PERCEPTIONS OF EMPOWERMENT AMONG PART-TIME
NURSING STUDENTS
DOJEMANJE OPOLNOMOČENJA PRI IZREDNIH ŠTUDENTIH
ZDRAVSTVENE NEGE
Suzana Mlinar1 Prispelo: 21. 3. 2011 - Sprejeto: 29. 6. 2011
Original scientific article UDC 614.253.5:616-083
Abstract
Objective: Empowerment is an important construct because it offers the potential to positively influence outcomes that benefit individuals and organisations. The purpose of the study was to examine the characteristics of individual perceptions of empowerment among part-time nursing students in their work.
Methods: The study involved 57 part-time nursing students of the Faculty of Health Science. Survey measures used included the modified Spreitzer empowerment instrument. A questionnaire was used to collect data on the variables of the Psychological Empowerment Instrument. Friedman's test and Spearman's test were used to analyse the data collected. The data was analysed using the statistical package SPSS v. 17.0 for Windows. Results: The results show that the participants expressed a high level of mean score in the areas of competence and meaning. Friedman's test showed a statistically significant difference in the perceived area of meaning, self-determination and impact. In the area of competence, there were no significant differences. Spearman's test showed that the scales of competence and self-determination had more correlation rankings between the psychological empowerment items.
Conclusion: Employee empowerment is an important organisational issue. The results showed that participants have the capability to perform work activities with the necessary skills and knowledge, as well as valuing the work goals or purposes highly when judged by an individual's perception relative to his or her own personal mission or expectations. The findings also suggest that the participants in the study did not put much emphasis on the importance of impact.
Key words: nursing students, empowerment, organisational climate
Izvirni znanstveni članek UDK 614.253.5:616-083
Izvleček
Uvod: Opolnomočenje je pomemben konstrukt, saj ponuja možnost pozitivnega vpliva na rezultate, ki koristijo posameznikom in or^ganizacijam. Namen te študije je bil p^rouči^i, l^ako izr^edni študentje dojemajo in^ivi^ua^lno opolnomočenje pri njihovem delu.
Metode: V r^azisk^vo je bilo zajetih 57 izr^ednih študentov zc^ravstvene n^ge na Zdravstveni fakulteti. Za potr^ebe ankete je bil upor^ablj^n modificir^ani Spr^eitzerjev insti^ument za ocenjevanje opolnomočenja. S pomočjo vpr^ašalnika so blli zbra^ni podatki o spr^emenljiv^ah instr^umenta psihološkega opolnomočenja (Psychological Empowerment Instrument). Pri analizi zbranih podatkov sta bila uporabljena Friedmanov in Spearmanov test. Podatki so bili analizir^^ni s statističnim pr^ogr^amom SPSS 17.0 za Windows.
Rezultati: Ti kažejo, da so izr^^dni študentje zdr^^vstv^ne nege dosegli visok^e povp^r^ečne r^^zultat^, k^a^r se tiče dimenzij kompetenc in pomena.. Fr^ieč^ma^nov test je pokazal statistično pomembne r^azli^e v smislu dojemanja dimenzij pom^na^, samoodločbe in vp^liv^. V smislu kompetenc ni t^ilo pomembnih r^azlik. Spearmanov test je po^az^l, da je bilo v dimenzijah kompetenc in samoodločbe več k^or^^lacij med elementi psihološkega opolnomočenja.
'Jniversity of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia Correspondence to: e-mail; suzana.mlinar@zf.un\-\j.s\
Zaključek: Opolnomočenje zaposlenih je pomembno organizacijsko vprašanje. Rezultati so pokazali, da so udeleženci raziskave sposobni opi^avljati delo, ^i z^ht^^a določane sp^r^etnosti in znanje. Študijaje pokazala, da ud^l^^enci visoko vi^ednotijo delovne cilje in namene, ki jih pi^^sojajo glede na svoja lastna poslanstva in pr^ič^ko^anja. Rezultati so poleg t^ga n^kaz^li, da izr^edni študentje zc^ravstv^ne n^ge, h^i jih je zajela študija, niso poudar^ili pomembnosti vpliva.
