EMPIRICAL STUDIES

doi: 10.1111/j.1471-6712.2012.01069.x

Nursing power as viewed by nursing professionals

Peltomaa Katriina MNSc, RN (Nursing Director)1, Viinikainen Sari MNSc, RN (Doctoral Student)2, Rantanen
Anja PhD, RN (Senior Lecturer)2, Sieloff Christina PhD (Associate Professor)3, Asikainen
Paula PhD, RN (Adjunct Professor)1 and Suominen Tarja PhD, RN (Professor)2
1

Satakunta Hospital District, Pori, Finland, 2School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland and 3College
of Nursing, Montana State University, Bozeman, MT, USA

Scand J Caring Sci; 2013; 27; 580588

Nursing power as viewed by nursing professionals
Background: The concept of nursing power has not been
extensively reported in the nursing literature. Power is an
extremely abstract concept, making it difficult to define and
study. However, when defined as the capacity to achieve
goals, power becomes a significant resource in nursing.
Aims: The aim of this study was to describe how nursing
professionals perceive the level of nursing group power in
public healthcare organizations. Additionally, the connections between the background variables and nursing
group power were analysed.
Methods: The participants in the study consisted of 289
Finnish nurses working in the specialist healthcare sector
in Finland. The Sieloff-King Assessment of Group Outcome
Attainment within Organizations (SKAGOAO) instrument was utilized to assess the level of nursing group
power within the selected organizations.
Findings: According to the present study, nursing professionals rated the outcome attainment (mean, 1.93), as well
as goals/outcome competency (mean, 2.24), as very good.

Introduction
Power is a widely used concept by authors from different
disciplines, and, as a result, there are many definitions.
Hokanson Hawks (1) defined two meanings for power:
power to and power over. The concept of power to
relates to effectiveness and includes the ability or capacity
to achieve objectives. Power over refers to the ability or
capacity to influence the behaviours and decisions of
others. According to Foucault (2), power and knowledge
have a complex relationship, and they are closely interwoven where there is power, there is also knowledge.

Correspondence to:
Peltomaa Katriina, Satakunta Hospital District, Sairaalantie 3, 28500,
Pori, Finland.
E-mail: katriina.peltomaa@satshp.fi

580

The position of nursing (mean, 2.55) as part of the

healthcare service system was considered fairly respected.
The role of nursing (mean, 2.54) was also considered to be
at a good level. As regards to the actualization of power or
outcome attainment capacity, respondents gave the lowest
ratings to controlling the effects of environmental forces
(mean, 2.75), resources (mean, 3.48), communication
competency (mean, 3.00) and group supervisors outcome
attainment competency (mean, 2.87). Age, education, type
of employment and work experience had an impact on
how nursing group power was perceived.
Conclusions: The results of the present study indicated
that the nurses perceived the lowest levels of group
power in relation to the subscales of controlling the
effects of environmental forces, resources, communication
competency and group supervisors outcome attainment
competency.
Keywords: nursing power, nursing staff, specialist health
care, instrument, Sieloff-King.
Submitted 30 May 2012, Accepted 20 June 2012

Organizations have various things in common, for

example goals, human factors and hierarchy. The common
goal of organizations is to achieve outcomes through collaboration (3). Kanter (4) stated that power can be derived
from both the formal and informal systems of an organization, and is often described as the ability to get things
done.
Historically and in the nursing literature, power is often
viewed as a negative notion, as something that is imposed
on someone or as control over someone or something (5,
6). In addition, nurses, as a professional group, have been
oppressed by healthcare institutions, physicians and
administrators (68). However, nurses need power to
effectively work with patients, physicians, other healthcare
professionals and each other. Powerless nurses are
ineffective and less satisfied with their jobs (9, 10).
Furthermore, nurses need at least three types of power to
ensure optimal contributions to their work: control over

