Perception of work-related empowerment of nurse managers

Abstract

Purpose/Aim

The paper aims to analyse the perception of being empowered according to the self-evaluation of nurse managers, presenting it as structural and psychological empowerment.

Methods

A questionnaire-based study was conducted. The sample consisted of 193 nurse managers working in a total of seven university and general level hospitals in Lithuania. The Conditions of Work Effectiveness Questionnaire-II measuring structural empowerment and the Work Empowerment Questionnaire measuring psychological empowerment were used.

Results

The paper reveals that nurse managers experienced structural empowerment at a moderate level and were highly psychologically empowered.

Conclusions

These findings are in line with previous research. The results showed that particular background factors were related to aspects of empowerment. The findings of this research can be used to examine the structural and psychological aspects that function as barriers to feeling empowered. The results are also useful for chief nurses who are involved in the recruitment and retention of nurse managers. Further research is needed to look into the question of improving formal power issues, e.g. the rewards for innovation at work, and also outcome empowerment aspects that may affect changes in the way that nurse managers carry out their work.

Keywords

empowerment hospital management Lithuania nurse manager nursing

Introduction

Today’s health care system faces many challenges, including organisational change and limited resources. Increased requirements and higher patient expectations have an impact on health care delivery standards, nurse competencies and the working environment (Ahmad and Oranye, 2010; Davies et al., 2011; Royer, 2011). It should be noted that leadership is a crucial component in creating empowering conditions in the workplace that serve to attract and retain employees in the organisation. Furthermore, this results in empowered, engaged and committed managers who practise in accordance with professional standards (Laschinger et al., 2009). Within the pursuit of quality care provision, empowerment is an important issue due to its influence on health care specialists and the solutions that are implemented to achieve positive organisational and patient outcomes (Casey et al., 2010; Smith et al., 2012).

The concept of nurse manager (nurse administrator, head nurse of unit) in the hospital context varies in different countries. Each employer defines the responsibilities, competencies, functions and requirements for the working content of a nurse manager role, but the main responsibility is to organise nursing care within the unit.

In this study, the term ‘nurse manager’ encompasses the activities and functions of the job title that are seen to be understood both nationally and internationally. In a European context, there is no statistical information on how many nurses work as nurse managers in health care organisations. However, they face many challenges, and have to meet the demands and responsibilities of their role, so it is of utmost importance to investigate how this particular group of nursing professionals manages this situation.

Concept of empowerment

The concept of empowerment is subject to different views and approaches. Difficulties in defining the concept arise due to differences in situation and time; however, researchers have successfully managed to adopt it from the social and psychological literature, and apply it to the field of nursing (Cai et al., 2011). Despite numerous studies of empowerment, nurse manager empowerment has mostly been investigated from the perspectives of structural and psychological empowerment (e.g. Bish et al., 2014; Laschinger et al., 2007; Patrick and Laschinger, 2006; Regan and Rodriguez, 2011; Suominen et al., 2005).

Structural empowerment

Kanter’s (1993) well-known theory of empowerment is used to form the ground for the domain of structural empowerment. According to Kanter (1993), there are certain factors of the organisation that describe empowerment, and these include access to information, access to support, access to resources and opportunities for mobility and growth. When combined, these factors define the concept of feeling empowered. Additionally, the influences of formal and informal power facilitate access to these empowerment structures, and the results of previous studies have tended to find that nurse managers feel only moderately empowered (Bish et al., 2014; Casey et al., 2010; Laschinger et al., 2007, 2009, 2011a, 2011b; Patrick and Laschinger, 2006; Regan and Rodriguez, 2011; Wagner et al., 2010).

Psychological empowerment

Psychological empowerment is one of the important aspects of workplace empowerment (Wagner et al., 2010). A few studies (Irvine et al., 1999; MacPhee et al., 2012) refer to the earlier work of Bandura (1997) stating that psychological empowerment is a process of gaining and having the experience of self-confidence and an ability to act successfully. Empowering work conditions also enhance the feelings of self-esteem and self-efficacy. Therefore empowerment can be understood as three dimensions that are related to each other, and which can be expressed in terms of verbal, behavioural and outcome empowerment (Irvine et al., 1999). According to previous research (Suominen et al., 2005), nurse managers perceived high levels of psychological empowerment.

