Nurse empowerment is one of my passions, and I've been exploring why nurses flourish in some settings but feel stifled in others. When I started reading about the disparities, the topic of oppression kept cropping up. Now I better understand what was going on in some practice settings I've encountered.
Each health care organization has a unique culture and hierarchy. In some cultures, physicians and "medicine" are considered the primary influences on health care, and nursing has less value. As a nurse, you exist to carry out "doctor's orders"-and you'd better think twice about trying to reshape nursing practice. Exercising autonomy and initiating change might garner little or no support from your nurse-manager and even earn you a reprimand.
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When an organization treats nurses like second-class citizens, their group identity weakens and teamwork suffers. Oppressed and unable to advocate for change, they may fall into self-defeating behaviors, including backbiting, sabotage, and verbal attacks on each other.
This isn't the way it has to be. Many organizations, especially hospitals with Magnet status, value forward thinking and independent action by nurses. In this kind of culture, nurses share power with other disciplines and are expected to control their own practice. No single discipline is superior and oppression isn't tolerated. Statistics show that organizations that eliminate power struggles between medicine and nursing and among nursing groups are better equipped to attract new nurses and retain those already on staff.
Changing a nursing environment takes effort, but you can do it. First, recognize if oppression exists where you work. Research group oppression and share your findings with colleagues. Reading our current series on magnetic nursing environments is a good place to start: "Essentials of a Magnetic Work Environment, Part 2" in this issue discusses nursing autonomy and control over practice in depth.
Trust your ability to bring about change. If you can't manage it where you work now, consider moving to a different environment where nurses have power and the support to use it.
Cheryl L. Mee
Dunn, H.: "Horizontal Violence among Nurses in the Operating Room," AORN Journal. 78(6):977-988, December 2003.
Roberts, S.: "Development of a Positive Professional Identity: Liberating Oneself from the Oppressor Within," Advances in Nursing Science. 22(4):71-82, June 2000.
Sofield, L., and Salmond, S.: "A Focus on Verbal Abuse and Intent to Leave the Organization," Orthopaedic Nursing. 22(4):274-283, July/August 2003.