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Nursing power as viewed by nursing professionals

the content of practice, control over the context of practice
and control over competence (11).
Autonomous nursing practice has been operationalized
as control over the practice environment, decision-making
ability and collegial relationships with physicians, suggesting an important link between power and nursing
outcomes (12, 13). Nurses have associated six factors with
power: professional knowledge and skills, authority, selfconfidence, professional unity, supportive management
and organizational structure and culture (14).
Knowledge about power in nursing is also needed,
because it is critical for the successful functioning of the
departments in an organization and is a resource to be
used to achieve goals (15). King defined power in a
positive way, and it is important that nursing groups
recognize their power and also use that power to achieve
goals or outcomes (16). Nursing groups face many
challenges as they seek to achieve their goals in healthcare organizations today. All possible resources must be
recognized and utilized, and power is a valuable resource
that can assist nursing groups in the achievement of goals
(17). As nurses are the largest professional group within
healthcare service organizations, explaining organizational power from the perspective of a nursing theorist is
important (17).
Using the Sieloff-King Assessment of Group Outcome
Attainment within Organizations (SKAGOAO) instrument assists nursing groups to assess their initial level of
outcome attainment/power capacity and the groups
level of actualized power/outcome attainment or use of
power (16). Certain components contribute to the power
of a nursing group. These components include control
over the effects of environmental forces, a groups
position within a healthcare organization, the role of a
nursing group within healthcare organizations, available
resources, and the goals of the nursing group, the
communication competency of the group, the power
perspective and the outcome attainment/power competence of the supervisor or leader of the nursing group
(16).

Aim
The aim of the present study was to examine how nursing
personnel perceive the level of nursing group power as
part of their public healthcare organization. Additionally,
the significance of different background variables on
nursing power was also analysed. This study aimed to raise
awareness about nursing group power and related factors.
The research questions included:
1 How do nursing professionals perceive the level of nursing
group power in public healthcare organizations?
2 What types of relationships exist between the nursing
professionals background variables and nursing group
power?

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Materials and methods

Participants and data collection
The population consisted of 289 Finnish nurses, including
registered nurses (RN) and practical nurses (PN). The
respondents to the study included nursing professionals
working in the specialist healthcare sector in Finland. All
11 public specialist healthcare hospital districts, having a
population base in the region of 200 000, were intentionally selected for the study. From the selected hospital
districts, specific wards were randomly selected based on
operational similarity (surgical, medical, psychiatric, etc.).
All of the nurses from the randomly selected wards were
asked to participate.
All of the participating public-health hospital districts
granted permission to conduct the study in the chosen
wards. The consent, signed by all participants, contained
statements of confidentiality and indicated voluntary participation. All of the respondents (N = 289) filled in the
questionnaire in the presence of the researcher.
A pilot study was initially conducted prior to ensure the
validity of the questionnaire. A total of 33 nursing professionals in two wards completed the questionnaire.
These data were not, however, included in the data for the
final study. The purpose of the pilot study was to improve
the content validity of the questionnaire. Once the
instrument had been modified and back-translated into
Finnish, a group of experts comprising two nursing directors, two head nurses, two expert researchers on power
and two experts in instruments evaluated the validity of it.
The results of the evaluation indicated that the questionnaire items were relevant.

Instrument
The Sieloff-King Assessment of Group Outcome Attainment within Organizations (SKAGOAO) instrument with
36 items was utilized in the present study to assess the
level of nursing group power within organizations. The
components or subscales used to evaluate the level of
nursing group power (36 questions) include controlling
the effects of environmental forces (seven items), position
(four items), role (three items), resources (six items),
communication competency (three items), goals/outcome
competency (four items), group supervisors outcome
attainment competency (four items) and power perspective (five items). This structured questionnaire was used to
gather the research data, and it contained a 5-point Likerttype scale from totally agree (1), agree (2), do not
disagree or agree (3) to disagree (4) and totally disagree
(5) (18), the smaller number depicting more agreement.
A Cronbachs alpha coefficient was used to assess the
reliability of the overall instrument and the subscales. The
reliability of this instrument has consistently been

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582

P. Katriina et al.

supported. The Cronbachs alpha coefficient of the abbreviated form of the criterion was 0.92 (n = 336) (18, 19).
The questionnaire included 15 questions designed to
gather demographic data, that is, age, gender, years of
work experience, type of employment, education, working
experience in the present unit, highest level of education,
further education, supervisors title, district and units
number of staff.

Data analysis
The research data were analysed using SPSS 18.0 software.
The data were evaluated using frequencies, percentages,
means, standard deviations and ranges. Sum variables
were formed from the eight subscales of the instrument.
The sum variables were calculated by summing up the
values obtained for the items and then dividing the sum by
the number of variables.
The differences between the groups were specified by
means of the independent samples t-test, one-way analysis
of variance (ANOVA) with Bonferroni post hoc analysis and
the KruskalWallis. In the present study, the statistical
significance was p < 0.05. The demographic variables were
reclassified to facilitate the processing of the material.

