Case Discussion: Power and Leadership

Case Discussion: Power and Leadership

Case Discussion: Power and Leadership

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Power Defined Power is the potential ability to influence others (Hersey, 2011). Power is involved in every human encounter, whether you recognize it or not. Power can be symmetrical when two parties have equal and reciprocal power, or it may be asymmetrical with one person or group having more control than another (Mason, Leavitt, & Chaffee, 2011). Power can be exclusive to one party or may be shared among many people or groups. To acquire power, maintain it effectively, and use it skillfully, nurses must be aware of the sources and types of power that they will use to influence and transform patient care.

Power and Leadership Real power—principle-centered power—is based on honor, respect, loyalty, and commitment. Principle-centered power is a model congruent with nursing’s values. It is based on respect, honor, loyalty, and commitment. Originally conceived by Stephen Covey (1991), the model is increasingly used by leaders in many fields (Ikeda, 2009). Power sharing evolves naturally when power is centered on one’s values and principles. In fact, the notion that power is something to be shared seems to contradict the usual belief that power is something to be amassed, protected, and used for one’s own purposes.

Leadership power comes from the ability to sustain proactive influence, because followers trust and respect the leader to do the right thing for the right reason. As leaders in health care, nurses must understand and select behaviors that activate principle-centered leadership:

● Get to know people. Understanding what other people want is not always simple. ● Be open. Keep others informed. Trust, honor, and respect spread just as equally as fear,

suspicion, and deceit. ● Know your values and visions. The power to define your goals is the power to choose. ● Sharpen your interpersonal competence. Actively listen to others and learn to express your

ideas well. ● Use your power to enable others. Be attentive to the dynamics of power and pay attention

to ground rules, such as encouraging dissenting voices and respecting disagreement. ● Enlarge your sphere of influence and connectedness. Power sometimes grows out of

someone else’s need.

Case Discussion: Power and Leadership

Power: How Managers and Leaders Get Things Done Classically, managers relied on authority to rouse employees to perform tasks and accomplish goals. In contemporary health care organizations, managers use persuasion, enticement, and inspiration to mobilize the energy and talent of a work group and to overcome resistance to change.

A leader’s use of power alters attitudes and behavior by addressing individual needs and motivations. There are seven generally accepted types of interpersonal power used in organizations to influence others (Hersey, 2011):

1. Reward power is based on the inducements the manager can offer group members in exchange for cooperation and contributions that advance the manager’s objectives. The degree of compliance depends on how much the follower values the expected benefits. For example, a nurse manager may grant paid educational leave as a way of rewarding a staff nurse who agreed to work overtime. Reward power often is used in relation to a manager’s formal job responsibilities.

2. Coercive power is based on the penalties a manager might impose on an individual or a group. Motivation to comply is based on fear of punishment (coercive power) or withholding of rewards. For example, the nurse manager might make undesirable job assignments, mete out

88 PART 1 • LEARNING KEY SKILLS IN NURSING MANAGEMENT

a formal reprimand, or recommend termination for a nurse who engages in disruptive behavior. Coercion is used in relation to a manager’s perceived authority to determine employment status.

3. Legitimate power stems from the manager’s right to make a request because of the author- ity associated with job and rank in an organizational hierarchy. Followers comply because they accept a manager’s prerogative to impose requirements, sanctions, and rewards in keeping with the organization’s mission and aims. For instance, staff nurses will com- ply with a nurse manager’s directive to take time off without pay when the workload has dropped below projected levels because they know that the manager is charged with main- taining unit expenses within budget limitations.

4. Expert power is based on possession of unique skills, knowledge, and competence. Nurse man- agers, by virtue of experience and advanced education, are often the best qualified to determine what to do in a given situation. Employees are motivated to comply because they respect the manager’s expertise. Expert power relates to the development of personal abilities through edu- cation and experience. Newly graduated nurses might ask the nurse manager for advice in learn- ing clinical procedures or how to resolve conflicts with coworkers or other health professionals.

5. Referent power is based on admiration and respect for an individual. Followers comply because they like and identify with the manager. Referent power relates to the manager’s likeability and success. For example, a new graduate might ask the advice of a more expe- rienced and admired nurse about career planning.

6. Information power is based on access to valued data. Followers comply because they want the information for their own needs. Information power depends on a manager’s or- ganizational position, connections, and communication skills. For example, the nurse man- ager is frequently privy to information about pending organizational changes that affect employees’ work situations. A nurse manager may exercise information power by sharing significant information at staff meetings, thereby improving attendance.

7. Connection power is based on an individual’s formal and informal links to influential or prestigious persons within and outside an area or organization. Followers comply because they want to be linked to influential individuals. Connection power also relates to the status and visibility of the individual as well. If, for example, a nurse manager is a neighbor of an organization’s board member, followers may believe that connection will protect or ad- vance their work situation.

Managers have both personal and position power. Position power is determined by the job description, assigned responsibilities, recognition, advancement, authority, the ability to with- hold money, and decision making. Legitimate, coercive, and reward power are positional because they relate to the “right” to influence others based on rank or role. The extent to which managers mete out rewards and punishment is usually dictated by organizational policy. Information and legitimate power are directly related to the manager’s role in the organizational structure.

Expert, referent, information, and connection power are based, for the most part, on personal traits. Personal power refers to one’s credibility, reputation, expertise, experience, control of resources or information, and ability to build trust. The extent to which one may exercise expert, referent, information, and connection power relates to personal skills and positive interpersonal relationships as well as employees’ needs and motivations. Box 7-1 illustrates how nurses can learn to use power in organizations.

Using Power Despite an increase in pride and self-esteem that comes with using power and influence, some nurses still consider power unattractive. Power grabbing, which has been the tradition- ally accepted means of relating to power for one’s own self-interests and use, is how nurses

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often think of power. Rather, nurses tend to be more comfortable with power sharing and empowerment: power “with” rather than power “over” others.

Image as Power A major source of power for nurses is an image of power. Even if one does not have actual power from other sources, the perception by others that one is powerful bestows a degree of power. The same is true for the profession as a whole. If the public sees the profession of nursing as powerful, the profession’s ability to achieve its goals and agendas is enhanced.

Images emerge from interactions and communications with others. If nurses present themselves as caring and compassionate experts in health care through their interactions and communications with the public, then a strong, favorable image develops for both the individual nurse and the profession. Nurses, as the ambassadors of care, must understand the importance and benefits of positive therapeutic communications and image. Developing a positive image of power is important for both the individual and the profession.

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