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Staff nurses' perceptions of their power bases in a nursing care setting Watson, Karen Elizabeth 1990

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STAFF NURSES' PERCEPTIONS OF THEIR POWER BASES IN A NURSING  CARE SETTING  by KAREN ELIZABETH WATSON B.Sc.N., The U n i v e r s i t y  THESIS  o f T o r o n t o , 1983  SUBMITTED IN PARTIAL  THE  REQUIREMENTS MASTER  FULFILLMENT  FOR THE DEGREE OF  OF SCIENCE IN NURSING in  THE  FACULTY OF GRADUATE STUDIES School  We a c c e p t to  THE  this  of Nursing  thesis  the required  as  conforming  standard  UNIVERSITY OF BRITISH  COLUMBIA  A p r i l 1990 @  Karen E l i z a b e t h  Watson, 1990  In  presenting  degree freely  at  the  available  copying  of  department publication  this  of  in  partial  fulfilment  of  the  University  of  British  Columbia,  I  agree  for  this or  thesis  reference  thesis by  this  for  his thesis  and  scholarly  or for  her  of  NURSING  The University of British Columbia Vancouver, Canada  Date  DE-6  (2/88)  APRIL  24,  19 90  I  further  purposes  gain  shall  that  agree  may  representatives.  financial  permission.  Department  study.  requirements  be  It not  is be  that  the  for  Library  an  advanced  shall  permission for  granted  by  understood allowed  the that  without  make  it  extensive  head  of  copying my  my or  written  i i Abstract  The  purpose  perceptions Power, take  the  action  nursing  power  and  a  issue  to  about  staff A  staff  analyze  of  found  on  the  nursing have  the  nurse  in  a  369  comparative  consider goal  Empowering the  about  l i t t l e  nursing  is  written  power. was  used  through  B r i t i s h  content  was  c o l l e c t  interviews  Columbia  analysis  to  of  community  used  to  data.  to  showed  recognize that  nurses'  that  impacted work  and  most  on  the  communication  of  information sense  of  staff  factors  their  the  be  nurses'  the  certain  to  influence  and  design  to  with  research  their  the  attainable  coping  collected  bed  In  process.  for  and  increasingly  an  manager of  decisions  encouraged as  nurses'  environment.  profession.  However,  were  an  change  strategy  staff  work  make  is  been  research  Data  describe  their  care  perception  theory  nurses  environment  a  in  others,  shortage.  findings  able  in  to  conditions,  nursing  become  data.  the  The  the  nurses  nurses'  A  set  element  may  grounded  hospital.  were  within  focused  analyze  nature  to  was  bases  influences  manpower  has  study  power  influence  nurses  power  were  that  necessary  nursing  nine  their  literature,  the  staff  this  capacity  important  and  of  of  nurse in  sense  their of  was  power,  of  factors.  perceived while  the  work  power.  communication  significant  participants  to  The  information The positively  nature  of  iii n u r s e s ' work was Nurses'  to l i m i t  l a c k of c o n t r o l  contribute units  found  to a sense  using The  over  nurses'  client  sense  c a r e was  of powerlessness  o f power. found  and was  linked  e i g h t power  bases  outlined  i n R a n d o l p h ' s framework,  as a b a s i s f o r d e s c r i b i n g t h e s t a f f  perceptions  of t h e i r  s t u d i e d were  referent, These  expert,  nurses  found  t o have t h e l e a s t  coercion, legitimate,  Primary  n u r s i n g was  was  strenghthen  nurses'  Knowledge about subjects assist  i n this  nurses'  recognize. nurses'  power  sense  power.  The  nurse  framework and was for nursing  since  of n u r s e s ' work was  of p e r s o n a l  while  to o n e s e l f . not w e l l support  found  to  power.  provides  power b a s e s  i n f o r m a t i o n to that  t h e y may n o t  increased understanding of power  to i d e n t i f y client  power  t h e p e r c e p t i o n s d e s c r i b e d by t h e  to i d e n t i f y  perceptions  enhancing  nature  bases.  bases.  by t h e  in relation  Randolph's  investigation  As w e l l ,  administration and  to enhance l e g i t i m a t e  T h i s has i m p l i c a t i o n s  the p r o f e s s i o n a l  power  power  t o enhance c o n n e c t i o n  personal  staff  affinity for  and r e s o u r c e  f r e q u e n t l y mentioned  d i d not f i t i n t o  defined. for  found  of power most  participants This  found  The  t o have t h e most a f f i n i t y f o r  i n f o r m a t i o n , and c o n n e c t i o n  were found  team n u r s i n g was  nurses'  o r g a n i z a t i o n a l power b a s e s .  reward,  source  to  team n u r s i n g .  were u s e f u l  nurses  to  care.  should  enable  strategies  about  staff  nursing  for retaining  nurses  Table  of  Contents  Page Abstract Table List  i i  of of  Contents  iv  Tables  v i i i  Acknowledgement s  Chapter  I  -  Background  ix  Introduction  to  the  Theoretical Research  Problem Perspective  1 of  the  I n v e s t i g a t i o n . . . . 3  Question  4  Purpose  4  Assumptions Definition  • of  Terms  5  Limitations  Chapter  II  5  6  -  Review  of  Literature  Related  to  the  Problem  Introduction  8  Models  9  of  Power  French  and  Raven  9  Etzioni  11  Ferguson  12  Hagberg  13  Organizational  Power  Research  15  V  Women i n O r g a n i z a t i o n s  15  Organizational  17  Power and N u r s i n g  Managers and Nonmanagers Power  and t h e S t a f f Perceptions  19  Nurse  20  of Power.....  20  Professionalism  21  Change  22  Leadership  23  Conceptual  Framework  24  Summary Chapter  28 III -  Methodology  Introduction The Selection  30  Research of  for Selection  Selection  31  Procedure  Demographic  31  I n f o r m a t i o n of P a r t i c i p a n t s  32  Collection Ethical  Considerations  Procedure Data  30  Participants  Criteria  Data  Setting  f o r Data  33  Collection  34  Analysis Data  Coding  Procedure  f o r Comparative  35 Analysis  36  vi Chapter  IV  -  Presentation  and  Discussion  of  Findings  Introduction  38  Themes  38  Nature  of  Nurses'  Non-Client  Work  Focused  39 Tasks  Communication  44 47  Recognition  52  Satisfaction  55  Control  58  Resources  62  Discussion  of  Power  Bases  63  Personal  Referent  64  Personal  Expert  66  Positional  Reward  69  Positional  Coercive  70  Positional  Legitimate  71  Organizational  Information  73  Organizational  Connection  75  Organizational  Resources  76  Personal  Sense  of  Self..,  77  Summary  Chapter  79  V  -  Conclusions  and  Implications  Introduction  82  Major  82  Conclusions  Implications  for  Nursing  84  vii Control Personal  84 Power...  Information Connection Nursing  .......86  Processing  87  Power  88  Research  89  Summary  90  References  92  Appendices: Appendix A - I n f o r m a t i o n  Letter  96  Appendix  B - Interview  G u i d e One  97  Appendix  C - Interview  G u i d e Two  99  Appendix D - I n t e r v i e w Appendix  E - Consent  Guide Three  Form  101 102  viii List  Table  1.  Sources  of Tables  Page  of  Power  Bases  26  ix Acknowledgements  I  would  their  like  personal  Elaine  Baxter,  Hospital,  my  support.  I  members  of  J i l l i n g s , this  to  thank  Director  Nursing  thesis  r e l i e f  for  to  express  me  F i n a l l y ,  diversion the  for  committee,  challenging  their  during  of  their  gratitude  like  investigation.  Chase  nurses  of  would  for  staff  perceptions  sincere  my  the  work  of  work at  I  her  wish  this  Gormick their  that  me I  owe  Memorial  ongoing  to  with  environment.  professional  appreciation  for  tactics  shared  Surrey  Janet  and  who  to and  the Carol  contribution  thank  Kevin  provided  investigation.  and  'comic  to  Power Bases 1 Chapter  I  Introduction  Background  Registered group  i n h e a l t h care  vacant, of  client  beds or  the  nurses  client  province are  comprise  agencies.  delay  the v a c a n c i e s ,  leaving needs.  positions nursing  and  nurses  to promote c a r e e r  decreased  turnover"  nursing. factors Parsons,  1989).  has  why  1989).  there  will  positions,  positions  Filling  vacant  dissatisfaction environment.  stability  leave  i s one  of  and  1989).  the  practice  the  overriding  studies (Butler i s o f t e n the These  for  c o n d i t i o n s are  Statement",  they  data  registered  become a p r i o r i t y working  to  in various  vacant  1988).  satisfaction  many f o r c e s w i t h i n the  of  rate i n nursing to 38%  cover  attending  o n l y 84%  indicate  i n work r e t e n t i o n  Job  care i s  membership  positions  ("RNABC P o s i t i o n  job  identified  to 1988  are  closing  e x t r a work to  l o n g e v i t y , job  g i v e many r e a s o n s  L a c k of  to spend  "Improved  essential  the  Client  time  shortage",  administration.  Nurses  through  on  nursing  e x p e r i e n c i n g up  retaining  positions  ("RNABC Membership",  turnover  nursing  professional  take  i n h e a l t h care  a high  the  affected  Columbia,  nurses  Trends  ("Battling  less  of B r i t i s h  departments.  agencies  largest  According  have v a c a n t  with  the  When n u r s i n g  when n u r s e s  practicing  to be  Problem  of v a r i o u s s e r v i c e s .  Many a g e n c i e s  continue  the  is directly  affected  individual in  care  the  indirectly for  nurses  to  forces  &  result may  of  of  Power include  monetary  scheduling, with has  other been  client Bush  recognition, d i s c i p l i n e s .  linked  care  to  both  impact  powerlessness satisfaction their  work  Nurses  are  status  in  As nurses  to  a  on  was  most  they  work  c l i n i c i a n ,  who  complain  reason  for  leaving  of  term  decisions. to  use  nurses'  of  making  powerlessness thus an  Hagberg  dependent  Hagberg  as  end  towards  recognizing  covert about  stage  on  a  own  power  force.  given  through is  that  of  a  as  a  the  use  opportunity and  this  is  the  powerlessness  This a  many  influencing  of  constantly  as  their  resources,  of  needs.  p o l i t i c s  lack  be  with  encountered  management  others. rather  with  sometimes  may  sense  two,  job  client  imply  by  were  the  to  behaviour  It  feeling  Of  the  of  conducted  work  has  their  (1984),  but  one's  the  control  their  as  is  They  autonomy.  describes  meet  tolerate  This  s k i l l s ,  describing  study  frustrations  cannot  management  d i s s a t i s f i e d  to  leaving  satisfaction  the  related  investigator  complain  1985).  and  their  that  job  powerlessness  are  power  by  a  relationships  s a t i s f a c t i o n .  employer.  (Maraldo,  others  In  2  support,  and  over  and  Nurses  agency.  professional way  job  the  this  ' p o l i t i e s ' ,  decision  exercise  lack  an  Nurses  1988).  s i g n i f i c a n t l y  they  employing  control  control  setting  a  staff  of  1988).  particular  the  nurses,  of  demonstrating the  For  nurses'  (Bush,  when  power  Key",  locus  administrative  autonomy,  sense  ("Autonomy  (1988),  found  compensation,  Bases  is  consultant, manipulated not  beginning  bases.  viewed stage  Powerlessness  by by  Power Bases 3 has  also  believe  been d e s c r i b e d as " t h e e x t e n t they  to which  are not p e r m i t t e d j o b - r e l a t e d  nurses  independence  and  c  the  freedom  judgement p.718).  p e r c e i v e t h e y need  i n their Nurses  affecting to  they  professional  are concerned  nursing practice  t h e consumer; b u t t h e y  these  policies  powerlessness these  (Campbell, to a sense  concerns.  Nurses' impact  i n order  practice"  about  ( B u s h , 1988,  policy  and t h e q u a l i t y often  feel  1984).  decisions of care p r o v i d e d  powerless  Moving  from  p e r c e p t i o n s of t h e i r  may  Theoretical  P e r s p e c t i v e of the I n v e s t i g a t i o n  unattainable are  on t h e i r  i s equated status  It i s desired  people  with  as a d e s i r a b l e b u t because  people  suggests  that  p e r s o n a l power  of  nurses  by  this  power  or m a i n t a i n  on t h e v a l u e s and b e l i e f s  the v a r i e t y  of sources  of the  1976).  i n Canada a r e f e m a l e ,  nurses  conditioning.  use i t t o a c h i e v e  o f power o r  power.  women have been s o c i a l i z e d  (Grissum,  F o r some n u r s e s  evokes n e g a t i v e f e e l i n g s , and  with  and o t h e r s .  to make changes  when t h e y have been c o n d i t i o n e d n o t t o d e s i r e  desire  work  Power i s p e r c e i v e d t o be u n a t t a i n a b l e when  do n o t u n d e r s t a n d  Literature  a sense o f  o f power.  of themselves  the a b i l i t y  quo, d e p e n d i n g  power h o l d e r .  sense  i s seen  p e r c e i v e d t o be i n c o n t r o l  This the  goal.  t o change  o f power i s one way o f a d d r e s s i n g  environment  Power t o many p e o p l e  to e x e r c i s e  but nurses  organizational  not to  Since the m a j o r i t y have been  influenced  the concept  must goals  o f power  understand  power  (Gorman & C l a r k ,  Power  1986).  Power  nursing in  provided  is  increasingly  to  as  change of  as  consider  an  written  staff  to  research  for  many  and  a  within  years  the  1985).  nurse  managers  on  nurses'  perception  of  care  element  Lerner,  focuses  women  are  nursing  necessary  4 the  with  Nurses  influence  1985;  question  issue  1988).  Maas,  Research The  important  been  goal  (Smith,  l i t e r a t u r e about  has  power  attainable  process  the  it  1985;  (Ferguson,  encouraged  much  an  profession,  general  the  is  Bases  in  However, and  their  l i t t l e  power.  Question  for  this  research  investigation  was : "How  do  their  staff  work  nurses  perceive  their  power  bases  within  environment"?  Purpose Nurses' the  context  the  head  1986;  perceive implement  on  of  the  nurse, et  managers  client for  perceive  and  researched  the  nursing  nursing  However,  care  who  are  new  p o l i c i e s ,  established  p o l i c i e s .  so  to  factors  be of  it  to  unit,  think  been  in  1988).  a l ,  need  the  has  supervisor  direct the  power  contribution  their  nurses  of  Johnson  providing  unique  use  is  make  to  the  important impacting  themselves  as  in  is a  who  are  their  powerless,  staff  nurses  to  asked  making  understand  either to  have  a  process  what  involvement. their  i.e. Bueno,  nurses  decision  on  the  in  (Del  position  Staff  to  mainly  department,  executive it  or  but  a b i l i t y  they If to  Power recognize  strategies  investigation perceptions context  of  analyze  the  The  their  to  This  change the  of  of  power  nurses'  sense  power  of  is  relation  to  to  bases  nurses' within  intent  identify  the  was  to  phenomena  power.  abstract focuses  the  5  This  staff  The  and  investigation  in  limited.  environment.  responses  of  is  problem  sources  work  nurses'  bases  nursing  their  concept  observe. power  addressed  of  contributing  for  Bases  and on  d i f f i c u l t  the  provision  to  recognition  of  of  professional  care.  Assumptions It in  was  their  may  have  assumed  work  d i f f i c u l t y them.  nurses'  a b i l i t y  It to  1988;  of  Trofino,  was  also  used  in  Power: take  the  action  that  made  these  assumptions  nursing 1984;  are  was  literature Kidder  &  sources that  power  power  Schattschneider,  following this  their  assumed  Definition The  assumed  their  power",  1989 ;  It  have  use  relevant  "Nurse  nurses  identifying  was  investigator  content  staff  environment.  u t i l i z e  This  that  a  of  staff  bases  and  power nurses how  increasing  staff  desirable  goal.  based  (Farley,  Gruending,  on  the  1987;  Maas,  1989;  1988).  of  operational  Terms definitions  of  the  terms  investigation.  capacity which  to  set  influences  to  conditions, others.  make  decisions  and  Power  Nurses'  power:  direct  client  actual  or  behaviour  Power  Change: status  Work  care;  the  to  control  decisions  staff  nurses'  perception  a b i l i t y  of  to  others  bases:  staff  a b i l i t y  potential  conceptual the  the  the  nurse  the  achieve  eight  framework and  willingness nursing  sources  that the  process  and  of  6  affecting of  their  influence  the  objectives.  power  represent  to  Bases  outlined  in  relationships  the  between  environment.  of  actualizing  an  alteration  in  the  quo.  environment:  emotional  forces  employment;  the  existing  this  organizational  p h y s i c a l , in  includes  structure  psychological,  the  the  nurses'  place  immediate  supporting  unit  s o c i a l  and  of and  the  it.  Limitations This amount  investigation  of  power  investigation power  that  process the  of  available  aimed  existed  The  to in  analyzing  effectiveness  discussed  in  of  medical-surgical investigation  of  relation  sample  did  has  or  not  u t i l i z e d  discover the  this  form data,  nurses' to  staff  nursing limited  measure  and of  strength  staff  describe  and  nurses.  the  bases.  inferences  The  sources In  were  these  or  the  made  w i l l  of  about  be  conclusions.  nurses f i e l d  by  power  power  the  the  was of  limited  one  to  agency;  generalization  to  the therefore  a l l  fields  the of  Power nursing.  The  nurses  nursing  from years of  to  different in  this  investigation managers,  agencies.  nursing,  sex,  investigation.  and  did  not  attempt  nor  did  it  Also,  compare  variables  marital  to  status  Bases  compare staff  such  as  were  not  7  staff  nurses  education, a  focus  Power  Bases  8  Chapter I I Review o f L i t e r a t u r e Related  The many a  different  term  the  concept  appearing  abundance  of  addressing inherent  delineated nursing  of  power  been staff  various has  of  1982). of  power  chapter  to  sciences  described  care,  in  are  thinking  is  about  in  and  to  and  that  there and  In  of  the  of  changes  drawn  from  to  staff  ten  years  evidence  about  and  current nurse.  about  opinion  of  social  Research  s p e c i f i c a l l y  not  staff  research  The  has  known  variety  of  research  care.  nursing.  summarize  been  client  a  an  has  nursing  or  from  power  the  i d e n t i f i e d . and  The  past  is  is  sociology  importance  power in  is  the  l i t t l e  in  It  study  structures  empirical  themes  the  academic  relationships.  explore  power,  study.  notably  theoretical,  power  of  science  review  relation  reviewed power  to a  make  organizational examined  l i t e r a t u r e  of  Most  concept  reviews  Models  of  Relatively  the  l i t e r a t u r e . are  fields  perspectives. begun  operationalized  f i e l d  organizational  indicates  use  the  power  phenomena  This  studies  of  However,  view  and  p o l i t i c a l  nursing.  nurses'  on  a l l  in  relevance  (Beck,  defined  sciences.  