Nursing Power

EMP IR ICAL STUD IES doi: 10.1111/j.1471-6712.2012.01069.x

Nursing power as viewed by nursing professionals

Peltomaa Katriina MNSc, RN (Nursing Director)1, Viinikainen Sari MNSc, RN (Doctoral Student)2, RantanenAnja PhD, RN (Senior Lecturer)2, Sieloff Christina PhD (Associate Professor)3, AsikainenPaula PhD, RN (Adjunct Professor)1 and Suominen Tarja PhD, RN (Professor)21Satakunta Hospital District, Pori, Finland, 2School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland and 3College

of Nursing, Montana State University, Bozeman, MT, USA

Scand J Caring Sci; 2013; 27; 580588

Nursing power as viewed by nursing professionals

Background: The concept of nursing power has not been

extensively reported in the nursing literature. Power is an

extremely abstract concept, making it difficult to define and

study. However, when defined as the capacity to achieve

goals, power becomes a significant resource in nursing.

Aims: The aim of this study was to describe how nursing

professionals perceive the level of nursing group power in

public healthcare organizations. Additionally, the con-

nections between the background variables and nursing

group power were analysed.

Methods: The participants in the study consisted of 289

Finnish nurses working in the specialist healthcare sector

in Finland. The Sieloff-King Assessment of Group Outcome

Attainment within Organizations (SKAGOAO) instru-

ment was utilized to assess the level of nursing group

power within the selected organizations.

Findings: According to the present study, nursing profes-

sionals rated the outcome attainment (mean, 1.93), as well

as goals/outcome competency (mean, 2.24), as very good.

The position of nursing (mean, 2.55) as part of the

healthcare service system was considered fairly respected.

The role of nursing (mean, 2.54) was also considered to be

at a good level. As regards to the actualization of power or

outcome attainment capacity, respondents gave the lowest

ratings to controlling the effects of environmental forces

(mean, 2.75), resources (mean, 3.48), communication

competency (mean, 3.00) and group supervisors outcome

attainment competency (mean, 2.87). Age, education, type

of employment and work experience had an impact on

how nursing group power was perceived.

Conclusions: The results of the present study indicated

that the nurses perceived the lowest levels of group

power in relation to the subscales of controlling the

effects of environmental forces, resources, communication

competency and group supervisors outcome attainment

competency.

Keywords: nursing power, nursing staff, specialist health

care, instrument, Sieloff-King.

Submitted 30 May 2012, Accepted 20 June 2012

Introduction

Power is a widely used concept by authors from different

disciplines, and, as a result, there are many definitions.

Hokanson Hawks (1) defined two meanings for power:

power to and power over. The concept of power to

relates to effectiveness and includes the ability or capacity

to achieve objectives. Power over refers to the ability or

capacity to influence the behaviours and decisions of

others. According to Foucault (2), power and knowledge

have a complex relationship, and they are closely inter-

woven where there is power, there is also knowledge.

Organizations have various things in common, for

example goals, human factors and hierarchy. The common

goal of organizations is to achieve outcomes through col-

laboration (3). Kanter (4) stated that power can be derived

from both the formal and informal systems of an organi-

zation, and is often described as the ability to get things

done.

Historically and in the nursing literature, power is often

viewed as a negative notion, as something that is imposed

on someone or as control over someone or something (5,

6). In addition, nurses, as a professional group, have been

oppressed by healthcare institutions, physicians and

administrators (68). However, nurses need power to

effectively work with patients, physicians, other healthcare

professionals and each other. Powerless nurses are

ineffective and less satisfied with their jobs (9, 10).

Furthermore, nurses need at least three types of power to

ensure optimal contributions to their work: control over

Correspondence to:

Peltomaa Katriina, Satakunta Hospital District, Sairaalantie 3, 28500,

Pori, Finland.

E-mail: [email protected]

2012 The Authors580 Scandinavian Journal of Caring Sciences 2012 Nordic College of Caring Science

the content of practice, control over the context of practice

and control over competence (11).

Autonomous nursing practice has been operationalized

as control over the practice environment, decision-making

ability and collegial relationships with physicians, sug-

gesting an important link between power and nursing

outcomes (12, 13). Nurses have associated six factors with

power: professional knowledge and skills, authority, self-

confidence, professional unity, supportive management

and organizational structure and culture (14).

Knowledge about power in nursing is also needed,

because it is critical for the successful functioning of the

departments in an organization and is a resource to be

used to achieve goals (15). King defined power in a

positive way, and it is important that nursing groups

recognize their power and also use that power to achieve

goals or outcomes (16). Nursing groups face many

challenges as they seek to achieve their goals in health-

care organizations today. All possible resources must be

recognized and utilized, and power is a valuable resource

that can assist nursing groups in the achievement of goals

(17). As nurses are the largest professional group within

healthcare service organizations, explaining organiza-

tional power from the perspective of a nursing theorist is

important (17).

