Increase Nursing’s Power Base
DISPLAY 13.2 Six Driving Forces to Increase Nursing’s Power Base
1. The timing is right
2. The size of the nursing profession 3. Nursing’s referent power
4. Increasing knowledge base and education for nurses 5. Nursing’s unique perspective
6. Desire of consumers and providers for change
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.
LEARNING EXERCISE
13.4
Cultural Diversity
D
o you think that cultural diversity might be a challenge when empowering nurses? Think of ways that various cultures may view power and empowerment differently. If you know people from other cultures, ask them how powerful people or those in authority positions are viewed in their culture and compare that with your own culture.Right timing. The errors reported in our medical system, the numbers of uninsured, and the shortcomings of our current health-care system are all reasons that consumers and legislators are willing to listen to nurses as an attempt is made to fix the health-care crisis. Clearly, the public wants a better health-care system, and nurses want to be able to provide high-quality nursing care. Both are powerful elements for change, and new nurses are entering the profession at a time when their energy and expertise will be more valued than ever. The passage and implementation of the Patient Protection and Affordable Care Act (PPACA) has only escalated public awareness and debate about flaws in publicly funded or subsidized health care in the United States. Furthermore, as a result of publications such as To Err Is Human, consumers, health-care providers, and legislators are more aware than ever of the shortcomings of the current health-care system, and the clamor for action has never been louder.
Size of the nursing profession. Numbers are very important in politics, and the nursing profession’s size is its greatest asset. The United States has just over 3.1 million active professional RNs (Henry J. Kaiser Family Foundation, 2016), which represents an impressive potential voting bloc.
Nursing’s referent power. The nursing profession has a great deal of referent power as a result of the high degree of trust and credibility the public places in them. Indeed, nurses have placed number 1 almost every year in the Gallup Organization’s annual poll on professional honesty and ethical standards since nurses were first included in the survey in 1999.
Increasing knowledge base and education for nurses. There are more nurses being awarded master’s and doctoral degrees than ever before. Eileen Breslin, current president of the American Association of Colleges of Nursing (AACN), stated she “expects to see the momentum continue to build for advancing nursing education at all levels” because “employers are looking for highly skilled nurses able to translate the latest scientific evidence into practice” (Wood, 2015, para. 19). One of the greatest areas of growth will be in the number of Doctor of Nursing Practice (DNP) students, with more than 15,000 students now pursuing a practice doctorate. Additionally, during the past decade, enrollment in Doctor of Philosophy (PhD) in nursing programs increased by 49% and is expected to further increase this year (Wood, 2015).
In addition, more nurses are stepping into advanced practice roles as nurse practitioners, clinical nurse specialists, certified nurse midwives, RN anesthetists, or clinical nurse-leaders. If knowledge is power, then those having knowledge can influence others, gain credibility, and gain power.
Furthermore, leadership, management, and political theory are increasingly a part of baccalaureate nursing education, although the majority of nurses still do not hold baccalaureate degrees. These are learned skills, and collectively, the nursing profession’s knowledge of leadership, politics, negotiation, and finance is increasing. This can only increase the nursing profession’s influence outside the field (Huston, 2017).
Nursing’s unique perspective. Thakore (2015) suggests that one of the characteristics of a profession is that professionals have power over the practice of their discipline. This is often referred to as professional autonomy or “the freedom to act on what one knows.” Nursing has long been recognized as having a strong caring component. Combine that with nursing’s recent surge in scientific knowledge and critical
thinking and there is a blend of art and science that brings a unique perspective to the health-care arena.
Desire of consumers and providers for change. Limited consumer choice, hospital restructuring, the downsizing of registered nursing, and the Institute of Medicine (IOM) medical error reports were the sparks needed to mobilize nurses, as well as consumers, to take action. Nurses began speaking out about how downsizing and restructuring were affecting the care they were providing, and the public began demanding accountability. The public does care who is caring for them and how that affects the quality of their care. The flaws of the health-care system are no longer secret, and nursing has the opportunity to use its expertise and influence to help create a better health-care system for the future.
An Action Plan for Increasing Professional Power in Nursing
Huston (2017) also developed an action plan for the nursing profession to build its power base (Display 13.3 shows a summary of these actions). This action plan includes the following strategies:
Place more nurses in positions that influence public policy. The IOM (2011) suggested that for health- care reform to work, nurses must be a part of decision-making processes in the health care-system. This means placing nurses on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care (IOM, 2011). Training will be required, however, because many nurses lack basic skills in health-care finance and policy. Indeed, a 2015 study suggested that increased orientation to liabilities and fiduciary duties were needed for nurses to be present and active on boards at all levels (Walton, Lake, Mullinix, Allen, & Mooney, 2015) (see Examining the Evidence 13.1).
EXAMINING THE EVIDENCE 13.1
Source: Walton, A., Lake, D., Mullinix, C., Allen, D., & Mooney, K. (2015). Enabling nurses to lead change: The orientation experiences of nurses to boards. Nursing Outlook, 63(2), 110–116.
doi:10.1016/j.outlook.2014.12.015
The purpose of this study was to examine the orientation experiences of nurses to boards and their preparation to influence health care and health-care policy.
A web-based survey about the efficacy of board orientation was sent to members of three local boards made up exclusively of nurses. A convenience sample of 46 board members was eligible and invited to participate in the survey about their board orientation experience.
The study found that liabilities and fiduciary duties were least likely to be addressed in board orientation for nurses. Board members requested more training in finance and a more formal/structured orientation process. One respondent in the narrative comments mentioned wanting more information about “teamwork and group process.” Two respondents said they wanted more information about “strategic planning.” The researchers concluded that orientation elements for nurses serving on boards would best prepare them to serve on interprofessional hospital boards and work in the health policy arena.
Unfortunately, although nurses typically represent the greatest percentage of the workforce in hospitals, few nurses serve on hospital boards or hold positions of significant power. A survey by the American Hospital Association (AHA) of over 1,000 hospitals in 2010 found that nurses made up only 6% of board members, whereas physicians held more than 20% of board seats (Walton et al., 2015).
Holding office, however, is the ultimate in political activism. Huston (2017) argues that nurses are uniquely qualified to hold public office because they have the greatest firsthand experience of problems faced by patients in today’s health-care system as well as an uncanny ability to translate the health-care experience to the general public. As a result, more nurses need to seek out this role. In addition, because the public respects and trusts nurses, nurses who choose to run for public office are often elected. The problem then is not that nurses are not elected; the problem is that not enough nurses are running for
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.