hierarchical  sought  nurses'  the  literature  to  almost  literature  from  is  depending  in  to  the  in  power  ways  humanities  power  of  to the Problem  health  nursing  trends  in  F i n a l l y ,  a  Power  conceptual analysis  framework  of  is  presented  for  Bases  consideration  9  during  data.  M o d e l s o f Power Power science  is  and  reviewed  conceptualized  sociology.  in  order  discussion  of  French  Raven  and  French social they  and  not  assume  Since  the  power  described as  premises  introduced  assumptions a  a  basis  in  most  relationship  merely  an  one  agent  but  not  necessarily  function,  to  the  influence.  agent  can  be  necessarily  was  analogous  of  for by  their and  dominate. must  be  to  the  In  power  one  of  that  setting  model  analyzed  have  this  not or  and  Four  become  standard  is  outcome  the  than  the  it a  of  being  relationship  for  of  since  literature.  order  is  study  time  the  been  rather  action  the  domination.  Power  of  perceive  F i n a l l y ,  with  has  agents  the  their  Raven  purpose  in  1959,  power  and  two  The  one.  in  literature.  influence  every  work  in  French  in  for  Raven  study  power  powerful in  pioneers  power  agents  exert  were  novel  between  for  p o l i t i c a l  w i l l  contribution  was  attribute.  in  power  work  French  u t i l i z e d  of  (1959)  publication by  their  of  ways  power.  Raven Their  various  models  examine  nurses'  power.  did  to  Four  in  other  agent,  power is  is  to  possible  constant.  situation  but  to  An not  Power  French influence exert  a  and  between  positive  influence  is  agent  the  and  as:  (a)  the  social  on  the  Raven a  (1959)  person  force  based  on  on the  based  agent  can  perception  legitimate  that  the  social  agent  has  power,  based  on  that  agent;  the  social  influenced  of  (e)  power  &  to  operationalized.  the  phenomena  Influence  was  subsystems (French  &  outlined  and  of  to  power  Raven,  from  one  of  these  used  the  the  way  the  power  power,  on  based  can  punish  perception  him;  the  area  that  (d) with  the  perception to  be  p.156). their  d i s t i n c t i o n  resulting  they and  The  Power so  this  social  relationship  were thus  five  is  to  s o c i a l  each describe  two  influence of  power  characterizing not  various  five  power.  between  bases  of  when  able  possible  variables  sources  of  of  person's  the  to  perception  influence  in  maximu  agents.  the  agent  relationship  p.152).  acting  bases  s o c i a l  changes  the  different two  five  based  expertise 1959 ,  between  10  potential  strength  coercive  to  power,  this  be  The  person's  influence  was  1959,  represent between  possible.  s o c i a l  found  relations just  In  on  right  (1959)  compare  was  a  Raven,  Raven  the  the  agent  person's  (b)  based  the  has  the  him;  expert  agent  and  on  as  s o c i a l  person.  that  power,  (French  French bases  and  the  described  reward  (c)  power  relationship  power,  him;  social  the  They  person's  referent  and  person.  reward  viewed  Bases  usually  they the  derived  combinations  are  Power  French model,  and  however  Raven social  organizations. to  many  levels  did  The of  not  specify  relationships  bases  of  personnel  power  organizations  do  exist  depicted  within  Bases  an  in  in  11  their  formal  can  be  applied  organization.  Etzioni Etzioni in  relation  (1961), to  E t z i o n i ' s  view  which  one  agent  power  as  "an  actor  to  carry  supports" those  be  in  'power  is  also  perceived  out  a b i l i t y  his Thus,  and  have  those access  positions  must  depicted  position  Etzioni a  position  is  to  or  any  is  influence other  an  power  are  purpose  of  their  power  To  do  orientation  positions Thus  actions  of  Raven  described  three  exercise  t h i s ,  of  the  said  types  who  is in  to to power  organizational  authority  management. (1959)  it.  people  to  he  between  of  goals.  they  another  norms  element  in viewed  means  a  power.  of  are  powp'  This  implied  is  he not  any  power. types  sanctions. to  or  He  to  for  perceived  induce  The  and  influence.  whom  potential  of  to  power  relationship  over  that  of  French  threat  have  positive  implied  linked  with  has  involves  a  positions  are  consistent  have  a  to  compliance  organizational  legitimate  bureaucracy.  directives  p o s i t i o n s ' .  Etzioni  government  depicted  power  actualize  power.  examined  of  actor's  who  s c i e n t i s t ,  and  power  Those  p o l i t i c a l  organizations  (p.4).  with  a  have  the  of  The  power. actor  a b i l i t y  in to  Coercive the  power  power  d i s c i p l i n e  or  Power  remove to  something  French  and  Remunerative  power  as  salaries  with  management  manipulation normative Raven's  usually  when of  or  control  rely  power.  hospitals on  one  power  Etzioni power  use  type  associated  involves  to  and  French  did  not  three  (Etzioni,  and  address  holder.  a l l  similar  resources  typically  similar  the  is  12  power.  Remunerative  are  of  This  material  is  Normative  expertise  more  over  This  combined  as  actor.  coercive  rewards.  reward  such  of  benefits.  symbolic  concept  another  concept  requires  and  power,  attributes  to  positions.  of  organizations but  value  Raven's  such  the  of  Bases  Complex  types  of  power  1961).  Ferguson Ferguson model  within  hospitals affects model  power  three  leading  to  This a  where  nurses'  of  of  (1985)  set  use  of  program  that  of  nurses  of  than  the  perceived  the  power,  concept p o l i t i c s  twPower  such  and  relationship to  as  Ferguson's the between  achieve  results  p.10).  previous is  models,  gained  confer  authority.  of  nurses  acquiring  policy  in  depicts  through  to  and  power  environment  management  The  1985,  this  1985).  institutions  relationship. is  thus  (Ferguson,  a c t i v i t i e s .  a  organizations  work,  (Ferguson,  more  described  governance,  enables  goals  educator, Complex  power  consists  model,  promoted  knowledge  nurse  most  components  hierarchical  knowledge  a  organizations.  are  performance the  (1985),  order  Ferguson substantive to  move  Power  Into  these  power  "power-head" nurses power  are has  that  the  and  noted  that  l e v e l , of  but  input  level  of  more  nurses  where  policy the  in  are  they  in  operating  not  a  model  to  of  of  Ferguson at  this their  lack  program  and  nurses  considered are  level the  by  of  power  Staff  or  interpretation  effectiveness  of  women  a c t i v i t i e s .  are  13  the  This  decisions the  as  Few  l e v e l .  Performance  work.  model  since  on  category  nurses  power  this  their  viewed  making.  program  making.  final  power  decision  and  limited  most  hierarchical  unit  women  was  involves  implementation  is  of  at  influence  Management  into  sources  policy  involved  greatest  are  a c t i v i t i e s  Governance  initiates  currently  organization. policy  roles.  Bases  this  in  the  this  have  included  is  in  very  few  policy  or  making.  Hagberg Hagberg the is  stages quite  (1984)  of  personal  different  relationships  personal  to  the  the  inner  capacity  (Hagberg,  1984,  result  personal  model  of has  six  the  as  capacity for  is  s k i l l with  power  emphasizing  organizations.  not  models the  This  focus.  Hagberg  extent  to  for  action  (external  Power and  is  needs  which  (internal  one  power)  to  be  Hagberg's  identified  is  able with  power)"  perceived  attitudes.  model  since  "the  reflection  p . x v i i ) .  stages  in  of  previous  agents  power  outer  power  from  between  defined link  depicted  at  each  partly power stage.  a  Power  These  needs  stage.  It  stages  must is  a  be  linear  sequentially.  that  people  l i f e  circumstances  power person  gain  go  rather  their  can  Stage trapped  or  and  power  by  need  purpose, have Stage  refers  gained six,  a  description said  when  to  have  of  by  others  a  wisdom  stages  and  person  The  needs  to  v i s i b l e  two,  move  marks  of  r e f l e c t i o n ,  Stage  an  their  who  and  others  considered  Those  able  of is  to  to  the  to  have  acquired  have  and  by  with  a  role  Stage  control  three,  over  the  need  is  is  less  v i s i b l e  power.  power  for  The  by  ' v i s i o n '  and  who  expertise.  abstract  achieved  understanding  feels  esteem  seeking  five,  most  person  on.  by  is  a  goal  power  power  gestalt,  focus,  self  status  for  when  personal  be  or  those  again  The  then  the  l i k e l y ,  regardless  identifies  mentoring  next  situations.  Stage  e g o t i s t i c a l .  and  the  t i t l e s  by  power.  of  confidence  reputation  power  six  is  14  through  and  begin  organization.  progress.  four,  to  power  the  moves  Since  powerlessness.  by  self  less  and  variety  includes  be  the  the  involves  Stage  to  stages  in  characterized  is  in  a  one  to  p o s s i b l e ,  actualization,  occurs  This  is  self  to  requires  i s ,  moves  dramatically.  through  manipulated  integrity. is  earlier  termed  symbols,  others.  and  is  development  model  it  organizational  power  association,  person  However,  position  one  a  that  change  through  this  before model;  to  progress  power  u t i l i z e  back  than  current  s k i l l  met  Bases  of  the  stage  six  world.  are  Power Bases H a g b e r g ' s model within  an  i s u s e f u l when a n a l y z i n g i n d i v i d u a l s  o r g a n i z a t i o n and  Self-actualization influencing  their  i s s e e n as  Organizations literature.  pressure greater the  conflict  which  p.158).  Conflict  negative  process.  enabling  process  1985;  Conflict  means  of  and  examined  at  length  become more f i n i t e are  resolved  experiencing  through  organization  considered be  to r e d e f i n e  i t l e g i t i m i z e s the  as  the  (Morgan,  r e s o l u t i o n can  in  and  Power i s o f t e n v i e w e d  are  organization  1986,  to be  a  a creative  itself need  in a  f o r power  Power t h r o u g h human r e l a t i o n s i s  a focus  Randolph,  of  o r g a n i z a t i o n a l t h e o r i s t s (Gibson  1985;  on  interpersonal  relations.  investigation  three  organizations  will  goal  Mintzberg,  achievement, For  research be  the  1983).  resource purposes  studies  et  Organizational utilization of  relating  and  this to h e a l t h  care  discussed.  Organizations  Chernesky a research  and  1979).  i n an  power i m p a c t s  Women i n  self-fulfillment.  Research  r e s o l u t i o n i s not  the  a l l levels.  Power  organizations  conflicts  environment  increasingly al,  resources  (Perrow,  making  at  of  a powerful  described  increase,  decision  changing  are  As  groups  means by  force  sense  others.  Organizational  the  15  and  study  Tirrito  (1987) d i d not  t h e m s e l v e s but  they  a c t u a l l y complete  synthesized  the  data  Power Bases 16 obtained care. of  from  In t h e i r  their social were  they  related focused  power a v a i l a b l e  they held  analysis  research  report  organizational  position  of  other  on t h e v a r i o u s  towards  w o r k e r , however, t h e y  sources  t o women, no m a t t e r  i n the o r g a n i z a t i o n .  was d i r e c t e d  As s o c i a l  what  workers,  the r o l e of the female  explained  t h e same f o r any d i s c i p l i n e .  organizational  t o women i n h e a l t h  that  Four  the p r i n c i p l e s  s t r u c t u r a l sources  power were i d e n t i f i e d  as "network  centrality,  organizational  criticality,  and  of u n c e r t a i n t y  (Chernesky  & T i r r i t o , 1987,  the h e a l t h  care  control  p.95).  Any p o s i t i o n w i t h i n  addressing viewed  individuals  The the  i n an o r g a n i z a t i o n  by V a k i l impetus  relatively  low number given  health  care  This  nurses  constitute  system.  agencies  i s often  the l a r g e s t  that  was  various  reported  "women a r e more l i k e l y  and T i r r i t o  positions  of high  where  of the s t a f f i n decision  and T i r r i t o  t o advance  making  ( 1987)  into  top-level  mentors, p a r t i c i p a t e i n support  n e t w o r k s , use i n f o r m a t i o n a l  s y s t e m s , make  the o r g a n i z a t i o n a l  was  o f women i n t h e  i n nursing  c o n t r o l over  Chernesky  acquire  found  percentage  1981, p . 1 8 9 ) .  and f i t i n t o  by C h e r n e s k y  the preponderance  b u t have l i t t l e  i f they  The c o n c e p t  o f women h o l d i n g  (Garant,  visible,  agency  have p o t e n t i a l power was a l s o  f o r the report  and a u t h o r i t y  positions  resources,  (1983).  status  most  to  t h e p r o b l e m s and needs o f t h e o r g a n i z a t i o n  as p o t e n t i a l l y p o w e r f u l .  reported  access  themselves culture"  (p.94).  Power  Four found  structural  to  aid  Network  in  centrality  departments for  their  the  degree  that  work of  of  both  important  source  a b i l i t y The  to  Individuals p o l i t i c a l have  went  on  a  report  individual nurses.  towards  Maas  power  relations.  power  Power  (1988)  undertaken  a  Del  Research  the of  bases  Bueno,  to  in  order  linked  to  mission.  Access  uncertainty to  deal  in  to  and  they  which  changes.  986)  i  use to  Bueno  given  'grasped'  and  network,  Del  rarely  the  y  nurses  to  an  by must  organization  enhancing  and  power.  Nursing nursing  collective non-nursing  to use  be of  to  T i r r i t o .  when  be  refers  with  Bueno  (p.125).  women  to  increasingly  from  must  or  be  and  essential  Del  are  available  perceived  through  base  power  access  and  by  resources  power  is  of  powerful  power  authority.  persons  can  were  positions  an  Chernesky  as  of  17  resolution.  organization  hence  to  gaining  Organizational  exert  that  is  power  position  This  c o n f l i c t  to  of  the  Control  scarce  group,  where  the  have  According  recognize work  or  with  material  perceived  of  number  represents  findings  share  to  in  power.  study  "savvy",  positions  organization's  and  assist  were  to  the  interact  the  of  similar  organizational  accomplished.  human  research  reported  and  be  to  c r i t i c a l i t y  resources  the  refers  involvement  achievement  of  advancement  must  to  Organizational the  the  sources  Bases  in  a  position  to  organizational  organizations  resulted  Power  In  a  causal  power.  model  This  defined  power,  and  the  1988,  p.  153).  exist  in  nursing  and  Maas  basis  of  an  Maas  shortage,  to  value  of  which  that  to  exercise  the  of  increase" power  can  control  manipulate  the  is  them  gaining  control  of  services,  nursing  can  power. directed  This  (Maas,  characteristics  (Maas, the  client  care.  of  basis  the  relates  to  interactions.  The of  the  access.  The  current  nursing  that p.  with the  perceived  155). to  coordinate  i d e n t i f i e d , the  The  the  the  the of  the  available  manifestations and  of  structure  u t i l i z a t i o n  and  power of  to costing  to  meet  power  exercise  strategies  and  whoever  needs  control  specific  1976).  s p e c i f i c  acquire  power  personnel  nurses  meet  the  type  the  (Grissum,  are  of  on  of  by  1988).  type  type  a b i l i t y  to  nursing.  outcomes  the  opportunity  so  resources  influences  the  power  nursing  the  of  the  organization  of  on  (1988,  has  goals  power  want  this  organization  the  power,  and  depending  practice,  Once  nursing  of  amount  resource  numbers  resources.  of  of  similar  hospitals,  seize  use  By  basis  the  capitalize  enter  w i l l  to  vary  In  should  who  and  the  others  valuable  control  nurses  The  and  that  qualifications  refers  resources  "nursing  attempting  interorganizational  manifestations  question.  essential  suggested  to  of  in  as  speculated  power  possessed  organization  of  18  organizations.  a v a i l a b i l i t y  are  process  was  of  resources  the  model  exercise  The  of  Bases  used  are  of in  goal  Power  In stated  the  discussion  nursing  organization. influence  and  p.161). basis to  1988,  Managers  and  need  has  model  can of  a in  be  used  power  to  policy to  that  strategies  the  study,  similarly gain  power  decisions identify  nursing of  Maas  to  any  in  order  (Maas,  aspects  currently  interactions"  to  1988, of  the  has,  and  (Maas,  Nonmanagers  (1987) i n v e s t i g a t e d  orientation  to  power  Farley's  nonmanagers  in  communication Orientation scale  their  results  on  person's  the  the  compared  six how  ' S o c i a l in  than  With  scale  style  the  the  power power were  nurse's  c o l l e c t i v e  nurse  managers  to  use  of  of  the  data  P r o f i l e ' .  in  were  their  outlined.  perceived.  the The  assertiveness  of  'Power  and  with  use to  and  the  valued  matched  terms  power  orientations was  Style  individual  the  orientations  s t y l e s .  examined  from  rather  study  S c a l e ' ,  results  a  Nursing  s p e c i f i c  Farley  The  function  of  19  163).  p.  power.  results  organizations  exercise  consider  the  participate  "The  and  of  Bases  The  respondents profile  defined  and  responsiveness . The  analysis  difference and  nonmanagers  managers The  between in  perceived  managers  also  of  the  power  four power rated  of  showed  there  orientations  the  more higher  six  areas  p o s i t i v e l y in  their  was of  a  significant  nurse  studied. than  staff  orientation  managers Nurse nurses. to  power  Power Bases as p o l i t i c a l  and  i n h e r e n t to autonomy.  significant  correlation  differences  i n the  concluded concept  "nurses  social need  of power and  organizations"  between styles  how  i t may  (Farley,  however, few found.  and  the  recognize linked  f o r empowering  Perceptions Staff involving personal  suggests  Secondly, have  nurses  and  last  five  of  the  maintained  and  in  has  o f n u r s i n g power; concept  the need  n u r s i n g power.  can  be  to Power i s  leadership.  assisting are  years, there  this  f o c u s e s on  c o n f r o n t and  as  day  (McClure,  nurses  to  achieve  suggested.  the n u r s e of power nurses  must  deal with  whether 1985).  opportunities be  In o r d e r  to use able  (Grissum,  power as  1986,  to see  power, the  1976;  Maraldo, t o use Nurses  force.  their these  literature  to r e c o g n i z e and  p. 4 0 ) .  a positive  situations  at work or i n  must have the w i l l  (Courtemanche,  recognize  Farley  o f Power  lives  the n a t u r e  a  Nurse  c h a n g e , and  potential  power e v e r y  situations  studied.  