Results

Table 1 Nurses background information (n, %)

Background variable
Gender (n = 289)
Female
Male
Age (n = 289)
30
3140
4150
51
Education (n = 288)
Registered Nurse
Practical Nurse
Other
The type of employment (n = 288)
Full-time
Part-time
Other
Work experience, years (n = 286)
4
510
1120
21
Work experience in the same unit, years
4
510
1120
21

259
30

90
10

71
69
86
63

25
24
30
22

247
30
11

86
10
4

213
72
3

74
25
1

58
72
64
92
(n = 277)
102
80
54
41

20
25
22
32
37
29
19
15

Background factors
The majority of the respondents in the study were RN
(86%, n = 247). Their mean age was 40 (range, 2064; SD,
11.02). Over two-thirds (74%, n = 213) of the nurses held
full-time positions in their unit. The respondents average
amount of work experience after their studies was 15 years
(SD, 10.74), and more than half of the nurses (66%,
n = 182) have been working in their current unit from 1 to
10 years (see Table 1).
In the present study, the respondents evaluated both
their own and their supervisors power and responsibility
(range, 010). More than half of the respondents (56%,
n = 161) stated that their supervisors possessed a high
level of power/outcome attainment (810 on the 010
scale), and only 7% (n = 21) stated that the level of power
of their supervisors was low (04 on the 010 scale).
Indeed, most of the respondents (72%, n = 207) stated
that their supervisors had many responsibilities.

Respondents perception of the level of nursing group power

Nursing professionals perceived the group levels of the
power perspective (mean, 1.93), as well as goals/outcome
competency (mean, 2.24), as very good. The position of the
nursing group, as part of the healthcare service system, was
perceived by the nurses as moderate (mean, 2.55), as was
the role of the nursing group (mean, 2.54). Respondents

perceived the lowest level of group power in relation to the

following subscales: controlling the effects of environmental forces (mean, 2.75), resources (mean, 3.48),
communication competency (mean, 3.00) and group
supervisors power/outcome attainment competency
(mean, 2.87) (Table 2).

Background factors related to nursing power

There were many statistically significant connections
between the demographic variables and nursing group
power/outcome attainment and its components (see
Table 3). Age had a statistically significant connection to
the respondents perceptions of their groups level of
controlling the effect of environmental forces (p = 0.007)
and role (p = 0.007). As regards, the groups role in the
delivery and coordination of care, guidance and group goal
development, the responses to the questionnaire indicated
that nurses aged 30 years and less perceived higher levels
of group power than nurses aged 3140 years (p = 0.003).
Furthermore, nurses aged 30 years and less reacted in the
items of change more positively towards changes than
nurses aged 5164. A statistically significant connection
was also evident in the relationship between nurses education and their perceptions of their groups level of power
in relation to the subscale of communication competency

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Nursing power as viewed by nursing professionals

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Table 2 Nurses perception of the level of nursing power and Group Outcome Attainment within Organizations (SKAGPO) instruments variables,
number of items and Cronbachs alphas

Variable

Mean

SD

Range

Minmax

Controlling the effects of environmental forces

Position
Role
Resources
Communication competency
Goals/outcomes competency
Nursing supervisors power competency
Power perspective
Nursing power

280
285
283
273
281
278
268
280

2.75
2.55
2.54
3.48
3.00
2.24
2.87
1.93

0.48
0.61
0.63
0.56
0.65
0.47
0.62
0.43

1.144.14
1.004.50
1.004.67
1.505.00
1.334.67
1.003.75
1.505.00
1.003.60

15
15
15
15
15
15
15
15

Number
of items

Cronbachs
alpha

7
4
3
6
3
4
4
5
36

0.699
0.599
0.632
0.697
0.558
0.411
0.710
0.574
0.614

Scale: The smaller mean depicts more agreement.

Copyright Sieloff.

