Feeling of powerlessness
The feeling of powerlessness is a rather common complaint among employees who are dissatisfied with their jobs. First of all, the feeling usually accompanies stress in the workplace. While sometimes it is the defensive reaction of the human psyche and thus appears as a result of stressful situations not connected with power, most often it is the cause of stress (Ulrich, O’Donnell, Taylor, Farrar, Danis, & Grady, 2007). The reasons for the feeling vary but can be narrowed down to three major contributors.
The first is the excess of responsibility coupled with the lack of authority. Such cause is common among the wide variety of jobs including nursing. The staff could get unnecessary pressure from the management, which may be Nancy or somebody above her in the hierarchy. In both cases, she must identify it and, if possible, reduce the pressure to the acceptable level to de-escalate the tension.
The second reason is the range of events that the staff deals with. The employees that frequently witness dramatic events that possibly result in human casualties are more likely to be stressed. The reasons vary from the direct gruesomeness of the events, which include physical trauma and death to the philosophical and ethical implications behind them, such as feeling insignificant in comparison to the forces of nature (Laposa, Alden, & Fullerton, 2003). The emergency department is obviously in the highest risk groups of this cause.
Finally, workplace conditions can play some role in the issue. The poor condition of equipment or the inadequate supply of medications can trigger the feeling of powerlessness, especially if such issues result in casualties or other negative outcomes. This reason is the least likely of the three but should be addressed to identify every possible cause.
The main source of power that can be found in the workplace is the authority. However, as we can see from what has been mentioned above, there are several manifestations of it that the nurses in the emergency department deal with: the authority over the co-workers and management and the power to influence the outcome for the patient. The first is an issue of leadership, while the second is grounded in psychological and, to some degree, ethical and philosophical foundations.
Regarding the first variant, Nancy needs to first adequately assess the situation. This can be done by self-reflection, measuring the efficacy and efficiency of the workplace environment, and collecting the opinions of employees by conducting surveys. If the first and third suggestions will prove to be true, she can either adjust her management techniques to reduce pressure and give her subordinates more freedom to make decisions and come forward with initiatives (the most common step in empowering the staff) or address the issues of material basis that result in the actual inability to effectively provide adequate health care.
If the second suggestion surfaces as a primary reason, Nancy must first compare the conditions and incident rates of her department to similar ones in other areas. If no difference is observed, the reason may be in the underqualified workforce that is not prepared to operate in the emergency department. If they are significantly more challenging, she should organize appropriate psychological aid for the staff members.
Shared governance model
Before going to the meeting, it is important first to gather all the available information to ensure that the staff is taking part in the decision-making process. The unit-based council which is likely to exist within the shared-governance facility will likely have the information regarding the benefits of the extended working day that is planned to be removed. The insider’s view on the changes in efficiency and their reasons can be used to either disprove or reinforce the results of patient satisfaction surveys.
Besides, the personnel’s thoughts regarding the benefits of the prolonged shifts should be considered if possible. For instance, such a schedule likely results in more consecutive days off. Additionally, the model is usually accompanied by the more responsible treatment of professional duties, so the council will likely be able to provide information that will give additional insights regarding the medication errors and their correlation with the extended working hours.
Except for the information from the unit council, relevant research on the matter is highly advised for consideration. Specifically, the extended working day has long been proven to cause adverse health effects resulting from the shifts in circadian rhythms, such as cardiovascular disorders, gastrointestinal diseases, and numerous negative effects on social life (Keller, 2009). Besides, some sources point to the possible ways of preventing negative outcomes (Harrington, 2001). This information should also be studied to be able to compare the efficiency of addressing the problem versus changing the policy.
In itself, the process of gathering information and providing a comprehensive picture is already convincing enough in showing the benefits of a shared governance model. The fact that all the aspects of the unsuccessful policy are considered instead of just focusing on the satisfaction of the patients is empowering for the personnel. Additionally, the opportunity to voice their opinion on the shortcomings and their reasons should be viewed as an advantage, because in this way the employees establish their responsibilities and eliminate the possibility of groundless accusations.
Harrington, J. M. (2001). Health effects of shift work and extended hours of work. Occupational and Environmental Medicine, 58(1), 68-72.
Keller, S. M. (2009). Effects of extended work shifts and shift work on patient safety, productivity, and employee health. Workplace Health & Safety, 57(12), 497-502.
Laposa, J. M., Alden, L. E., & Fullerton, L. M. (2003). Work stress and posttraumatic stress disorder in ED nurses/personnel (CE). Journal of Emergency Nursing, 29(1), 23-28.
Ulrich, C., O’Donnell, P., Taylor, C., Farrar, A., Danis, M., & Grady, C. (2007). Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Social Science & Medicine, 65(8), 1708-1719.