i n the c o n c e p t  literature  to p r o f e s s i o n a l i s m ,  professional  and  gained  Staff  the v a l u e of i n c r e a s i n g  Strategies their  be  i n the  interest  the  differences  those  research investigations  Much of  not  1987).  In n u r s i n g l i t e r a t u r e increasing  of  was  to become more c o m f o r t a b l e w i t h  Power  been an  these  There  20  understand  1985).  the power are  There  they  encouraged  i s power i n  to  Power  caring 1984,  that p.  enables  208).  perceptions s k i l l  to  nurses  Gorman  of  make  power,  and  decisions due  to  negative  feelings  understand the  power  perception  decisions In tested  in  of  areas  Gorman to  and  empower  organizational a c t i v i t i e s ; nursing  (c)  the  in  which  nurses:  a  and  action  (b)  that  of  the  these  f i l l e d else a  nursing in  (d)  four  nursing  made  part. were  process  support  to  p.  by  130).  strategies over  suggest  with  change  1986,  control  study  achieves  play  nurses  Clark,  of  were  found  not  strategies  the  and  was  did  someone  c o l l e g i a l i t y ; &  nurses'  resolving Power  should four  of  21  (Benner,  knowledge  Nurses  because  engage  sense  of  the  Nurses  apply  (Gorman  greater  results  use  it.  study, (a)  study  power.  nurses  Clark's  clients  d i f f i c u l t y of  powerlessness in  have  nurses.  use  implementation  The  can  lack  to  strengthen  reported  taking  a  problems;  practice.  nurses  how  administration  Following nurses  or  to  have  their  (1986)  nurses  but  problems  empower  Clark's  found  practice evoke  to  Bases  staff  their  making  decisions  objectives  is  how  power.  Professionalism Gorman  and  Clark  professionalism. function can  be  s k i l l s "  more  (1986)  "Professional  effectively  designed (Gorman  linked  to &  in  promote Clark,  empowerment  (nurses)  can  organizations  better  1986 ,  use  p.134).  of  be  and  to prepared  organizations  professional Trofino  to  (  1989)  Power  linked  the  power  environment. function  of  staff when  to  agency's  recognize  authors Referent  "Nurses  to  to  at  must  promote  power  and  is  a  authority  retention  and  structure  the  need  are  foster  (Stevens,  and  the  power  staff  identify  and  bases  as  profession"  difference  health  bases  nurse  a  in  bases  power  make a  and  recognize expert  care  for  power  step  able  difference  nurses  work  administration's  and  f i r s t  power  survive  professional  empowering  The  professional to  a  r e s p o n s i b i l i t y  u t i l i z e  their  and  available  to  hospital  philosophy  1982).  is  that  satisfaction  authors  professionals  Beck,  and  nurse  22  to  the  enhanced a  environment.  Nursing  1985;  stated  nursing  Staff  professional  to  staff  delegating  nurse. the  the  Trofino the  commitment  of  Bases  for  are  level  be  educated  Maraldo,  by  these  a v a i l a b i l i t y .  considered  to  (Estabrook,  be  readily  1986,  p.  the  many  personal  and  to  them  in  to  health  (Stevens, means  to  1983;  suggested  available in  nurses  its  develop  nursing  order  be  care  as  well  as  1983,  p.  3).  Making  influencing  61).  to a  change.  Change The change.  l i t e r a t u r e "Power  interaction, this  fact  and  w i l l  disadvantage  is  in  indicates an  those  only  inevitable persons,  find  making  power  part  central of  a l l  including  themselves  change"  is  at  (Kalisch  a  to  forms  nurses,  making of who  human deny  serious & Kalisch,  1982,  p.  Power  3).  Power  improving wanting how p.  to  is  client  power do,  -  and  an  end  in  care. to  i t s e l f  "We  allow  receive  (nurses)  us  the  but  to  do  credit  rather  have  those we  a  a  means  reason  things  deserve"  we  23  to  for know  best  (Diers,  1978,  54). As  members  in  many  to  assert  their  changes  and  future  1989,  of  the  health  r e l a t i o n s h i p s .  for  in  of  much  of  How  power  to  autonomous  (Grissum,  p.  how  is  with get  to  use  &  nursing open  decisions  to  the  and  perceive  power  plan present  their nurses  using  w i l l  and  strategies  Gruending,  themselves  "By  involved  and  with  (Kidder  others  are  power  practice  granted.  more  nurses  compatible  perceive  changes,  to  need  clients"  nursing  a b i l i t y  team  nursing are  influences  profession  1976,  that  their  implement  our  over  nurses  autonomy  designed  through  nursing  care  "Nurses  control  needs  p.10).  sources how  not  Bases  be to  a  strategies more  help  plans  and  nearly  patients  implemented"  238).  Leadership A l l others  nurses,  to  nursing  process  planning; managers. power  some  and  processes"  to  do  whatever  extent  (Kron  involves these  Effective influence (Sullivan  their &  Gray,  decision  things  through  role,  1987,  making,  nurses  leadership  &  formal  must  1985,  p.  and  16).  goal  The  "exercise  The  and  and  interaction  131).  manage  setting  leaders  the  interpersonal  Decker,  Ch.  be  involves  lead  of  Power Bases perception The  of  ability  from  to  within  Diagnosing  defined  the  as  of  the  1984).  how  defining nursing  nurses  'power of  use  their  (1988), a nurse,  i n d i c a t e d nurses  power at  lower, l e v e l s  cognitive  d i d not  processes  nursing  diagnoses.  need  "recognize  to  strength  rather  expression (p.13).  The  staff  d i d not  i n the  s u c h as  has  i s s u e s , i n t e r p r e t these  into  decisions  affecting  of  organizational developed  nursing  rather  behaviour  a conceptual  theory  i s an  t h a n what  power  The their  care  in  and  nurses  inner is  an  (nurses)  to i d e n t i f y  to management, and  client  nurses.  of  promote  (1988) s t a t e d  do"  client  have  (Estabrook,  input  1986).  Framework  framework i s a means of  staff  a study  f o r c e - power w h i c h  the  Conceptual  power b a s e s  or  is  1988).  power i s i n h e r e n t  power w h i c h  are  care  A conceptual  that  outside  (nurses)  clients  relationships.  applying  affirm  nurse  for  power. T h i s  described  recognize  Schattschneider and  actions  organizational structure.  recognize  t h a n an  of who  at a l l  caring' (Schattschneider,  findings  nurses  Nurses  personal  power i n p h y s i c i a n - n u r s e - p a t i e n t  Staff  process.  o r g a n i z a t i o n have p o t e n t i a l power.  Schattschneider the  leadership  i n c l u d i n g p a t i e n t s , comes  (Douglass,  p r o b l e m s and  examples  i n the  influence others,  one's power b a s e s  levels  are  power i s i n h e r e n t  24  In  order  in general,  framework of  to  analyzing analyze  Randolph power.  the  (1985)  Randolph  (1985)  Power  linked an  the  model  analysis  of  of  power  organizational  framework  groups  personal,  p o s i t i o n a l ,  represents referent  two  and  legitimate; resource.  through  sources  or  expert;  of  and  three  power  p o l i t i c a l  reward,  that  power can  behaviours  are  be  cannot  be  undertaken  without  f i r s t  how  use  sources  power  The sources  framework of  power  level  within  basis  to  is  Personal considered These  two  personnel  or in  importance  time  by  of  power.  for  this  can  staff  sources  bases  in  of  Randolph  to were  An  be  of  study is  two  to  be action  but  these  and  p.  knowing  308). to  any  describe  personnel  appropriate The  so  to  are  Randolph peers  must  and  most  linked  to  and  as  a  conceptual  1.  the  and  and  p.314).  (1985)  referent  task  power  1985,  position.  not  individual  source  This  Table  organization.  subordinates  of  to  personal  into  recognizing  used  power,  professional an  be  nurse  summarized  power:  considered  Randolph  organization.  the  power  management  expert  the  study  framework  bases  by  category  connection  (Randolph,  outlined  of  power  use  with  The  Each  1985 ,  the  25  categories:  (Randolph,  involve  of  298).  translated  behaviours  Raven  coercive  information,  of  and  three  sources  P o l i t i c a l  to  (p.  organizational.  positional  bases  French  into  s p e c i f i c  sources  by  behaviour  power  organizational These  potential  described  Bases  common any  particular  emphasized  perceiving a  were  sources.  applicable  develop be  expert,  to  any the  referent  reputation  accessed.  At  the  and over  staff  Power  Table  Bases  26  1  Sources  of  Power  Bases  Personal . referent the p e r s o n has c h a r a c t e r i s t i c s s u c h as charisma, reputation or s t y l e that draws a d m i r a t i o n , respect and i d e n t i f i c a t i o n from peers. . expert the person exhibits certain a s p e c t s of the job.  competence  in  performing  Positional . reward the person exerts control over something valued by o t h e r s such that the person is able to reward other people for desired behaviour. . coercive the p e r s o n has the a b i l i t y or i n f l u e n c e with the p e r s o n who h a s a b i l i t y to p u n i s h p e o p l e f o r not doing what the person wants. . legitimate the p e r s o n i s p e r c e i v e d to have the right to i n f l u e n c e others b a s e d on t h e p o s i t i o n h e l d on the unit.  Organizational . information the p e r s o n has a c c e s s to i n f o r m a t i o n or knowledge that i s of v a l u e to others. . connection the person links with other people in the organization. . resource the person c o n t r o l s the supplies, equipment, budget of the unit.  W.A. R a n d o l p h . (1985). U n d e r s t a n d i n g and organizational behavior: A developmental Homewood, 111.: R.D. Irwin Inc.  managing perspective.  Power  nurse  l e v e l ,  colleagues  and  clients  provide  the  Bases  source  27  of  power. Positional legitimate.  sources  These  attributes  and  i n d i v i d u a l ' s  The  staff  sources  nurse but  of  power  t i t l e d  relationships  the  functions  are  of  management does  the  power  not  nurse are  reward,  positional involved  position  have does  also  are  because  are in  the  evident  based  on  organization.  management  client  in  and  the  usually  traditional manage  coercive,  peer  care. and  Positional  c o l l e g i a l  interactions . Organizational information, the  connections  organization  power  bases  access  and  these  To  as  sources  situations power This  bases  equal  effectively  to  of  use  leads  framework  nurses'  of  to  perceptions  of  resources. who  has  through  does  amounts use  not or  power  as  the  possible  (Randolph,  structure  their  power  access  access is  the  of for  know p.  sources  in  in  the  of  should  have  which  power  examining  bases.  to  person  310).  other  these  means.  individual and  to  of  possible  every  of  to  structure  informal  1985,  development a  It  imply use  to  The  formal  power  the  provides  refer  valued.  power them  power  are  framework  has  power.  and  these  sources  organization  of  determines how  Randolph's  many  sources  U t i l i z i n g bases. staff  Power  Bases  28  Summary Power Four  has  models  sciences  been  of  power  including  (1961),  Ferguson  focused  on  a  terminology similar but  they  the  been of  French  and  aspect  viewed  four  this  models  of  of  the  power  influenced.  Power  was  the  interaction  between  a v a i l a b i l i t y Any  of  investigation the  purposes  designed Raven,  by  is  nurses' The  the  could of  be  this  Randolph  literature that  organization. for  result  used  of  a  and  attainable Four  was  a  holders  Power on  power  analyze  result  of  or  exerted  differed  the  presented  nurses'  in  an its  s i t u a t i o n . in  this  power.  For  based  on  the  work  application  to  the  analysis  conceptual of  framework French  and  of  power.  presented  Each  themes  persons  (1985),  power  were  relationship  Power  of  author  They  the  Etzioni  different  the  of  using  and  depending  to  used  Power  power.  models  Each  power.  power.  less  (1959),  investigation  for  perceptions  opportunity  four  and  social  accomplished.  elements.  with  the  positive  holder  u t i l i z a t i o n  outlined  emphasized an  those  and  one  two  was  in  (1984).  of as  perspectives.  Raven  power  was  the  over  of  power  how  and  Hagberg  process  in  various  developed  the  perceptions  influence  from  depict  that  in  those  (1985),  differed  appeared  have  different to  in  described  is  not  study power.  on  organizational  power  limited  to  authority  focused  on  a  A  review  of  figures  different the  literature  in  Power Bases 29 suggested by  that  women and n u r s e s Research  The  opinion  between actual  1986;  studies  on s t a f f  o f many a u t h o r s  identification  care  organizations.  nurses'  i s that  power a r e l i m i t e d .  discrepancies  and use o f t h i s  1985; F a r l e y ,  Schattschneider,  focused from  i n health  t h e p o t e n t i a l power a v a i l a b l e t o n u r s e s  Maraldo,  is  a v a i l a b l e power i s u n d e r u t i l i z e d e s p e c i a l l y  on t h e v a l u e  the p e r s p e c t i v e  1987; Maas, 1988).  perception.  their  While  of the s t a f f staff  and  their  (McClure,  1985;  1988; Gorman & C l a r k , nursing  o f power f o r n u r s i n g ,  i n d i c a t e d to i d e n t i f y  power and how  power  exist  nurse.  nurses'  work e n v i r o n m e n t  literature  has  few a r e w r i t t e n Further  perception  i s involved  research of  their  i n this  Power  Bases  30  Chapter I I I Methodology  Introduction This  investigation  methodological ( 1967 )  and  research  followed  approach  Munhall  design  and  as  for  staff  nurses'  perceptions.  about  factors  related  prompted  the  phenomenon. and  by  this  of  This  December This  use  to  The  exploration  The  lack  power  of  methodology  Strauss  grounded  the  of  and  of  a  the to  staff  place  describes  methodological  of  evidence  nurse  describe  took  theory-,  range  empirical  investigation  investigator. of  Glaser  the  between  September  1989.  chapter  selection  by  ( 1986).  the  this  qualitative  outlined  Oiler  allowed  a  It  outlines  participants,  participants,  data  the  the  demographic  c o l l e c t i o n ,  data  approach  research  setting,  information  coding  used  and  of  data  analysis .  The  Research Four  hospital  medical-surgical located  served  as  acuity  ranged  the  treatment, average hospital  Setting  in  the  setting from  with  patient employs  the  lower  for  long  average  of  a  mainland  this  term  population 450  units  369  bed  of  B r i t i s h  investigation.  preplacement length  for  registered  each  of  nurses  to  stay  unit  community  f u l l  The  patient  short  13  was  Columbia  term  days. 40.  time  The  The or  part  Power  time the  and  230  casual  educational  staff  nurses.  preparation  Selection C r i t e r i a  for  The staff at  least  one  with  two  year;  for RN  of  sample  status;  years;  (d)  communicate  the  (c)  consent  in  intentionally  selection (b)  worked  to  English.  This  volunteered  and  females  nursing  staff  the  participants  Selection The  identify nurses  method  if  units. were  to  at  Two  with  f u l l  the  and  able  (e)  up  did  the  least  to  however  c r i t e r i a  their  at  for  not  90-95% in  time  hospital  unit  years as  (a)  current  females,  made  chosen  experience  of  from  nurses three  were  selection  sampling.  of  three  to  in  to  give  their in  the  of  only  of  the  hospital to  and  ensure  working  participants  investigator  units  potential  encouraged  interested  This  four  asked  investigation were  unit  had  participants head  on  that  environment.  Procedure  convenience  the  the  were:  investigator  females  on  the  participate;  sample  on  available  nurses.  employed on  the  year  staff  were  Participants  limit  one  data  31  Selection  c r i t e r i a  nurse  of  No  Bases  within  units  were  volunteers  the  letter  to  p a r t i c i p a t i n g .  non-random  selected h o s p i t a l .  I n i t i a l l y  approached  and  from  unit.  information  registered  was  their  letters  nursing contact  about  staff. this  asked  to  Head the  Nurses  investigator  Power  Within would  not  director  four  be of  weeks,  able  to  nursing  participants.  A  through  goal  this  set  by  participants, three for  more  the  head  identify asked  total  interviewed  one  a  of  this  three  fourth  six  process,  A  total  investigation,  of  indicated  participants. unit  to  three  To  investigator  units.  had  registered  investigator.  this  nurse  Bases  nurses people  telephoned  The  agreed short  three head  four  units  to  of  be the  more  nurses  participants  representing  she  s o l i c i t  identify  nine  32  from  volunteered  within  the  agency. Two head  of  the  nurses  respond  on  their  units.  a  staff  nurse  this  role.  from  experience  with  participants, This she  nine  was  A the  of  was  programs.  with  a  B.S.N.  2  33,  with  Of  the  worked  since  they  remaining on  the  asked  unit  for  experience  in  the  agency  four  involved  of  Six  One  registered  and  had  more  six  weeks.  because  her  previous  investigation.  nurses  participants and  two  participant  years  average  the  to  Participants  female  programs  in  them  seven  investigation  Their an  investigator  assistant  the  investigation.  college  This  become  in  nine  diploma  recently  included  the  of  had  perspective  only  Information  total  hospital  to  had  years  one  Demographic  in  one  participant had  unit  participants  of  of 19  graduated  graduated graduated  nursing years  participated  from from  experience in  nursing.  from foreign university ranged  from  Experience  Power  on  their  current  an  average  of  unit  3.5  ranged  to  investigator  i n i t i a t i n g obtained  Columbia's Human  Education  Committee  proposal  for  hospital, involved  explain  interviews.  The be  was  to  of  years,  with  withdraw  transcripts  by  and  investigation. investigator  and  met  the  from  in  participants  at  any  the  prior  the  data  No  refuse  a  contact E)  the  from  f i r s t  participant from  the  participants Confidentiality names  on  completion  limited  committee.  could  to  withdrawal  the  was  of  the  time.  at  Department  (Appendix  participants'  advisory they  stated  tapes  the  participant  investigation.  the  to  each  and  from  investigation.  beginning  way  the  Nursing  consents  the  any  the  erasing  the  investigation  at  and  reviewed  approval  the  gave  consent  coding  the  of  Written  occur  Access  with  of  Research  Research  then  Upon  this  University for  Nursing  purpose  written  the  hospital  obtained  could  maintained  informed  the  identified  investigation  The  the  investigator. were  chose  of  from  Committee  administrator  explanation  not  approval  investigator  participants  would  9  investigation,  investigation.  