Ključne besede: študentje zdravstvene nege, opolnomočenje, organizacijska klima
1 Introduction
Organisational climate is defined as a set of measurable properties of the work environment, perceived directly or indirectly by the people who live and work in this environment and assumed to influence their motivation and behaviour (1). The organisation's characteristics and climate exert a strong influence on the behaviour of the organisations' members and their culture. The climate and individuals' responses are continually influencing one another cyclically. Over time, the climate has the capacity to convey the general psychological atmosphere of an organisation and can consequently affect the satisfaction, motivation and behaviour patterns of the individuals in the workplace (2-3). Work environments that provide access to information, resources, support and the opportunity to learn and develop are empowering and enable employees to accomplish their work (4). Kanter (4) links the degree of control that people have over their work environment to their work effectiveness. Formal power constitutes the degree of discretionary decision-making one has in the workplace (autonomy); informal power refers to the social support and communication available within the workplace.
Nurses have a significant influence on people's health and lives. In this way, nurses assume a great responsibility that cannot be defined in laws and regulations alone. Here, personal ethics arising from an individual's moral values play an important part. Nurses advocate the needs of their patients and offer them physical, mental, social, spiritual and moral support. Respect and the development of human values in this occupation ensure the nurses' personal growth and contentment at work. In this challenging working environment, one way to empower staff is to allow them to make decisions about their care delivery tasks or get them involved in a participative way (5). These management practices not only enhance the contributions or productivity of nurses in an effective manner, but also enable nurses to exercise their autonomy, to feel the value of their work and satisfaction (6). Thus, it is important to identify factors that enhance the work environment for nurses in order to improve work effectiveness and provide quality patient care (7).
Empowerment is defined as the motivational concept of self-efficacy (8), as well as being multifaceted and unable to be captured by the single concept (7). Empowerment is defined more broadly as increased intrinsic task motivation manifested in a set of four cognitions reflecting an individual's orientation to his or her work role: meaning, competence (which is synonymous for self-efficacy), self-determination and impact. When nurses' values, beliefs and behaviours are congruent with the workplace requirements, there is meaning. Confidence in the ability to perform job requirements is competence. Feeling that one has the autonomy to have control over one's work is self-determination, and impact is when one feels that he or she is able to influence the organisation's outcomes (5, 9-10). Meaning is the value of the work goal or purpose, judged in relation to an individual's own ideals or standards (11). Meaning involves the requirements of a work role matching beliefs, values and behaviours
(12).	Competence or self-efficacy is an individual's belief in his or her capability to perform activities with skill (13). Competence is analogous to agency beliefs, personal mastery, or effort-performance expectancy
(13).	This area is labelled competence because it focuses on efficacy that is specific to a work role. Where competence is a mastery of behaviour, self-determination is an individual's sense of having a choice in initiating and regulating actions. Self-determination reflects autonomy in the initiation and contribution of work behaviours and processes; examples include making decisions about work methods, pace and efforts (14). Impact is the degree that an individual can influence strategic, administrative or operating outcomes at work. Impact is the converse of learned helplessness (14). Furthermore, impact is different from locus of control; it is a global personality characteristic that endures across situations (14).
These four cognitions reflect an active rather than a passive orientation to a work role. Active orientation means an orientation in which an individual wishes and feels able to shape his or her work role and context. Empowerment is not an enduring personality trait that is generalisable across situations, but rather a set of cognitions shaped by the work environment (11). Thus, empowerment reflects the flow of people's
perceptions about themselves in relation to their work environments (3, 12). The conceptual framework for this study is based on examining empowerment in the nursing workplace. The purpose of the study was to examine the characteristics of individual perceptions of empowerment by part-time nursing students in their work. The study focused on exploring the areas of psychological empowerment for part-time nursing students in the workplace.
