Nurses have always been held to a very high standard when it comes to their role in the healthcare system. They are expected to put their patients’ needs before their own, aim for the highest quality of care imaginable, and ensure the most efficient and safe environment possible. The hectic environment of any healthcare setting, combined with the heavy workload, long hours and high stress rates can sometimes lead to burnout, especially in the nurse who hasn’t yet found her place or is not completely satisfied in her position. Evidence has shown that work environments that provide access to resources, support between colleagues, and the opportunity to continue education and personal development will ultimately increase feelings of professional empowerment in their staff, enabling employees to feel more satisfied and be more effective at their job (Oliver et al., 2014).
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Advancing our own careers as nurses:
In the field of nursing, personal and professional empowerment is crucial to job satisfaction. The empowered nurse will feel inspired and motivated to contribute to their cause, and will have a greater feeling of respect and trust among colleagues, knowing that their contributions are recognized and valued by the other members of the healthcare team (Larkin et al., 2008). The organizational structure of the environment in which the nurse works can greatly impact professional empowerment of the nurse, and with a moving trend towards “inter-disciplinary practice”, the integration of nurses into positions of power within these structures can have an immensely positive impact on the quality of care provided throughout the healthcare setting.
Professional empowerment and career advancement are highly attainable goals, especially for young nurses in this day and age. Although our first few years are spent “paying our dues” by working hard on night shifts, getting last choice of vacation days, and picking up extra shifts to show our dedication, the hard work will eventually pay off for some when we are finally offered the position of “nurse manager”. These positions are currently held by men and women from the “baby boomer” generation who are now nearing the age of retirement, and will need young, ambitious and determined nurses to fill their spots when they leave (Keys, 2014). The role of the nurse manager is a critical part of the health care organization, and is essentially a link between administration and the actual floor workers. It is also the responsibility of the nurse manager to create an environment where the staff nurses feel supported and encouraged to continue their growth and development as future nurse leaders in their workplace. Studies have shown that both job satisfaction and commitment to the organization are both greatly influenced by a feeling of trust in management, the perception that management act fairly in their practices, and respect the staff working below them (Oliver et al., 2014). By incorporating nurses into these management roles, feelings of trust and comradery will increase amongst the nursing staff and provide for a more positive and rewarding work environment.
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Finding our voice in healthcare:
Another area where nurses can achieve great success in professional empowerment and standing within their organization is in participation on the board of directors, the highest level of organizational leadership in healthcare. Surprisingly, nurses very rarely strive to (or are sought out to) occupy this prestigious position, and are often overlooked in the recruitment for board members (Hassmiller et al., 2012). According to the AHA, a recent survey of over 100,000 hospital boards found that nurses only occupied about 6 percent of board positions. There are numerous (speculated) reasons for this lack of nurse representation on the boards, but are generally related to biases and misconceptions regarding the nursing profession. Some of these reasons include gender bias, the perception that nurses do not have adequate leadership skills, and the lack of understanding of the nurse’s role in determining quality care for their patients. There is also a belief that nurses would be more suitable as representatives for their fellow nurses, rather than as representatives for the institution as a whole (Hassmiller et al., 2012). These reasons are entirely based on bias and false perceptions surrounding the nursing profession, and contribute to the distorted belief that nurses do not have the skill or experience to serve in a role where they can help to make important decisions in healthcare.
In order to squash these fictitious convictions, nurses need to step up and prove that we are worthy and fully capable of holding these high-powered positions, and that we can bring great value to the organization as a whole. Many traits exhibited by nurses are inherent in the profession, including an intimate knowledge of patient care and how to best improve healthcare quality and safety. Nurses also have received education in healthcare administration, including time and money management, methods of quality improvement and knowledge about the newest technologies in the field (Hassmiller et al., 2012). These multi-faceted attributes qualify members of the nursing profession to hold positions on the board, where their educational background, willingness to learn, and desire to participate in decision-making processes will undoubtedly bring value and respect back to a profession that has been discounted and slandered by others who had previously held power in these positions.
Nursing leadership and voice:
One of the most important factors influencing career satisfaction in nursing is being able to voice your opinion and feel that it is being accepted and respected by the other members of the healthcare team. Since the nurse is generally expected to be the greatest advocate for the patient, it is important that they step up and work to advance their positions within that multi-disciplinary team. Aiming to advance their career as a nurse manager is a great way to make their voices heard, as nurse managers are generally present during multi-disciplinary round and act as the voice of the patient, to give their pertinent background as well as any significant changes in the plan of care for each individual case. Although the advancement to nurse manager can have a great impact on their feelings of professional empowerment through respect from other members outside of the nursing field, it also helps the staff nurses to feel that they can step up as leaders and have their voices heard as well. By creating an environment where all of the nursing staff feel empowered in their work, the nurse manager creates a healthier workspace, with decreased turnover rate, as well as increased staff and patient satisfaction overall (Oliver et al., 2014).