nursing  this  this  Subjects.  the  this to  The  with  to  C o l l e c t i o n  Screening  Involving  written  weeks  Considerations  Prior  B r i t i s h  6  33  years.  Data Ethical  from  Bases  The to  to  the of  this  consent  answer  the  any  form  Power  question.  The  participant's i n d i v i d u a l ' s interviews  written  consent  included  employer  would  comments.  This  investigator  room  in  in  a  private  not  be  a  made  the  Bases  statement aware  of  34  that  the  an  conducted  agency  to  f a c i l i t a t e  to  describe  confidentiality.  Procedure The  for  purpose  phenomena  from  accomplish inductive and  The  and  each  Each  participant the  However,  as  expand the  as  their  and  of  the  grounded  Oiler  To  method  coding  (Glaser theory  (1986)  was  the  investigator, data.  occurred asked  questions  considered  arose,  guided and  this  analysis  to  be  to  a  coding  comfort  with  three  interviews,  the the  her  a  an  relevant were  hours.  interview scope to  the  encouraged question.  observations  questions. interview  interviews  working  broad  particular of  c o l l e c t e d ,  taped  from  of  participants  response allowed  Two  during  c o l l e c t i o n  participants' i n i t i a l  nurse.  u t i l i z e d  c o l l e c t i o n ,  principal  analyzed  topics  interviews  staff  theory"  description  data  consistent  interview on  "grounded  Munhall  the  participant  ensuring  the  by  the  investigator  the The  of  was  investigation.  with  of  of  during  author,  transcribed  this  outlined  the  investigation  perspective  1967).  investigator of  this  goal  approach  methodology  Collection  of  the  this  Strauss,  phases  Data  about  After  guide  the  guide  of  data.  purpose to Taping the f i r s t  (Appendix  B)  Power  was  altered  most  relevant  interview second  c l a r i f y to  guide  round  existence the  to  was  of  of  the  f i r s t  (Appendix  topic  under  developed  interviews,  trends  participants  their  questions,  an  and  to  collected  The to  C).  were  address  second  the  A  were  second  Prior  coded  expand  35  to  and  the the  interviews  on  the  trends  gave  content  of  identified  D).  Analysis  Coding Following  raw  data  opportunity  data  investigation,  established.  interview  the  (Appendix  the  Data Data  so  Bases  data  Oiler  using  the  (1986).  standardize  d i r e c t l y exact  to  and in  remarks  used  the  codes be  by  could  be  the  with  thesis  investigator data  to  one  this coding  point, used  so  no a  the  of  the  investigator  coded  described  Munhall  effort variety  i d e n t i f i e d .  content  margin  of  relevant  this  non-verbal  analysis the  interview, level  could the  words  verbal  At  the  perspectives  coded  each  The  data  participant.  linked i n i t i a l  the to  (Appendix  at  one  members,  the C).  of  theoretical names  frequently  This  sheets  codes  level  committee adjust  data  made  Coding  communication.  of  was  code  and  a  so  and  to  related were  the  incorporated  investigator p a r t i c i p a n t s '  later  coding  in  stage.  guide  An  consultation  directed  interview  by  the  this to  obtain  more  Power  Once  the  completed, were  level  focused  category  this  Coding  and  regarding were  (e)  the  the  categorized  The  power  the  within  product  within  the  under  validate  analyzed  for  of  themes  (c)  second the  analysis. the  were  resources.  or  identified  was  a  grouped  theme  codes.  Level  of  the  client  one  by codes  themes. memos  of  made  categories between  and  the  conceptual  in  the  data  in  were  order  codes  base  spreadsheet to  coded to  were  conceptual  relation  and  c l a r i f y then  framework. on  which  codes  corresponding  bases.  Procedure This method coding,  to  for  Comparative  investigator analyze  the  categorizing  Analysis  u t i l i z e d data.  and  the  Trends  constant and  i d e n t i f i c a t i o n  the  guide.  data  one  the  grid in  was  interview  themes  of  as  components  gaps  Level  context  coding  (g)  interviews, six  (a)  control,  categories  same  categories  non  analysis  second  were  (d)  the  and  36  workload,  (f)  and  coding  Six  simultaneously  trends  the  one  i d e n t i f i e d :  properties  comparative two  codes  trend  findings  level  basis  or  occurred  Identified  the  the  a  level  undertaken.  grouping  components  A  Following  and  after  significant  framework. became  reflected  analysis  within  was  s a t i s f a c t i o n ,  names  recorded.  codes  and  communication,  investigator  represented  coding  incorporating  (b)  tasks,  interviews  two  established  recognition,  The  i n i t i a l  Bases  comparative  patterns of  in  the  theoretical  Power  constructs using then in  the  were coded  compared  the  construct. the  concept  the  the  findings  eight  of  from  conceptual to  academic  of  themes  categories.  sources  framework.  obtained  data  of  Data with  to  The  Properties  components  conceptual  understanding  relate  noted.  This the  of  The  power  process  data  to  framework  were  and  by  were  outlined  related  the  37  defined  themes  bases  the  theoretical  provided  knowledge  Bases  a  means  to  s p e c i f i c a l l y  the  power. coded  and  organized  under  conceptual  framework  were  of  the  analysis  w i l l  be  themes  but  analyzed  reported  in  not  linked  separately. chapter  The  four.  Power  Chapter Presentation Analysis found of  that  set  out  main  be  based  Randolph. The  degree  to  Randolph  data. sense  segment  The  second  the  presents  source  themes  data a  is  to  w i l l  three  nine  power  staff  themes. bases  by  power,  used  theme. not  to  as  by The  part  analysis  referred  w i l l  the  framework  during  be  framework  six  categorized of  the  references  power  source  sources  into  the  under  cross  the  the  divided  them  identified  power  certain  and  relate  not  ninth  but  of  with  investigator  d i s c u s s i o n of  outlines  segment  themes  this  identified  categorizes  framework,  This of  and  a  analysis  f i r s t  highlights  segment  Randolph's  The  by  Findings  recognized  presents  these  under and  nurses  which  discussed.  D i s c u s s i o n of  themes  38  IV  collected  staff  the  responses  responses  data  chapter on  segments.  third  the  nine  This  by  nurses' The  the  power.  findings  of  and  Bases  of  of  personal  self.  Themes After themes:  coding  nature  of  the  data,  work,  s a t i s f a c t i o n ,  resources  represented  grouping  The  codes  the  factors  sense  of  a  reflected in  power.  their In  the  this  investigator  communication, and of  codes  nine  work  control. with  general,  their  six  recognition, These  themes  similar  participants'  environment  identified  that  comments  properties.  perceptions impacted  on  indicated  of their that  Power  even  if  they  sources  of  did  power,  circumstances and  not  control  was  the and  a l l  before  Nature  Nurses'  Statements type  of  work  work  involved  significant non-client A l l trust  nursing  relevant  d i f f i c u l t  The the  issues.  issue  participants  made  for  client  were  focused  most of  comments  given  and  concept  of  c l a r i f i c a t i o n to  to  and  this.  relating and  the  presented  were  made  When  more  their  indicated  nurses  clients  care  of  most  to  the  amount  as  of  issues.  A  regarding  tasks.  provided.  their  care  frequently  participants  the  work  participants  related  undertaken  respect  and  their  were  the  required  questions  of  The  for  with  issues  nature  agency  participants  understanding nurse  them.  the  participants, perceived  recognize  39  Work  number  care  to  within  answering  perceptions  by  nine  and  as  their  able  to  patterns  most  prompting  of  were  significant  identified  understand  head  they  communication  frequently  associate  Bases  the  amount  influenced  the  type  clients  appeared  The  trusted  more  p o s i t i v e l y ,  care.  co-workers  that  contributed  to  of  nurse  cooperative,  and  trust  the  of  had  and  a  greater  respect  more  of  the  autonomous  practice. It allows y o u t o u s e y o u r own j u d g e m e n t in making decisions. I think if you d i d n ' t have the trust of the head nurse you would p r o b a b l y q u e s t i o n a lot o f y o u r own d e c i s i o n s and d o u b l e check them w i t h p e o p l e more often.  Power  Having  the  trust  reduce  the  amount  made  the  work  important  on  clients  had  quality  of  their  a  asked  to  what  one  participants patients teaching. majority  g r a t i f y i n g .  This  where  to  thus  the  the  they  the  of  time  nurses  trust  gave  client  thing  amount  compensate  theme  These of  the  for and  them  studied t h i s .  staff  was  with  felt  of  the  c l i e n t s ,  power  to  nurses  make  felt  needs. nursing's  throughout  they  would  focus  the  on  change  on  their  desire  to  have  could  l i s t e n  to  concerns  statements  reflect  client  interviews.  a  nine  it  The  respect  referent  These  spent  40  not  and  expressed  when  did  productive  strengthen  consistent  nurses  reported  effective.  meet  and  participants  perceived  to  clients  but  had  more  of  workload  decreased;  Wanting was  respect  supervisors  work  empowered  more  time  and  of  units  participants peers,  and  Bases  the  more  When unit,  time or  needs  with  do  feelings  the  patient of  the  participants.  I w i s h I had more time w i t h the patients. I think basically I really like bedside nursing. When it comes a r o u n d to the teaching part you d o n ' t have much time to teach because y o u ' r e so b u s y . The time t h a t we d o h a v e w e ' r e doing chores. We could perhaps spend the time with the patient. We've lost that, s o m e how w e ' v e lost this time w i t h the patients. And yet there a r e more and more of u s . And w e ' r e d o i n g more and m o r e . We're busy. B u t we s e e m t o h a v e l o s t quality time with patients. The the  types  of  participants  client valued  focused were  a c t i v i t i e s  assessments,  that  several  p r i o r i z i n g  of  client  Power  problems, family to  client  and  promoting  f a c i l i t a t e  these  restructuring nurses The  teaching,  the  helping  unit  participating  them  of  nurses'  participants they  were  to  able  so  to  others.  participant  One  nursing  knowledge  a  nursing  had  to  a  s p e c i f i c  consistent that  their  by  client  a  was the  greater  focus,  assignment.  a c t i v i t i e s  knowledge. a l l  expert  expertise  plan,  client  these  nursing  recognized  have  care  of  base;  valued  need  impact  The  However,  not  to  on  gave  the  power  p r o f e s s i o n a l l y .  their  to  seen  considered  practice  thought  A c t i v i t i e s  their  was  participants  independence.  implied  contribute to  with  and  use  work  interaction  it  other  41  care,  doing  nurses  opportunities  nature  client were  each  h o l i s t i c  Bases  when  several by  assert  her  physicians'  decisions. We p u s s y f o o t a r o u n d s a y i n g w e l l d o y o u t h i n k this a n d do y o u t h i n k that. I think it w o u l d be nice to say t h i n g s with a l o t more a u t h o r i t y . Like not, 'do you t h i n k ? ' : I think t h i s . Knowing was  perceived  expert  power.  knowledge nurses' were  the  and  the  other  by  this  to  participants  Nursing A l l  to  nursing  increase  indicated  knowledge  her  that  potential nursing  influenced  the  kind  of  information  histories  and  ongoing  assessments  information  their  communicate  participant  Nursing  nurses. of  when  practice  primary  nature  and  Other  share.  d i s c i p l i n e s . by  how  base  sought  interventions participants  work  gave  them  were  by  other  reportedly  expressed  the  information  sought  belief power.  that  Power  Providing  twenty-four  considered  to  give  hour  nurses  direct  care  information  to no  clients other  Bases  42  was  d i s c i p l i n e  had . Participants' similar  for  systems. Feeding  those  Their  Nurses more  outline  care  were  'ought  to  be  constraints not  and  with  trying  related  inhibiting  the in  to  of  their  primary  their  and  work  was  medications, tasks  the  dones'  Combined  in  of  giving  participating  nursing.  tasks  working  patients,  documenting  descriptions  the  when  client  they  someone  care  were  team  nursing  task  doctors,  there  were  entered  pressure e l s e ' s  and  described.  felt  f i r s t  were  oriented.  frequently  increasing  meet  days  c a l l i n g  investigation  than  to  most  work  of  time  deadline,  perceived  as  factors. I think that's the trouble, y o u know y o u many t h i n g s y o u r e a l l y think ought t o be get t h i s many d o n e , t h e n r u n o u t o f time. what's so f r u s t r a t i n g , you have more and things that ought t o be d o n e , h a v e t o be  have this done, you That is more done.  We're d o i n g more and m o r e , w e ' r e busy. But we seem to have l o s t quality time with patients. This  may  explain  why  it  was  investigation.  participants  for  the  research  not  mentioned  nursing  was work.  considered constraint.  the  This  d i f f i c u l t  as  an  investigator  interviews  to  be  to  s o l i c i t  Participation  accepted  function  observed  that  an  added  task  in of  participants and  time  Power  Upon  analysis  participants provide  to  a  primary  of  the  nursing team of  c l i e n t s ,  nursing ways  plan  It  in  was  care  but  to  nurses their  team  conveying  did  that  or  care.  care  not  other  was  a  power  result  for  the  recognize  not  the  of care  their  the  recognized  nurses.  valuable  unit  team  Following  were  a  The  modified  it  work.  on  of  r e s p o n s i b i l i t y  r e s p o n s i b i l i t y  influence how  of  whether  their  documenting  of  legitimate  control  participants  opinion  had  and  clear  source  worked  a  that  to  who  perceived  combined  could  potential  she  on  found  r e s p o n s i b i l i t y  She  control  and  a  felt  worked  not  or  these  power  in  was  solving  process  that  varied  client  as  investigator  participant  model  care.  this their  care  one  participants  problem  legitimate  The  client  units.  data,  recognize  nursing  individual  rest  the  client  power.  influence  for  not  individual  legitimate using  did  of  43  Bases  as  Participants  nursing  care  information.  I'd say, (the nursing care plan) w o u l d be a problem that i s s p e c i f i c to the p a t i e n t with a plan, g o a l s and n u r s i n g ' s s p e c i f i c a c t i v i t i e s . It would c o m m u n i c a t e to e v e r y b o d y what y o u ' r e trying t o a c c o m p l i s h a n d how t o go a b o u t i t . Keeping viewed  care by  sharing this not  plans  most  was  as  updated an  arduous  preferred  was  not  helpful  know  the  c l i e n t s .  view  that  nursing  when  time  was  with  by on  care  task.  many units  This plans  available.  relevant  information  Verbal  participants with  many  response were  a  information but  casual  reflected luxury  was  to  they  admitted  staff the be  who  common  indulged  did  Power  Bases  44  Really when y o u s e e how l i t t l e they get u s e d by nurses you r e a l l y wonder whether kardexes are a l l they're c r a c k e d up to b e . Its a great idea in theory. You s i t down and w r i t e the nursing care p l a n on t h i s patient, you change i t and keep i t up to d a t e and so o n . But you never see nurses look at them. Preoccupation nursing the of  process  potential those  nursing  meet  were  care  client  recognize  as  could bases  a  source  indicated  nursing  were  nurses of  reported  client  did  assessments  all.  the  and  the  individual  of on  night  have  These bases  Related  the  of  non-nursing  tasks  is  factors the  bases  that and  assist  nurses  to  because  their  communicating  and  sample  lack  Since  of  s p e c i f i c i t y  assignment,  team  updated to  of  most  client  nurses  power  able  This  served  limiting  planning.  care  limit  plans  for  the  studied.  Tasks  nature  non-client  and  during  and  to  not  partly  s p e c i f i c  wrote  factors;  used  were  units.  the  legitimate  done.  occurred  of  Focused  concept  a  staff  non-client to  were  continuity  of  recognize  expert,  power  use  legitimate  not  planning  most  planning  power  did  they  of  that  lack  not  c l i e n t s .  and  inconsistently  assignments  participants  Sometimes  a  negative  promote when  inadequate  Participants  descriptions care  be  information  needs.  this  to  and  Participants  plans power  tasks  found  expert,  studied.  information to  with  of  focused used  but  nursing  work  tasks.  Traditionally  analysis  of  issues  the  data  was the  the term  showed  Power  that  these  focused  participants  tasks.  non-nursing them, if  but  they  about  focused.  "mechanical worker  be  that  work".  a  in  the  few  tasks  Many  to  of were  to  able  doing  do tasks  non-client checking patients  mentioned.  " c l e r i c a l  to  and  Terms  tasks"  suggested  attend  work  expressed  transferring those  to  these  was  also  nurses'  cupboards,  participants  hospital  non-client  of  equally  were  and  by  some  Frustration  records,  were  these  was  object  refrigerators  work"  hired  not  tasks  administration  summarize  else  focused.  non-nursing  "office to  did  frustrated  considered  someone  client  Cleaning  medication  used  if  participants  were  more  Participants  tasks  doing  doing  were  45  Bases  and  some  these  type  tasks.  I would put on u n i t aides to do t h e errands and do t h e c l e a n i n g the m e d i c i n e c u p b o a r d s , the refrigerators once per week, run patients to a c t i v i t i e s and o r d e r supplies. Factors care  were  staffed, tasks  considered  considered not  and  having  doing  participants. to  do  work  leaving  reminder  notes  focusing power. doing  mentioned raised  physicians  physicians  physician  factors.  supplies,  were  the  from  legitimate  participants  thought  Phoning  the  negative  adequate  Three  because  detract  limit  paperwork  they  themselves.  