Structural and psychological empowerment in relation to background factors

Several studies (e.g. Casey et al., 2010; Laschinger et al., 2009) have found interrelations between structural and psychological empowerment in nursing. Laschinger et al. (2007) also suggested that higher levels of psychological empowerment were predicted by higher levels of structural empowerment.

It should be noted that several researchers (Cai et al., 2011; Davies et al., 2011; Hauck et al., 2011; Laschinger et al., 2007, 2009, 2011a, 2011b; Leggat et al., 2010; Wagner et al., 2010; Wahlin et al., 2010) have indicated that structural empowerment and psychological empowerment have relationships with organisational and nursing issues, as well as with patient outcomes. However, a key problem with much of the literature regarding empowerment is that nurse managers’ background factors have not tended to be investigated in relation to their perceptions of empowerment.

Based on the earlier literature and the results of previous studies (e.g. Bish et al., 2014; Laschinger et al., 2009; Regan and Rodriguez, 2011; Suominen et al., 2005), several research questions were determined for this research:

How structurally empowered are nurse managers?

How psychologically empowered do nurse managers feel?

What background factors are connected to empowerment?

Methods

A systematic review by Trus et al. (2012) undertaken before this study revealed that the most common method used to collect data about nurse manager empowerment was by way of questionnaire. A range of valid and reliable instruments were found, and therefore this approach was adopted to examine Lithuanian nurse managers’ work-related empowerment. The target group consisted of nurse managers working in a total of seven university and general level hospitals in Lithuania. The number of beds in each hospital varied from between 700 and 1500, depending on the hospital type.

The structure of the health care system in Lithuania is based on general principles that are common to most European countries. The supervision of the health care system is undertaken by the Ministry of Health (Murauskiene et al., 2013). Health care services are provided to the majority of the population, and are financed by the National Health Insurance Fund that is based on compulsory insurance contributions together with transfers from the State budget. Most of the Lithuanian health care organisations are non-profit (European Commission and Economic Policy Committee, 2016; Meižis, 2013).

University and general level hospitals are state-funded and were chosen due to the high level of specialised multi-profile services they provide. The care provided in these hospitals is evidence-based, and the hospitals implement continuing education programmes and conduct scientific research. In general, Lithuanian healthcare is seen to be comprehensive and of a high quality (Murauskiene et al., 2013), and the hospitals included in this study have out-patient consultations, a wide range of treatment paths and diagnostic facilities, and nursing and rehabilitation services that are provided by highly qualified healthcare professionals.

Questionnaire

The data were collected using a questionnaire that consisted of two parts: background questions and questions measuring a manager’s empowerment. The background questions used were both demographic (e.g. age, family status, education, language spoken) and work-related (e.g. unit, experience, workload, motivation for doing the work, stress at work, satisfaction with the work, skills for handling the work).

The nurse managers’ work-related empowerment was measured using the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II: Laschinger et al., 2001) for structural empowerment, and the Work Empowerment Questionnaire (Irvine et al., 1999) for psychological empowerment. The CWEQ-II questionnaire consisted of 19 items that measured six components of structural empowerment: access to opportunity, information, support, resources, formal and informal power. A Likert scale ranging from 1 to 5 provided a score for each item.

The Work Empowerment Questionnaire (Irvine et al., 1999) consisted of 22 items that were divided into three areas: verbal, behavioural and outcome empowerment. Nurse managers were asked to enter a number from 0 (not at all confident) to 10 (fully confident) to indicate their confidence in their ability to successfully perform each activity being examined.

Permission to use the questionnaires was obtained from the respective instrument developers. The CWEQ-II (Laschinger et al., 2001) and the Work Empowerment Questionnaire (Irvine et al., 1999) both originate from Canada. English and Lithuanian language professionals translated the instruments using the translation/back-translation technique (Burns and Grove, 2009).