Using the Sieloff-King Assessment of Group Outcome

Attainment within Organizations (SKAGOAO) instru-

ment assists nursing groups to assess their initial level of

outcome attainment/power capacity and the groups

level of actualized power/outcome attainment or use of

power (16). Certain components contribute to the power

of a nursing group. These components include control

over the effects of environmental forces, a groups

position within a healthcare organization, the role of a

nursing group within healthcare organizations, available

resources, and the goals of the nursing group, the

communication competency of the group, the power

perspective and the outcome attainment/power compe-

tence of the supervisor or leader of the nursing group

(16).

Aim

The aim of the present study was to examine how nursing

personnel perceive the level of nursing group power as

part of their public healthcare organization. Additionally,

the significance of different background variables on

nursing power was also analysed. This study aimed to raise

awareness about nursing group power and related factors.

The research questions included:

1 Howdonursing professionals perceive the level ofnursing

group power in public healthcare organizations?

2 What types of relationships exist between the nursing

professionals background variables and nursing group

power?

Materials and methods

Participants and data collection

The population consisted of 289 Finnish nurses, including

registered nurses (RN) and practical nurses (PN). The

respondents to the study included nursing professionals

working in the specialist healthcare sector in Finland. All

11 public specialist healthcare hospital districts, having a

population base in the region of 200 000, were inten-

tionally selected for the study. From the selected hospital

districts, specific wards were randomly selected based on

operational similarity (surgical, medical, psychiatric, etc.).

All of the nurses from the randomly selected wards were

asked to participate.

All of the participating public-health hospital districts

granted permission to conduct the study in the chosen

wards. The consent, signed by all participants, contained

statements of confidentiality and indicated voluntary par-

ticipation. All of the respondents (N = 289) filled in the

questionnaire in the presence of the researcher.

A pilot study was initially conducted prior to ensure the

validity of the questionnaire. A total of 33 nursing pro-

fessionals in two wards completed the questionnaire.

These data were not, however, included in the data for the

final study. The purpose of the pilot study was to improve

the content validity of the questionnaire. Once the

instrument had been modified and back-translated into

Finnish, a group of experts comprising two nursing direc-

tors, two head nurses, two expert researchers on power

and two experts in instruments evaluated the validity of it.

The results of the evaluation indicated that the question-

naire items were relevant.

Instrument

The Sieloff-King Assessment of Group Outcome Attain-

ment within Organizations (SKAGOAO) instrument with

36 items was utilized in the present study to assess the

level of nursing group power within organizations. The

components or subscales used to evaluate the level of

nursing group power (36 questions) include controlling

the effects of environmental forces (seven items), position

(four items), role (three items), resources (six items),

communication competency (three items), goals/outcome

competency (four items), group supervisors outcome

attainment competency (four items) and power perspec-

tive (five items). This structured questionnaire was used to

gather the research data, and it contained a 5-point Likert-

type scale from totally agree (1), agree (2), do not

disagree or agree (3) to disagree (4) and totally disagree

(5) (18), the smaller number depicting more agreement.

A Cronbachs alpha coefficient was used to assess the

reliability of the overall instrument and the subscales. The

reliability of this instrument has consistently been

2012 The AuthorsScandinavian Journal of Caring Sciences 2012 Nordic College of Caring Science

Nursing power as viewed by nursing professionals 581

supported. The Cronbachs alpha coefficient of the abbre-

viated form of the criterion was 0.92 (n = 336) (18, 19).

The questionnaire included 15 questions designed to

gather demographic data, that is, age, gender, years of

work experience, type of employment, education, working

experience in the present unit, highest level of education,

further education, supervisors title, district and units

number of staff.

Data analysis

The research data were analysed using SPSS 18.0 software.

The data were evaluated using frequencies, percentages,

means, standard deviations and ranges. Sum variables

were formed from the eight subscales of the instrument.

The sum variables were calculated by summing up the

values obtained for the items and then dividing the sum by

the number of variables.

The differences between the groups were specified by

means of the independent samples t-test, one-way analysis

of variance (ANOVA) with Bonferroni post hoc analysis and

the KruskalWallis. In the present study, the statistical

significance was p < 0.05. The demographic variables were

reclassified to facilitate the processing of the material.

Results

Background factors

The majority of the respondents in the study were RN

(86%, n = 247). Their mean age was 40 (range, 2064; SD,

11.02). Over two-thirds (74%, n = 213) of the nurses held

full-time positions in their unit. The respondents average

amount of work experience after their studies was 15 years

(SD, 10.74), and more than half of the nurses (66%,

n = 182) have been working in their current unit from 1 to

10 years (see Table 1).