to  to  with  as  not  attended  on  the  kardex  Being  short  by  a l l  issue  of  having  should  for  client  issues  the  the  on  to  non-nursing  patient  had  of  be  doing  assessments  patient  them  were  or viewed  as  Power  Bases  46  They leave everything to u s . We're baby-sitting them. If a n y t h i n g n e e d s t o be r e o r d e r e d we're phoning them, they're not c h e c k i n g on the p r o f i l e . The  participants  dependence source. as  a  on  recognized  a  this  of  as  observed  to  this  as  The of  part  blamed  the  power  in  work. kept few with  of  the  their task.  participants  since  when  Even with of  role.  though  their  was  expressed  focused  they  the  was  workloads  others  to  non-client  the  did  not  considered were  topic  their  of  perception  the  tasks  sense  of  loss  were these  factors to  c o n t r o l .  nursing's  indicated  the  the  powerless  their  blamed  focused  nurses'  tasks  felt  of  with  about  address  influence  combined  participating  out  responses  power  was  concern  that  legitimate  they  they  limited.  commented  Their  legally  participants  work,  would  budget,  but It  power  documentation  that  discussing  they  issue  potential  documentation  how  agency's  doing  a  indicated  non-client  asked  physician's  identified  nursing  power  Heavy busy  for  of  general.  perceived  others  source  participants them  the  part  When  as  participant  comfortable  contact  the  information  as  a  change  of  recognize  sharing  undertaken. most  one  focused  nine  client  for  necessity  be  information  not  power,  the  non-client  of  them  Although  source  view  did  a  lack  lack  nature  Some of  of of  perception  their  of  contributed  to  being a  d i s s a t i s f a c t i o n  nursing. In  summary,  perceived  by  the  while  the  nature  participants  to  of be  nurses'  work  potentially  was  powerful,  Power  negative  factors  legitimate nature  of  terms have  of  and  limited  information  nurses'  work  referent  more  the  power  was  power.  influence  extent  over  which  bases  viewed This  to  as  a  power  clients  were  and  47  expert, recognized.  positive  base  Bases  was  peers  factor  The in  perceived  than  any  to  other  d i s c i p l i n e .  Communication Various were  types  mentioned  discussed  in  participant  an  in  the  state  the  staff  asked  was  to  h o s p i t a l . names,  Instead  most.  in  the  and  This  relationship. connection care  as and  information phenomena.  was  This a  a  referred  the  the  weak  one  and  two  most  a  asked  to  the  therapy,  the  used  people  one-to-one  limited  physicians  frequently  d i s c i p l i n e s  in  with  Communicating with  patients,  terminology  connection  a  with.  positions  the  communicating  were  people  that  base.  not  occupational  to  each  support were  not  was  communicated  the  were  people  nurses,  a l l  the to  services  contributed  power  she  staff  and  to  pharmacy,  social  who  This  though  participants refer  numerous  even  between  medicine  they  implied  positions  describe  not  Dietary,  physiotherapy by  did  with  sample.  fashion  Although  they  themselves.  nurse  described  administration,  positions.  plan  communication  impersonal  was  Communication nursing  by  of  perception  between to  give  described  of  nurses  to  Power  Communication for of  providing  were  to  the  nurses'  power, sense  with  provide  norms.  of  power.  working  and  quality  care  support  problem was  and  Verbal  Written  were  second was  as  ""nsidered the care  plans  in  care were  on  plan  a  strong  at  view  team  on  of  that to  nurses and  methods a  was  with  reflected  a  a  source  reported taped  book  means  and  to  or  kardex  communication.  nursing  the  provide  through  of  common The  a  morale.  communication  as  to  of  through  represented  contact  One  sources  This  also  to  power.  her  a  meetings  contributed  was  sense  with  positively  source  unit  communication  the  a  Conferring  question the  nurses.  on  felt  power  frequent  of  necessity  together,  the  synonymous  used  the  between  described  means be  in  a  contributed as  48  as  care  increased  face  notes  between a  to  nursing  solving  to  seen  team.  planning  prevailing  most  not  communication mentioned  unity  communication  report.  Charting  to  enhanced.  face  their  connection  resulted  through  the  that The  on  nursing  of  was  Participants  and  response  responded  happen  care  Team  in  nurses  care.  nurses  perceptions  participant,  of  client  connection  partner  between  Bases  of  care this  kardex.  differing  plan  was  was Comments  extent  to  about which  units.  A lot of times I think they're there just because we h a v e t o p u t something. I think most people g l a n c e at the p r o b l e m , and then s o r t of form their own p l a n i n t h e i r head. Unless its a major problem or d r e s s i n g or something that really deserves a very s p e c i f i c p l a n to f o l l o w . Then t h e y ' l l l o o k at the plan.  Power  We u s e i t a lot casuals t h a t we information and During asked  how  the  they  they  had  good  Many  implied  d i f f i c u l t y and  interviews  were each  and  families  as  based  power.  and in  a  the  to  on  was  them.  a  were  extent,  were  with  before  that  relationship.  physicians  to  trust  who  order was  of  perceived  Communication  promote  referent  reluctance  as  had  administration,  communication  expressed  nature.  second  peers,  considered  often  as  about they  did.  I don't like c a l l i n g a d o c t o r to remind him patient needs a l a x a t i v e order or something that. I s t i l l like c a l l i n g the doctor only have to. Similar  to  the  factor  nature  of  nurses'  viewed  as  a  staff so  felt  that  These  work,  negative  nurses  felt  time time  factor  that  most  communication  feelings  participants  of  were  constraints consuming  in  the  work  of  their  interfered  reflected  many  uncomfortable  related  that like if I  to  the  communication  was  environment.  contact with  issues.  with  of  stated  and  identify  in  their  49  were  I n i t i a l l y  the  to  mentioned  participants  communicate  asked  they  c o l l e g i a l  this  During  C l i e n t s ,  trusting  agency  a  relationship.  mentioned.  certain  However,  having  their  colleagues  of  lot  participants  d i s c i p l i n e s ,  considered  participant  To  patterns  not  respected  and  other  when  relationships  had  not  frequency. open  with  working they  because e s p e c i a l l y with a have, there is a basis of referrals and stuff.  interviews,  related  describing  respect  trusted  i n i t i a l  Bases  was  These  unnecessary  patient Some  a  care. nurse  changing  role  and  Power  with  the  expectations  mentioned nurse  that  called  they  the  set  for  them.  preferred  the  Two  system  Bases  50  participants where  the  head  physician.  There's a lot of phoning doctors. I've been away from day s h i f t for a l o n g time and at one time the h e a d n u r s e was t h e r e a n d t h e y looked after phoning doctors. Now we h a v e t o do t h e phoning. These team calls were  staff  nurses  perceived  leader  phoned  it  by  various  considered  checking written work.  up or  One  on if  nurses  the  one  the  physician  with  needs  the  in  when and  they  to  were  was  nurse  orders  felt  nurse  at had to  the  been do  strongly  meeting  phone  contacts  directed  the  or  repeat  These  sure  asking  particular  c l i e n t ' s  head  eliminated  make  was  physicians  the  physician.  if  physician  participant  not  to  time  unnecessary  communication and  saved  that  his  that  physician's  needs.  Some ( p h y s i c i a n s ) over-trust us. They leave everything up t o u s . And w e ' r e b a b y - s i t t i n g them. If anything n e e d s t o be r e o r d e r e d we're phoning them, they're not c h e c k i n g on t h e p r o f i l e . Their patient's conditions, t h e y w o n ' t come t h e y ' l l p h o n e a n d s e e how t h e y a r e . . . S o they leave too much up to o u r d i s c r e t i o n w h i c h I d o n ' t know if that's trust or what i t i s . Another  reason  for  phoning  feelings  about  the  need  to  something  query  herself.  One  the  the  for nurse  participant  doctor  time felt  summed  that  evoked  consuming capable this  up  negative  communication of  by  dealing  was  with  saying:  I think a lot of the d e c i s i o n s we a r e capable of making, b u t we h a v e to phone the doctor. An increase in diet, really stupid things, bowel regime, things that are really s i l l y . Nursing should have the power to d e t e r m i n e those things.  Power  Participants communicating that  even  client they the  expressed  with  though  physicians.  others  information,  had  did  expressed  by  on  not  power.  feelings  Certain  depended  they  information  emotions  mixed  This  several  to  this  type  of  51  about  participants  them  feel  Bases  stated  communicate necessarily  comment  meant  reflected  participants.  Its frustrating when y o u f e e l y o u h a v e no power. When y o u k n o w b a s e d o n y o u r a s s e s s m e n t that s o m e t h i n g s h o u l d be c h a n g e d , and y o u b r i n g i t up to t h e d o c t o r a n d t h e d o c t o r hums a n d h o s a n d forgets about it. Often it  nurse  was  not  participants acted  on  recognition  given  contributed  to  Team most  and  helpful  planning input  of  and  nurses  a  patients.  felt  and  important  the  their  with  without  nursing. considered  communication  nursing  existed.  contribution  was  direct  The  staff  valued  consulted  for  their  Involving  more  people  in  the  planning  quality  of  client  to  factor  improve  communication in  the  nursing  communicated  nurses' factor  work, in  was  was care  not  setting,  communication  relation  to  the  assessment of  care  perceived except  upon. was  a l l of was  care.  generally  acted  by  the  and  had  were  way  and  This  were  i n t e r d i s c i p l i n a r y  relationship  used  source.  meetings  meetings  information  they  summary,  of  as  was  d i s s a t i s f a c t i o n  these  c o l l e g i a l  In  nature  At  provided  information  nurse  of  for  care.  a  information  the  sense  forum  as  positive  to  the  they  m u l t i d i s c i p l i n a r y  studied  d i s c i p l i n e s  seen  a  or  felt  Next  when to  perceived  sources  of  as  power  to  a the  the be  an  Power  available  to  the  nine  nurses'  work  was  perceived  was  not  realized,  participants  promote  referent,  information  The  nine  these  participants.  participants  power  bases  communication  to  and  well  if  the  potential  perceived  indicated  increased  was  have  Where  the  nature  for  power  the  power  that to  bases.  significance  content  of  52  of  communication  connection  that  Bases  of  their  received.  Recognition Recognition consistently  to  process  most  for  giving  head e  staff  the  cellent  in  most  nurses  nurse  desire  to  as  meant  as  a  participants'  of  by  degree power  easily the  positive that  peer  The  following  of  feedback.  or  were  tangible  feedback.  felt  than  of  was  done  desirable  more  views  The  source  terms  feedback  v i s i b l e ,  recognition  studied  nurses.  for  environment.  Evaluations  reliable  considered The  work  recognition  participants. as  the  referred  participants' given  and  elements  of  importance  varied  It  nurse also  recognition hospital  the by  were  seen  was  feedback  response  but  identified  head  in  to  gain.  from  their  recognition  was  typical  of  of  I think it would r e a l l y help boost morale if we d i d get more p o s i t i v e feedback from the head nurse. From someone t h a t is in a charge role rather than from your f e l l o w staff members. It means a l o t more to get it from your head nurse. This  recognition  transfer  of  came  functions.  through The  formal  most  evaluations  frequent  type  or of  informal  Power  recognition being  mentioned  assigned  perceived  to  extra  have  administrator. charge  nurse  desirable this  as  nurse's  and  reward  nurse  given  empowering  based  extra  member  was  action.  trust  respect  for  the  confidence  and  self  staff  nurses  to  the  informal  peers  and  colleagues,  expert The  and  conscientious participant excellent  of  worthy  knowledgeable,  or  it  and  able  nurse. peer  Only  her  position  than  different one  as  and  expert was to  but  participants admitted  this  acknowledged rarely  was  the  perceived  power  more  bases.  v i s i b l e  contribute  to  more  participants experienced,  e f f i c i e n t ,  caring,  patients.  Each  c r i t e r i a  be  was  to  evaluations.  included:  to  It  for  determining  clearly  stated  an  that  valued.  I t h i n k t h a t we a r e quite supportive another a n d we o f t e n try to say that really good job or t h a t you d i d t h a t really about the best k i n d of recogn Some  described  served  esteem.  as  a  and  formal  to  such  individual  participant  recognition  as  head  considered  relate  was  head  the  competent,  to  nurse  The  characteristics  s k i l l f u l ,  was  participant  feedback  recognition  identified  perceived  power  nurse of  was  sample  indicated  referent  indirect  referent  types  considered  gain  the  portrayed  One  This  and  on  in  r e s p o n s i b i l i t i e s  feedback".  empower  she  power  committee  Since  to  staff  r e s p o n s i b i l i t i e s .  Being or  the  "indirect  increase to  by  53  Bases  benefit  actualized  of  of one you d i d a well. That's ition.  peer  through  support  recognition.  Power  Bases  54  I think we a r e a w a r e o f who ( e x c e l l e n t nurses) are but its just that they're not g i v e n recognition. In our hearts we k n o w t h a t they deserve it. With be  no  consistent  d i f f i c u l t  to  know  when  Participants  perceived  power.  As  result  empower  peers.  peers but  was  not  a  in  terms  to  of  in  awards  yearly  by  affect  them  did  not  received for  an  individual When  participants implying staff  made  they  nurse  to  in  I got way I Participants such  as  limited  nurses  a  group.  ' t h e y ' ,  contradicted  or when  a b i l i t y  personal expert  However, since  morale  power.  they  only a  a  to  of  acknowledged  considered  an  excellent  comments  recognize  sample  through felt  few  source  people  of  power  to  about  their  identify  own  more  It  nursing  often  two  themselves, expertise.  participants  was  n u r s e s ' .  were  that's  but  seemed group  'the  but  personal  preparation  strengths. The  nurse  One  stated:  educational  personal  'we',  describe  quick  recognize as  not  to  reward  strengths  and  an e x c e l l e n t evaluation feel about myself.  were  their  enhancing  was  found  limited  recognizing  personally  was  very  referent  was  feedback.  recognize  of  it  nurses.  not  the  give  h o s p i t a l .  demeaning  did  to have  not of  excellence  expertise  the  It  staff  asked  to  terms  nursing  award.  of how  enhancing  felt  this  did  concept  Participants given  and  nurses  they  The  referred  notion  the  limitations slow  easier  to to  referred This  directly  not  talk to  trend  of  as was  questioned  Power  about  their  staff  nurses  a  source  sources  of  sampled power.  conscientious for  their  of  encapsulated  the  l i s t e d  At  perceived needs.  views  such  as  One  of  least  personal  Attributes  were  clients  power.  four  sense as  of  of  the  participant's  esteem  caring  nurses  55  nine  self  kindness,  empowering  Bases  to  as  and  care  response  many.  ( P o w e r ) h a s to come f r o m y o u r s e l f . I don't know w h e r e we g e t it from but it just comes . . . . Your confidence that you're able t o do y o u r job. As  one  participants  personal the  sense  power In  and  of  stated,  well-being  motivation  summary,  having  the  to  theme  was  a  "love  of  l i f e "  perceived  to  give  achieve of  nursing  recognition  or  nurses  goals.  was  not  perceived  to  be  a  strong  external  source  of  power  but  was  to  be  a  strong  internal  source  of  power  for  nurses.  same  participants  personal stated  sense  they  who  of  felt  stated  self  their  esteem  s a t i s f i e d  source  were  with  also  of  the  a  considered Those  power  was  nurses  who  a  nursing.  Satisfaction P a r t i c i p a n t s ' nursing  varied  contentment getting toward  a  expressed Some  new  widely.  with  ready  to  her  career.  more  One  the The  with  the  participant  nursing  leave  emotions  desired  s a t i s f a c t i o n  role  and  somewhere complexity  between and  by  of  of  expressed  function.  profession remainder  profession  taking  the  these  challenge  One  was  courses  participants two in  extremes. the  nursing  Power  role;  some  desired  stimulating The with (b) a  and  factors  nursing gaining  participants feedback  (a)  the  relationships  from  was  described  both  56  as  depressing.  positive in  Nursing  identified  were:  difference  good  as  less.  Bases  as  contributing  functioning feedback,  health with  expressed  of  as  (c)  a  and  s a t i s f a c t i o n  in  advocate,  like  patient,  colleagues  satisfaction  patient  feeling  the  to  and  nurses (d)  peers.  make  having  A l l  receiving  positive  c l i e n t s .  I really enjoy working with patients and I think the g r e a t e s t s a t i s f a c t i o n i s when a p a t i e n t says thank you for the care that they've gotten. That's really rewarding. Those  participants  profession with  the  of  given  nursing  challenges  Factors were  nursing  expressed felt  of  to  Feeling  ignored  contact  with  nursing  image  through keep when  reflected  to  up  with  as the  decisions clients  cited the  had  personal  d i s s a t i s f a c t i o n  coding  individual were  they  s a t i s f a c t i o n  with  the  power  to  cope  nursing.  contributing  summarized  comments  who  as  an  i n a b i l i t y  changes  were and  being lack  examples.  emotions  with  in  This  expressed  for  by  the  value  nursing.  made, of  nursing  lack  change  of in  participant's the  nine  participants. There's a lot more e x p e c t a t i o n s of us t o o . We're expected to have a l o t more s k i l l s , k e e p them up and yet have l e s s time to use them. I think that's becoming very frustrating.  Power  Even  though  with  the  a l l  participating  increasing  powerless  to  personal  power  to  overcome  in  particular  for  nurses  they  with  the  lack  were  these  through  self  other  able  felt  issues For  of  to  these  expressed  only  nursing.  gained  but  f e l t  expectations,  influence  d i s s a t i s f a c t i o n  nurses  also these  not  frustration  who  felt  participants, was  bases.  recognize  not  Two  potential  participants power  actualized  and  terms  of  at  stage  one:  Some  Hagberg's  therefore  to  factors  nursing  participants.  