Nursing Empowerment for Quality Improvement

 

Dr. G. Radhakrishnan¹, Dr. S. Anuchithra²

¹Asst. Professor, Department of Nursing, NIMHANS, Bangalore 560029

²Professor and HOD, OBG Nursing, Government College of Nursing,

SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bangalore 560029.

 

ABSTRACT:

In the era of consumerism, quality of care is inevitable regardless of the health care setting. Nursing leaders, in employment settings or in professional organizations, exercise power in making professional judgements in their day to day activities. Power is authority over others. Empowerment, in contrast, it is authority purposefully shared with others. Nursing empowerment means the ability to effectively motivate and mobilize self and others to accomplish positive outcomes in nursing practice and work environment. Quality improvement is an organised process that assesses and evaluates health services to improve practice or quality of care. The nurse’s empowerment and patient quality care are both the sides of same coin. The empowered team influences staff morale, productivity, staff retention and associated costs, patient care quality, and patient safety.  Enhancing leadership skills, being a positive change agent, education upgradation and being an Evidence Based Practice (EBP) cheerleader abilities are required for nurses to become an empowered professional to render quality care. The factors contributing to nurse empowerment are: Decision-making, Autonomy, Manageable workload, Fairness, Reward and Recognition. Nursing empowerment becomes an inevitable component to achieve quality improvement in any health care setting.

 

 

 

INTRODUCTION:

Empowerment is a term that has come into common usage in nursing. That term has been used extensively in the nursing literature related to administration and management; it is also highly relevant to the domain of clinical practice.¹Today’s health care environment demands enormous amounts of energy and diligence, regardless of clinical setting: acute care hospitals, long-term care facilities, community-based agencies, home, or hospice care.²

 

In a given situation the challenges to nursing profession and Nurses are: to be highly competent, innovative, have leadership potential, and demonstrate flexibility in adapting to changes throughout their functions and professional relationships. (Porter O’grady, 2003).³

 

Health work environments channel their energy to foster encouragement and empowerment by their nurses bear witness to quality excellence and successful patient care outcomes. To accomplish the formidable task of unlocking the keys to excellence requires moral courage and commitment on behalf of nursing leadership. This means nurse leaders must be role modelsin moral courage for their nursing staff as well as ways to address their problems directly rather than ignore them. Sidestepping problems and broken systems can lead only to greater frustration and disappointment.²

 

Empowerment:

A management practice of sharing information, rewards, and power with employees so that they can take initiative and make decisions to solve problems and improve service and performance.⁴

 

Empowerment is based on the idea that giving employees skills, resources, authority, opportunity, motivation, as well holding them responsible and accountable for outcomes of their actions, will contribute to their competence and satisfaction.⁴

 

Empowerment is the process of exercising one’s own power to facilitate the participation of others in decision making and taking action so they are easy to exercise power (Leavitt, Mason and Whelan, 2012).¹

 

Empowerment is consistent with the contemporary view of leadership, a paradigm that is exemplified by behaviour characteristic of all nurse leaders: facilitator, coach, teacher, and collaborator. Nursing leaders, in employment settings or in professional organizations, exercise power in making professional judgements in their daily work.¹

Concept of power and empowerment:

Power is seen as authority over others. Empowerment, in contrast, expands: it is authority purposefully shared with others.⁵

 

Nursing empowerment:

Nursing empowerment means the ability to effectively motivate and mobilize self and others to accomplish positive outcomes in nursing practice and work environment.

 

Nursing empowerment is instilling a sense of power by granting decision-making authority, and/or creating opportunities to influence decisions, and providing ability to make choices by nurses.