(p = 0.014). Further, RN did not perceive as high level of

group power, as did the PN, in terms of the item concerning how well the organization considers the nurses
opinions and decisions (p = 0.011).
The nurses type of employment (full-time/part-time) was
significantly associated with many of the SKAGOAO subscales. Nurses working part-time perceived higher levels of
group power in relation to their supervisors power
competency than full-time nurses (p = 0.004). In addition,
part-time nurses perceived higher levels of group power in
relation to resources (p = 0.003) and environmental forces
(p = 0.033) as compared to the full-time nurses. Furthermore, full-time nurses perceived higher levels of group
power in relation to achieving the goals of the nursing group
than part-time nurses (p = 0.024). There were also significant connections between the amount of the respondents
work experience and the subscales of controlling the effects
of environmental forces (p < 0.001), role (p = 0.048) and
supervisors power competency (p = 0.045). Nurses with a
few years work experience (14 years) perceived higher
levels of group power in relation to the subscales of environmental forces, role and supervisors power competency
as compared to those nurses with more years of work
experience. Work experience on the same unit also had a
statistically significant connection with the subscales of role
(p = 0.022) and environmental forces (p = 0.002).
The demographic variables in the present study: gender,
further education, working district and units number of staff
members had no statistically significant correlation with the
subscales of nursing group power. Of the demographic
variables, the highest level of education and the supervisors
title were not included in the analysis because there were no
reliable differences. Nearly, all of the titles of the respondents supervisors were head nurse, and for this reason
different categories could not be created. Likewise, the
responses for the variables for the highest level of education
and current job duties were nearly the same. The responses
for current job duties were included in the analysis.

Discussion
The purpose of this study was to determine the way in
which nurses perceive the level of nursing group power in
their organization. The results of the study raise awareness
about the elements that affect the power of nursing
groups. The results are also useful to healthcare settings
and nursing management.
In the present study, nurses assessed the nursing
supervisors to have more responsibilities than power.
Nurses own responsibility was also assessed to be higher
than power, but at a lower level than that of nursing
supervisors. Similar results are evident in studies by Attree
(20) and Hintsala (21) where nurses felt that they have
many responsibilities, but not as much power. The nurses
explained that they are personally accountable and
responsible for the standards of practice, but, at the same
time, they have no personal control over everyday standards of nursing practice.
The younger nurses in this study perceived a higher level
of group power in relation to controlling the effects of
environmental forces, such as the anticipation of and
adjustment to changing healthcare trends than did older
nurses. This finding coincides with other studies. According
to Corey-Lisle and Tarzinia (22) and Laamanen et al. (23),
young employees found positive aspects in changes in skills
and content of their duties, while older employees experienced changes and new working methods as a threat.
Nursing group power was highest perceived in power
perspectives and goals/outcome competency. The respondents to the present study perceived a high level of group
power in relation to the subscale of power perspective. Most
of the nurses (83%) perceived a high level of group power in
relation to the item that addressed whether the desired
outcomes of the organization are consistent with the nursing group. According to Attree (20) and Ruston (24), the
viewpoints of the organization and nursing group concerning desired outcomes may be different. However, in this

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Mean SD

Position

Role

0.54 0.144
0.74
0.58
0.51
0.61 0.715
0.56
0.61 0.110
0.62
0.35
0.59 0.177
0.66
0.62 0.078
0.52
0.73
0.55
0.58 0.502
0.63
0.66
0.57
0.61 0.869
0.58
0.58 0.220
0.59
0.50 0.837
0.65
0.64

2.55
2.51
2.58
2.34
2.45
2.57
2.46
2.41
2.50
2.71
2.56
2.49
2.61
2.59
2.48
2.55
2.57
2.49
2.68
2.51
2.57
2.55

