Power and Leadership in Psychiatric Nursing. Directions for the Next Century: Part I

TOPIC. The application of power and leadership to psychiatric nursing in the next century PURPOSE. To suggest strategies for empowering psychiatric nursing SOURCE. Review of the literature and authors observations of the discipline CONCLUSIONS. Empowerment of our discipline rests with individuals committed to changing the societal problems holding us back. This will be accomplished through consciousness-raising, coalition- building, transformation, feminist leadership, political action, public relations, development of a new language, and research. Key words: Feminism, leadership, political action, power, psychiatric nursing, social problems At the time of this writing, both President Clinton and the U.S. Congress have introduced spending packages for the next fiscal year. Senators Grossley and Conrad introduced a Medicare reform bill that at first left out clinical nurse specialists (CNS) as providers. Through political action by CNSs around the country, this wrong has been corrected. The President in his budget has slashed funding for the Nurse Education Act from $63 million last year to $7.7 million this year. And yet Columbia University School of Nursing has won an Oxford Health Plan contract assigning primary care status to nurse practitioners in their nurse-run clinic, paying them at physician rates. How do these events foretell the future of psychiatric nursing and what must we do to get where we want to go? Burns (1978) cited the example of a powerful nurse in the following story: Despising the mildly Bohemian ways of his oldest son, the king of Prussia heaped humiliation on him and flogged him in public ... One of the few persons to stand up to the king was the nurse, who barred his way when he tried to drag his cowering children out from under the table, and she got away with it (p. 10). This nurse demonstrated power against what appeared to be overwhelming odds. Her courage allowed her to save another. This is a traditional way nurses employ power, for the benefit of another person, frequently as a patient advocate. Another way nurses use power is to persuade and influence change and ultimately build a power base (deVries, 1996; Huston & Marquis, 1988) for the good of a group, such as the underserved mentally ill. For example, psychiatric mental health nurses participated in the Health Reform Task Force convened by Hillary Rodham Clinton to address access to mental health care for the historically disenfranchised poor and minorities (Brooks, Polis, & Sills, 1993). Psychiatric mental health nurses are in a strong position to advocate, according to feminist scholars who argue that those oppressed or excluded from power have a unique advantage point from which to understand aspects of the world that may be invisible to dominant groups (Swidler & Arditi, 1994). Diversity With Unity Collective support of a leader is essential, but nurses must not mistakenly think that unity means there can be no divergence of thought (Lanza, 1984). Freedom of thought is essential for creativity and growth. Collective support and unity can be achieved by treating differences among nurses as merely that and not placing value judgments on differences. Effort should be made to address the needs that nurses have in common; for example, Sills has advocated unity for psychiatric nurses under "one tent" (Sills, 1995a). Considering the subspecialty organizations in psychiatric nursing, she observed that however diverse, groups can form coalitions around certain projects and tasks. In increasingly complex societies, people seek participation in smaller segments of the social arena. Coalitions, partnering, collaborating, joint sponsorship, and shared resources are becoming the norm (Haber, 1996). Another current example of the needs of smaller factions versus larger groups is the debate about whether it is better to view psychiatric clinical nurse specialists and psychiatric nurse practitioners as different and distinct or as essentially the same (Lego & Caverly, 1995; Lego, 1966, in press). …