 

Quality improvement:

Quality improvement can be defined as “an organised process that assesses and evaluates health services to improve practice or quality of care”⁶

 

 

 

Nursing empowerment essential for quality improvement⁷

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When the nurse committed to enhancing her/his knowledge base and incorporating evidence-based practice (EBP) research findings, they become a positive change agent and can serve as a role model for their peers, supervisors, and the community.⁸

 

Creating an empowered team is a vital nurse leadership function that can significantly influence staff morale, productivity, staff retention and associated costs, patient care quality, and patient safety.⁸

 

And also expecting and receiving the quality health care is the basic human right of the consumers. Nursing empowerment facilitates nurses in delivering quality care to the clients.

 

Common tasks to improve the ability to be empowered;

1.      Enhancing leadership skills

2.      Be a positive change agent

3.      Get certified

4.      Be an EBP cheerleader⁸

 

1. Enhancing leadership skills:

Nurses should be encouraged to participate in leadership and management internship programs. Inquire if your employer has formal or informal opportunities for nurses to shadow organizational nursing leaders. Many healthcare organizations encourage nurses to participate in organizational committees that make decisions and develop policies that impact nursing job responsibilities and practice.

 

 

These programs allow nurses to enhance your global view of leadership styles, develop a rapport with organizational leaders, and attain insight into how your organization operates. Nurses also should consider enrolling in leadership continuing-education classes at a local community college, university, or online.

 

2. Be a positive change agent:

Evaluate the environment to find areas for improvement that will increase the efficiency of working area, heighten job role satisfaction, or improve patient outcomes. Consider forming a workgroup or committee. Workgroups allow nurses to collaborate to accomplish specific tasks, such as initiating a new protocol for a procedure that will improve patient safety and systems efficiency, resolve knowledge deficits, or increase nurses’ workplace satisfaction.

 

3. Get certified:

Speciality certification reflects level of expertise in a specialized area.Forming a study group with co-workers for specialty certification exams. Research has shown that when hospitals are staffed with baccalaureate-prepared nurses who hold specialty certifications, 30-day patient mortality is dramatically lower. Nurses who attain specialty certification are more invested in the success of their organization, collaborate more effectively with their healthcare team, and are more empowered in their work area.

 

4. Be an ebp cheerleader:

Evaluate new EBP data to find more efficient ways to perform tasks and procedures or provide patient care. When nurses implement EBP and research councils into their practice, patient care outcomes are improved, as well as patient satisfaction with the level of care received. Nurses must enhance their knowledge base by completing continuing-education courses offered by employers, community colleges, or universities or by attending workshops held by employers or nursing conventions at the local, state, or national level. Many state and national nursing associations offer virtual learning continuingeducation opportunities that allow you to acquire new EBP data from home.

 

Factors contributing to nurse empowerment⁹:

§  Decision-making: Control of nursing practice within an organization.

§  Autonomy: Ability to act on the basis of one’s knowledge and experience (Manojlovich,2007)

§  Manageable workload: Reasonable work assignments

§  Reward and recognition: Appreciation received for a job well done

§  Fairness: Consistent, equitable treatment of all staff (Spence, Lashingerand Finegan,2005)

 

Key strategies help foster quality improvement

·        Supportive hospital leadership actively engaged in the work;

·        Setting expectations for all staff not just nurses -that quality is a shared responsibility;

·        Holding staff accountable for individual roles;

·        Inspiring and using physicians and nurses to champion efforts and

·        Providing ongoing, visible and useful feedback to engage staff effectively.¹⁰

 

Challenges specific to nurses’ involvement in quality improvement:

Hospital respondents reported several challenges related specifically to nurses’ involvement in quality improvement, including:

·        Having adequate nursing staff when resources are scarce;

·        Engaging nurses at all levels from bedside to management

·        Facing growing demands to participate in more, often duplicative, quality improvement activities

·        Dealing with the high level of administrative burden associated with these activities; and

·        Confronting traditional nursing education that does not always adequately prepare nurses for their evolving role in today’s contemporary hospital setting.¹⁰

 

Related research evidences on nursing empowerment:

·        Empowering staff nurses ³

§  Ensure excellence in nursing care (Marquis and Huston, 2000).