identified  as  was  conducted  the  nurses  eight  Some night  two  The  these  two  l i t e r a t u r e  of  a  money  s h i f t s .  of  patient  new  did  and  nurses  were  was  the  contract been  by  were  not  investigation was  negotiated  dealt  with  for  s a t i s f a c t i o n  with  only  want  increasing care  mentioned  control  Whether not  suggested  not  since  had  expressed  nurses  concept  were  Perhaps  after  issue  evening  affecting .  issues.  the  the  scheduling  participants  shifts  participants  power,  satisfaction  months  the  or  scheduling. decisions  of  that  Money,  major  felt  hour  model  not n . . . . nursing you have  powerlessness.  common  contributed  working  bases  powerless.  In  awhile.  the  sufficient  Then you f e e l really powerless. They're taking your assessment into c o n s i d e r a t i o that's when you f e e l not very good about and not v e r y good about the relationship with the doctor.  the  57  expressed  esteem  power  were  those  Bases  working to  change  nurses'  never  twelve their  control  raised  by  or  over the  Power  more  In  summary,  as  an  outcome  contributing esteem by  was  some  it  satisfaction  to  of  power.  perceived was  power  not  with  rather  While  to  nursing  a  than  perceived  a  personal  contribute as  was  most  58  perceived  factor sense  strongly  the  Bases  of  to  self  s a t i s f a c t i o n ,  important  source  power.  Control When the Many  care  asked they  asked their  the  concept.  control that  concept  the  This  saying  being of  This  was  tied  what  could  "What  be  about  about was  c l a r i f i e d a  as  to  be  l e f t  control  Time  the  concept  into For  needs  some  components  of  a  nursing.  affecting  patient  were  mentioned  also  was  care  and  Having  when  self  mechanisms. and  deciding  undone.  word  was  of  the  I o r g a n i z e my o w n w o r k . We h a v e t o a s s e s s p r i o r i t i e s , s o m e t i m e s y o u h a v e no c h o i c e have to l o o k a f t e r what h a s t o be done. Responsibility  of  decisions  management  controlling  patient  responding  understanding  input  care?"  over  hesitated.  before  c l a r i f i e d  concrete.  p r i o r i z i n g  had  varied  having  to  they  participants  patient  referred  into  afford  nine  demonstrated  made  were  a l l  ways  investigator  control  organization  the  concept  responses  by  are  describe  provided,  that  and  to  also  used  to  input  describe  into  mentioned.  outlining  the  our you  various  decisions These  amount  of  issues control  of  Power  u t i l i z e d .  One  nursing  participant  who  worked  on  unit  Bases  using  59  primary  stated: As s t a f f nurse you have f u l l c o n t r o l over the care. B e c a u s e y o u do e v e r y t h i n g and the responsibility is a l l w i t h the primary nurse. You p l a n y o u r day as you t h i n k is best for the patient and c a r r y on as you c a n . I think the control is right with y o u . . . . I think the staff nurse is in f u l l c o n t r o l of the situation.  This  participant  care  and  increased  r e s p o n s i b i l i t y  than  was  indicated  by  participant primary She  the  functioning  nursing  perceived  care  indicated  giver,  as  she  other a  strengthened  that  she  as  had  a  had  more for  her  function  legitimate  to  individual  eight  primary  autonomy  staff  The  implied  source  of  of  position  control  clients  nurses.  nurse  her  plan  that  legitimate  over  her  as  power. primary  c l i e n t s '  care . There i n d i r e c t l y patient  was  applied.  care  rewarding  evidence  use  control  Manipulating  decisions of  that  was  seen  could  be  physicians  as  a  valid  directly to  but  make not  The ways i n suggestions to the head type  termed  by  change".  of one  certain  as  a  control.  You s o r t of have to use a b i t of manip actually. That i s something you l e a r n is how t o g e t the d o c t o r s to take c a r e patients i n what you t h i n k is the best might know b e t t e r s i n c e you are there.  This  or  which you c o n t r o l at m e e t i n g s . You nurse.  contribution  to  patient  participant  as  "using  it; can  care the  ulation in nursing of their way. You  by making suggest things  decisions  back  door  to  was  Power  The  fact  that  twenty-four  hours  unavailable  to  Participants gain  per  day  others,  reported  information  indicated  nursing  this  a  and  contact thereby  with has  the  considered  a  that  physicians  sought  their  means  patients.  source  of  60  patients  information  was  about  was  has  Bases  control.  them  One  information  of  out  to  participant power.  You see the patient more t h a n he d o e s , he just comes i n and out s o he d o e s n ' t s e e i t on an overall basis. And a l o t of them r e a l l y rely on you knowledge of what's happening w i t h the patient a n d how t h e c h a n g e s h a v e b e e n h a p p e n i n g . They w i l l change the therapy or the treatment according to what you say and t h a t i s a source of power. However,  many  physician patient  did  care.  legitimate  felt not  that  once  further  One  information  consult  participant  the  felt  was  nurse  this  attained, to  the  discuss  decreased  her  power. You f e e l that this patient needs t h i s and you feel i t ' s important and i t ' s not g e t t i n g done. And you feel really frustrated once you b r i n g i t up t o the doctor and the d o c t o r d o e s n ' t a g r e e w i t h you or just doesn't think its important and leaves i t . . . . I f you r e a l l y think its something important you have to keep f o l l o w i n g it up. That is a feeling of p o w e r l e s s n e s s that you c a n ' t do anything.  It  was  studied  d i f f i c u l t  controlled  understanding they  were  practice their orders  of  let  and  in  alone  legitimate  their  the  limited  to  determine work.  concept, their  power  directing  was  the  to  others.  care.  nine  their  participants control  staff  lack  by  Many  their  physicians times  nurses  of  indicated  Participants  undermined  patient  the  Through  a b i l i t y  influence  how  own thought giving  participants  Power  mentioned action.  having In  effect  participants plans  were  nursing Rather nurse felt  than  were  had  to  hospital  retention  not  of  nurse  able  "what  was  nurses.  hospital  was  staff  nurse  department  more  readily  limited. patient  care  education  or  participants  but  care  affecting  meetings.  fact  that  the  participants  in  a  sample  in  order  in  groups  committees committee  other  committees  where  staff  typical  of  are  the  to  local  interests but  rather  did  dealt  events.  perceived  the  the  with The  power  examine  the  participants nurses to  have were  were  the  question  a l l the different at the moment. at  the of  have staff  degree of  limited.  on?"  scope not  such  committees  responses  nurses  was  to  hospital the  committees  social  Nursing  few  since  identified  These  a  unknown,  committees  serving  the  covertly  I'm not too f a m i l i a r with committees that are going Committees  on  taking  by  Decisions  care,  others  Whether is  identify This  s o l v i n g .  based  client  involved  members  to  involved.  this  nursing  participant  described  61  goals.  of  and  before  m u l t i d i s c i p l i n a r y  others  manipulate  nursing  control  nurse  meetings.  in  for  head  problem  team  debated  the  the  group  in  responsible  they  staff  in  with  of  influencing  Involvement  One  much  discussed  accomplish  as  check  rested  care  was  to  Bases  unit the  level  committees  input  was  regarding  issues to  were  such  as  which  connection  to  impact  on  Power  the  provision  involvement In in  the  which  of  in  client  of  control  nursing  the  data was  affecting  expressed  as  of  significant power.  limited  than  by  nature  of  in  their  lack  of  of  was  nurses'  influencing  control  the  significant frequency  and  less  control  over  not  as  work,  it  to  with  team  the  frequently was  participants'  contributed  more  with  working  control  issue  care  of  was  Participants  the  client  factor  Lack  control  individual  While  decisions  a  of  obtained  less  power.  the  issue  mentioned.  perceived  legitimate  was  62  committees.  summary, lack  care  Bases  a  found  to  be  perceptions  sense  of  general  powerlessness.  Resources One no  area  control  funding  over  was  were  which  resources.  blamed  for  supplies.  Hospital  controlled  and  complained  that  d i f f i c u l t y  obtaining  patient  care  One  unit  of  Budget of  finances  with  was  nine  lack  therefore  example  allocation  a l l  participants cuts  and  necessary  were  viewed  untouchable.  beds  f u l l ,  equipment  they  had  government equipment  as  and  government  Participants  staffing and  f e l t  shortages  supplies,  and  quality  of  suffering. of  successful  resources  were  informed  that  discharge  planning  unit,  was  lobbying  given.  their they  unit  to  When would  strategized  influence  the be to  nurses  on  one  re-designated have  input  a into  Power  the  f i n a l  l i s t  the  human was  decision. reasons  The  why  nurses  their  resource  for  a  circulated  and  signed  unit  discharge by  was  made  to  the  result  was  decision  to  leave  unit.  When  e f f o r t s ,  asked  one  any  were  lobbying  significant In  However,  that this  a  an  Generally  participants  strong  rather  negative  (1985)  was  guidelines themes. was of  used and  While  referenced  by to  in  participants'  examined  were:  A  a  unity  A The  medical their  and  Even  did  or  petition  assisted  that  after  not  linked  and that  in  feel  they  had  the  perceptions  of  referent  achieved.  power  of  over  power. power  this  was  Bases l i t e r a t u r e to  the  data,  this  participants  environment.  reference the  to  terms  Power in  was  connection  their  of  basis,  power  investigator  c l a r i f y  personal  power  of  not  documented  analyzing to  physical  designation  s p e c i f i c  was  felt  cross  to  administration.  participants  referent  this  hospital  physicians.  factors.  amount  factor  framework  of  main  Discussion The  the  good  unit.  and  nursing  issue  perception  but  a  the  63  power.  certain  resources  a  two  these  on  not  responded  resource  summary,  expressed  the  was  planning  sources  participant  documentation successful  what  outside  nurses  presentation a  met  Bases  design  data  the  and  the  Randolph interview  categorized  conceptual  investigator's power  by  bases. expert;  under  framework  understanding Power  bases  positional  Power  reward,  coercion,  information, factors  the  that power  themes.  of  also  was  themes be  Personal  (Randolph,  segment  of  found  not  referent such  nurses'  been the  to  perceptions  discussed chapter  related  consistent  or  nurses  studied.  nurses  tried  Since  to  power  as  This  groups Also gain  of  each  anyone  trusted  direct  question  during  and  in  relation  s p e c i f i c a l l y  with  any  sources  of  explores  one  of  data  to  the  theme.  power  the  people  trust did  not  i n i t i a l  was  trusted  The  bases  the or  and  to  what  and  respect  volunteer  interviews,  was  asked  to  her.  In  participants  were  able  administration  and  nurse style  from  extent  in  the  people.  information during  response  the  to  identify  other  what  these  identify  to  that  respected  of  has  peers  interested  was  respected  families,  when  reputation  investigator  participant and  present  i d e n t i f i c a t i o n  examined  participants  power  is  charisma,  respect  1985).  individuals  c l i e n t s ,  have  contributing  admiration,  interview  power  Environmental  Referent  characteristics  referent  resources.  discussed.  Personal  draws  of  This  and  and  64  organizational  participating  investigator  bases  variety w i l l  sources  this  legitimate;  connection  influencing  potential to  and  Bases  about second  whether this peers,  d i s c i p l i n e s .  I guess co-workers (trust and r e s p e c t me). Patients because they trust t h e m s e l v e s to us their care. I think also family.  for  The  effect  studied  this  trust  to  improve  was  provide. nursing  Clients actions,  practice  more  collaborated  and  respect  the  were  quality  described  administration  autonomously to  meet  had  and  client  on  of  as  care  more  gave  the  Power  Bases  staff  nurses  they  were  able  to  freedom  to  receptive  to  participants  other  65  d i s c i p l i n e s  needs.  I think it makes i t easier f o r me. (Clients) are more c o o p e r a t i v e and t h e y seem to l i k e my g u i d a n c e and d i r e c t i o n . I find I c a n do m o r e w i t h them that way. The power  themes  were  the  s a t i s f a c t i o n .  while  referent were the  nature  of  nurses'  nursing  communication  power.  The  of  were was  nature  seen  work  of  being  trusted  effective.  Trust  gave  them  and  Communication  was  perceived  the  referent  agency  were  Participants place.  considered expressed  of  pride more  power. to  as  their an  for  this the  s a t i s f a c t i o n because  that  being  their to  work  the  level  work.  influencing  Communication  promote  support  make  contributed in  on  were  belief  to  of  referent  power  respected the  of  and  and  degree  impact  referent  power  respect  degree  of  and  expressed  and  degree  by  and  outcomes  nurses'  advantages  respected  as  work  to  of  referent  communication,  perceived  influenced  and  personal  nurses'  being  Participants  to  work,  as  confidence  in  related  perceived  trusted  of  be  with  actualized.  more  to  Effectiveness  satisfaction power  found  source  factor  patterns of  in  on the  power.  communication  systems  Power  When of  participants  power,  others  referent  was  not  environment referent  were  power,  or  mentioned.  indicated  power  but  they  this  asked  to  being  identify  trusted  descriptions  did  recognize  was  not  their  and  The  sources  their  value  a  66  respected  of  the  considered  Bases  by  work of  significant  source.  Personal  Expert  When certain  the  aspects  available for  ways  experts was  the and  to  of  exhibits the  (Randolph, nurses to  important  found  be  to  the  others  in  personal  nature  of  nurses'  found  factors  to  nurses,  of  was  but  determine  be  how,  by  chance  use  recognized  was  for  most  their  nursing  work,  for  The the  nine  personal knowledge  to  expert went  of  nurses' give  power.  into  work  p a r t i c i p a n t s '  them  to  Themes  nurses'  of  others'  staff  was  to  translated  studied  that  were  participating  of  looking  control.  nature  for  is  knowledge  Recognition  this  nature  was  jobs.  power  and  power  themselves  had  their  the  d i f f i c u l t  i n d i v i d u a l s ,  of  they  expert  power.  easy  more  power.  felt  and  expert  considered  contributing  expert  relatively  organizational  to  their  what  perceived  expertise  performing  investigator  performing  to  of  expertise  This  they  in  personal  sample  extent  Recognition  perceptions  then  1985). in  what  job  competence  related  recognition,  were  nurse  into  work  was  nurses  a  Participants  drafting  care  plans  1  Power  and  expertise  fact  that  optimal its  was  nurses  client  always  that  only  had  to  had  recently think  I  just Nursing hour  basis  expressed  client  were  back  and  power.  expert  legitimate  and  to  by  let  some  much  With  the  power  can  spent  diminish  we run  on  a l l  a  base,  was  nursing  as  felt  from  a  tended the  show.  a  participants  spent  nurses' of  nurses  twenty-four  nine  away  perception  in  participate  nurses others  time  powerful though  participants  that  to  as  achieve  it.  person  However,  Time  to  67  The  participant  use  the  total  too  care.  Even  We  factor.  perceived  legitimate  able  s a y . . . . A s  the  tasks.  some  one  better.  sit  belief  was  is to  focused  care  power  more  recognized  by  d i s c i p l i n e s .  nurses  of  client  interventions  recognized  nursing  powerful  non-client  of  potential  knowledge  the  providing  Have to  was  potentially  was  a n c i l l a r y  this  more.  when  knowledge  health  importance  have  valued  Bases  doing direct  expert  and  diminished  s a t i s f a c t i o n  was  decreased.  have  In  response  in  their  Making or  at  nurses while  the  work,  suggestions team the the  expertise on  to  the  personal based  meetings  was  power  have  nurses they  client  to  studied  had care  question  on not  expert nursing always  input did  d i f f i c u l t y they  of  into  how  much  power  was  not  knowledge perceived decision  recognize  the  identifying  provided.  control  to as  mentioned. physicians  giving  making.  power ways  nurses  Hence,  of  this  impacted  Power  Many power  participants  than  expert  themselves  power  c l i n i c i a n s  of  in  investigation changed  to  verbalize  perceive These the  their  part  c l i n i c i a n s  power  had  c l i n i c i a n s  c l i n i c i a n reduced  to  resource,  the  attention.  on  time  nurses  practice. status and  the  gaining  how  of  Nurse  this c l i n i c i a n s began  the  did  the  warranted.  of  from the  c l i n i c i a n s lost  power  nurse  not  input  role  to  the  expertise  participants  diminishing  participant  to  Once  expert  be  While  participants  considering  the  to  nurse  role.  68  recognizing  participants  c l i n i c i a n s '  unit.  more  During  of  that  time  have  c l i n i c i a n s .  staff  conditioned  the  to  comfortable  nurse  the  in  the  and  sudden  One  of  f u l l  become  without  part  by  inherent  that  impacted  more  positions  working  others  the  employment  power  nurses  like  area  time  were  the  were  considered  the  the  and  others,  were  specialists  perceived  Bases  were  that  caught  their  stated:  I'm certainly not p l e a s e d w i t h them c u t t i n g out the s e n i o r r e s o u r c e n u r s e s , the instructors that we h a v e , because they are such a great resource for this h o s p i t a l . Their  value  nurses  was  a  response one  staff the  to  of  was  influenced  power.  nurses  power  the  participant  source  experience this  the  recognized  In power,  to  their  question did  degree  by of  increase  their  that  participant physicians input  to  as  expertise.  