Piazza, Irene M. DNP, RN, OCN, AOCNS; Donahue, Moreen DNP, RN, CNA, BC; Dykes, Patricia C. DNSc, RN; Griffin, Mary Quinn PhD, RN; Fitzpatrick, Joyce J. PhD, RN, FAAN
The need to create a work environment that empowers nurses is an important issue in healthcare. This study was built on Kanter's theory of empowerment.1 According to Kanter, power is the ability to get things done and is derived primarily from structural conditions in the organization. These structural conditions are access to opportunity, resources, information, and support. Access to opportunity includes job mobility and growth, whereas access to resources refers to the supplies, time, and equipment needed to complete the work. Access to support from superiors and peers is important as well as access to the information required to function effectively.1
Kanter's theory encompasses formal and informal power structures. Formal power is found in jobs with high relevance, visibility, and flexibility, whereas informal power is derived from social connections inside and outside the organization. Individuals with high degrees of formal and informal power have increased access to job-related power and opportunity structures in the organization. Degree of access to these empowerment structures increases the employees' level of self-efficacy, motivation, commitment, and ultimately, work effectiveness.2 The components of Kanter's model are diagrammed in Figure 1.2
Kanter's theory of empowerment includes access to opportunity structures that enable employee mobility and growth fostered by such factors as enhancement of skills, movement into new situations, and continuing challenge with recognition.1 Attainment of certification provides such opportunity. Certification also correlates with Kanter's view of formal empowerment. Attainment of certification denotes achievement and success and results in the recognition of the nurse in the organization. Certification can also increase a nurse's informal power on the nursing unit as it indicates knowledge and expertise in the specialty. There has been no previous study of the relationship between national certification and nurses' perceptions of empowerment.
Chandler3 was the first nurse researcher to use Kanter's theory to explore the nature of nursing work environments related to perceptions of empowerment and powerlessness in staff nurses. The Conditions of Work Effectiveness Questionnaire designed by Kanter and modified by Chandler was used to study 246 nurse administrators, nurse managers, and staff nurses. Staff nurses reported low perceptions of empowerment with support, opportunity, and information identified as important environmental factors for work effectiveness. Sarmiento et al4 examined the relationship of nurses' perceptions of empowerment, burnout, and job satisfaction in 85 college nurse educators working in community colleges in Canada. Higher levels of perceived empowerment were associated with lower levels of burnout and greater job satisfaction.
Laschinger et al5 examined Kanter's empowerment theory, Magnet hospital characteristics, and job satisfaction in 3 nursing populations in Canada. There was a strong relationship between perceptions of empowerment, Magnet characteristics, and job satisfaction. Almost and Laschinger6 examined the relationship between nurse practitioners' perceptions of empowerment, collaboration with physicians and nurse managers, and job strain. The nurse practitioners reported moderate levels of perceived empowerment. They indicated that their collaboration with physicians and managers was also moderate and that they had low levels of job strain.
Cary7 surveyed 19,452 nurses from the registries of 23 certifying organizations in the United States, Canada, and US territories. She found that the benefits of certification included personal growth, recognition, career advancement, and financial rewards. These nurses reported that certification provided autonomy and enhanced collaboration, as well as allowing them to assert control over their work. Gaberson et al8 conducted a study to determine the perceived value of certification in perioperative nurses. Results showed that the certified nurses' perceived value of certification was found in 3 areas: personal value, recognition by others, and professional credibility.
Byrne et al9 studied perioperative nurses perceived value of certification and barriers to obtaining certification. The results showed that certification was valued by all 3 groups regardless of certification status. Certification was related to a sense of accomplishment and satisfaction. Nurses felt that certification enhanced professional credibility and marketability. Coleman et al10 explored opinions about certification, preparatory strategies, and motivation for obtaining oncology nursing certification. They reported that the 3 reasons for certification were personal reasons, recognition, and career development.
Redd and Alexander11 studied job performance and self-esteem levels of certified and noncertified staff nurses among 83 staff nurses from 2 acute care hospitals. Results of the supervisor's rating of staff performance showed no significant difference between the performance scores of certified and noncertified nurses. The supervisors did score the certified nurses higher in performance scores for planning/evaluation and teaching/collaboration. Certified nurses were also found to have higher self-esteem. Personal achievement and professional growth were the most frequently reported reasons for seeking certification.
