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Background Research into the structural empowerment of nurse leaders (matrons, sisters / charge nurses, senior staff nurses) in middle management positions is of importance, as it is they who set an example to their teams and attempt to overcome barriers and maximise facilitators to high quality care and patient safety. A theoretical framework developed by Kanter (1977, 1993) established that opportunity, power and proportion are key determinants of structural empowerment in organisations. Few quantitative studies conducted in acute healthcare settings have investigated empowerment in nurse leaders and none have explored potential differences between unit leaders (matrons, sisters / charge nurses) and senior staff nurses. Qualitative exploration of the nature of empowerment is these groups is also lacking. Method The aim of this study was to investigate the level and nature of nurse leader empowerment in a large NHS Foundation Trust. A mixed methods design was implemented in four phases conducted over a 3 year period. In phase 1 the Conditions of Work Effectiveness Questionnaire II (CWEQII) was distributed to the total population (n=517) of nurse leaders achieving a response rate of 44.1% (n=228), of whom 35.9% (n=102) were senior staff nurses and 54.1% (n=126) unit leaders. In phases 2 and 3 semi-structured interviews were conducted with senior nurse managers (n=16) and a purposive sample of nurse leaders (n=21) who had completed the CWEQII. In phase 4, a documentary analysis was completed to support the identification and contextualisation of the organisational culture of the Trust. Quantitative data was entered into SPSS and analysed using descriptive and inferential statistics; qualitative data was analysed thematically. Results Across the study population a mean total empowerment score of 20.32 (SD 3.23) indicated a moderately high level of empowerment. No significant differences were found between senior staff nurses and unit leaders for total or global empowerment scores. Significant differences between groups were identified for information scores and those for selected components of informal power and support. Groups did not differ significantly on the sub-scores and components of opportunity, formal power and global empowerment. Qualitative analysis identified four core themes and eleven sub-themes relating to the nature of nurse leader empowerment. Nurture and advocacy were vital aspects of support and development in empowering junior colleagues. Use of the term influence was preferred to that of power. Disempowering aspects of organisational culture included hierarchies, tight control and outcome drivers created by the pressure to maintain status, achieve targets and risk aversion. Positive, empowering aspects of culture were related to leadership behaviours; role modelling, credibility, collaborative team working and communication, beneficence and respect for opinions, passion, motivation and enthusiasm. Conclusions Study findings have extended current knowledge on the level and nature of nurse leader empowerment and confirm that this is a complex, multi-faceted concept. In the single organisational setting of a high performing NHS Foundation Trust, integrated findings demonstrated the influence and inter-relationships of role responsibilities and hierarchical position, organisational constraints and cultural factors on organisational structural empowerment. Findings have contributed to further development of Kanter’s theoretical framework and have identified areas for further research, professional practice and service. |