about  respond  This  recognized the  of  appeared  sources  nursing thought and  nurses  knowledge nursing  others, had.  of  and  Other  that  Power  participants source  of  impacted  power on  exerts nurse  good  be  able  found  to  be  give  by  nurse  to  or  prizes  power  was  by  people  for  which  limited. to  valued  someone  to  the  this  nine  the  when  others  as  how  The  examined nurse  theme of  the  a  this  nurse  such  desired  that  the  behaviour  how  the  nurse  thought  had  done  participants  source  of  nursing  of  recognized  this  recognition  power  delegate  but  participants personally.  did  to  be  not  was  in  an  a  few  not  nurses  feel  this  Head  by  process  influenced  to reward  charge  based  awards;  be  or  the  p a r t i c i p a n t s '  received  to  positional  Hospital  be  nurses  peers  to  to  positional  desire  available  the  had  to  power  have  more  referred  to  to  rewarded  control  contribute  reward  power.  expressed  r e s p o n s i b i l i t i e s .  not  only  the  of  perceived  participant  describing  since  were  than  perceived  source  Participants  One  did  nurses  based  superiors  reward. when  expertise  expressing  exists  investigator  reward  position  power.  power  nursing  way.  directors  rewarded  power  other  This  related  authority  reward  of  d i f f i c u l t y  something  extent  power  Typically  and  had  reward  reward  to  The  empowering  an  over to  able  of  for  1985).  job.  source  they  value  care.  potential  (Randolph, would  the  69  Reward  control is  but  client  Positional The  recognized  Bases  awards  sense the them  of  a  1  Power  Giving was  the  peers  most  common  recognition. another  method  their  of  did  in  No  to  head  Positional This presumed of  supportive  participants clients  was  perceived team  to  also  not  be  a  factor the  recognizing  recognition  to  nurses  give was  However,  mentioned  by  praise  environment  mentioned. this  verbal  70  impacting  power their  other  d i s c i p l i n e s  addressed.  Coercive investigator  to  be  a  authority.  a b i l i t y  a  Giving  nurses  through  participants  perceive  rewarding  accomplishments. and  feedback  recognition not  power.  inherent  way  Creating  participants on  positive  Bases  or  found  source  of  Coercive  influence  punish  people  1985);  thus  for  it  participants  was  took  power  power  with  not  that  the  doing  action  only  if  for  exists  when  person  who  what  important  coercive  to  the look  someone  power those the  has  nurse for  in  the  an  also  positions  nurse  wants  the  made  was  has  the  a b i l i t y  to  (Randolph,  extent error  to  or  which  broke  a  rule . In  response  discovered that  they  incident nurse  a  to  nurse  the had  would  speak  report  form.  existed  except  question made  to  the  No by  participants  mentioned  constructive  feedback.  an  error?",  nurse  a b i l i t y  giving the  "What  and to  you  negative  do  if  you  participants then  f i l l  reprimand  p o s s i b i l i t y  Many  would  of  participants  out  the  feedback. giving implied  replied an other  No each that  other they  Power  were it  uncomfortable  unless  something  perceived  to  Position  have  the  she  sample and  nurses' of  this  to  source  exists  on  the  analyzed  used to  what  that  in  their  of  power The  and  head  rarely  nurse  used  was  power.  did  not  were  be  to  unit  nurse  based  is  on  (Randolph,  to  often Upon  get  had  a  perceived  the  This  those  nurses  someone  to  duty  follow  indicated  to this  to  staff  1985).  circumstances  Participants  they  the  others  others  discussing.  found  when  position  uncomfortable  do  in  some  was  the  a  source  consider  and  that  analysis,  the  related  themes  nurses'  work  communication,  the  nature  of  nurses  did  recognize  they  were  c o n t r o l . Most  power  in  decision their  stated  the  c o l l e g i a l making. to  making  that  l i a i s e d using  of  a b i l i t y  decision  care  of  what  extent  requests.  power  and  source  occurred.  influence  holds  investigator  tasks  severe  power  right  position  the  this  71  Legitimate  Legitimate have  with  Bases  head  with  and  nursing  relationships However,  use were  nursing  perceived  they  participants power  taken  by  over  chaired  The  by  for  influenced felt  team  blocked  in  others.  Participants  of  the  who  had  individual  this  potential  communication  many  she  the  when  participant  indicated  r e s p o n s i b i l i t y was  as  legitimate  nurses  others.  primary  studied  meetings  worked  on  autonomy  to  c l i e n t s .  participant  to  and  and a  unit  plan  Primary  strengthen  Power  legitimate of  the  task  sources  participants,  of  writing  sources tasks,  of  as  own  practice relation  to  Most  of  theme their  influence  of  relationship  Teaching  clients  about  their  given  as  participants  recognized  clients  make  about  clients  as  source  a  were  l i f e s t y l e of  power  Also,  something  that  was  not  their  legitimate by as  to  power  participants. one  in  improve  examples  nurses  changes.  as  participants  treatments  two  the as  viewed  control  described  to  health  do  to  mentioned  was  and  care.  a b i l i t y  never  were  72  most  perceived  c o n t r o l ,  others.  for  clients  not  plans  clients  general  for  controlling  the  was  However,  were  influenced  health. their  Care  clients  nurse-client  responsible  power.  under  to  nurses.  plans  recognizing  or  for  care  process  discussed  d i f f i c u l t y  nurses  being  nursing  a  had  The  power  legitimate  not  As  in  of  Bases  considered  about  t h i s .  influence  However,  their  and of  which  decisions  looking by  to  the  participants. When  asked  r e s p o n s i b i l i t y  to and  l i s t  The  perceptions  of  relation  non-client  their  to  sense  of  sources  accountability  mentioned.  data the  their  indicated  nature  of  that  nurses'  focused  legitimate  as  tasks,  power.  of  power,  staff  the  nurses  level  was  or  not  p a r t i c i p a n t s ' work,  especially  negatively  in  impacted  on  Power  Organizational For has  others kind  to  that  investigator participant  felt  comfortable  sense  during were,  about  of  of  in  participants  access  someone  one did  the not  c l a r i f i e d  their what  and This  on  the  observed  participants request  and  that  they  When  sources  information  the  exhibited  interactions. their  stated  to,  depended  to  what  else.  investigator  was  nurse  value  examined  This  be  interviews  by  the  of  others  They  relating  had  is  ways  information  information  second  several  needed  discussing.  pride  the  nurses  information.  concept  that  nine  what  for  information  investigator  was  seeking  on  This  was  the  a  these  based  knowledge  information  that  questions  or  1985).  information  whether  power  information  (Randolph,  of  73  Information  organizational  access  Bases  of  asked  power  and  documentation. The  themes  satisfaction of  power.  given  meetings,  were  provide  nine  staff  between  the  phone  media  information.  information to  control  were  was  sought  background nurses  nurses  to  also  the  nature  found  to  information  i n t e r d i s c i p l i n a r y  Charting,  transmit  and  Communicating  for  kardex  communication,  and  peer  c a l l s ,  for  physicians treatment  thought  provide  was  the  this  main  source  reason  report were  recognized and  other  plans.  information  continuity  to  work,  interactions.  reported  Participants  nurses'  relate  audio-taped  participants  by  of  of  care  used  the  to  that d i s c i p l i n e s  This was  and  sample  of  sought  between  shifts  Power  and  to  supplement  Communication be  strong  the  and  in  the  P r i o r i z i n g participant in  as  as ways  processing  nature  a  always  way  control  for  the  not  was  when  the  implied  had  processed.  their by  The  based  on  nursing  to  control  s t i l l  felt  factors  of  perceived Next  to  though client  to  power  of  care  was  important power,  mentioned.  not  power and  one  was  When  asked  information  then  of  influences  on  information  was  that  transmitting was  client  not care.  information  important of  it  interpreting  using  nature  to  Their  recognized,  was  not  Two  presented  judgement  for  The  information  was  of  care.  others  nurses.  and  control  potential  communication  personal  frequently  the  information  as  found  their  to  work,  process  information  with  of  presenting  judgement  connection  only  expected.  nursing  Even  were  participants.  they  were  this  by  information  way  they  for  using  in  c l i e n t s .  information  presented  information  mentioned  work  control  mechanism  mentioned that  given  gain  controlled  received  been  particular  nurses'  was  nurses  descriptions not  factors  information  felt  of  of  74  sample.  they  was  participants not  a  knowledge  information  which  mentioned identify  the  contributing  nurses  manner  nurses'  Bases  participants to  their  them. work  information power  power  was  The  were power.  most  Power  Organizational  links  with  connection  other  people  1985).  This  investigator  contact  with  in  involved was  in  chosen  nurses'  they  the  by  this  broader  to  be  needed  to  Participants d i e t i c i a n s ,  relationship  and  were  the  than  direct  the  agency  connection  power.  Participants' committees  was  member  of  the  nurses  were  not  limited.  aware  of  h o s p i t a l .  the  The  themes  control  people  about  were  client  whom  care.  therapists, Frequently  a  with  personal  people  Influencing as  an  nursing  and  did  for  and the and  its  not  purposes  p o l i c i e s  outcome  in  committee  these  fashion  Participants  committee  with  administrators,  individual  retention this  with  have  mentioned  One  were  of  and  impersonal  not  on  had  source.  an  care.  involvement  nursing  the  workers.  connecting  client  was  indicator  i n d i v i d u a l .  in  (Randolph,  they  an  connect  did  the  participation  satisfaction  in  when  participants  extent  physicians,  described  value  what  information  social  the  the  occupational  participant  with  the  to  power  organization  who  as  power  nurses,  pharmacists,  indicating  within  this  reported  listed  professionals  broader  to  work,  of  Committee  within  communicate  physiotherapists  recognize  of  source  the  to  investigator  related  a  committees.  nature  were  in  and  connection  Nurses  is  explored  agency  hospital  communication, found  75  Connection  Organizational nurse  Bases  of  hospital study the  goals.  was  other When  a  Power  asked  to  name  a  committee  most  participants  could  they  did  what  stated  not  this  know was  Knowledge  of  nurses  these  on  potential  not  the  on  was  within  team  nursing  gained  through  unit  connection broader  even  of the  systems  and  participants though  they  them. of  as  staff  a  connection.  of  of  unity  power,  a  recognized not  that  source the  perceive  one  amongst  participants  perceive  did  Others  v i s i b i l i t y  sources  was  i n ,  stated  available.  recognized  Those did  involved  Some  interested  sense  connection  working  the  of  nurses  support  power.  power  of  this  in  At  a  Resource  The  power  source  the  nurse  controls  the  a  be  76  perspective.  Organizational  when  that  to  answer.  not  their  s i g n i f i c a n t .  this  l e v e l ,  system  about  mentioned  unit  that  were  like  were  organizational  questioned  the  an  committees  committee  of  would  give  something  participant  the  not  committees  source  When  they  Bases  unit  input  (Randolph,  the  nurses  supplies,  equipment  are  management  often  examined  of  how  organizational the  supplies,  1985).  studied and  This had  staff.  controlled,  participants  control  of  the  supplies,  related  to  the  theme  of  resource  equipment,  the  this  influenced  that  analyzed  and  person  s t a f f i n g .  of  resources  investigator the  to  budget  a v a i l a b i l i t y  Recognizing  resources.  and  investigator  into  equipment  refers  also  who  had  This  Power  unit  Generally  participants  stated  they  resources  nor  person  who  resources. to  have  affect  Head  hence  resources. were  these  of  the  of  Not source  only  of  and  busy  by  these  control  over  control by  was  participants  not  perceived  and  government  control  of  resources.  perceived  as  beyond  nurses  Without  to  their  work  they  them  budget  have was  does  perceived  organizational  a b i l i t y  that  to  no  77  the  to  scope  nurse.  participants  describing so  was  power  their  hospital  factors  staff  not  influencing  The  powerlessness.  staffing  were  considered  Influencing power  the  nurses  c o n t r o l ,  funding  of  over  had  Bases  but  it  adequate  felt  quality  control  did  resource  day, not  was  work  the  seen  care  participants have  perceived  supplies, of  their  not  time  as  a  a  source  equipment  was  as  and  jeopardized  limited.  In  indicated  they  or  to  energy  were plan  care .  Personal Upon that fit  analysis  participants Randolph's  during  the  to  question  the  from  the  personal  of  (1985)  on  set  a  of  source  of The  power  investigator of  power was  by  that  nurses  stating was  regardless  others.  discovered did  confirmed  several  implication  powerful  relationship^with  Self  This  interviews  sources  were  of  this  framework.  himself.  attributes  i n d i v i d u a l ' s  data,  perceived  second  person  the  Sense  The  of  when  responded  power made  comes that  the  themes  not  most  Power  strongly nature  linked  of  The  to  nurses' nurses  attributes  that  personal work,  in  patience,  clients  were  the  sample to  admitted  they  their  They  this  strength  as  of  about  nursing  practice.  "bedside in  While  had  that  to  most source  of  felt  this  was  Participants  who  needs.  described perceived  Nursing  profession:  was  source  did  not  perceived  as  by  the  client  had  changes  the  nurses  in  the  sample.  a  a  from  of  work power who  felt  was  pressures  meeting  being  client  demanding of  shift  short  s e l f - a c t u a l i z a t i o n  Participants  was  professional  power  physically  and  a  power.  preponderance  acuity  sense  of  valuing  considered  psychological  nurses  complicated  in  strong  was  as  with  personal  prevented  increasing  most  and  had  participants  a  feel  described  personal  not  relation  what  was  deal  thought  strong  study  self  to  about  (1984)  and  nursing  physical  in  the  to  relate  in  interpreted  of  other  to  existed  nurse  power  Kindness,  confident  practice  Deadlines, caused  a  sense  power, to  in  was  participants  able  they  be  this  nurses'  been  available,  many  Personal  not  manner,  to  and  personal  Some  Hagberg  Nurses  meant  For  relation  significant  they  it  nursing".  issues. a  what  valued  a b i l i t y  power  character.  s e l f - a c t u a l i z a t i o n .  beliefs  factor  their  their  recognition,  expertise.  proud  78  control.  mentioned.  felt  perceived  were  they  c o n s c i e n t i o u s n e s s and  participants  the  and  nursing  attributes  to  self  indicated  personal  work.  of  s a t i s f a c t i o n  contribute  caring,  sense  Bases  described  work. staffed for  Power  experiencing busy  to  do  meet  client As  the  discussed  of  the  One  because  nurse.  she  no  of  decreased  her  powerless  to  as  sense help  enabling  them  personal  power  and  meeting  the  of be  failure dones'  a  whole who  of  if  they  and  were  hence  too  could  not  had  felt  profession  a  on  decided sense  with  personal  to  sense  empower  u t i l i z e  base  c l i e n t s '  the  impacted  had  personal  to  s a t i s f a c t i o n ,  leave  her  nursing  power.  Views  sense  a  of  nursing  identity  as  She  degree  varied.  personal to  of  the  as  did a  profession  felt  personally  c l i e n t s .  other  was  legitimate  participants  theme  with  longer  participants  expert  to  satisfaction  positive  the  under  participant  Lack  A  'ought  satisfaction  profession  power.  sense  79  needs.  personal  of  personal  a l l  of  so  a  Bases  self  them  or  to  sources  perceived  power  needs  of  as  bases.  of  perceived  control of  power.  Whether  it  most  work  Having  by a  referent, was  themselves,  tackling  by  their  enhancing  organizing  capable  was  through these  change.  Summary The the  perception  sources  using  a  power  grounded  c o l l e c t i o n themes  of  were  of  of  bases  theory  statements  i d e n t i f i e d .  communication,  the  s u i t a b i l i t y for  nurses  research made The  recognition,  by  and has  design. nine  themes  a c c e s s i b i l i t y been  examined  From  the  staff  nature  s a t i s f a c t i o n ,  nurses, of  six  nurses'  control  of  and  work,  Power  resources  were  found  throughout  comparatively  analyzed  themes  factors  power  became bases.  The  environmental It  was  and  to  informational  nature  of  personal be  a  of  individual  with  negative  the  of  most  frequently  The  As  positively  nature  factor  when  of  was  p a r t i c i p a n t s '  perceptions  positively degree  to  which  to  power.  Participants  recognition  of  others  nursing  as  a  more  an  outcome  of  felt  Recognition as  of  the  than  expert  of  was  power  was  power  and  than  lack  linked  bases. to  power.  The  was were  not  influencing  reward  by  power  more  Satisfaction participants  a  as  contributing  factor. The  theme  determinant  of  uncomfortable  of  control  power with  was  bases.  discussing  not  perceived  Participants this  concept  to  power.  potential  factors  the  of  and  frequently  themselves.  rather  tasks  s a t i s f a c t i o n  described  expert  perceived  communication  and  the  power.  sense  connection  significant  related  profession  be  and  with  legitimate  their  have  information  perceived  work  a  focused  to  of  to  participants  varied.  be  found  perceived  influence  effective, found  was  also  be  participants  influenced  nurses'  their  to  referent,  some  inhibited  Communication  Communication  for  these  of  found  associated  non-client  r e s p o n s i b i l i t y  was  influence  well,  framework,  perceptions  work  80  When  conceptual  nurses'  p o s i t i v e l y  work  data.  participants'  power.  nurses' power.  in  nature  factor  perceived  with  the  Bases  as  a  strong  appeared and  lacked  to  with  Power  understanding lack by  of  of  control  its and  participants.  