The healthcare system as a whole is trending towards an increase in interdisciplinary and team based structures, and as such, power is being shifted from just a few individuals to everyone involved in the organization. One example of this type of a healthcare system model is the Collaborative Governance (or shared governance) theory. This model has already been implemented in many different healthcare settings, and emphasizes an increase in participation and communication within and across all medical disciplines in order to facilitate and improve the decision-making process. These types of models aim to support professional development, empowerment and commitment to the overall mission of the organization (Larkin et al., 2008). Nurses have the opportunity to play an incredibly important role in these types of healthcare systems by joining one of the many committees that are contained within the model. One example of a healthcare organization that has implemented the Collaborative Governance model of systems organization is Massachusetts General Hospital. This particular hospital has seven different committees that comprise their Collaborative Governance structure: Nursing Practice, Ethics in Clinical Practice, Diversity Steering, Patient Education, Quality, Staff Nurse Advisory, and Nursing Research (Larkin et al., 2008). As you can see, each of these committees focuses on building empowerment within their nursing staff. By joining these committees and taking on roles as committee leaders, the nurses in this environment are able to develop both personally and professionally. With Collaborative Governance, the nurse is able to exhibit greater feelings of professional empowerment by improving the nursing conditions in her workplace, as well as communicating more efficiently with the other members of the healthcare team in order to provide an environment where important decisions regarding patient care and safety are made based on the input of all of the individuals involved.
Professional and Interprofessional Practice:
When it comes to success in interprofessional practice, the nurse must first find empowerment and satisfaction in his or her own personal professional practice. When nurses are unsatisfied in their position, whether it be due to fatigue, burnout, lack of feelings of empowerment, or feelings of underappreciation, the rest of the team (as well as the patients) suffer. Creating an environment where nurses feel empowered and valued as members of the healthcare team with create better relationships between colleagues, thus resulting in an increase in collaboration between disciplines. By advancing their own education, as well as stepping up as members of committees and boards, the nurse will be able to improve drastically when it comes to interdisciplinary communication and coordination. The leadership skills that he or she will gain from these experiences will in turn improve their communication within their own nursing setting as well, fostering a workplace where staff nurses also feel empowered and satisfied in their positions.
Value – The Quality of Nursing Care and Outcomes:
Building empowerment in the nursing field will have a direct impact on the care provided to our patients. By increasing the number of nurses on hospitals’ board of directors, we can bring the voice of the patient to the forefront of some of the biggest decisions made in the healthcare setting. The experience obtained from working directly with our patients allows us as nurses to share valuable input about ways to improve quality and safety in our patient care, as well as the ways that these changes can be implemented while still saving the organization money. The quality of care and patient outcomes can also be greatly improved by providing environments where there are low levels of nurse burnout. When nurses are overworked and overstressed with few support resources, burnout rates increase greatly (Vahey et al., 2010). These rates are also affected by organizational stressors and the negative characteristics associated with the workplace. Research shows that healthcare organizations where nurses have a greater level of autonomy, greater support from their administration, and better relationships between nurses, physicians and other members of the healthcare team generally result in lower rates of nurse burnout as well as a much higher rate of patient satisfaction (Vahey et al., 2010). This research proves that increasing empowerment and satisfaction in nursing practice has a direct effect on the quality of the care provided to our patients, as well as improved outcomes overall.
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Emerging Theory – Evidence-based Tool for Professional Growth:
The concept and creation of a “Clinical Ladder” program has gained a lot of momentum in the past twenty years. These programs were implemented as a mechanism to enhance recruitment and retention of competent, experienced staff, to foster professional development, to establish a reward system for improved clinical performance of staff, to strengthen the quality of nursing practice, and to recognize staff nurses for excellence in patient care (Pierson et al., 2010). This type of program enhanced nurse empowerment by focusing on six major characteristics of the exemplar nurse: education, experience, professional and leader, provider, teacher, and advocate (Pierson et al., 2010). These six characteristics provided the areas in which the staff nurse could potentially earn points required to advance to the next level of the “ladder”. Advancement to the next level could only occur if the staff nurse reached a minimum number of points for each category, putting greater emphasis on the fact that nursing is a multi-faceted profession, and in order to succeed and develop further as a nurse, he or she must progress in all of these different areas. By stepping up to the next level of the ladder, staff nurses are rewarded with a salary increase each year at their annual review. This encourages the nurses to continue participating in the ladder program, and consequently improves their value as a member of the healthcare team.