2 Method
2.1	Participants and Procedure
A total of 86 questionnaires were distributed to all parttime nursing students connected to the undergraduate second-year study programme of the Faculty of Health Science. 57 part-time nursing students provided data for the study (a response rate of 66.3%). The average age of the subjects was 30.17±5.97 years. The study data was collected in May, during the 2009/2010 school year. Participation in the study was voluntary. Prior to the study, written and verbal information was given to the participants about the purpose and nature of the study. Participants were asked to put their completed questionnaire into the envelope.
2.2	Instrument
Psychological empowerment is a process that occurs when one has a sense of motivation in relation to the workplace environment (10). Drawing from literature on empowerment from psychology, social work, sociology and education, four areas were included in the instrument developed by Spreitzer (5) to reflect psychological empowerment in the workplace. These areas are meaning (M-1 to M-3), competence (C-1 to C-3), self-determination (S-1 to S-3) and impact (I-1 to I-3). In this study, a questionnaire was used to collect data on the variables of the Psychological Empowerment
Instrument. The questionnaire is freely available. The questionnaire was composed of four areas and each area was measured using three items. An example item from each area is "The work I do is very important to me" (meaning); "I am confident about my ability to do my job" (competence); "I have significant autonomy in determining how I do my job" (self-determination); and "My impact on what happens in my department is significant" (impact). The rating scale ranged from 1, ^"very strongly disagree," to 7, "very strongly agree." The higher score means a higher degree of psychological empowerment. The questionnaire was a double random translation into Slovene. Before utilising the instrument in the study, a reliability test was performed for the current data set and the Cronbach's alpha was 0.732.
2.3 Data Analysis
Data was analysed using SPSS for Windows version 17. Descriptive statistics were used to describe study variables and sample demographics. Nonparametric tests were used to measure the agreement with empowerment items. Friedman's test was used to compare the distributions of rankings for these four areas of psychological empowerment. Spearman's test was calculated to correlate the rankings between the empowerment items.
3 Results
The sample included 57 part-time nursing students. The average age of the research subjects was 30.17±5.17 years, range = 23-46. There were 45 females and 12 males in the study. The majority (30) of part-time nursing students work in various hospital wards, 17 in various intensive care units, 7 in various Residential Homes and 3 in various Community Health Centres. Their average length of work/service was 9.91±6.24 years.
Table 1. Areas of empowerment and value of Friedman test. Tabela 1. Dimenzije opolnomočenja in vrednosti Friedmanovega testa.
Empowerment areas/	Range/	M	SD	Friedman test
Dimenzije opolnomočenja	Rang			Mean Rank/Povprečni rang
Meaning/Pomen				X2 (6.73), p=.03
M-1	4-7	6.39	1.12	2.22
M-2	1-7	5.52	1.41	1.67
M-3	5-7	6.39	0.78	2.11
Competence/Kompetence				X2 (2.84), p=.24
C-1	5-7	6.13	0.87	1.80
C-2	5-7	6.35	0.71	2.09
C-3	5-7	6.35	0.71	2.11
Self-determination/Samoodločbe				X2 (5.70), p=.05
S-1	1-7	4.48	1.73	1.67
S-2	4-7	5.43	0.99	2.13
S-3	3-7	5.65	1.07	2.20
Impact/Vpliv				X2 (12.27), p=.00
I-1	3-7	4.65	1.40	1.78
I-2	3-7	5.57	1.16	2.50
I-3	1-7	4.48	1.73	1.72
Legend: Meaning (M-1 to M-3), Competence (C-1 to C-3), Self-determination (S-1 to S-3), Impact (I-1 to I-3) Pomen (M1 do M3), Kompetence (C1 do C3), Samoodločbe (S1 do S3), Vpliv (I1 do I3)
Table 1 compares the distributions of the four areas of psychological empowerment. The part-time nursing students declared a high level of mean score in the areas of psychological empowerment, competence and meaning. In the area of "Meaning", there was a high mean ranking of the participants in "The work I do is very important to me". There was a statistically significant difference in the perceived meaning among the participants. In the area of "Competence", there was a high mean ranking of participants in "I have mastered the skills necessary for my job". There were no significant differences in perceived competence among the participants. In the area of "Self-determination", there was a high mean ranking of participants in "I have considerable opportunity for independence and freedom in how I do my job". There was a statistically significant difference in the perceived self-determination among the participants. In the area of "Impact", there was a high mean ranking of participants in "I have a great deal of control over what happens in my department". There was a statistically significant difference in perceived impact among the participants. The results related to the Spearman's correlation rankings in the psychological empowerment items are included in Table 2. The areas of competence and self-determination had more correlation rankings in the psychological empowerment items. The extent of item C-1 "I am confident about my ability to do my job" was