A pilot study was conducted; the Cronbach’s alpha values of the piloted questionnaire were 0.7 for the CWEQ-II and 0.9 for the Work Empowerment Questionnaire. Only minor linguistic changes were made. The data from the pilot study were not included in the main study.

Ethical approval

Ethical approval for the research was received from the Ethics Committee of the Klaipeda University in Lithuania. The copyright holders gave their permission to use the respective questionnaires. Permissions to collect the data were obtained from the directors/director generals and chief nurses/directors of nursing of each hospital involved in the study. All of the study participants were informed about the purpose of the study and main methodological issues involved (e.g. data collection, completion requirements and ethical aspects) in an initial meeting prior to the data collection, and research-relevant information was provided in a cover letter. The research was voluntary and the participants had the right to decide whether to take part in the research or to withdraw at any time without explanation. No influence was exerted by the researcher during the data collection and no payment or other compensation for time was given for participation. There was also no coercion or influence from the institutions involved. Participation in the research followed the principles expressed in the World Medical Association Declaration of Helsinki (2013).

Data collection and analysis

The data were collected during a period of four months in 2012. Eleven university and general level hospitals were purposefully selected for the research, with seven from the eleven hospitals giving permission to perform the research. In each hospital, all of the nurse managers were asked to participate in the research, thus the response rate was 97%. The study data were collected during specifically organised meetings, with the researcher present in the room (in case of questions concerning completion) when the nurse managers individually completed the questionnaires. The questionnaires were returned to the researcher in sealed envelopes.

A power calculation was carried out to determine the sample size required for statistical analysis (Parahoo, 2014). The sample size was calculated with a sample power of 3 with 5% standard error and 95% confidence level, and a minimum power of 80%. The sample size achieved for the research met these requirements.

The Statistical Package for Social Sciences (SPSS 21.0 version) was used to statistically analyse the data. Descriptive statistics were used to describe the main characteristics of the data, and to summarise it numerically. The non-parametric Shapiro–Wilk test was used to assess whether the data formed a normal distribution. Spearman’s correlation coefficient was used to determine the relationships between variables (Burns and Grove, 2009).

The total structural empowerment score was calculated by summing the averages for each of the six subscales, ranging from 6 to 30. Higher scores indicate a higher level of empowerment (Laschinger et al., 2001). Moreover, the sum variables of appropriate items were used to form the three main categories of the Work Empowerment Questionnaire: verbal, behavioural and outcome empowerment. Higher scores represent stronger confidence in the ability to do the job (Irvine et al. 1999).

The reliability of the questionnaire was measured using Cronbach’s alpha coefficient. The coefficient alpha values were found to be acceptable (Burns and Grove, 2009), with coefficients of 0.8 for the CWEQ-II (structural empowerment) and 0.9 for the Work Empowerment Questionnaire (psychological empowerment). This is in line with previous studies that suggest the instruments to be reliable and valid (e.g. Laschinger et al., 2007; Suominen et al., 2005).

Participants

The study sample consisted of 193 nurse managers, stemming almost equally from medical (31.6%), surgical (32.1%) and other (36.3%) nursing areas. The mean age of the respondents was 48.4 years (SD 8.9), ranging from 27 to 67 years. Participants had a mean duration of nursing experience of 27.3 years (SD 9.9). The mean experience in their current unit was 19.0 years (SD 10.7), and the mean experience in their position of nurse manager was 14.7 years (SD 10.6) (Table 1).

Table 1.

Background data of respondents (n = 193).

Background factors	Percentage (%)
Marital status:
Married/live in partnership	75.1
Not married/live alone	7.8
Divorced/widow	16.1
Missing	1.0
Recent education:
Medical school (special education)	43.5
College (professional bachelor’s degree)	16.1
University (bachelor’s degree)	26.9
University (master’s degree)	13.0
Missing	0.5
Working area:
Medical	31.6
Surgical	32.1
Other (e.g. psychiatric, paediatric, midwifery, elderly care)	36.3
Licence:
General practice nurse	94.3
Midwifery practice nurse	5.7
Nursing specialisation (n = 84) (e.g. anaesthesia and intensive care nursing, surgical nursing, mental health nursing)	43.5
Native language:
Lithuanian	91.2
Russian	5.7
Polish	3.1
Working place (n = 187):
University level hospital	48.7
General level hospital	48.2
Missing	3.1

