Earn 1 free credit hour with this continuing education course
article-down-arrow
Nurse empowerment is building at some facilities
editors-noteEDITOR’S NOTE: Sandra Swearingen, PhD, RN, is a senior consultant with Courageous Healthcare.
You are an experienced registered nurse looking for a new job in a local hospital. Your current hospital does not offer a great deal of support for professional practice, and you feel you have failed your patients. You want structures and systems to help you deliver high-quality care and want to be involved in decisions about the delivery of care.
You talk to your friends at hospitals in the area. One nurse keeps talking about how she loves her job and goes on and on about the changes that have taken place since her hospital became Magnet accredited last year. She talks about structural empowerment and what a difference it has made in her work. You start to wonder, “What the heck is structural empowerment?” and “Why does it make such a difference?”

Structural empowerment gives nurses greater autonomy in their practice and a greater voice in decision making in their organizations.1 “Empowerment” refers to the ability to fully practice as a professional nurse. “Structural empowerment” means that staff members are involved in structures of an organization that result in an empowered nursing professional practice.

Structural empowerment promotes the highest levels of clinical excellence and professional practice.2 Structural empowerment is found to be fundamental to the provision of high-quality healthcare.2 Empowerment structures of an organization include its policies, councils, and processes. The following are included: the development of policies and procedures, effective staffing models, staff membership in leadership and administrative councils, professional development, shared governance councils/professional practice work environments, access to information, access to support, access to resources, and the support needed to optimize a nurse’s practice.2-6

Shared governance is a governing system that relies on teams of nurses who are self-managed, autonomous in problem solving, and are decision makers for patients and nurses.6 One place for information about shared governance is the Forum for Shared Governance website, where tools for measuring shared governance are available. With more than 3 million RNs in the U.S. today,7 nurses make up the largest segment of the healthcare professions. An environment that lets nurses practice to the optimum levels of their training is important for the future of healthcare.8 There are also concerns about an increasing nursing shortage. Researchers note that plans to leave the profession are escalating among nurses. Oppressive workloads, burnout, and job dissatisfaction are fueling nurse retention problems.9 In addition, the downsizing of RN positions from 1995 to 2000 resulted in fewer educational schools for nursing. The negative effect of this downsizing is still being felt today, leading to continued projections of a nursing shortage in the future.
Nursing leaders worldwide have made improving the workplace environment a goal. Leaders have worked at determining the workplace dynamics that encourage nurses to enter nursing and those that discourage nurses from remaining. Dynamics such as autonomy in the workplace, the ability to practice as a professional nurse, and job satisfaction are important in recruiting and retaining nursing staff. The lack of empowerment in the workplace is a factor in nurses’ leaving the profession and one of the reasons for the growing shortage of nurses worldwide.10 (Level B) Some research correlates quality patient care with an empowered nursing workforce; that is, a workforce that has access not only to the resources, information, and support that improve nursing professional practice but also uses professional standards of nursing in the delivery of care.2 Typical work environments, with their heavy workloads and high stress, are resulting in burnout and increased absenteeism. This is especially evident in new graduate nurses.11

Workplaces that have authentic leadership demonstrate a positive impact on staff empowerment. Staff who are empowered are linked to positive organizational environments, decreased short staffing, and increased work-life balance, resulting in increased retention of nurses. Nurses in these environments experience job satisfaction, less burnout, and improvement in their perception of the quality of care they are delivering, and are dedicated to their organizations.9
Research also has shown that employees are more engaged when they feel that they have job resources (such as support from coworkers and leadership).9 Nurses who are engaged have high energy levels and are resilient in the face of stress. Engaged nurses are persistent and resilient in difficult situations, such as periods of rapid patient turnover or patient crises.

They are immersed in their work to a point that their awareness of time disappears, and they are reluctant to leave at the end of their shifts. Supportive leaders and developmental opportunities motivate nurses and lead to greater work satisfaction and commitment to organizations. Engagement is the opposite of burnout. Engagement is linked to lower depression and fewer physical problems.

Engagement is seen as a positive response to empowered work environments.12 Job satisfaction, autonomy, commitment to the organization, and job resources — all central to engagement — are a result of empowered work environments.2
The Magnet definition
Workplaces in which nursing professional practice flourishes are a result of solid structures and processes that have been influenced by inventive leadership, according to the American Nurses Credentialing Center’s Magnet Program.5 Inventive leadership is leadership that uses new and innovative approaches for improving the workplace environment.