Manojlovich12 included specialty certification as a control variable in her study, exploring the relationship of Kanter's concept of empowerment and self-efficacy. However, the author did not explore the relationship between nurses' perceptions of empowerment and certification status.
The research questions for this study were as follows:
1. What is the level of perceived empowerment among registered nurses employed at the study hospital?
2. Is there a difference in perceptions of empowerment between registered nurses who are nationally certified and those who are not?
This study was conducted at a 174-bed acute care, community hospital located in Connecticut. All active status registered nurses including staff nurses, advanced practice nurses, and nursing administrators were included in this study. At the time of this study, there were 457 active status registered nurses at the study hospital.
The Conditions of Work Effectiveness Questionnaire developed by Kanter and revised by Laschinger et al13 was used in this study. The Conditions of Work Effectiveness II Questionnaire (CWEQ-II) consists of 6 subscales. The first 4 scales contain 3 questions each for a total of 12 questions that refer to Kanter's 4 empowerment structures. The Job Activities Scale II (JAS-II) consists of 3 items to measure formal power, and the Organizational Relationship Scale (ORS-II) uses 4 items to measure informal power. A 2-item Global Empowerment Subscale is used for construct reliability and is not included in the total empowerment score. Each scale has a Likert scale with a range of 1 to 5, where 1 = none and 5 = a lot. Items are then summed and averaged to obtain subscale scores ranging from 1 to 5. The total empowerment score is obtained by summing the subscales for a range of 6 to 30. Higher scores indicate higher perception of access to the particular subset of empowerment. The CWEQ-II has high correlations with the global measure of empowerment (r = 0.56) providing evidence of construct validity. Cronbach coefficient α was used to test the CWEQ-II scales for reliability. The total CWEQ-II α was .778, indicating that this was a reliable instrument. Certification information was obtained through the demographic portion of the nursing questionnaire.
Upon approval by an institutional review board, a computerized list of all active status registered nurses at the study hospital was obtained. The CWEQ-II and cover letter were attached to the paychecks of eligible nurses. Participants completed the surveys anonymously and at a time and place convenient to them. Questionnaires could be returned to any of the confidential envelopes in the hospital or via interoffice mail to the nursing department secretary.
A total of 265 questionnaires were returned, for an overall return rate of 58%. Six questionnaires with greater than 10% missing data were excluded. A total of 259 questionnaires were included in the final sample. Data were entered into the Statistical Package for the Social Sciences (2003) software program.
The nurse empowerment study sample comprised 252 women (97.3%) and 7 men (2.7%). The mean age of the nurses was 44.05 years with a range of 23 to 77 years. Most respondents reported working in staff positions (72.2%) followed by administration (12%) and advanced practice (3.5%). Bachelor's degree was the highest degree earned by 52% of the respondents and 69% worked the day shift. National certification had been achieved by 103 nurses that represented 39.9% of the sample. Registered nurse (certified) was reported as the certification for 34 (33%) of the nurses, and Certification in Critical Care Nursing (CCRN) by AACN Certification Corporation and Certification in Operative Nursing (CNOR) by Competency and Credentialing Institute (CCI) each had 11 nurses with that certification. Two of the certified nurses in the sample did not indicate the certification body.
Research Question 1: What is the Level of Perceived Empowerment Among Registered Nurses Employed at the Study Hospital?
Registered nurses at the study hospital perceived themselves to be moderately empowered. According to Laschinger, CWEQ-II scores ranging from 14 to 22 indicate moderate levels of empowerment with a score of 23 to 30 representing high levels of empowerment.14 The CWEQ-II total empowerment score was 21.28 out of a maximum score of 30. The total mean score was 3.55 (see Table 1 for descriptive statistics related to the total nurse empowerment scores). Nurse empowerment scale data were analyzed for normal distribution and met this requirement.
Nurse empowerment scores by position indicate that administrators were highly empowered with advanced practice nurses and staff nurses indicating moderate empowerment (see Table 2 for further additional empowerment scores by position). None of the respondents in this sample indicated their perception of empowerment to be low.
Research Question 2: Is There a Difference in Perceptions of Empowerment Between Registered Nurses Who Are Nationally Certified and Those Who Are Not?