Almost all of the participants (94.3%) had a general practice nurse licence. Most of the nurse managers (91.2%) were Lithuanian native speakers (Table 1), but apart from their native language nurse managers could speak Russian (87.0%), Polish (23.8%), English (22.8%), German (11.4%) and French (4.7%). In comparing responses from the medical, surgical, other nursing areas, it was found that statistically nurse managers from the surgical working area could speak more languages (p = 0.029 compared to their medical counterparts, and p = 0.041 compared to other working areas). No other significant differences were found based on the demographic variables.

Half of the managers (53.9%) felt that they had good enough skills to conduct their work, and one third (31.1%) of the respondents partly agreed that they had enough staff to do the work of the unit. Nurse managers did, however, experience stress at work. Other work-related information is presented in Tables 2 and 3.

Table 2.

Work-related background variables of respondents (n = 193).

Answers Background factors	Strongly agree (%)	Agree (%)	Partly agree (%)	Disagree (%)	Totally disagree (%)
Sufficiency of means to do the work as a nurse manager	14.5	42.5	34.2	7.8	1.0
Potential skills for handling the work as a nurse manager	20.7	53.9	21.8	2.6	1.0
Sufficiency of staff to do the work in working unit	14.0	24.4	31.1	25.9	4.7
Stress experienced at work	28.5	34.2	32.1	4.1	1.0
Commitment to the nursing profession	59.6	35.2	5.2	0	0
Support of research utilisation in working unit	44.0	31.6	20.2	3.6	0.5

Table 3.

Other work-related background variables of respondents (n = 193).

Answers Background factors	Yes (%)	Cannot say (%)	No (%)
Feelings of motivation doing the work of a nurse manager	57.0	35.8	7.3
Satisfaction with the work of a nurse manager	73.6	21.2	5.2
Importance of work autonomy	85.5	11.4	3.1
Appreciation of the work of a nurse manager by society	14.0	59.1	26.9

Findings

Work-related empowerment

Structural empowerment

The total structural empowerment of nurse managers was of a moderate level (21.0, SD 2.9), suggesting that there is still room for increasing the perceptions of access to empowering structures. Nurse managers generally felt that they were empowered and this was indicated with most of the subscales of the questionnaire averaging above 3. The highest evaluated area was access to opportunity (mean 4.0, SD 0.6), and the lowest evaluated area was that of formal power (2.5, SD 0.9) (Table 4).

Table 4.

Work empowerment experienced by respondents (n = 193).

Work empowerment structures	Cronbach’s alpha	Min	Max	Mean	SD	Me (25–75)	Shapiro–Wilk p^a
Access to opportunity	0.6	2.3	5.0	4.0	0.6	4.0 (3.7–4.3)	<0.001
Access to information	0.9	1.0	5.0	3.4	0.9	3.3 (3.0–4.0)	<0.001
Access to support	0.8	1.0	5.0	3.5	0.8	3.7 (3.0–4.0)	<0.001
Access to resources	0.6	1.0	5.0	3.7	0.6	3.7 (3.3–4.0)	<0.001
Formal power	0.7	1.0	4.7	2.5	0.9	2.3 (2.0–3.3)	<0.001
Informal power	0.6	2.0	5.0	3.9	0.7	4.0 (3.5–4.5)	<0.001
Total structural empowerment	0.8	12.5	27.3	21.01	2.93	21.0 (19.3–22.8)	0.248
Behavioural empowerment	0.9	4.4	10.0	8.7	0.8	8.8 (8.2–9.3)	<0.001
Outcome empowerment	0.9	1.4	10.0	7.4	1.6	7.7 (6.6-8.6)	<0.001
Verbal empowerment	0.8	4.2	10.0	8.7	1.1	8.8 (8.0-9.6)	<0.001
Psychological empowerment	0.9	4.0	10.0	8.3	1.0	8.4 (7.7-9.1)	<0.001

The p-value is less than 0.05, meaning that the data are not normally distributed.

