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This assignment will discuss one of the critical leadership roles in the use of power and authority is the empowerment of subordinates. As my first assignment focused on the transformation model of leadership for which empowerment was one area that this model excels in, this assignment will focus on breakthrough model of clinical leadership (Lett, 2002). The concept of empowerment is vague, as its meanings change with each person and in different situations, whereas the definition of power is more defined. The originator of the concept of empowerment was Rappaport, who in 1984 explains empowerment was easier to understand by its absence: powerless, helplessness, hopelessness, victimisation, alienation, paternalism, subordination, loss of sense of control over their life and dependency. It's more difficult to positively define, as it takes on different meanings for different situations and contexts. According to De Raeve (2002) authority is legitimate reasons to follow its directives regardless of the balance of reasons on the merits of such action.
Harper (2002) suggests breakthrough leadership attributes are: I) showing a genuine interest in the development of each person by making the time to build a deeper personal and sincere professional relationship with each individual; 2) listening to people and asking them for their ideas which shows respect for the individual and a confidence that they have something of value to contribute, thereby indicating that the leader does not have all of the answers and is prepared to listen to the ideas of others; 3) acting on the advice you receive, leaders do not have to act on all advice received but on enough to show people not only that their opinions matter, but also that they can influence the organisation's politics. Once people observe the impact of their concepts in action, they take a significantly more ownership on enacting change. Harper states this is the initial step on the empowerment pathway whereby people gradually achieve greater influence, accept greater accountability and deliver better results; 4) establishing challenges for people and displaying confidence in their ability to deliver. The author points out to do this a leader needs to know each person well and know what is an appropriate challenge for each individual. To achieve this task a clinical leader needs to understand the alignment between organizational aims and personal goals and correctly evaluate the ability and the learning aptitude of the individual concerned; 5) supporting and coaching-when leaders provide support by establishing a safety net which may provide the individual the courage to step "out on a limb" and the coaching then provides them the experience required to master new skills. People will develop greater confidence to experiment something new when they feel supported; 6) providing feedback and recognition are important ingredients in building a relationship because they display the depth of care that a leader possesses. Over time, they are vital elements in developing resilience and sustaining motivation. Harper concludes by stressing this active, constructive, involvement with the leader not only builds competence but also contributes to self-esteem building in the individuals concerned.
De Raeve (2002) considers there are two common categories of practical authority, primarily one that concerns knowledge and experience. Secondly, the other concerns the necessity for coordination and social cooperation for the achievement of social goals. Harper (2002) states expertise alone is not sufficient to warrant a person's acceptance of authority because advice can justifiably be ignored in such situations but advice can becomes saturated with authority if the recipient's goals warrant that it should.
The perceived originator whom studied empowerment is Rappaport in 1981, a psychologist. Numerous authors, including several nursing theorists have based some of their studies on his work. Rappaport (1984) acknowledges freedom and equality are both positively valued in society. Nevertheless, one inhibits the other. Limiting freedom, to do as a person desires, are often required to accomplish steps toward equality for others. Likewise, rights and needs are occasionally in opposition in social systems (Rappaport, 1984) (Ryles, 1999).
Nursing theorists often attempt to describe the phenomena of nursing empowerment from a psychological-physiological perspective, while neglecting sociological issues, such as power, ideology and social status. The role of democratising the nursing systems is permitting increased multidisciplinary participation, while fulfilling statutory obligations is a considerable challenge to the nursing practice in the future (Glenister, 1994) (Rodwell, 1996).
Numerous authors discuss nursing empowerment. The most prominent nursing theorist is Gibson (1991), who was one of the first authors to embellish the paradigm of empowerment as a nursing discipline. Gibson (1991) and Foucault (Radbury-Jones, Sambrook, & Irvine, 2008) explore nursing empowerment as it lacks a clear interpretation: as each person provides their own understanding in each situation. Suggesting, the empowerment concept has vague definitions. The concept of empowerment is easier to understand by its absence: powerlessness, helplessness and hopelessness.