legitimate  indicated  they  lack  perceived The sample power  of to  the  in  their  staff  of  to  reward,  were  a  not  was  issues found  area  sense  connection  did  not Of  was  of  in  four  perceived  to  a l l  relation two  a l l  to  themes  were  that  the  power  of  outlined  recognized  potential  this  sources  bases  factors  sources:  organizational  connection.  legitimate,  made  negatively  indicated  participants  expert,  not  powerlessness.  eight  influencing  to  These  recognize  the  was  81  between  participants  investigation  personal  and  work  power  organizational  coercive  resource,  this  of  framework,  referent, and  One  The  resources.  to  them.  environment  information,  over  nurses  of  control  sense  contribute  conceptual  personal  of  no  control  available  in  nature  power.  felt  findings  of  the  Lack  influence  their  implications.  Bases  along be  Positional  with  sources  organizational of  power  for  nurses . Data eight  within  power  reflect  for  perceived These be  were  source  personal  frequently power  bases  another  entitled  themes  sense  mentioned nurses. to  in  and  the  chapter  did  examined of  not as  power.  of the  strong  p o s i t i v e l y  findings  discussed  A  by  that  self.  a  relate group  This  influence  Personal  of  were  base  power  as  a  personal  several  implications five.  and  power  participants sense  directly  has was  power  from  the  found  to  been most  source  other  arising  to  of was  power them  bases. w i l l  Power  Bases  82  Chapter V Conclusions The staff  question  nurses  that  the  sources them.  The  nurses of  addressed  perceived  environment.  their  findings  while  chapter  investigation  and  is  organizations care  and  known  the  about  degree staff  about  their  analysis  1.  The  work  to  2.  a  These  sense  The  of  nature  job  the  included  nurses that  nurses  bases  able  sources the  to  were  major  work  indicated  perceive not  how  their  certain  apparent  conclusions  implications  for  to  of  this  nursing.  Conclusions nurses  working the  perceptions  Conclusions the  were  also  complex of  However,  of  perceptions  in  delivery  s a t i s f a c t i o n .  impacted were  within  was  investigation  influences  bases.  staff  environment  power.  of  examined  data  nine  it  nurses'  power  of  to  investigation  this were  identifies  because  investigation  of  presents  important  this  power  other  Major Power  in  investigated  power  This  and I m p l i c a t i o n s  their  of  l i t t l e  power.  nine  drawn  client  staff  from  is  This nurses  the  following:  cognizant  of  positively aware  of  on  factors their  factors  in  their  sense  of  contributing  powerlessness.  of  nurses'  significant  environmental  perceptions  of  their  power  work  and  factors bases.  communication impacting  on  were  these  two nurses'  Power  3.  The  care  concept  was  control source  4.  not  well  nurses of  over  understood  had  over  decisions  by  client  bases  framework  available  described  in  framework  provided  of  control  the  affecting  nurses.  care  was  The  not  83  client  degree  recognized  of as  a  power.  Randolph's  power  of  Bases  the  was  to  one  way  nurses.  Of  l i t e r a t u r e the  review,  broadest  of  understanding  the this  models  of  the  power  conceptual  organizational  perspective  power.  5.  The  eight  not  equally  power  bases  important  or  in  the  conceptual  available  to  framework  staff  were  nurse  participants .  6.  The  nurses  a f f i n i t y  for  conceptual  four  Personal  source  8.  of  The  evidenced settings  eight  of  power  personal  information,  sense  degree  Other  the  recognized  self  bases  referent,  and  was  and  felt  most  outlined  personal  organizational  i t s e l f  the  in  the  expert,  connection.  considered  to  be  a  power.  influenced  9.  of  framework:  organizational  7.  investigated  of  their  sources by  the  studied.  personal  power  s a t i s f a c t i o n  of  power  themes  f e l t  with  existed  described  by  the  nurses  studied  nurses  as  nursing.  for in  these  the  nursing  care  Power  10. to  Nurses them:  did  not  recognize  positional  legitimate,  and  reward,  certain  positional  organizational  the  nine  the  staff  nurses  investigation main to  data  implications  the  s e l f ,  theme the  of  connections. need  for  analyzed  from  control,  The  further  of  the  for  nursing  positional  generalized of  of  nursing.  personal  and  have  the  past  this The  investigation  power  also  be  findings  information  findings  coercive,  cannot  this  the  available  Nursing  implications  drawn  processing  for  studied,  suggest  bases  84  resources.  Implications Although  power  Bases  are  four related  sense  need  of  for  implications  for  the  research.  Control The factors  findings in  the  perceptions According factors  to  in  a  is  not  team  of  the  their  the  for  nurses  to of  nurses'  their  as  or  client  to  as  a  influence  client  care.  investigation,  environment  when to  source  they  the have  of  power  they  the  legitimate  when  head  power  care  nurses'  nurses  work  delegate  their of  nurses'  certain  limit  Positional  source  control  perceive  staff  this  care  that  affect  bases. a  indicate  setting  work  power  system  this  r e s p o n s i b i l i t y  Primary  power  findings  nursing  perceive  investigation  practice  perceived  r e s p o n s i b i l i t y nurses  this  nursing  the  within  perceptions power  of  of  nurse.  because  for power  they  assigned to  Primary have  c l i e n t s .  influence  Power  decisions of  their  team  affecting legitimate  approach  legitimate  was  power  coordination to  of  accomplish  function nurses  the  don't  responsible  of  their  clients  as  position  as  staff  nurse.  A  reported to  some  care  their  under  care  a  up  nursing  demands  of  the  job.  This  reinforces  the  power  of  staff  potential Nurses  have  client  care.  nursing  diagnoses  concept  of  legitimate  basis.  to  to  promote  find  basis  when  What  with  easier  nursing, are  gain  is  the  the  physical  the  nursing  weakens  the  they  they  they  for  it  team  because  but  modified  may  modified  power  function  responsible  accomplish  care  power  the  not  strong  over  their  nursing  legitimate  power  over  have  on  their  nursing  team  sense  and are  is  of  based in  plan  care  able  team  to  give  the practice.  a  actions.  for them  The  positional  clients  describe  to  developing  nursing,  for  opportunities these  on  of  decisions  and  powerful  Even  source  responsibility  theory  potentially  feel  a  recognize  base.  and  be  could  nursing  nurses  could  nurses  based  are  monitor  do  base  if  they  primary  Staff  but  In  connection  Applying  r e s p o n s i b i l i t i e s making  daily  connection  power  potential  provide  assigned  a  c l i e n t s .  team  nurses  control  affecting  on  to  a  85  power.  legitimate  for  clients  particular  the  power  assigned  legitimate  of  The  Nurses  approach.  support  legitimate  participants  extent.  workload  team  give for  for  by  Bases  nurses on  a  are daily  their  input  into  control.  decision Factors  in  Power  the  environment  the  nursing  legitimacy  process of  base.  Nurses  their  control  Personal  are  the  over  a  of  of  recognition  r e s p o n s i b i l i t i e s to  recognize  others,  weakens how  to  of  the this  power  strengthen  is  to  as  an  in a  self  is  a  their  i.e.  and  negative  levels  high  findings  of  untapped  source  Even of  fostered.  time  this  though power  pressures  power  by  Nurses  is  who  attributes  for  in  feel  limit  of  power  a  conscientiousness  to  right.  end  these  others,  staff  Personal  i t s e l f to  others.  such  as  sense  rather  low  of  than  The  d i s s a t i s f i e d  power  with  the  staffing  s e l f - f u l f i l l m e n t .  indicate  personal  internally  feel  are  relate  to  The  personal  power  sense  of  self  it  can  is  an  nurses.  definition  that  and  Although  factors  investigation of  caring  own  nurses  source  characterize  relating  profession and  that  nurses'  when  when  their  of  powerful  end,  in  relation  attributes.  how  only  in  Kindness,  them  not  also  attributes  influence  means  personal  of  but  sense  powerful  perceived  power,  weakened  source  application  care.  identify  has  recognize  self  lack  nurse.  as  attributes  just  and  client  with  nurse  valued  is  consistent  Personal  professional  self  of  unable  nurses  themselves.  nurses  lack  nurses'  relationships  are  as  86  Power  Staff  when  such  Bases  they  generated,  have  generally  power  more  because  s a t i s f i e d  of  with  is  a  be their  Power  nursing. about of  Personal  nursing  and  themselves  others.  so  feedback.  are  what  they  like  Information This  nurses  to  their  of  and  type  others of of  of  of  pride  more  in  control  to  take  control  through  peer  recognition  they  feel  self  and  client  personally  as  of  powerful  professionals  doing  nursing.  information  because  care.  examine  how  systems.  unknowingly  give  up  plan  power,  care  It some  in  thereby  documenting  there  possible  of  their  delineating and  to  is  need  is  a  this  There  processing  perceive for  nursing  improving  to  power  value  nursing  a  consistent  nurses  is  and  as  by  of  is and  formulated  on  for  to  base  able  information  the  power  access  development  is  d i s c i p l i n e s ,  information  capitalize the  have  are  recognize  can  other  communication  knowledge  nurses  information.  nursing  nurses  nurses  that  connection  information  through  information  and  this  nurses  unprocessed  as  and  nursing's  Although  Since  power,  of  showed  nursing  information  effectiveness  giving  sense  feel  fostered  findings  between  information  disseminated. source  a  87  Processing  The  value  be  bedside  influences  continuity  Nurses  function  investigation's  positively  the  best:  to  to  prepared  can  indicate  allowed  nurses,  by  work.  better  power  Nurses  they  valued  are  contributes  opportunities,  when  bases.  about  Personal  improvement  between  power  Bases  in  base the  process  and  information.  by  Power  Staff to  be  nurses  their  necessity well  strongest  for  known.  source  of  nurses  feel  to  and  use  is  is  when  weakened up  negative  Nurses  to  or  have  Connection  every  date. in  their  a  d i s c i p l i n e s  have  telephone  of  this  power  or  assistant  potential nurses.  of  direct  of  sharing  is  perceive  the  of  power  it  provision how  of  power  base  informally  paperwork when  Staff  both  this  done  this  possibly  care the  is  use  care.  power,  that  client  nurses  client  strength  recognizing  for  been  to  be  becomes  of  client  manipulation  or  a time care.  of  mechanism.  is  client  nurses  when head the  occur  they  connect  to  with  resented  if  This  others,  connect  connection  power  other it  for base  people,  means  sense  with  other  M u l t i d i s c i p l i n a r y  regularly.  allow  nurse  care.  to  developed.  contacts  Connecting  necessity,  in  the  and  Power  Opportunities  and  others,  way  environment  control  about  88  power  advantages  Documenting  The  with  information  The  type  tangible  Nurses  interferes  is  this  day.  a  for  changes  information  d i f f i c u l t y  information  persons  with  is  power.  information  actualized.  factor  consuming  it  provided  information  of  influence  comfortable  planned  kept  source  resource  power  they  organizational  communicating As  because  not  perceive  Bases  of  Nurses  such  as  meetings  give  up  some  the  head  them.  The  f u l l  is  recognized  not  even  taking  if  time  infringement  it  is  away on  nurse  a from their  by  Power  time  makes  it  d i f f i c u l t  connecting  for  Increasing  nurses'  committees  would  connection. this  a  the  serve  quality  lower  investigation  in  nurses  staff  This  value  to  agency  of  comfortable  assured  in  in  care.  power  feel  nurses' It  power.  use  of  would  their  with  absence.  be  themes  personal  the lead on  to  staff  sense  limits  to  did  their not  a  what  Behaviours  of  staff  is  B r i t i s h  this  larger  in  sample  agencies  of  impact  bases.  on  to  nurses  g e n e r a l i z a b i l i t y  power  or  staff  replicate  with  focus  of  the  the  useful and  in  differences  power  useful  limited  impacting  sample  the  issue  extent  they  nurses  indicated  to  of  how  are  were  describe  able  not staff  power.  The  would  if  research  i n d i v i d u a l l y . to  small  hospital  be  perceive  their  Further  a  This  determine  use  their  examined.  This  is  agencies  investigation  nurses  used  would  other  on  use  the  not  the  client  contribution  w i l l  community  It  to  to  and  care  recognize  direct  strengthen  nurses  mainland.  participants  staff  to  client  sized  findings.  how  than  investigation  medium  Columbia of  other  to  89  Research  This from  nurses  v i s i b i l i t y  However,  unless  Nursing  reasons  for  Bases  of  to  explore  properties  of  identified  each  the in  of  power this  further  understanding  nurses'  sense  self  and  the  of  the  of  bases  may  bases not  be  investigation. of  power.  concept  power  the The  factors power  of  powerlessness  have  Power  not  been  well  defined.  investigation stages  of  did  power  F i n a l l y , efforts  on  increase  go  further  behalf  data  into  identified  nurses'  influence  not  The  depth  by  the  nurses'  is  nursing  perceptions  in  about  90  this  the  personal  Hagberg.  research  of  analyzed  Bases  of  satisfaction  indicated  to  determine  profession  or  the  their and  power  if  agency  bases,  to  would  retention.  Summary The  findings  perceptions staff  nurses  were and  of  certain  These  to  them  work  were  of  based of  power  found  were  to  be  in  lack  This  nursing  was  found  to  enhance  nursing  was  found  to  limit  for  conceptual  describing  organizational did  not  relation  implications  nurses'  to  oneself.  factors  for  was  over for  nursing  nature  since  team  power.  relationships  in  an  on  care.  primary  and  a  Capitalizing  of  client  be  personal  self  legitimate  power  found  the  of  power  by  to  However,  describe  the  control  legitimate  power  setting.  adequately  of  sense  of  However,  recognized to  nine  sources  information.  regards  nurses'  the  personal  legitimate  framework  staff  that  certain  their  not  limiting  power.  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Bases  97  B  Guide  One  information letter from you your p e r c e p t i o n s of  me. I would your work  General 1.  How  long  2.  What  have  you  type  of  basic  Have  you  If  yes,  been  a  nurse?  nursing  taken  any  explain  education  courses  how  this  did  since  has  you  your  affected  complete?  graduation? your  nursing  care . if  If had  you  no, the  what t y p e s chance?  Why 3.  How  would  of  these  l o n g have you worked What other types of  courses  be  would  you  like  to  take  helpful?  on t h i s nursing  unit? units  have  you  worked  on? Describe worked on.  have 4.  Describe  5.  In  what  for  how  me  ways  a  does  this  unit  typical your  differs  day  role  from  shift  change  for on  other  you  other  on  units  the  you  unit.  shifts?  Specific 6. D e s c r i b e t h e g r o u p s you i n t e r a c t w i t h on a How  do  you  feel  7. D e s c r i b e the ways care you provide. 8.  How  would How  you are  Are  you  on  when  in  excellent  any  if  you  which  describe  9. W h a t w o u l d y o u d o h a d made an error? 10.  of people w i t h i n regular basis.  an  you  hospital  interact  you  have  excellent  nurses  the  given  discovered  committees?  hospital  with  control  these over  that  people? the  nurse? recognition? that  another  person  Power  what  a  is  part  11. be?  If y e s , what your role? If no, are of and why?  If you Why?  could  Explain  is  there  change  how  you  the  purpose  any  one  of  committees  thing  would  12. Now t h a t y o u h a v e b e e n i n your thoughts about nursing?  go  at  committees  you  work  about  nursing  the  Bases  would  what  making  like  would  that  years,  98  and  to  that  change?  what  are  be  Power  Appendix  Interveiw You have r e c e i v e d an like to e x p l o r e w i t h s i t u a t i o n .  Bases  99  C  Guide  Two  information letter from you your p e r c e p t i o n s of  me. I would your work  General 1.  How  long  2.  What  have  you  type  of  basic  Have  you  If  yes,  been  a  nurse?  nursing  taken  any  explain  education  courses  how  this  did  since  has  you  your  affected  complete?  graduation? your  nursing  care. if  you  If had  no, the  what t y p e s chance?  Why 3.  How  would  of  these  long have you worked What o t h e r types of  courses  be  would  you  like  to  take  helpful?  on t h i s nursing  unit? units  have  you  worked  on?  have  Describe worked on.  4.  Describe  5.  In  what  for  how  me  ways  a  does  this  unit  typical your  differs  day  role  from  shift  change  for on  other  you  other  on  units  the  you  unit.  shifts?  Specific 6. D e s c r i b e t h e g r o u p s you i n t e r a c t w i t h on a How  do  you  feel  7. D e s c r i b e the ways care you p r o v i d e . 8.  How  would How  you are  of people w i t h i n regular basis. when  in  which  describe excellent  9. W h a t w o u l d y o u d o h a d made an error?  if  you  an  you  interact  you  have  excellent  nurses  the  given  discovered  hospital  with  control  these over  that  people? the  nurse? recognition? that  another  person  Power  10.  what  a  Are  is  part  11. be?  you  on  any  hospital  If y e s , what your role? If no, are of and why?  If you Why?  could  Explain  is  there  change  how  you  the  100  committees? purpose  any  one  Bases  of  committees  thing  would  12. Now t h a t y o u h a v e b e e n i n your thoughts about nursing?  go  at  committees  you  work  about  nursing  the  would  what  making  like  would  that  years,  and  to  that  change?  what  are  be  Power  Appendix  Interview  1. Since our comments that  last interview, you would l i k e  2.  Who  trusts  3.  How  does  4.  Define  5.  How  6.  Describe  and  this  respects  respect  nursing  are  care  nursing  your  D  Guide  Three  do y o u h a v e a n y t h o u g h t s to add to what you said?  you  as  influence  a  nurse?  your  practice?  plans.  care  sources  plans  of  Bases  implemented?  power  at  work.  or  

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