Participants reported that their work gave them the opportunity to gain new skills and knowledge (4.3, SD 0.7). Concerning the access respondents had to information, the item about the current state of the hospital was evaluated the highest (3.9, SD 0.8). An access to support was evaluated equally to receiving information about things done well (3.5, SD 0.9), specific remarks about things that could be improved (3.4, SD 1.0), and receiving helpful hints or problem-solving advice (3.5, SD 1.0). Managers also had some access to resources, such as having the time necessary for completing documentation (3.7, SD 0.7), time to perform the job (3.8, SD 0.7) and gaining temporary assistance when needed (3.5, SD 1.0).

Measuring formal power, nurse managers indicated that they did not experience reward for demonstrating any work innovations (1.6, SD 1.0), but they still had a certain degree of flexibility at work (3.1, SD 1.2). As for informal power, the results were almost equal, indicating that participants were able to collaborate with physicians on issues of patient care (4.2, SD 1.0), and were sought out by colleagues (4.3, SD 0.7) and other managers (4.0, SD 1.0) to help with problems.

In accordance with their working area, from a perspective of informal power, nurse managers from the medical field evaluated most highly being sought out by colleagues to help with problems (4.4, SD 0.7), and from a perspective of formal power their lowest evaluated area was that of being rewarded for work innovations (1.5, SD 1.0). Nurse managers within the surgical working area reported that their work gave them the opportunity to gain new skills and knowledge (4.5, SD 0.7), and their lowest evaluated area was also that of being rewarded for work innovations. Similar to nurse managers working in the medical area, those from other working areas also evaluated being sought out by colleagues to help with problems the highest (4.3, SD 0.7) and being rewarded for work innovations the lowest (1.8, SD 1.1).

Psychological empowerment

Nurse managers felt quite a strong level of psychological empowerment (mean 8.3, SD 1.0), but with higher behavioural (8.7, SD 0.8) and verbal (8.7, SD 1.1) levels of empowerment than those of outcome empowerment (7.4, SD 1.6) (Table 4). With regard to behavioural empowerment, participants were most confident in doing their work well (9.3, SD 0.8) and working with co-workers in the group (9.2, SD 0.9). Nurse managers were least confident in their ability to use analytical skills for collecting data about work problems and to use when recommending solutions (7.9, SD 1.6), and also in their ability to use mathematical and statistical skills in their work (8.1, SD 1.6). Verbal empowerment showed that nurse managers were more confident in debating their opinion with co-workers (9.0, SD 1.2), and they were least confident in their ability to state their opinion in group meetings (8.4, SD 1.6), and when stating their opinion about working problems to managers outside their own unit (8.4, SD 1.7). Regarding outcome empowerment, the results showed that nurse managers were most confident in helping co-workers to improve their work (8.8, SD 1.1), and least confident in their ability to effect changes in the way they did their work in the hospital (6.2, SD 2.9).

Nurse managers from medical, surgical and other working areas tended to report the same issues in their confidence and abilities. From a perspective of behavioural empowerment they felt most confident in doing their work well (accordingly 9.4, SD 0.7; 9.4, SD 0.8 and 9.1, SD 1.0), but they felt least confident in their ability to bring changes to the way that they did their work in the hospital (accordingly 6.6, SD 2.8; 6.1, SD 2.9 and 6.0, SD 2.9), which reflects outcome empowerment.

Several significant relations were found between structural and psychological empowerment. All of the empowering structures of structural empowerment correlated with each other (with a significance level p ≤ 0.001) and with psychological empowerment areas (0.001 < p ≤ 0.01), apart from the area of access to resources that had no statistical relationships with psychological empowerment and its areas. Overall, however, it could be seen that structural empowerment and psychological empowerment were statistically associated with each other with a high degree of significance (p ≤ 0.001).

Background factor association with work-related empowerment

The results of this study showed that three particular background factors were related to aspects of empowerment. Education and languages spoken were associated with psychological empowerment and its areas (0.001 < p ≤ 0.01), whilst the duration of working experience as a nurse manager was related to total structural empowerment (0.01 < p ≤ 0.05). Negative correlation was found between education and access to resources, meaning that nurse managers with higher education evaluated lower access to resources (Table 5).

