1. Organizational Power and Politics

2. Power, politics, and policy Power, politics, and policy should be familiar concepts for all nurses and are especially important for nursing leaders. Power, politics, and policy influence nursing practice, education, and research, which in turn influence health care. Power and politics are intricately entwined concepts and are sometimes difficult to differentiate.

3. Power There are multiple definitions of power. Some assert that power is an overall concept that includes authority and influence. Others see authority and influence as separate ideas or concepts; as such, they require individual consideration. Power is the ability to influence other people despite their resistance and may be actual or potential, intended or unintended. It may be used for good or evil, for serious purposes or for frivolous and selfish ones.

4. Common types of power Leaders who act in ways that are important to followers are given power. Common types of power include (a) authority, (b) expertise, (c) reward, (d) coercive, and (e) referent.

5. Authority and Administrative Nurse managers and team leaders have more power than do staff nurses. CNEs, deans, senators, mayors, governors, presidents, and other elected officials have administrative power. Administrative authority is the power or right to give orders or commands, to enforce compliance, to take action, and to make final decisions.

6. Expert power Expert power is influence that results from knowledge or expertise that is needed by others. It is similar to personal authority, but it is gained and affirmed through respect for expertise. Expertise can be an indispensable source of power within health-care organizations. Such power is granted by choice to a person, not to a position, and applies to competent professionals. Nurses work in dynamic environments where change is rapid and where power and influence often take new forms.

7. Reward power The American Nurses Association (ANA) lobbies for legislation that is important to patient care and nursing. Lobbyists or advocates can have relationships with legislators where one rewards the other.

8. Coercion Coercion is the real or perceived threat of pain or harm of one person by another. Coercive power may be physical, psychological, social, or economic and involves the use of force in the form of penalties and rewards to effect change. It shows a lack of respect for the autonomy of others and is seen in sexual harassment and threats to livelihood. Those who use coercion are interested in their own goals and are rarely interested in the wants and needs of subordinates.

9. Referent A leader who is followed based on admiration and belief has referent power. The chair of a committee, for example, has referent power for those who work closely with her. Referent power is gained through association with a powerful person or organization. Selection of a powerful person as a mentor and working on powerful committees are ways to develop and hold referent power.

10. The need for power Nurses are predominantly women and provide the most direct patient care in male-dominated organizations. Nurses have rarely had significant power in health-care organizations. Over the past 15 years, nurse administrators have made progress in gaining recognition at the top levels; some have even made inroads to governance. These leaders are all too often terminated, however, which is an all too graphic indication that role acceptance has not been accomplished.

11. Methods to acquire power ■ Broad human networks: the more networks and the more extensive they are, the more power potential. ■ Broad information networks: the more diverse types of information controlled, the more power. ■ Multiple formal and informal leadership roles: high engagement and visibility bring increased power. ■ Ability to assess situations accurately (especially unstructured ones) and to solve problems. ■ Authority over others and resources via legitimate work organizational roles. ■ Vision for the future and creativity. ■ Ability to grant services to others, which builds debts. ■ Expertise that is sought by others.

12. Ways to Increase Expert Power ■ Keep knowledge and skills current to maintain and extend power. Continuing education offerings, books, and journals are effective means. ■ Earn higher degrees; education brings expertise and enhances credibility. ■ Participate actively in professional associations such as the ANA, state nurses associations, and specialty groups to broaden networks, hone expertise, and develop legitimate and referent power. ■ Participate in nursing research to develop knowledge and increase expertise. ■ Problem-solve with colleagues in nursing and other disciplines to develop expertise and networks and to polish skills.

13. Empowerment Empowerment is a sense of having both the ability and the opportunity to act effectively. Empowerment is a process or strategy the goal of which is to change the nature and distribution of power in a specific context. It is a group activity that increases political and social consciousness, is based on the need for autonomy, and is accomplished with continuing cycles of assessment and action. Nursing organizations seek to empower nurses; nurses endeavor to empower patients to seek and adopt healthy lifestyles.

14. Politics Power and politics are the means to achieve health-care goals in a compassionate and humane way. Application of power and politics through collaboration, creativity, and empowerment are effective ways to influence policy. Politics is the negotiation for, or influencing of, allocation of scarce resources. Influence is the act or power to produce an effect without apparent use of force or direct command.

15. Political action spheres The process of influencing others, or politics, in order to achieve ends can be seen in relation to four arenas, spheres, or domains. These spheres are (a) the workplace, (b) professional organizations, (c) community, and (d) local, state, and federal governments. Although the ranges of these domains differ, and the target publics to be influenced differ, the political tactics and strategies are similar.

16. Workplace ■ Mandatory overtime work requirements. ■ A nursing clinical ladder program that rewards excellence with promotions and pay incentives. ■ Work scheduling length of shift, evening and night rotation, vacation priority. ■ A smoking ban in the entire facility; designation of smoking areas. ■ Visiting hours in special care units. ■ Identification and security procedures. ■ Authority to delay discharge from or admission to special care units based on professional nurse assessment. ■ Authority to refer patients to a home healthcare agency. ■ Decisions regarding substitution of unlicensed personnel for RNs to provide care.

17. Professional Organizations Professional organizations have made significant contributions in developing nursing practice. They have set standards of practice, advocated for change in the scope of practice and passage of nurse practice acts, and advocated for nurses in collective action in the workplace.