Empowerment can be a process or an outcome Rappaport (1984) Kieffer (1984) (Katz 1984; cited in Gibson, 1991) Kuokkanen & Leino-Kilpi (2000). As a process, Rappaport (1984) suggests: empowerment is the event where people achieve mastery and control over their lives. Simmons & Parson (1983, cited in Gibson, 1991) claim empowerment is the process where people advance to master their environment. The process of empowerment could be perceived as normative, because the process defines what should be performed in various situations (Gibson 1991). Empowerment as the outcome: Gibson (1991) proposes empowerment is the quality or property. The outcome of empowerment could be self-efficacy, sense of control, growth, mastery, sense of well-being and improved health.
Power is a shared experience, as there are elements of reciprocity Gibson (1991) (Boswell, Cannon, & Miller, 2005). Redistribution of power is accomplished through people releasing some of their power and the powerless accepting this power. Nurses need to surrender the need to control and embrace an atmosphere for co-operation (Gibson, 1991). Kieffer (1984) Kuokkanen & Leino-Kilpi (2000) divides and aligns the stages of empowerment to normal human development. In essence, it is the development of how people learn to empower themselves, commencing with infancy where one explores the unknown. In the second stage, one bonds with a support person and accepts responsibilities for their decisions. The third stage, people take on leadership roles as their self-esteem becomes increasingly powerful. The fourth stage, one accepts commitment such as people who are responsible adults (Gibson, 1991).
Boswell, Cannon, & Miller (2005) maintain clinical leaders cannot empower other nurses. Individual nurses can only empower themselves, although clinical leaders can assist, the nurse become empowered. Empowerment offers the clinical leader-nurse relationship the opportunity to share trusts with each other. Trust is achieved as each party earns respect for each other. Gibson (1991) proposes the relationship is not one sided, where one side perceives the other as inferior or inadequate, whilst the other side is viewed as superior or proficient. Rodwell (1996) and Kuokkanen & Leino-Kilpi (2000) advises nurses to expose the power imbalances that prohibit people from reaching their optimum. Gibson (1991) argues that nurses should develop new techniques to foster the concept of empowerment and for the promotion of positive healthy behaviours for people to maintain good health.
Lord & Hutchison (1993) are counterparts that enhance Gibson and Foucault statements concerning the difficulty in defining empowerment. The authors note empowerment is best understood by examining power and powerlessness. Lord & Hutchison (1993) defines power as "capacity of some persons and organisations to produce intended, foreseen and unforeseen effects on others", whereas Lord & Hutchison cite Galbraith (1983) maintains power is derived from a person's income earning capacity, status and influence in an organisation over others. Moreover, the authors continue that powerlessness is defined as the person's inability to influence the outcome of their work environment.
Manojlovich (2007) defines power as having control, influence, or domination over something or someone. The author continues suggests another definition views power as "the ability to get things done, to mobilize resources, to get and use whatever it is that a person needs for the goals he or she is attempting to meet". Manojlovich (2007) cites Benner definition of power as a positive, infinite force that helps to establish the possibility that people can free themselves from oppression.
Other authors, Skelton (1994) and Kuokkanen & Leino-Kilpi (2000) describe empowerment as a concept. Clinical leaders cannot empower nurses unless they are empowered themselves. Clinical leaders, who were empowered, may not necessarily empower the nurses in a team. Caution must be exercised, to prevent empowering process from being halted by the clinical leaders. Clinical leaders can empower the individual nurses through advocacy (Kuokkanen & Leino-Kilpi, 2000). The clinical leader's viewpoints on empowered nurses are: the nurses often perceive nursing managers to retain some if not all of that power and nursing management have an ethical stance to partake their knowledge to the other nurses (Kuokkanen & Leino-Kilpi, 2000). Empowerment is difficult to execute, as nursing managers are reluctant to hand over power and knowledge to their subordinates. Empowerment involves struggles over control of resources, over definitions of what health is and how to implement health enhancing policies and actions. Advocacy is an integral component of empowerment. In theory, advocacy is the voice of the individual. In a democracy, a person has a right to free speech in the provision of the power. However, in practice, some voices are more powerful than others. Nursing managers should consider how they can effectively advocate democratic rights for the least powerful nurse within a team. Skelton (1994) Rodwell (1996) and Kuokkanen & Leino-Kilpi (2000) assert nursing leaders who empower individual nurses may conflict with authority over them, such as providing information may intimidate them and by place them in a situation that the nurse might opt out. Such a situation could be informing and encouraging individuals that they should attend enshrined additional responsibilities, knowing that the nurse was overawed with a previous situation.
