Nurse unit manager’s translation of structural empowerment in daily practice on the unit

Abstract

Background: Nurses play an important role in quality of patient care and therefore, structural empowerment (SE) was introduced in nursing practice. SE consists of access to information, resources and support, the opportunity to learn and grow and (in)formal power and leads to better patient outcomes. Nurse unit managers can have a positive influence on conditions at nursing units when they focus on SE. Little is known about managers thoughts and ideas about nurses’ SE and how they experience their role in supporting the nursing staff. Objective: To describe the nurse unit managers’ perception and experience regarding structural empowerment of frontline nurses in hospitals. Method: This qualitative descriptive study was performed in three teaching hospitals, with a purposive sample of 15 nurse unit managers, positioned between the nursing staff and higher management. Data was collected from January until April 2018 through semi-structured interviews. All interviews were audiotaped, transcribed and analysed with thematic analysis. Results: Three subthemes were identified ‘from managing to leadership on operational level’, ‘nurses‘ current position and influence’ and ‘tomorrow’s challenges’. This provided insight into the opportunities and challenges participants experienced in daily practice, supporting their team to more empowerment. This could be captured in an overall theme leadership on the way; development was seen from managing the team to become a nursing leader. Conclusion and recommendation: Unit managers were not familiar with term SE, but they described empowering elements in their managerial role, like coaching, encouraging nurses to learn and grow, implementing skill level differentiation and having a Nursing Council in the hospital. However, managers were struggling with high turnover, lack of resources on the unit and developing their personal skills. In the future it’s important to invest in empowerment of unit managers because this will lead to empowered nurses and eventually to better patient outcomes.