To achieve goals, nurses need to be developed and empowered. Development and empowerment in healthcare organizations are achieved through a mixture of structures and programs. Structures and programs that support empowerment include in-house continuing education programs, a shared governance structure through which nurses are involved in management and decision making on their units, leadership support, and communication plans.5

Increased pay differentials for nurses with certification, and an emphasis on professional practice are other factors that increase empowerment.5 An empowered nurse has the ability to be autonomous in nursing practice and follow professional guidelines in caring for patients. Empowerment of nurses is included in the idea of structural empowerment. Nurses who are empowered are more likely to practice decision-making skills and problem solving, and can change care provisions as needed.6 Nurses have higher levels of job satisfaction with higher degrees of structural empowerment.9

The concept of empowerment is vital to nursing practice because nurses are licensed healthcare providers. Licensure means that a person has a greater body of knowledge in a field than a member of the general population. Along with greater knowledge, there is the power to use that knowledge and the accountability for using the knowledge appropriately. Power and accountability are all part of being licensed.13
Various academic and nursing leaders have developed models of structural empowerment.
Gretchen Spreitzer, a professor of business administration and management at the University of Michigan, originated a theory about psychological empowerment; it states that the feelings an employee has about the work environment shape his or her perceptions of empowerment.

Structural empowerment addresses the environment of the workplace but it does not describe the employee’s feelings about the environment. If an employee is not interested in empowerment, structurally related empowerment conditions, such as shared governance, autonomy in practice, and the ability to use professional standards of nursing, will not make a difference in his view of the work environment.19 Psychological empowerment has four components: autonomy, competence, meaning, and impact. Autonomy refers to the perception of control that people have in relation to their work environment.

Competence is employees’ view of their capability to do the job to the best of their ability. Meaning refers to the fit of the employee in relation to the standards and goals of the organization. Impact is the power that employees perceive to have over patient outcomes, which in turn support organizational outcomes.20

If nurses feel their work is autonomous and has meaning and importance, and they feel competent in their role, the physical environment where they work may not have an impact on their ability to do their jobs.19 Burnout, low organizational trust (the trust employees have in an organization’s ability to meet their needs), low commitment to the organization, and a feeling that the organization does not justly deal with all employees are linked to a lack of structural and psychological empowerment.

Employees are likely to feel more empowered if they are autonomous in their professional practice, find meaning in their work, and believe that they have an impact on organizational outcomes. Removal of “disempowering” structures (such as a top-down leadership style that does not allow nurses’ input into the way they practice) increases nurses’ perception of being empowered.9, 21 (Level B) Environments that provide structural empowerment contribute to an RN’s psychological empowerment. Psychological empowerment, in turn, leads to a healthy, productive, engaged, innovative RN workforce, which increases job satisfaction and retention.22
The theory of critical social empowerment originated in the 1920s in Germany but was first published by Max Horkheiner of the Frankfurt School of Sociology in 1937. This theory is based on the fact that certain groups are in subordinate positions.23 Under this theory, nursing falls into one of the subordinated groups, with the nurse being deferential to the physician for orders for care and to the manager for direction in care delivery (institutionalized power).

Healthcare has long functioned on institutionalized power: the power to keep people from having grievances with how they function by shaping their perceptions and attitudes to the point that they accept the differential order of things.23 Many nurses acquire beliefs and form needs that result in an adjustment to domination; nurses who adjust to domination see it as a normal part of their profession. To reach their potential in relation to organizational contribution, nurses need an equal voice in decision making with physicians and managers. Only when nurses are given an equal voice in decision making in relation to policy setting, regulations in the workplace, and the ability to practice with autonomy will they become engaged, innovative, and productive staff.1
The relationship that a leader and follower form over time is the basis of leader-member exchange theory (LMX).24 A strong LMX relationship has four dimensions: contribution (performing work beyond expectations), affect (friendship and liking), loyalty, and professional respect for each other’s capabilities. An affirmative LMX is tied to job satisfaction, commitment, and job performance.25 A positive manager/employee relationship in organizations that are structurally empowered results in empowered employees. High-LMX relationships improve access to structurally empowering conditions in the workplace.25 A high LMX relationship will result in the leader’s increasing the staff member’s formal power.

Leaders at different levels in an organization have different levels of influence and affect the experience of the workers in different ways. Leaders influence the employees’ assessment of their work.26 (Level B) This is done by increasing flexibility and scope of decision-making power for the staff member, which in turn increases the staff member’s access to more empowering circumstances.

