Introduction, Background, and Purpose
Power is more relational than absolute. Power relates to the degree of control that one exercises over outcomes, resources, actions, and process. The power can either be formal or informal. The formal power is the leeway that one is given through the rules of the organization in which he works to influence the course of certain elements in that organization. This is legitimate power afforded to a worker to enable them to deliver their mandate. Illegitimate power is different from the legitimate authority because unlike in the former case, the illegitimate power lacks authority. Nonetheless, it can be significantly influential as advance nurse practitioners have come to learn over time.
I am an advance nurse practitioner by profession and my practice setting is in primary care. My mandate involves the provision of preventive services to the people who attend the health center where I am stationed. Some of the preventive services that form the bulk of the work include the screening for colorectal cancer among other common preventable diseases. Part of the practice also involves the treatment of patients who are diagnosed with acute medical as well as chronic conditions.
The efforts in increasing the compliance with the screening protocols for colorectal cancer have taken shape in the recent past in the locality in which I practice as an advance nurse practitioner. This is due to the recognition of the role of preventive services in the early detection and successful treatment of colorectal cancer as well as the low compliance with the screening protocols among the population aged above fifty years.
While the advance nurse practitioners at the primary level of care have practical insights based on the direct assessment of patients, their socioeconomic realities, and the barriers to compliance, the communication of these insights to inform the policy guidelines on screening for colorectal cancer is impeded by both legitimate and illegitimate power. Janes & Lundy (2016) define legitimate power as the power that comes from the authority given under one’s position at the work place.
As highlighted above, the illegitimate power entails the exercise of power that is not backed by authority. The two dynamics are more different than is expressed in their definitions Janes & Lundy (2016) find that legitimate power, unlike illegitimate power is recognized by the people, and the persons who exercise legitimate power are seen as having the right to do so courtesy of their position.
It is based on the background presented above that the paper seeks to appraise how the application of both legitimate and illegitimate power influences the outcomes of a health policy and the ability of an advanced nurse practitioner in primary health care to inform that outcome. Using illustrations derived from my practice, the paper will explain how the legitimate and illegitimate power affects policy outcomes from the stakeholder, sociopolitical and the perspective of the interested parties. The paper will also highlight the enabling and impeding factors that influence the power and ability of an advance nurse practitioner to influence change at different levels of care in the healthcare system.
Description of the Power Dynamic
Legitimate and illegitimate power has diverse impacts on the ability of an advance nurse practitioner to influence the outcomes of a policy initiative. When considered through different perspectives, legitimate and illegitimate power influences the ability of an advance nurse practitioner to influence policy outcomes. One of the perspectives through which legitimate and illegitimate power is the stakeholder perspective.
Nurses need to coordinate their actions as a profession in order to influence policy outcomes (Benton, 2012). For instance, the collective initiative of advance nurse practitioners in my locality can help influence the outcomes on the policy guidelines on the screening for colorectal cancer. This is because the nurses are part of the stakeholders that are involved in the policy formulation process. Legitimate power can help fast track the influence of the nurses in affect the policy formulation process.
Harnessing legitimate power entails getting the support of the stakeholders in positions to help push the initiatives of the nurses. For instance, I enjoy the support of other advance nurse practitioners working in primary health care on policy matters regarding the screening for colorectal cancer. Sharing information is one of the ways through which we harness the support of other stakeholders However, illegitimate power can be an impediment to the policy formulation process. In practices, there are advanced nurse practitioners who will not share the empirical or qualitative information they have acquired through practice. This served as an impediment because it impedes the nurse’s perspective in the policy formulation process.
The sociopolitical factor perspective is another dimension through which the impact of legitimate and illegitimate power can be considered. The interaction between societal and political factors affects the impact that legitimate and illegitimate power have on the ability of nurses to influence policy outcomes.
For instance, cultural competency is one of the dimensions through which legitimate and illegitimate power be viewed (Truong, Paradies & Priest, 2014). I practice in a culturally diverse setting. However, there are negative attitudes that can be perceived when working with multidisciplinary teams. In a culturally incompetent setting, the people in a position to help influence policy outcomes because the fail to recognize that a diverse set of knowledge and skills are required to improve health care.
Interested parties are the people who have an interest in certain policy initiative. They could range from nurses, advance nurse practitioners, nurse managers or the other members of the multidisciplinary team (Arabi, Raffi, Cheraghi & Ghiyasvandian, 2014). The positional power of these people could be harnessed to help push the perspectives of nurses towards the policy outcomes. However, illegitimate power can stifle any progress, especially when some of the interested parties fail to cooperate. Even those with no authority can exercise their power to the detriment of the efforts of the nurses.
Reflection on Power Dynamic
The ability of a nurse to influence change at the different levels of health care is affected by various barriers and facilitating factors. At the micro level, the influence of the nurse is felt in the practice settings. Even though advanced nurse practitioners work independently, the organization structure can both be a barrier and a facilitating factor depending on the expression of the positional power by the administrators of the health care institution. Administrators who have a regard for evidence-based practice will allow advance nurse practitioners to institute changes that through evidence, have been shown to lead to better outcomes. Bureaucracy might be a barrier to effecting changes at the micro level, especially if the advance nurse practitioner has to seek the approval of many people. Other factors include licensure and state practice, nursing education, and payer policies (Hain & Fleck, 2014).
At the meso-level, the changes instituted by nurses are felt in the form of programs that have definite deliverables and scope. The ability of the nurse to implement changes that are felt at this level is facilitated by the availability of funding to design, implement, and evaluate the program. This can also be restraining factor if the program and policy initiatives are not funded. Shariff (2014) also finds that other enabling factors at this level include the involvement of the nurses in the program development process and the policy initiatives, the presence of enabling processes and structures, and the skills and knowledge of the nurses. The restraining factors include the exclusion of nurses in the policy initiatives, a negative image of the nursing fraternity, and stifling processes and structures (Shariff, 2014).
At the macro-level, the changes are felt in terms of national policies that affect the manner in which the health care procedures related to the policy are performed. The involvement of the nurses in the policy formulation processes is important to their ability to influence change. They can offer practical insights and their appreciation for the needs of the population that are gained through close communication during practice. The existence of supportive programs, many of which are formed at the meso-level of care is another enabling factor. It is from these programs that the qualitative resources required for policy formulation can be drawn (Caldwell & Mays, 2012).
Conclusion
Through the exercise of power, people get to control processes, resources, and outcomes. Power can be legitimate or illegitimate. Despite the illegitimacy of power, it still has effects on the ability of nurses to influence change through policy outcomes. Legitimate and illegitimate power can either facilitate or impede the efforts of nurses to achieve change at different levels of care. The exercise of power dynamic is something that I have experienced in the practice setting. Depending on the extent and the nature in which the power is exercised, nurses can either be empower to influence policy outcomes at the micro, meso, and macro levels of care or not.
References
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