Kirkman, Rosen, and Tesluk, (2004) advocates dependency breeds dependency: the less individuals do for themselves the less they become able to do, likewise, encouraging an individual to do more for themselves the greater their abilities become and are more independent. Therefore, clinical leaders must empower their nurses. Chavesse (1992) and Fulton (1997) declare clinical leaders cannot empower nurses, unless they are empowered themselves. Hence, clinical leaders need to empower themselves, to empower others.
Opposing this notion, Lord and Hutchison (1993) propose clinical leaders can utilise teamwork in numerous ways to empower individual nurses. Nurses encouraged to participate in such activities will enhance their assertiveness. Active participation is particularly important, as participation is empowering in itself, also as a self-confidence builder and a self-efficacy provider and to increase the nurse's knowledge of their environment and their inner strengths.
To accomplished empowerment within the nursing field, clinical leaders need self-confidence that is derived from expertise and knowledge. They require an awareness of their own feelings and prejudices. They require willingness to relinquish their control of the clinical leadership-nurse relationship. To allow the individual nurse to experiment and make mistakes. They need the ability to evaluate the probable consequences of control or freedom (Chavesse, 1992). Fulton (1997) states empowerment of staff allows for productivity and innovations to flourish. Empowerment allows staff to have power over the system in which they work. However, empowerment is often difficult to achieve, due to the resilience, resistance from supervisors and irresponsiveness from nurses.
Health organisations just simple cannot decide to empower nurses by issuing memorandums. There are obstacles on the road to empowerment, Cornwall (1994) studied health organisations, categorised those obstacles as: 1) Speed bumps: these slow down the process. Traditionally, nurses worked through the chain of command. Nowadays, nurses work through a multi-disciplinary team working to achieve the common goal. Speed bumps can be reduced by employing nurses who have previously worked in empowering multi-disciplinary teams and by nurse training and education. 2) Detours: often nurses have never worked in organisations that empower their employees and the nurses are unsure how to react to such opportunities. Occasionally, they resist the hierarchy. To minimise the detour on the road to empowerment, trust is essential in the organisation. Trust must be built-up over time and maintained. 3) Roadblocks: some large health organisations make the road to empowerment almost, if not, impossible. These organisations have rules, regulations and policies that all but eliminate the possibility for empowerment. Attempts to empower employees in these situations are doomed to failure. A pragmatic viewpoint of such organisations, the road to empowerment is over before it has begun.
Wood et al. (2008) claims once established, for the success of empowerment, the organisation must ensure great care in maintaining accountability. Often, one assumes empowerment means turning people loose. Empowerment implies granting power along with responsibility. Moreover, Wood et al. (2008) (Bird, 1994) argue empowerment requires a system of control that assumes basic goals, objectives and standards are being fulfilled.
Several authors such as Kleinman Wood et al (2008), Manojlovich and Spence Laschinger (2002), Kleinman (2004) and Lacy et al (2011) have suggested that nurses' job satisfaction is entwined with how nurses perceive their empowerment within their work environment. The authors propose that if nurses are empowered they are better able to act professionally, deliver more effective patient care. Patients are
Morrison, Jones and Fuller (1997) study concluded that planning interventions that permit for the virtual inspiration of clinical leadership style, as well as empowerment on differing levels of nursing might be a more successful manoeuvre and acheive a greater effect on staff attitudes and behaviours. Spence-Laschinger, Almost and Tuer-Hodes (2006) and a follow-up study by Armstrong, Laschinger and Wong (2009) concluded in their findings suggests that nursing leaders' efforts to create empowering work environments can influence nurses' ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes. Often, nurses have poor role models in their hierarchy to guide them and to set good examples and then if clinical leaders are responsible for the empowerment of nurses within their multidisciplinary team, it should not be a surprise that they have such a difficulty in empowering individual nurses. Occasionally, administrators themselves are unable to liberate their own power, due their own short sightedness or their own inexperience or by legislation.