Nurse managers' work-related empowerment : Evaluated in connection to power issues and Organizational Social Context

Nowadays, health care organizations are affected by changes and reforms, thus, new challenges arise for nurse managers, whose role entails a large number of administrative responsibilities. Nurse managers need to have power in order to achieve their personal and organizational goals. Power and its exercise is incorporated into the concept of empowerment. Thus, being empowered plays an important role in providing nursing leadership, as it enables nurse managers to perform their everyday tasks more effectively and in a meaningful way. Furthermore, there has been an interest in research on organizational issues, e.g. organizational culture and climate, that shape the organization and provide a complex understanding of organizational factors such as empowerment. The overall purpose of this study was to explore how empowered nurse managers were, and the connection of empowerment to power issues and the Organizational Social Context (organizational culture, organizational climate, and morale). The study was divided into two main phases (systematic literature review and empirical research). In Phase 1, previous empirical studies revealed that empowerment of nurse managers was mostly evaluated by way of selfadministered questionnaires, and mainly two approaches to describe it were used, in particular structural and psychological. It was revealed that nurse managers were moderately or highly structurally and psychologically empowered. In Phase 2, a quantitative descriptive cross-sectional design study was carried out. The research process followed the main ethical principles and standards declared in the World Medical Association Declaration of Helsinki. The study data was collected in seven state-funded university and general level hospitals among nurse managers (n=193). They were divided/grouped into teams (n=22) based on their clinical nursing area, and also in regard to their common daily tasks undertaken in the organization in collaboration with chief nurses/directors of nursing. The data was collected by way of a self-administered questionnaire that consisted of four parts: demographic and work-related questions, the Conditions of Work Effectiveness Questionnaire-II for structural empowerment, the Work Empowerment Questionnaire for psychological empowerment, with power related items at unit level and the Manager’s Activity Scale at organizational level, and the Organizational Social Context measurement system. Permissions to use the respective instruments were granted from the copyright holders. The data was analyzed statistically. The results of the study showed that nurse managers were moderately structurally empowered, but perceived a high level of psychological empowerment. A few background factors correlated with both structural and psychological empowerment. Additionally, several significant relations were found between structural empowerment subscales and psychological empowerment dimensions. Nurse managers experienced unit level power and organizational level power at a moderate level. In addition, structural and psychological empowerment correlated with both unit and organizational level power. The differences in Organizational Social Context between teams and organizations were calculated. The results showed that differences in culture dimensions were significant at team level in resistance, and at organization level in resistance and proficiency. The differences in climate dimensions between teams were significant in functionality, and between organizations in engagement and functionality. The differences in morale were significant at both team and organization level. Several correlations were found between organizational culture and climate, and empowerment. These correlations were statistically significant, however, most of them were weak. Several significant relationships were also found between morale, structural and psychological empowerment, and organizational culture and climate dimensions. This study offers implications for practice, management, education and future research. The role of chief nurses/directors of nursing is vital for nurse managers, as they should create and empowering working environment. Power-seeking strategies should be adopted in order to increase self-confidence in nurse managers. In addition, it is important to provide nurse managers with opportunities to grow professionally and to apply new knowledge and skills in order to work effectively and experience professional power. This study offers a general and valuable view of the topic, however, other research alternatives would be beneficial to further explore the experiences and perceptions of nurse managers regarding the phenomena of empowerment and Organizational Social Context.