A staff member with a positive working relationship with an empowered manager who speaks highly of the staff member’s position and mentors the employee may also seek future leadership roles.26 Unfortunately, not all nurse leaders understand how to empower their staff. However, one study noted that nurse leaders can be trained in structural and psychological empowerment strategies that increase safety and patient outcomes. This research found that through education on empowerment strategies, nurse leaders who were empowered increased staff empowerment.27 (Level B) OnCourse Learning guarantees that this educational activity is free from bias. Go online to read the full continuing education module and take the test.
How to earn continuing education
THIS COURSE IS 1 CONTACT HOURS
Read the Continuing Education article.
This continuing education course is FREE ONLINE until September 29, 2018, courtesy of Nurse.com. To take the test for FREE, go to https://www.nurse.com/ce/structural-empowerment. After that date, you can take the course for $12 at the same link. If you have a CE Direct login and password (generally provided by your employer), please login as you normally would at https://cedirect.continuingeducation.com and complete the course on that system.
1.
2.
3.
If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.
4.
Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.
5.
All users must complete the evaluation process to complete the course. You will be able to view a certificate on screen and print or save it for your records.
In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider # 50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider # CEP16588.
You can take this test online or select from the list of courses available. Prices subject to change.
ONLINE
QUESTIONS
T | 800-866-0919
Structural empowerment: Boosting professional practice
By Sandra Swearingen, PhD, RN
This course is 1 contact hour
Courses must be completed by December 15, 2019
Goals and objectives: The goal of this program is to inform nurses of the significance of structural empowerment in organizations and its effect on nurses’ work. After studying the information presented here, you will be able to:
  1. Describe theories associated with structural empowerment
  2. Discuss the importance of structural empowerment in relation to nursing
  3. Describe the implications of structural empowerment in the workplace
Nurse.com educational activities are provided by OnCourse Learning. For further information and accreditation statements, please visit Nurse.com/Accreditation. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. OnCourse Learning guarantees this educational activity is free from bias. See “How to Earn Continuing Education” to learn how to earn CE credit for this module or visit http://ce.nurse.com/instructions.aspx.
A key goal worldwide
Empowerment structures
Critical social empowerment
Leader-member exchange theory
Rosabeth Moss Kanter, a professor of business administration at Harvard Business School, is one of the principal theorists of empowerment. Kanter believes that effective work conditions are created through empowering an organization’s work structures.14 Kanter’s influential work identifies organizational structures that contribute to workplace empowerment:

  • Access to information: comprehension and technical knowledge required to work effectively
  • Support: advice and support received from colleagues, managers, and subordinates
  • Resources: time and material to get the job done well
  • Learning opportunities: possibilities for learning and development in the organization
  • Formal power: visible and important workplace positions (i.e., manager, director, supervisor)
  • Informal power: power that evolves from peer associations and alliances
Employees who have access to empowering work structures (such as those above) are more motivated than those without access.15 These employees are also more satisfied with their jobs and more committed to their organizations.14

Managers play an important role in providing access to these organizational structures in the workplace.15 An example of this is a manager who shares the results of a high-level meeting with one of the administrative nurse managers, thus giving her access to information that she would not normally have. Or it could be a nurse manager who lets a designated charge nurse make and post the work schedule for the whole unit. Research is beginning to document the importance of structural empowerment in the mid-level leader or nurse manager positions. The greater empowerment of the mid-level leader translates into increased abilities to empower the lower-level staff to deliver high-quality patient care.

As healthcare becomes more complex, the role of the mid-level manager becomes more comprehensive, requiring clinical and operational control. Mid-level managers are critically important in relation to the retention of nursing staff.16,17 (Level B)
One study demonstrated that structurally empowering conditions in the workplace made employees feel that managers were more concerned with employees’ well-being when they made decisions and that managers were willing to explain to employees the decisions they made.8 Kanter believes that these structures are highly significant to employees’ attitudes and behaviors, more so than personal characteristics of the employee.18 Access to structural empowerment in the workplace is encouraged by formal and informal power. Formal empowerment is also called “positional power,” or the power that one gains by obtaining a certain position in a nursing structure. Higher-level jobs in a nursing structure, such as nurse manager, director, or chief nursing officer, carry certain advantages. Jobs with flexible schedules, jobs essential to the goals of an organization (such as manager, director, and chief nursing officer), and jobs that allow originality and decision making are enhancements of formal power.18 Informal power is power shared through a relationship of a leader who has formal power with someone in a lesser-status position. It also may be power given informally through relationships that an employee may develop through communication with other coworkers, leaders, or physicians. Informal power encompasses possible knowledge that an employee may have, such as expert knowledge of a specific task or service line.