Table 5.

Spearman’s correlation between background variables and empowerment (n = 193).

Variables	r (p)
Variables	Education	Languages spoken	Working experience as a nurse manager
Access to opportunity	NS^a	NS	NS
Access to information	0.143 (0.048)	NS	NS
Access to support	NS	NS	NS
Access to resources	−0.179 (0.013)	NS	NS
Formal power	NS	NS	0.145 (0.047)
Informal power	NS	NS	NS
Total structural empowerment	NS	NS	0.148 (0.043)
Behavioural empowerment	0.262 (<0.001)	0.264 (<0.001)	NS
Outcome empowerment	0.257 (<0.001)	NS	NS
Verbal empowerment	0.210 (0.003)	0.225 (0.002)	NS
Psychological empowerment	0.290 (<0.001)	0.217 (0.002)	NS

The p-value is more than 0.05, meaning that the data are not significant.

Discussion

Notwithstanding the fact of the changing environment in which they worked, this study revealed that nurse managers felt empowered. The total structural empowerment was of a moderate level (21.0, SD 2.9), and this is in line with previous research (Bish et al., 2014; Laschinger et al., 2011b; Patrick and Laschinger, 2006; Regan and Rodriguez, 2011). The lowest evaluated issues of formal power reflect that managers did not feel that their job is visible for work-related activities, and they were unable to gain reward for innovations they implemented in the working setting. Nurse managers form a considerable group in the health care system, and should have the opportunity to make decisions concerning quality of care, patient safety and working conditions. As such, chief nurses have to find ways to promote innovative behaviour in nurse managers that will help them achieve their work-related goals.

The nurse managers reported that they had some access to information from the top management regarding the values and aims of their organisation; these results are similar to other studies which have been conducted (Bish et al., 2014; Laschinger et al., 2011b; Regan and Rodriguez, 2011). There is much to be gained when nurse managers have information concerning the goals, solutions and financial issues of their organisation. Particularly, it has been seen that interaction between chief nurses and nurse managers creates a positive work environment (Davies et al., 2011), and increases feelings of empowerment (Laschinger et al., 2011b) and role satisfaction (Laschinger et al., 2007) that result in the achievement of both the organisational mission and patient care delivery.

Psychological empowerment is understood as a feeling of self-efficacy and belief in the ability to perform work-related activities (Bandura, 1997). The nurse managers of this study perceived high levels of psychological empowerment (8.3, SD 1.0), and again, this was similar to the evidence presented in previous studies (Suominen et al., 2005). The findings of the present study support the findings of Suominen et al. (2005) showing that nurse managers experience more verbal and behavioural areas of empowerment than outcome empowerment, and similarities were found between this and the present study. Concerning verbal empowerment, the results showed the same confidence in being able to debate opinion with co-workers, and a lack of confidence in their ability to state opinions about working problems to managers from outside their unit. The role of the nurse manager has changed from the coordination of the everyday activities of the unit and having a responsibility for patients, to include having a direct involvement in the overall functioning of services and the wider management of the unit. Nurse managers should have competencies and skills in collaboration and team building (Huston, 2008) that will help to assure organisational success, the achievement of desired goals, and the productivity of the organisation.

In this study (see also Suominen et al., 2005), behavioural empowerment showed that nurse managers felt confident working with co-workers in a group, but not in using mathematical and statistical skills in their work. Nurse managers are accountable for the nursing budget, and managing resources and staffing (Hughes et al., 2015), all of which require mathematical and statistical skills. Thus, new strategies of learning should be developed to improve and promote the development and utilisation of these skills in nurse managers.

The lowest levels of confidence were expressed in the area of outcome empowerment. Nurse managers felt that they could not make changes to the way they did their work in the hospital, even though organisational change is vital, because it has a direct effect on staff and is an integral part of contemporary health care systems. The amount of organisational change has increased and presents significant challenges to nurse managers (Hewison, 2012). Thus, nurse managers should be provided with administrative support during organisational transformations, and also be involved in the planning of organisational changes. In addition, considerable attention must be paid to the fact that more educated nurse managers evaluated lower access to resources. It is probable that they had competence to do more but not resources for that.