In the present study, the respondents evaluated both

their own and their supervisors power and responsibility

(range, 010). More than half of the respondents (56%,

n = 161) stated that their supervisors possessed a high

level of power/outcome attainment (810 on the 010

scale), and only 7% (n = 21) stated that the level of power

of their supervisors was low (04 on the 010 scale).

Indeed, most of the respondents (72%, n = 207) stated

that their supervisors had many responsibilities.

Respondents perception of the level of nursing group power

Nursing professionals perceived the group levels of the

power perspective (mean, 1.93), as well as goals/outcome

competency (mean, 2.24), as very good. The position of the

nursing group, as part of the healthcare service system, was

perceived by the nurses as moderate (mean, 2.55), as was

the role of the nursing group (mean, 2.54). Respondents

perceived the lowest level of group power in relation to the

following subscales: controlling the effects of environ-

mental forces (mean, 2.75), resources (mean, 3.48),

communication competency (mean, 3.00) and group

supervisors power/outcome attainment competency

(mean, 2.87) (Table 2).

Background factors related to nursing power

There were many statistically significant connections

between the demographic variables and nursing group

power/outcome attainment and its components (see

Table 3). Age had a statistically significant connection to

the respondents perceptions of their groups level of

controlling the effect of environmental forces (p = 0.007)

and role (p = 0.007). As regards, the groups role in the

delivery and coordination of care, guidance and group goal

development, the responses to the questionnaire indicated

that nurses aged 30 years and less perceived higher levels

of group power than nurses aged 3140 years (p = 0.003).

Furthermore, nurses aged 30 years and less reacted in the

items of change more positively towards changes than

nurses aged 5164. A statistically significant connection

was also evident in the relationship between nurses edu-

cation and their perceptions of their groups level of power

in relation to the subscale of communication competency

Table 1 Nurses background information (n, %)

Background variable N %

Gender (n = 289)

Female 259 90

Male 30 10

Age (n = 289)

30 71 253140 69 24

4150 86 30

51 63 22Education (n = 288)

Registered Nurse 247 86

Practical Nurse 30 10

Other 11 4

The type of employment (n = 288)

Full-time 213 74

Part-time 72 25

Other 3 1

Work experience, years (n = 286)

4 58 20510 72 25

1120 64 22

21 92 32Work experience in the same unit, years (n = 277)

4 102 37510 80 29

1120 54 19

21 41 15


582 P. Katriina et al.

(p = 0.014). Further, RN did not perceive as high level of

group power, as did the PN, in terms of the item con-

cerning how well the organization considers the nurses

opinions and decisions (p = 0.011).

Thenurses typeof employment (full-time/part-time)was

significantly associated with many of the SKAGOAO sub-

scales. Nurses working part-time perceived higher levels of

group power in relation to their supervisors power

competency than full-time nurses (p = 0.004). In addition,

part-time nurses perceived higher levels of group power in

relation to resources (p = 0.003) and environmental forces

(p = 0.033) as compared to the full-time nurses. Further-

more, full-time nurses perceived higher levels of group

power in relation to achieving the goals of the nursing group

than part-time nurses (p = 0.024). There were also signifi-

cant connections between the amount of the respondents

work experience and the subscales of controlling the effects

of environmental forces (p < 0.001), role (p = 0.048) and

supervisors power competency (p = 0.045). Nurses with a

few years work experience (14 years) perceived higher

levels of group power in relation to the subscales of envi-

ronmental forces, role and supervisors power competency

as compared to those nurses with more years of work

experience. Work experience on the same unit also had a

statistically significant connection with the subscales of role

(p = 0.022) and environmental forces (p = 0.002).

The demographic variables in the present study: gender,

further education,workingdistrict andunitsnumberof staff

members had no statistically significant correlation with the

subscales of nursing group power. Of the demographic

variables, the highest level of education and the supervisors

titlewere not included in the analysis because therewere no

reliable differences. Nearly, all of the titles of the respon-

dents supervisors were head nurse, and for this reason

different categories could not be created. Likewise, the

responses for the variables for the highest level of education

and current job duties were nearly the same. The responses

for current job duties were included in the analysis.

Discussion

The purpose of this study was to determine the way in

which nurses perceive the level of nursing group power in

their organization. The results of the study raise awareness

about the elements that affect the power of nursing

groups. The results are also useful to healthcare settings

and nursing management.

In the present study, nurses assessed the nursing

supervisors to have more responsibilities than power.

Nurses own responsibility was also assessed to be higher

than power, but at a lower level than that of nursing

supervisors. Similar results are evident in studies by Attree

(20) and Hintsala (21) where nurses felt that they have

many responsibilities, but not as much power. The nurses

explained that they are personally accountable and

responsible for the standards of practice, but, at the same

time, they have no personal control over everyday stan-

dards of nursing practice.