The development of relationships and open communication resulting in knowledge between all groups within and outside the organization are enhancements of informal power.18 Empowered structures result in empowered employees. Empowered employees are more motivated and more dedicated to the organization. Nurses who do not have access to empowerment structures have lower aspirations and are less committed to their organizations.8, 15
Psychological empowerment
Read the rest of this course and take the test to earn credit
CE Direct subscribers complete course here
High energy and resilience
left-arrowright-arrow-3right-arrow
© 2018 OnCourse Learning Corp. All rights reserved
20225 Water Tower Blvd. Brookfield, WI 53045
hamburguer-icon-shadow
MENU
toc-imageX
Contents
arrow-TOC
Make 3 mammoth decisions
female_student_at_library
Choose your goal and platform before heading back to school.
woman_writing_and_sitting_with_laptop
Create a winning resume
Jump ahead of the competition with a top-notch resume.
arrow-TOC
ThinkstockPhotos-77295814
Salaries on the upswing
Find out how your salary compares to RNs across the country.
arrow-TOC
nurse_with_arms_crossed_standing_in_hallway
Job satisfaction study
RNs reveal how they really feel about their jobs.
arrow-TOC
airplane_taking_off_at_sunset
Avoid turbulent travel nursing
Seek advice on travel contracts before signing on the dotted line.
arrow-TOC
woman_at_an_job_interview
5 tips for job interviews
Make a memorable first impression at your next interview.
arrow-TOC
toy_car_on_globe_map
Is travel nursing for you?
If you have an adventurous spirit, you might like this specialty.
arrow-TOC
woman_throwing_graduation_cap_into_sky
CE COURSE: Terminal degrees
PhD, EdD, DNP — which one should you pursue?
arrow-TOC
construction_worker_holding_hard_hat
Legally protect your practice
Know the tools you need to protect your license from potential liability.
arrow-TOC
woman_typing_on_laptop
Get on boards when job hunting
Nursing job boards can help you find the perfect job.
arrow-TOC
birds-low
Boost your career trajectory
The right plan and tools will help you carve out a successful career.
arrow-TOC
woman_smiling_and_sitting_on_hill_
Get to the heart of bioethics
Big ethical decisions have a way of influencing all aspects of RNs' lives.
arrow-TOC
ThinkstockPhotos-175218925
Speak their language
Bilingual nurses are in demand by recruiters.
arrow-TOC
young_male_and_female_nurses_with_patient
Engaging millennials
Nurse leaders are finding ways to retain younger nurses.
arrow-TOC
ThinkstockPhotos-128960079
Healthcare in the outlands
Rural areas seek nurses willing to make the move.
arrow-TOC
ThinkstockPhotos-506752188_TOC_RZ
Continuing education catalog
Read this list of CE modules geared toward your professional growth.
arrow-TOC
group_of_nurses_talking
CE COURSE: Precepting
Find out why preceptors are critical to the nursing profession.
arrow-TOC
gavel
Protect against retaliation
Nurse attorney discusses your discrimination rights on the job.
arrow-TOC
paper_planes_with_a_yellow_one_veering_off_course
Tips on how to change jobs
When you're ready for a new career direction make a flight plan first.
arrow-TOC
hands_of_people_arguing
Learn how to keep the peace
Conflict management isn't easy, but it's worth the time and effort.
arrow-TOC
woman_looking_through_binoculars
Job search like a pro
Become a savvy job seeker by following these guidelines.
arrow-TOC
wood_beams_at_construction_site
FREE CE: Become empowered
Learn how to gain a greater voice at your organization.
arrow-TOC
share-dots-shadow
How to Navigate
Nurse-logo
Subscribe
X
How to Navigate
BROWSE
FIND
right-arrowleft-arrow
hamburguer-icon-shadow
MENU
Move forward or backward between articles by clicking the arrows.
Click or tap to bring up the Table of Contents.
READ
share-dots-shadow
facebooktwitterLinkedingoogle-pluspinterest
SHARE
scroll
Share articles by clicking on one of the social media icons in the upper right corner of the page.
Use your mouse wheel, keyboard arrow keys, or scroll bar to move up and down in an article.
Don't miss our next edition! Get free tips and nursing content delivered right to your inbox