1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 17 Power

3. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Define the concept of power from more than one perspective. Identify the various ways power has been described in the literature. Describe how a nurse’s perception of and orientation to power affects patient care.

4. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company4 Objectives Discuss the relationships among empowerment and personal and collective commitment. Describe the association of connection power and relationships. Explain why nurses are faced with a paradox within the context of information power.

5. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company5 Definitions of Power  Power is described as the ability to create, get, and/or use resources to achieve one’s goals.  Power can be defined at various levels: personal, cultural, professional, or organizational.  Power, regardless of level, comes from the ability to influence others or affect others’ thinking or behavior.

6. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company6 Power and Accountability  Effective nurses view their ability to understand and use power as a significant part of their responsibilities to patients, their coworkers, the nursing profession, and themselves.  Nurses are accountable, both professionally and legally, for decisions and actions occurring under their supervision.

7. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company7 Power and Accountability  Accountability without authority to make responsible decisions poses a threat to nurses individually and collectively.  Nurses must understand that power is a means of developing and retaining the authority that must accompany their accountability.

8. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company8 Sources of Power  Expert power: derived from knowledge and skills  Legitimate power: derived from the position of authority a person holds  Referent (charismatic) power: derived from how much others respect and like a person  Reward power: derived from a person’s ability to bestow rewards on people

9. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company9 Sources of Power  Coercive power: derived from a person’s ability to punish or threaten others  Connection power: derived from a person’s connection to others with power  Information power: derived from a person’s ability to provide information

10. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company10 Power and Decision Making  Power and decision making are intricately connected.  Emphasis on cost containment in health care has created opportunities for nurses.  Nurses’ knowledge allows them to participate in health care and cost-containment discussions, giving them more opportunities for decision making.  This, in turn, gives nurses greater power.

11. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company11 Personal Orientation and Motivation in Relation to Power  A person can desire and wield power for personal gain or for the common good.  Nursing has traditionally worked for the common good.  To continue doing so, nursing must exert power and control over its decision-making abilities.  Nurses must examine their personal motivations for seeking and exerting power.  Any one perspective on power is incomplete.

12. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company12 Empowerment and Disempowerment  Empowerment is the “process by which we facilitate the participation of others in decision making and take action within an environment where there is an equitable distribution of power.”  Nurses can disempower themselves by acting powerless when interacting with other professionals, legislators, or the media.  Nursing can empower itself through a greater presence in the media and in the minds of the public.

13. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company13 The Power of Relationships  Nurses regularly are afforded special opportunities to form relationships, by entering into a loop of information sharing.  However, information sharing alone does not create power—it must be accompanied by commitment.  Nursing expresses a commitment to patients, and nurses must articulate and act upon that commitment.

14. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company14 The Power and Limits of Information  Information alone does not create power, as potentially there is no end to information and information gathering.  Nurses must be able to gather the necessary information for competent decision making and make decisions in an appropriate time frame.  The critical thinking process that nurses use to gather, interpret, share, and apply information is what transforms their information into power.

15. Chapter 17Copyright © 2003 Delmar Learning, a Thomson Learning company15 The Power of Critical Thinking  Critical thinking enables nurses to understand more and to find better information.  Effective nurses can take information they have acquired in the past and apply it to their present situation.  Power is associated with transforming thought into action.