Feelings of powerlessness are a common occurrence in nursing. These feelings can be attributed to the high demands of the job, including the long hours, changing shifts, the emotional rollercoasters, and the acute changes in patient status. Additionally, many hands are involved in the patients’ cases that make different decisions and the nurse may feel like he/she is not in control of what is happening at the bedside. Furthermore, policy changes within the institution are enacted by other personnel who often do not ask employees their thoughts and opinions on the matter. To decrease the feelings of powerlessness, many units have enacted the policy of shared governance, in which nurses are represented within meetings to give their opinions on changes within the unit (Barden, Griffin, Donahue, & Fitzpatrick).
Nancy is the emergency department manager. For the past 2 years there has been a high turnover rate and poor morale in the department. When Nancy asks nurses who are resigning their reasons, many of them said that they “feel powerless.”
What issues could be present in a unit that would create feelings of powerlessness among the staff?
The emergency department is a high stress environment in which every case is different. These nurses are faced with challenged every single day. Some causes of powerlessness in this acute and critical department may be the stress, the inability to control the developing situations, and the death of patients (Kornhaber & Wilson). These nurses may feel like they have lost the power of caring, as many situations are uncontrolled in the ED. Additionally, if there are changes within the administration or policies within the institution, this can cause the feeling of losing power over decision making within the unit.
What are some of the sources that might be found?
In an ED, many cases are admitted every day, each different in its own way. These nurses must be able to treat a variety of conditions in a quick manner. Not only are there a variety of situations but they are also emergent situations in which patients need stabilized as soon as possible (Burgess). It is pertinent that each and every patient is seen immediately and that the condition is identified and controlled so the patient may be discharged to another unit to recover.
How might Nancy encourage the staff to become empowered as well as diffuse some of the behaviors of others contributing to the staff’s feelings of powerlessness?
Nancy should encourage change within the department to boost the morale of her staff. Nancy should encourage her staff to talk to one another and to her about their concerns on the unit. The nurses can find comfort in one another and work towards changing the unit in such a way that will make them feel like they are important and in control of the situations. Nancy should also ask them for their suggestions on how they can improve the morale in the unit.
You are fortunate to be working in a magnet facility that is very proud of its shared governance model. You have been invited to represent your unit on one of the policy-making councils. The council is meeting to discuss the possibility of returning to 8-hours shifts. This decision is based on patient satisfaction surveys and an increase in medication errors after the nurse has worked more than 8 hours.
What information should you obtain from the staff on your unit prior to attending the meeting?
I would ask the staff their opinion, if they would like to return to working the 8 hour shifts or continue working the 12 hours shifts. I would also ask the staff to list pros and cons of working both the 8 hour shift as well as the 12 hour shift to present these findings in the meeting, giving the other members of the meeting a good representation of my staff.
What other information would you gather about returning to 8-hour shifts prior to attending the meeting?
How nurses feel after working three 12-hour shifts versus working six 8-hour shifts. What is the percentage of medication errors during 8 hour shifts versus 12 hour shifts?
How will you assist your team members in understanding the role of shared governance in bringing about policy change?
I would explain to them the purpose and importance of shared governance. It is the attempt to “enable nurses to exercise control over decisions that affected their practice” (Barden, Griffin, Donahue, & Fitzpatrick). It is a theory that emphasizes “partnership, equity, accountability, and ownership” of one’s responsibilities within the practice of nursing. This practice gives nurses power to overcome the common feeling of powerlessness within the field (Barden, Griffin, Donahue, & Fitzpatrick). I would also stress to them that it improves job satisfaction and allows the nurses to more fully enjoy their career. When participating in shared governance, every member has a voice and is able to contribute his/her thoughts and feelings to the discussion.
Powerlessness is common in the field of nursing and is something that needs to be addressed as it is often associated with burnout, job dissatisfaction, and depersonalization (Manojlovich). Nurses can experiences three types of powerlessness: losing control over the content of practice, losing control over the context of practice, and losing control over competence (Manojlovich). The high stress, demands, and fast paced environment of the job are difficult to manage without the added stress of dealing with administration and policy changes. When employees feel powerless, this often leads to the development of job dissatisfaction and ultimately a higher turnover rate. To decrease the changes of disgruntled employees, nurse managers and supervisors should work with their supervisors to implement the practice of shared governance to show the staff they care about their thoughts and opinions. Using shared governance gives a voice to nurses, as well as other employees, as they gather together to discuss situations that need resolved. The more people involved leads to greater discussion and thus more options to solve the problem. Additionally, it will show the employees that they are valued and are important to the department/unit.
References
Barden, A., Griffin, M., Donahue, M., & Fitzpatrick, J. (2011). Shared Governance and
Empowerment in Registered Nurses Working in a Hospital Setting. Nursing Administration Quarterly, 35(3), 212-218.
Burgess, N. (n.d.). What is it Like to Work in an Emergency Room? Retrieved June 25, 2015,
Kornhaber, R., & Wilson, A. (2011). Enduring feelings of powerlessness as a burns nurse: A
descriptive phenomenological inquiry. Contemporary Nurse, 39(2), 172-179.
Manojlovich, M. (2007). Power and Empowerment in Nursing: Looking Backward to Inform the
Future. OJIN: The Online Journal of Issues in Nursing, 12(1), 1-2.