§  Increased job satisfaction (Greco, Lashinger, and Wong, 2006),

§  Organizational commitment (Lashinger, Leiter et al., 2009)

§  Reduced/Less burnout and incivility (Lashinger and Finagan, 2003, Smith et al., 2010).^{3, 12}

·        Empowered nurses ³

§  Highly motivated (Lashinger and Havens, 1996)

§  Able to motivate and empower others by sharing the sources of power” (Lashinger and Havens, 1996)

§  Less job strain (Lashinger, Shamian, 2001)

·        Structural empowerment related to¹¹

§  Strong nursing leadership predicted staff nurses’ perceptions of structural empowerment on their units (Laschinger, Finegan, and Wilk 2009, 2011)

§  Leader empowering behaviors (Conger and Kanungo, 1988; Greco et al., 2006; Laschinger et al., 1999),

§  Emotionally intelligent leadership (Lucas, Laschiner, and Wong, 2008; Young Ritchie, Laschinger, and Wong, 2009), and

§  Authentic leadership (Laschinger, Wong, and Grau, 2012; Wong and Laschinger, 2012).

§  Positive leadership styles, Thomas and Velthouse’s (1990)

·        Powerless nurses are:

§  Ineffective nurses (Page, 2004).

§  Less satisfied with their jobs (Manojlovich and Lashinger, 2002).

§  More susceptible to burnout and depersonalization (Leiter and Lashinger, 2006).

§  Poorer patient outcomes (Manojlovich and Recico).

·        Disempowerment, or the inability to act

§  Frustration and failure in staff nurses (Lashinger and Havens, 1996)

 

FOR A QUALITY IMPROVEMENT

 

Source: Concept from Dr. Latha Venkatesan¹²

 

 

Source: Concept from Ghada Khawand Ayle¹³

 

CONCLUSION:

As Nurses manages people, material, task and funds in the day to day activities, she/ he must be empowered completely in order to take wise decisions and smooth functioning of the health care delivery system. The empowered nurse gains autonomy and takes ownership of the happenings. Nursing empowerment also contributes for job satisfaction, productivity and higher standards of patient care.

 

REFERENCES:

1.       Patricia SYW. Leading and Managing in Nursing.6^th ed. Elsevier; 2015. Page no 167-183.

2.       Donna MN. Encouragement and Empowerment: Unlocking the Keys to Excellence. MEDSURG Nursing Academy of Medical-Surgical Nurses (AMSN). 17(6); 2008: 374, 390. www.medsurgnursing.net

3.       www.ahfonline.net/Empowering

4.       www.encyclopedia.com

5.       Barbara SB, Karlene MK. The Nurse as Executive. 4th ed. Aspen publication; 1995. Page no 113-118.

6.       http://www.fpm.anzca.edu.au/

7.       Mohanta GC. Participation and Empowerment: PPT. 2016.

8.       Rita J, Charlotte D. Are you empowered?. Nursing Made Incredibly Easy. 2013. http://www.NursingMadeIncrediblyEasy.com

9.       Diane K, Whitehead, Sally A, Weiss, Ruth M, Tappen. Essentials of nursing leadership and Management. 5^th ed. F.A. Davis Company Philadelphia; 2009. Page no 65-71.

10.     Debra AD, Laurie EF, Allison L, Lori M. The Role of Nurses in Hospital Quality Improvement. Centre for studying health system change HSC - Research Brief. 2008.

11.     Heather K, Spence LCA, Wong, Greta G, Cummings AL,Grau. Resonant Leadership and Workplace Empowerment: The Value of Positive Organizational Cultures in Reducing Workplace Incivility. Nursing economics. 32(1); 2014:5-15, 44.

12.     Latha Venkatesan. Concept of Nursing Empowerment: https://www.youtube.com/2015.

13.   Ghada Khawand Ayle. Empowering nursing role in decision-making: Medhealth. 2011.

 

 

 

Received on 24.05.2016           Modified on 07.07.2016

Accepted on 20.08.2016           © A&V Publication all right reserved