significantly related to "The work I do is meaningful to me" (p < .035). The extent of item C-2 "I am self-assured about my capabilities to perform my work activities" was significantly related to "I am confident about my ability to do my job" (p < .003). The extent of item C-3 "I have mastered the skills necessary for my job" was significantly related to "The work I do is meaningful to me" (p < .039), "I am confident about my ability to do my job" (p < .000) and "I am self-assured about my capabilities to perform my work activities" (p < .002). The extent of item S-2 "I can decide on my own how to go about doing my own work" was significantly related to "I am self-assured about my capabilities to perform my work activities" (p < .038). The extent of item S-3 "I have considerable opportunity for independence and freedom in how I do my job" was significantly related to "The work I do is meaningful to me" (p < .021), "I am confident about my ability to do my job" (p < .012), "I am self-assured about my capabilities to perform my work activities" (p < .015) and "I have mastered the skills necessary for my job" (p < .008). The extent of items I-3 "I have significant influence over what happens in my department" was significantly related to "My impact on what happens in my department is significant^' (p < .004) and "I have a great deal of control over what happens in my department (p < .001).
Table 2. Correlation coefficients among the empowerment items. Tabela 2. Koeficienti korelacije med elementi opolnomočenja.
EI	M-1	M-2	M-3	C-1	C-2	C-3	S-1	S-2	S-3 I-1 I-2 I-3
M-1	1.000								
M-2	.119	1.000							
M-3	.242	.210	1.000						
C-1	-.005	-.021	.441*	1.000					
C-2	.167	-.198	.396	.598**	1.000				
C-3	.020	-.124	.432*	.673**	.600**	1.000			
S-1	-.119	.024	.038	-.327	-.171	-.076	1.000		
S-2	-.073	.139	.317	.240	.436*	.010	.071	1.000	
S-3	.299	.190	.477*	.513*	.501*	.536**	-.078	.218	1.000
I-1	-.079	-.115	.033	.051	.128	.116	.400	-.012	.366 1.000
I-2	-.039	.174	.135	.391	.344	.362	-.395	-.054	.274 .325 1.000
I-3	-.099	.103	.073	.044	-.025	.135	-.055	-.180	.148 .582** .642** 1.000
Legend: Meaning (M-1 to M-3), Competence (C-1 to C-3), Self-determination (S-1 to S-3), Impact (I-1 to I-3) Pomen (M1 do M3), Kompetence (C1 do C3), Samoodločbe (S1 do S3), Vpliv (I1 do I3) *p < 0.05 at the two-tailed significant level; **p < 0.01 at the two-tailed significant level. * Korelacija je statistično pomembna na ravni p < 0,05; **Korelacija je statistično pomembna na ravni p < 0,01
4 Discussion
The results of this small study showed high mean scores in the area of psychological empowerment competencies, followed by meaning, self-determination and the least important, impact. We can see (Table 2) that the competence items significantly correlate with meaning and other competence items. The self-determination items significantly correlate with meaning and competence items. The impact items only significantly correlate with other impact items. The area of competence refers to self-efficacy that is specific to work and reflects an individual's capability to perform work activities with the necessary skills and knowledge (5). Thus, studies with a larger sample showed more accurately that nurses with strong self-efficacy exerted greater efforts to master a challenge and felt more effective in their work (12). The results in the area of competence suggest that the participants are competent and have the skills and ability to do their job in a proficient manner. This can indicate that the participants are responsible in their work, because they know that the nurses provide patients with comprehensive nursing care. However, in professional nursing practice, the participants are independent and autonomous and have a responsibility to their own conscience, their patients and to society. Thus, we can say that the participants bear personal responsibility and accountability for maintaining competence through
continual professional development, as well as for not performing procedures they are not qualified for and experienced in.