The younger nurses in this study perceived a higher level

of group power in relation to controlling the effects of

environmental forces, such as the anticipation of and

adjustment to changing healthcare trends than did older

nurses. This finding coincides with other studies. According

to Corey-Lisle and Tarzinia (22) and Laamanen et al. (23),

young employees found positive aspects in changes in skills

and content of their duties, while older employees experi-

enced changes and new working methods as a threat.

Nursing group power was highest perceived in power

perspectives and goals/outcome competency. The respon-

dents to the present study perceived a high level of group

power in relation to the subscale of power perspective. Most

of the nurses (83%) perceived a high level of group power in

relation to the item that addressed whether the desired

outcomes of the organization are consistent with the nurs-

ing group. According to Attree (20) and Ruston (24), the

viewpoints of the organization and nursing group con-

cerning desired outcomesmay be different. However, in this

Table 2 Nurses perception of the level of nursing power and Group Outcome Attainment within Organizations (SKAGPO) instruments variables,

number of items and Cronbachs alphas

Variable n Mean SD Range Minmax

Number

of items

Cronbachs

alpha

Controlling the effects of environmental forces 280 2.75 0.48 1.144.14 15 7 0.699

Position 285 2.55 0.61 1.004.50 15 4 0.599

Role 283 2.54 0.63 1.004.67 15 3 0.632

Resources 273 3.48 0.56 1.505.00 15 6 0.697

Communication competency 281 3.00 0.65 1.334.67 15 3 0.558

Goals/outcomes competency 278 2.24 0.47 1.003.75 15 4 0.411

Nursing supervisors power competency 268 2.87 0.62 1.505.00 15 4 0.710Power perspective 280 1.93 0.43 1.003.60 15 5 0.574

Nursing power 36 0.614

Scale: The smaller mean depicts more agreement.

Copyright Sieloff.


Nursing power as viewed by nursing professionals 583

Table

3Nurses(n

=2682

89)backg

roundfactors

relatedto

nursingpower

Backg

round

variab

les

Environmen

tal

forces

Position

Role

Resources

Communication

competen

cy

Goals/outcome

competen

cy

Nursingsupervisors

power

competen

cy

Power

perspective

Mean

SDp-Value

Mean

SDp-Value

Mean

SDp-Value

Mean

SDp-Value

Mean

SDp-Value

Mean

SDp-Value

Mean

SDp-Value

Mean

SDp-Value

Age

30

2.61

0.42

0.007

2.44

0.54

0.144

2.34

0.49

0.007

3.36

0.54

0.069

2.95

0.68

0.252

2.32

0.43

0.302

2.75

0.48

0.207

1.92

0.44

0.897

314

02.74

0.51

2.69

0.74

2.71

0.67

3.57

0.51

3.13

0.72

2.25

0.53

2.83

0.58

1.93

0.44

415

02.77

0.47

2.53

0.58

2.56

0.66

3.42

0.60

2.99

0.59

2.18

0.46

2.89

0.74

1.92

0.40

516

42.89

0.49

2.54

0.51

2.58

0.63

3.57

0.55

2.92

0.60

2.21

0.44

3.02

0.59

1.97

0.46

Gen

der

Female

2.75

0.48

0.750

2.55

0.61

0.715

2.55

0.63

0.898

3.48

0.56

0.328

3.02

0.65

0.092

2.24

0.48

0.634

2.87

0.63

0.970

1.94

0.44

0.156

Male

2.72

0.47

2.51

0.56

2.53

0.65

3.38

0.53

2.81

0.62

2.20

0.41

2.86

0.56

1.83

0.36

Education

Reg

isterednurse

2.76

0.48

0.051

2.58

0.61

0.110

2.56

0.63

0.117

3.49

0.57

0.305

3.04

0.65

0.014

2.23

0.48

0.477

2.86

0.63

0.829

1.94

0.43

0.932

Practicalnurse

2.61

0.52

2.34

0.62

2.35

0.62

3.33

0.50

2.67

0.64

2.32

0.39

2.92

0.60

1.91

0.44

Other

3.01

0.41

2.45

0.35

2.76

0.62

3.38

0.44

3.06

0.39

2.14

0.41

2.95

0.45

1.91

0.35

Typeofem

ploym

ent

Full-time

2.79

0.50

0.033

2.57

0.59

0.177

2.58

0.65

0.084

3.53

0.54

0.003

3.02

0.65

0.275

2.20

0.47

0.024

2.92

0.65

0.004

1.91

0.43

0.206

Part-tim

e2.65

0.42

2.46

0.66

2.44

0.55

3.30

0.59

2.92

0.65

2.34

0.46

2.70

0.51

1.99

0.44

Work

experience

(years)

14

2.61

0.37

Documents

Nursing Power