Staff motivation and adequate nurse-patient ratio are the fundamental aspects of nursing care delivery. Many researchers have come to the conclusion that several nurses quit their jobs due to burnout and lack of autonomy. Similarly, nurses feel fatigued when they are obliged to work for long hours without the adequate amount of rest. Consequently, they are likely to make errors in judgment when caring for clients. This paper examines two case scenarios about nurse autonomy, one about powerlessness, and another one about the importance of the shared governance model in policymaking.
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First Case Scenario
In the case of Nancy, a nurse manager in an emergency room department, there is a poor morale and a high turnover rate among nurses. Nurses say that they are quitting their jobs because they feel powerless. Tummers and Den Dulk (2013) define powerlessness as a situation where employees feel that they do not have control over what is happening in the workplace. Therefore, the department might be denying nurses of a chance to feel in control of their situation.
Three issues might be contributing to powerlessness among the nurses in the unit. The first one is the prevention of nurses from actively participating in delivering care to the emergency patients. Ajeigbe, McNeese-Smith, Leach, and Phillips (2013) contend that a healthy relationship among physicians and nurses in the emergency department contributes to autonomy among the staff. In this case, physicians might have a feeling of total control over the situation in the department, which, consequently, might lead to the feeling of powerlessness among nurses. The second factor that might be contributing to feelings of powerlessness is maximum supervision of the nurses. Mohite, Shinde, and Gulavani (2014) argue that close supervision in nursing care denies nurses of the autonomy and contributes to job dissatisfaction. Nancy, as a manager, may have created a habit of closely monitoring the activities of nurses in the department, which denies them of the freedom and, thus, results in powerlessness. The last factor is the low nurse-patient ratio, which is an important topic for discussion worldwide because nurse shortage is being experienced globally (World Health Organization [WHO], 2016). When there are not enough nurses in the workplace, they experience burnout (Cimiotti, Aiken, Sloane, & Wu, 2012). In such instances, the fatigued nurses might feel they do not have enough control over nursing staffing and, thus, they feel powerless.
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The sources of power that apply to this case include legitimate power, expert power and coercive power. Bertram Raven and his colleagues view legitimate power as a positional power, where the leader can inculcate a sense of responsibility and compulsion to another person (as cited in Mushtaq, Hamad, Anosh, & Iqbal, 2014). In this case, Nancy might be closely monitoring the nurses and holding them responsible for many issues that happen in the emergency department. The second source of power is expert power, which manifests wisdom, understanding, and absolute awareness of the real situation (Mushtaq et al., 2014). In this case, doctors are required to be collaborating efficiently with nurses in the emergency department. However, doctors might be prioritizing their decisions, ideas, and opinions, leading to the lack of autonomy among nurses and, thus, making them feel powerless. The last source of power is coercive power, where employees have to expect punishment for failure to conform to the given standards (Mushtaq et al., 2014). In this case, nurses might be working hard every day to meet the deadlines with the aim of avoiding punishment. This action might lead to burnout and lack of control over their nursing procedures and lead to the feeling that nurses have no power or authority.
Therefore, Nancy can help nurses to avoid feeling powerless in three ways. First, Nancy can contribute to improving collaboration and healthy working relationships in the emergency department. Ajeigbe et al. (2013) argue that healthy working relationships in the healthcare settings significantly contribute to autonomy and job satisfaction. The nursing staff will not feel powerless if the working environment if friendly and there is appreciation among workers. The second solution is to give nurses a chance to make independent decisions without absolute supervision. Nancy can implement this aspect by the delegation of some leadership roles, which can help the nurses feel in control of their actions, thereby reducing their powerlessness. Lastly, Nancy can schedule the frequent meetings with the nurses to discuss some of their personal attributes that might be leading to dissatisfaction with the emergency department. Then, Nancy can assign the nurses tasks, based on their competence and individual qualities, which can help nurses feel contented to work in the department and, thus, result in reduced powerlessness.
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Second Case Scenario
The second case scenario is a nurse working in a magnet facility, which has embraced the shared governance model. The nurse is attending the meeting to represent the unit on one of the policy-making councils. Consequently, the nurse needs to collect some information regarding returning to 8-hour shift due to its contribution to patient satisfaction.
The nurse needs to gather three different opinions from the staff. First, the nurse has collect information regarding the current working shifts in the facility. The views of the nursing staff about the current shifts can give the nurse a clue on whether the nursing staff is contented with the system or if it is in the need of change to another approach to working shifts. Secondly, the nurse has to get the views and attitude of nurses regarding the 8-hour shift. This information is essential, since the nurse can get an idea of the way nurses perceive the 8-hour shift. Lastly, the nurse can inquire from the staff about their willingness to change to the 8-hour shift. Considerably, to implement any changes in the healthcare setting, the nursing staff needs to be prepared because any changes can cause fear of failure and anxiety among the nursing staff, if not communicated in the appropriate manner (Sutherland, 2013). Therefore, the nurse can comprehend the attitude of the staff about their readiness to change and tell them of the expected outcomes of the council meeting. The second and the last information can also help the nurse to know the experience of the nursing staff with the 8-hour shift and any new propositions.
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The nurse can then inquire from other professionals who collaborate with nurses, such as physicians and pharmacists, about their views on the 8-hour shift among nurses. This information will be relevant, since they might have observed the trend and might be having valuable information on the discussed issue. Then the nurse can ask patients who have been hospitalized for a long time regarding their attitudes on the current shift and the 8-hour shift among nurses. This first-hand information from patients can help nurses to make significant contributions during the presentation of views in the council.
The shared governance model is important because it bridges the gap between the nursing leadership and the staff. Santos et al. (2013) contend that an effective relationship between nurse leaders and nursing staff ensures quality care and guarantees appropriate conduct in the healthcare environment. Therefore, the nurse can employ evidence-based practice in communicating this essential information to fellow nurses in understanding the role of shared governance. Most importantly, the nurse can tell them that collaborating with their leaders in every aspect is necessary, since the leaders have a significant influence in coming up with medical policies.
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Powerlessness is one of the reasons why nurses leave their jobs. Nurses can experience powerlessness due to lack of control over their work and limited decision making in the healthcare environment. Therefore, nurse managers must learn to give nurses autonomy and improve collaborations with allied health professionals, such as physicians to reduce powerlessness. Additionally, the inclusion of nurses in coming up with policies is necessary, considering that the policies affect nurses. Consequently, nurses need to cooperate with their leaders in the implementation of the shared governance model to come up with suggestions about policies that would not infringe on their freedom in decision-making in the healthcare facilities.