The area of meaning is the value of work goals or purposes judged by an individual's perception relative to his or her own personal mission or expectations (5). Thus, a larger sample of nurses found that meaning is related to the amount of importance and care people feel about their work (15). The results of this study showed that the participants have strong perceptions of meaning in their work and in the outcomes patient care. Thus, it can be assumed that the participants work to do their best. The results also indicate that the job has meaning for the participants - they believe that the work is important and care about what they do. It can be concluded that meaning represents those nurses' values, beliefs and behaviours that are congruent with workplace requirements.
The area of self-determination is an individual's sense of having choice in initiating and regulating actions (5). This small study shows that participants evaluate the self-determination subscale as less important. This possibly means that participants are unaware of autonomy in their work. It would be reasonable for the participants to become more involved in work behaviour and processes; examples include: making decisions about working methods, pace and efforts. Thus, the participants should increase their autonomy and responsibility for their actions. Foreign authors have
found that nurses are accountable for patient outcomes (16) and that nurses with greater autonomy have greater clinical productivity (17).
The area of impact reflects the degree to which one can make a difference in the workplace (15). This means that individuals see themselves as active participants with control over change (5). It seems that participants could have a higher score in impact from job satisfaction and be effective in their practice. Thus it can be assumed that the participants need to develop their impact, because this means that they can influence the organization's outcomes. They will also increase their independence and take an active rather than passive role in their work. During the education process, participants will gain additional impact skills that they can use in the workplace. Schiestel (18) said that nurses perceive themselves as being empowered when their superiors are open to ideas, give them positive criticism and when they have effective mutual communication.
The research reported here was limited to 57 parttime nursing students. This small sample of students, chosen only from among the students of the Faculty of Health Science, gives results that must be explained very carefully. The author suggests that these results should not be explained as a generalization of the perceptions of empowerment in the workplace. The given results can support other research as they show that empowerment reflects the flow of people's perceptions about themselves in relation to their work environments. Reliability could increase in the next study, which would include nurses from clinical practice throughout Slovenia. Responses from additional hospitals are needed to determine whether the present findings can be generalised to other organisations. To extend the study, we would have to include other organisations, which would provide an opportunity to determine the generality of the results.
5 Conclusion
Empowerment reflects the flow of people's perceptions of themselves in relation to their work environments. Empowerment thus improves work quality and increases job effectiveness. The present study is based on responses from only small sample of participants. The typical dimension of psychological empowerment for participants is competence. We can say that the participants have the capability of skilfully performing activities. The results also show that the participants need to increase their impact on the organization's outcomes. However, the most important of these is that nurses need to develop their formal job characteristics
such as visibility, innovation, flexibility and creative and critical thinking skills. It is expected that the findings from this study could be beneficial for part-time nursing students to further improve their practice in their work place and provide quality patient care. In further research, it would be useful to determine the empowerment of nurses to increase their motivation in relation to the workplace environment. It could be said that it is important to identify the factors that enhance the working environment for nurses in order to improve work effectiveness and provide quality patient care. Certainly, nurses are perceived as caring for patients, which can add to the feeling of overall empowerment.
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