An independent-sample t test was conducted to compare the perceptions of empowerment scores for nationally certified nurses and nurses who were not certified. Because 5 of the 259 nurses in this study did not answer the certification question on the demographic questionnaire, they were excluded from this analysis. The total sample size was 254 for certification status. The mean scores of certified and noncertified nurses for the CWEQ-II were compared using an independent-sample t test. Significant differences were noted in empowerment scores for certified (M = 3.68, SD = 0.7) and noncertified nurses (M = 3.45, SD = 0.74) as measured by the CWEQ-II (t = −2.45, P < .008).
An analysis of variance was used for additional analysis using the empowerment subscales. Certified nurses had higher perceptions of formal power than noncertified nurses (P < .038), with total JAS-II means of 3.49 and 3.24, respectively. The ORS-II mean scores indicated significantly higher perceptions of informal power (P < .000) in the certified nurses (mean of 3.91) than in the noncertified nurses (mean of 3.53). The certified nurses also indicated higher perceptions of access to information (P < .010) than noncertified nurses. Post hoc tests were not done on the empowerment subscales because only 2 empowerment groups were found in this sample. The nurses' scores were grouped into moderately or highly empowered categories. None of the nurses perceived their perception of empowerment to be in the low range. Analysis of variance scores are depicted in Table 3.
The findings of this study support the work of Laschinger and others who have studied nurse empowerment. This study was the first to explore the relationship between nurses' perceptions of empowerment and national certification. The American Nurses Credentialing Nursing Center views certification as a means of encouraging and recognizing achievement in nursing.15 Certification validates nursing knowledge in a specialty and enhances the nursing profession. Based on the results of this study, there is a significant difference in nurses' perceptions of empowerment among nurses who are certified versus those who are.
This study results supported the hypothesis that nurses with national certification have higher perceptions of empowerment than nurses who were not certified. The total CWEQ-II score for the certified nurses was 22.08 (P < .008; 1-tailed). Certified nurses also indicated higher perceptions of formal and informal power. Certified nurses perceived greater access to information than the nurses who were not certified (P < .010). Access to information was the only structural component in Kanter's theory that indicated significance. The high significance of informal power and the significance of formal power and access to information support the theory that obtainment of certification benefits nurses.
The study has several limitations. The results of the study are limited in its generalizability because of the convenient sample used in one community hospital in Connecticut. The study was also limited by the fact that the nurses were moderately and highly empowered with no scores in the low empowerment range. The use of a self-report for obtainment of certification status may also have been a study limitation.
The results of the study are consistent with Kanter's view of perceptions of empowerment. This study is the first to validate the importance of certification. Previous studies on certification focused on motivation for obtaining and personal values of certification. No prior study demonstrated tangible differences between certified and noncertified nurses. Replication of this study with a larger sample and in a variety of settings needs to be done. Because of the limited sample size, this study was unable to examine total empowerment scores by specialty unit and certification status. The results of this study may be used in future research to explore empowerment with different certification bodies. Empowerment and certification should also be studied with other variables such as patient outcomes and patient satisfaction.
Implications for Nursing
The results of this study suggest a positive benefit of certification in terms of nurses' perceptions of empowerment. The results support the American Nurses Credentialing Center's position that certification validates knowledge, builds confidence, and demonstrates competency.15 Results indicating that formal and informal power scores are higher in certified nurses also support the value of certification. The Cary study,7 which reported that certification provided autonomy and enhanced collaboration, may be demonstrated in the high significance of informal power and certification. Results of this study support the need for nurses to obtain certification in their specialty. Certified nurses had higher perceptions of empowerment with greater access to information. Informal power was significantly higher in certified nurses which supports attainment of certification. Nurses in previous studies reported that certification enhanced professional credibility and self-esteem, which can be demonstrated in the relationships seen with informal power.
The results of this study have important implications for nurse executives searching for ways to improve nursing turnover and retention rates. Nurses who are empowered to do their job and who are recognized for their expertise may be more likely to remain in the organization. Certification provides one avenue for this recognition. Certified nurses who participated in this study indicated higher levels of formal power and significantly higher perceptions of informal power. Nurse executes need to provide opportunities for nurses to increase formal power through recognition and informal power through connection inside and outside the organization. Encouraging and financially supporting nurses to obtain national certification may be one such opportunity.
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© 2006 Lippincott Williams & Wilkins, Inc.