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These types of clinical ladder incentive programs have been studied as evidence-based programs proven to increase nurse empowerment and encourage career growth in many areas including educational advancement, increases in committee involvement or project work, as well as a variety of other activities that contribute to a better work environment for staff nurses. This program is also essential to providing a workplace environment that promotes recruitment and retention of staff nurses, professional advancement within the nursing practice, as well as increasing staff satisfaction and empowerment (Pierson et al., 2010). By adapting this form of Clinical Ladder program, healthcare organizations across the world can provide the incentive for staff nurses to branch out and develop themselves both personally and professionally in order to advance their careers as nursing leaders.
Alexander et al article/course – This mini-course focused on the causes, symptoms, measurement and effects of nursing burnout. By examining the most common factors causing this dilemma, suggestions were made in order to help reduce this common occurrence, create a healthier work environment, and promote better quality care and safety for our patients.
Dent article – This article came from Scrubs Magazine and was an inspirational segment that aimed to lift the spirits of nurses who have had a tough shift, or are beginning to really feel the effects of nursing burnout.
Oliver et al article – This article looked at how advancement to a Clinical Nurse Manager position can affect levels of empowerment in nursing staff. It provided information regarding how structural empowerment in these nurses can have a great impact on quality care for the patient as well as increased career satisfaction in the staff nurses.
Pierson et al article – This article looked at one evidence-based practice program that has been proven to improve professional growth, increase leadership potential, and improve overall job satisfaction in staff nurses. The implementation of this program in a variety of settings has proven effective in increasing employee retention and creating a greater feel of professional empowerment in its staff.
Vahey et al article – This article also focused on the impact of nursing burnout and its negative effects on patient satisfaction. The study focused on interviews of patients about their satisfaction with the nursing care they received using the La Monica-Oberst Patient Satisfaction Scale. The results showed that the overall level of nurse burnout was associated with the amount of staffing, administrative support, and the relationship between the nurses and the other members of the healthcare team. These factors, in turn, affected patient satisfaction.
Alexander, L., Cannon, S. (2012). Burnout: Impact on Nursing. Continuing Medical Education Resource. Retrieved from http://www.netce.com/coursecontent.php?courseid=827
Dent, S. (2013). 18 inspirational quotes for burned-out nurses. Scrubs Magazine. Retrieved from http://scrubsmag.com/18-inspirational-quotes-for-burned-out-nurses/
Hassmiller, S. & Combes, J. (2012) Nurse leaders in the boardroom: a fitting choice. Journal of Healthcare Mangement 57(1). 8-11. Retrieved from http://thefutureofnursing.org/resource/detail/JHM-NurseLeadersintheBoardroom
Keys, Y. (2014) Looking ahead to our next generation of leaders: Generation X nurse managers. Journal of Nursing Management 22(1). 97-106. Retrieved from http://onlinelibrary.wiley.com.ezproxy.library.wisc.edu/doi/10.1111/jonm.12198/full
Larkin, M., Cierpial, C., Stack, J., Morrison, V., Griffith, C. (March 31, 2008) Empowerment Theory in Action: The Wisdom of Collaborative Governance. OJIN: The Online Journal of Issues in Nursing. 13(2). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN?TableofContents/vol132008/No2May08/AQrticlePreviousTopic/EmpowermentTheory.html.
Oliver, B., Gallo, K., Griffin, M.Q., White, M., Fitzpatrick, J. (2014). Structural Empowerment of Clinical Nurse Managers. JONA: The Journal of Nursing Administration 44(4). 226-231. Retrieved from http://ovidsp.tx.ovid.com.ezproxy.library.wisc.edu/sp-3.12.0b/ovidweb.cgi?QS2=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
Pierson, M.A., Liggett, C., Moore, S. (2010). Twenty Years of Experience With a Clinical Ladder: A Tool for Professional Growth, Evidence-Based practice, Recruitment, and Retention. The Journal of Continuing Education in Nursing 41(1). 33-40. Retrieved from http://web.b.ebscohost.com.ezproxy.library.wisc.edu/ehost/pdfviewer/pdfviewer?sid=498a866f-3468-4375-9137-ecb3608fcbe8%40sessionmgr110&vid=2&hid=125
Vahey, D.C., Aiken, L.H., Sloane, D.M., Clarke, S.P., Vargas, D. 2010. Nurse Burnout and Patient Satisfaction. PubMedCare 42(2). 1157-1166. Retrieved from http://web.b.ebscohost.com.ezproxy.library.wisc.edu/ehost/pdfviewer/pdfviewer?sid=498a866f-3468-4375-9137-ecb3608fcbe8%40sessionmgr110&vid=2&hid=125