Limitations

There are some limitations to this study that should be noted. Firstly, the generalisability of the findings may be limited due to the relatively small sample of nurse managers and the small number of hospitals that were included (Parahoo, 2014). However, nurse managers from seven of the eleven hospitals approached at the time of the research participated in the study, and the results may be seen to represent the national view. The questionnaire for nurse managers was used for the first time in a Lithuanian context, thus pilot tested. To deepen the research, further studies with nurse managers from primary health care institutions would be beneficial for providing additional information about the topic, both from national and international perspectives. Also, the research could be repeated in the same setting and with the same sample to observe any possible changes that might occur.

Despite presented limitations, there are some positive aspects that should be mentioned. The research highlights that nurse managers have important managerial obligations and responsibilities. In order to carry out these responsibilities, the research presents valuable information on the areas to be taken into consideration for strengthening nurse managers’ levels of empowerment. Given that there is a dearth of literature that addresses this topic, this study offers a contribution towards enhancing nurse managers’ understanding of empowerment, and presents a platform which may be used to direct future enquiries. Further, the original instrument has been found to be reliable and valid in previous studies, and this was also the case in this research.

Conclusion

Nurse managers were structurally empowered at a moderate level, and experienced a higher level of psychological empowerment. When taken together, structural and psychological empowerment could be seen as a powerful approach that creates a work environment in organisations that supports nurse managers, expands their role, and contributes to their development. Chief nurses have to take every effort to increase levels of empowerment in order to retain nurse managers in their positions.

Further research is needed to look into the question of improving formal power issues, e.g. the rewards for innovation at work, and also outcome empowerment aspects that may affect changes in the way that nurse managers carry out their work. From an administrative perspective, one direction for future research would be to analyse what behaviours of chief nurses increase the feelings of empowerment in the nurse managers they lead.

Key points for policy, practice and/or research

This research offers a contribution towards enhancing nurse managers’ understanding of empowerment, and presents the areas of empowerment that need to be strengthened.

Nurse managers experienced structural empowerment at a moderate level and were highly psychologically empowered.

The instruments used in this study were back-translated and piloted, and were considered to be valid and reliable when used in another cultural context.

The research provides information for chief nurses for optimising nurse managers’ work and retaining them in their positions.

Further studies in the same setting and with the same sample could be conducted for providing longitudinal information about nurse managers’ empowerment.

Footnotes

Acknowledgements

The authors would like to thank the University of Tampere (Finland), the Finnish Nurses’ Education Foundation, the Finnish Cultural Foundation and the Pirkanmaa Hospital District for their financial support of this study. The authors would also like to thank the nurse managers who took part in the research.

Declaration of conflicting interests

The author(s) declare that there is no conflict of interest. The authors assume sole responsibility for the content and writing of this paper.

Ethics

Ethical approval for the research was received from the Ethics Committee of the Klaipeda University in Lithuania.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Marija Trus, who is a PhD student at Faculty of Social Sciences, University of Tampere, Finland, is a Lecturer, Faculty of Health Sciences, Klaipeda University, Lithuania. Her research areas include empowerment in nursing, evidence-based nursing, nursing leadership and motivation.

Diane Doran, PhD, is Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. Her research areas include health services research, outcome measurement, patient safety and e-health.

Arvydas Martinkenas, ScD, is Professor, Faculty of Health Sciences, Klaipeda University, Lithuania. His research areas include bioengineering, functional state simulation, e-health, management of internet-based systems and databanks.

Paula Asikainen, PhD, is Adjunct Professor, Faculty of Social Sciences, University of Tampere, Finland and Chief Executive Officer of Nursing, Satakunta Hospital District, Pori, Finland. Her research areas include social health, nursing care, nursing education, health care and primary health care.

Tarja Suominen, PhD, is Professor, Faculty of Social Sciences, University of Tampere, Finland. Her research areas include health services research, outcomes, workplace culture, clinical nursing research, life with infection diseases and sexual health.

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