Nursing Staff Empowerment and Critical Thinking in Rural Acute Care Facilities
Authors:   , Burwell Robyn 
Published: February 2023

Critical thinking and empowerment are controversial concepts in nursing. A systematic review of the literature using a computer search of CINAHL, MEDLINE, ABI-Inform, Cochrane Library, National Library of Medicine, and the Virginia Henderson International Nursing Library (on-line: www.nursingsociety.org) suggests that in order for staff nurses to provide quality care, nurses need to be empowered and that empowerment of nursing staff then permits decision-making, built on knowledge and experience, then leading to the development and use of critical thinking. While quality care to all patients is not the same, the ability to utilize critical thinking skills allows a nurse to better determine the unique needs of an individual patient. Organizations today need to empower staff nurses to look for ways to make a difference in how they provide care to patients through the use of critical thinking. The relationship between staff nurse empowerment and critical thinking was investigated using a quantitative, non-experimental, descriptive-correlational research design. The convenience sample of 198 registered nurses (N=198) working in ten rural hospitals was taken from the population of registered nurses who work in Kansas rural counties in hospitals of 150 beds or less located throughout north-central and northeast Kansas. Orem’s (2001) Self Care Deficit Theory of Nursing (SCDTN), Kanter’s (1993) Structural Theory of Power, Facione and Facione’s (1996) Centrality of Critical Thinking in Nursing theory, and Benner’s (2001) Philosophy of Novice to Expert were abstracted together into a new conceptual model to guide this investigation. The Conditions of Work Effectiveness Questionnaire II (CWEQ-II), by Laschinger, Finegan, Shamian, and Wilk (2000), was used to measure staff nurse empowerment. The California Critical Thinking Dispositions Inventory (CCTDI), by Facione and Facione (1996), was utilized to measure the criterion variable of critical thinking. Statistical analyses using Pearson Product Moment Correlation coefficient was used to determine if a correlation existed between (a) the mean of the scores of the representation of empowerment, predictive empowerment, overall empowerment and global empowerment of the CWEQ-II and the mean of the total score of the CCTDI, (b) the number of years practicing as a registered nurse and the mean scores of the representation of empowerment, predictive empowerment, overall empowerment and global empowerment of the CWEQ-II, and (c) the number of years practicing as a registered nurse and the mean score of the CCTDI. Data from 198 registered nurses were used for the calculations. The value of the Pearson r correlation coefficients for the first research question included: (a) the mean of the representation of empowerment and the mean of the total score of the CCTDI was .208 (r=.208; p&lt;0.01), (b) the mean of predictive empowerment and the mean of the total score of the CCTDI was .221 (r=.221; p&lt;0.01), (c) the mean of overall empowerment and the mean of the total score of the CCTDI was .235 (r=.235; p&lt;0.01), and (d) the mean of global empowerment and the mean of the total score of the CCTDI was .028 (r=.028; p&gt;0.05). The first three were considered statistically significant. However the last correlation was not considered statistically significant. The value of the Pearson r correlation coefficients for research questions two includes (a) the number of years practicing as a registered nurse and the mean score of the representation of empowerment (r=/245; p&lt;0.01), (b) the number of years practicing as a registered nurse and the mean score of predictive empowerment (r=.164; p&lt;0.05), (c) the number of years practicing as a registered nursed and the mean score of overall empowerment (r=.237; p&lt;0.01), and (d) the number of years practicing as a registered nurse and the mean score of global empowerment (r=.073; p&gt;0.05). The first three were considered statistically significant. However the last correlation was not considered statistically significant. For research question three the value of the Pearson r correlation coefficient between the mean of the total score of the CCTDI was -0.086 (p&gt;0.05). This was not statistically significant. According to the data, there is a statistically significant relationship between: (a) the mean scores of three of the four subscales of empowerment that make up the CWEQ-II and the mean of the total score of the CCTDI, and (b) the number of years practicing as a registered nurse and the mean scores of three of the four subscales of empowerment that make up the CWEQ-II. However the data suggest there is not a statistically significant relationship between the number of years practicing as a registered nurse and the mean score of the CCTDI.