Power. Most nurses would agree that power is a very important topic for nurses and nursing, especially in the wake of the COVID-19 pandemic, and the subsequent effect of the pandemic on the nursing workplace. In 2020, day after day, images of masked and gowned nurses with weary expressions, crumpled scrubs, and tousled hair appeared in the media. The world became aware of the struggle nurses were experiencing, managing horrible work conditions and long hours. The lack of PPE and heightened risk of death escalated the sacrifices that nurses make every day to promote health and bring healing. The difference in light of this health crisis? Now – the world was watching. By and large before this global crisis, a lot of people were not watching. They were simply unaware and did not understand the nature and complexity of the nurse role. The huge contribution nurses make to health care and positive health care outcomes, the personal sacrifices and the toll on nurses and those who love them, often went unnoticed and unappreciated. Suddenly, the world noticed because of the pandemic and media publicity.
What has been the effect of media recognition of nurses as heroes on nurse perception of their role and value? Has that recognition changed working conditions for nurses? What would it take for nurses to view the value of their role, and their unique contribution, differently? I know the freebies and discounts offered to nurses over the past year by various businesses has lifted nurse spirits and promoted a sense of support and appreciation for nurses. I’m thinking the answer to the above questions lies in tangible support and recognition of the nurse, and that it relates to both the nurse perception of power versus powerlessness, as well as positional authority or power assigned to the nurse role. Could it be that nursing and nurses have internalized a projection of powerlessness, a perception rooted in the lack of positional authority given to nurses within complex health care systems?
Nurses and Power
One source of powerlessness lies in a misunderstanding of the nature and scope of power. When I have asked nursing students to describe the concept of power, I often hear such answers as “the authority to make change,” “having a position where you will be listened to,” or “having a position where you supervise people.” These type of descriptions are not wrong, and they do capture the aspect of power relating to position. But - what about the aspect of power that relates to influence? Power is influence, really, according to Rick Miller (2018), a “turnaround specialist” writing in Forbes magazine. You can bet those in the “turnaround” business know a thing or two about power, or the lack thereof. Turnaround specialists are corporate consulting leaders who specialize in salvaging struggling companies, often by embedding themselves within the troubled company to assess, gain cooperation, and rebuild operations and team from the ground up. Nurses know a lot about power too.
But nurses have a power problem, that is, a powerless problem. Nurses generally work in teams and coordinate complex care within multiple systems, balancing competing agendas and the perspectives of multiple partners and stakeholder. While managing this level of complexity, the knowledge base and skill of the nurse is also complex. Ottawa University’s RN to MSN online program addresses the core competencies vital to all advanced practice roles and health care in complex systems. In addition, students explore the complex ethical responsibilities that are faced by today’s nursing leaders.
The capacity to influence, and influence greatly, is embedded in the unique role of the nurse. However, the nurse perceives powerlessness even though the nurse role itself holds such great potential to continually influence – and influence multiple people and systems. Unfortunately, it seems that a perception of powerlessness has been internalized within nursing as a profession, and within the very souls and spirits of many nurses. If you talk with nurses, you will hear that the powerlessness problem in nursing is historic and lies in the nurse role and position or role oppression. It is about the lack of positional authority of the nurse role within complex systems, particularly hospitals and medical centers, where corporate and administrative authority have now replaced physician authority over the nurse role. As complex systems of health care increasingly struggle at every level in the wake of the Covid-19 pandemic, it is difficult at best for nurses to see anything beyond their lack of power to make needed changes so they can survive, can get their jobs done, and get them done well.
Though change is desperately and urgently needed within health care systems in regard to nurse positional authority, something needed for survival of those systems, as well as the nurses and the patients they care for. I propose a co-existing change which is desperately and urgently needed. The change I propose will not come easy for the currently oppressed majority group of hard working nurses hanging on to hope for positional authority change in order to survive. I propose that nurses, and those in support of nurses, continue to advocate for positional power within health care systems, and that nurses also extricate themselves from the current oppressed positional role problem. Nurses must actualize within ourselves to achieve power. I know that we can do this and begin now. We are important. We count. We deserve to survive. But we really need power and it must begin with us.
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