2.55
2.49
2.61

2.58
2.67

2.52
2.61

2.40
2.68
2.54
2.62

2.39
2.50
2.70
2.60

2.58
2.44

2.56
2.35
2.76

2.55
2.53

2.34
2.71
2.56
2.58

Resources

0.53 0.584
0.56
0.76

0.63 0.606
0.67

0.63 0.310
0.64

0.58 0.022
0.66
0.66
0.64

0.47 0.048
0.61
0.71
0.66

0.65 0.084
0.55

0.63 0.117
0.62
0.62

0.63 0.898
0.65

3.50
3.49
3.45

3.35
3.53

3.50
3.42

3.37
3.49
3.60
3.54

3.35
3.49
3.50
3.51

3.53
3.30

3.49
3.33
3.38

3.48
3.38

3.36
3.57
3.42
3.57

0.50 0.838
0.55
0.61

0.55 0.176
0.40

0.59 0.310
0.50

0.55 0.089
0.63
0.56
0.40

0.52 0.341
0.57
0.62
0.53

0.54 0.003
0.59

0.57 0.305
0.50
0.44

0.56 0.328
0.53

2.95
3.01
3.05

2.94
2.98

3.03
2.95

2.93
3.10
3.08
2.86

2.88
3.01
3.18
2.95

3.02
2.92

3.04
2.67
3.06

3.02
2.81

2.95
3.13
2.99
2.92

0.54 0.616
0.69
0.67

0.69 0.762
0.43

0.67 0.462
0.60

0.62 0.122
0.65
0.72
0.63

0.70 0.065
0.65
0.71
0.57

0.65 0.275
0.65

0.65 0.014
0.64
0.39

0.65 0.092
0.62

0.68 0.252
0.72
0.59
0.60

2.15
2.26
2.27

2.22
2.03

2.26
2.15

2.31
2.17
2.19
2.24

2.34
2.27
2.23
2.16

2.20
2.34

2.23
2.32
2.14

2.24
2.20

2.32
2.25
2.18
2.21

0.42 0.212
0.50
0.47

0.45 0.149
0.48

0.47 0.092
0.47

0.49 0.206
0.44
0.47
0.49

0.50 0.156
0.44
0.52
0.43

0.47 0.024
0.46

0.48 0.477
0.39
0.41

0.48 0.634
0.41

0.43 0.302
0.53
0.46
0.44

2.85
2.90
2.85

2.76
2.70

2.90
2.74

2.78
2.93
2.87
2.97

2.76
2.77
2.87
3.01

2.92
2.70

2.86
2.92
2.95

2.87
2.86

2.75
2.83
2.89
3.02

Power
perspective

0.52 0.801
0.66
0.65

0.51 0.730
0.63

0.63 0.084
0.55

0.57 0.302
0.73
0.54
0.58

0.54 0.045
0.56
0.67
0.67

0.65 0.004
0.51

0.63 0.829
0.60
0.45

0.63 0.970
0.56

0.48 0.207
0.58
0.74
0.59

1.88
1.95
1.93

1.84
1.93

1.95
1.87

1.97
1.93
1.87
1.95

1.89
1.95
1.90
1.95

1.91
1.99

1.94
1.91
1.91

1.94
1.83

1.92
1.93
1.92
1.97

p-Value

0.37 0.516
0.49
0.39

0.44 0.451
0.37

0.43 0.230
0.41

0.44 0.632
0.43
0.43
0.46

0.46 0.796
0.39
0.45
0.43

0.43 0.206
0.44

0.43 0.932
0.44
0.35

0.44 0.156
0.36

0.44 0.897
0.44
0.40
0.46

p-Value Mean SD

Nursing supervisors
power competency

p-Value Mean SD

Goals/outcome
competency

p-Value Mean SD

Communication
competency
p-Value Mean SD

0.54 0.069
0.51
0.60
0.55

p-Value Mean SD

0.49 0.007
0.67
0.66
0.63

p-Value Mean SD

2.44
2.69
2.53
2.54

p-Value Mean SD

Age
30
2.61 0.42 0.007
3140
2.74 0.51
4150
2.77 0.47
5164
2.89 0.49
Gender
Female
2.75 0.48 0.750
Male
2.72 0.47
Education
Registered nurse 2.76 0.48 0.051
Practical nurse
2.61 0.52
Other
3.01 0.41
Type of employment
Full-time
2.79 0.50 0.033
Part-time
2.65 0.42
Work experience (years)
14
2.61 0.37 <0.001
510
2.62 0.50
1120
2.90 0.49
21
2.84 0.49
Work experience in the same unit
4
2.61 0.42 0.002
510
2.81 0.48
1120
2.84 0.52
21
2.88 0.49
Further education
Yes
2.73 0.48 0.122
No
2.84 0.45
Further education (credits)
<30
2.80 0.47 0.396
>31
2.90 0.41
Units number of staff members
20
2.85 0.48 0.149
2130
2.72 0.47
31
2.71 0.50

Background
variables

Environmental
forces

Table 3 Nurses (n = 268289) background factors related to nursing power

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P. Katriina et al.

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0.43 0.589
0.45
0.36
1.96
1.93
1.89
0.64 0.808
0.65
0.49
2.91
2.86
2.84
0.42 0.122
0.50
0.45
2.33
2.22
2.17
0.67 0.413
0.65
0.64
3.09
2.98
2.95
0.51 0.377
0.59
0.56
3.52
3.49
3.39
0.63 0.223
0.68
0.46
2.46
2.61
2.50
0.59 0.887
0.63
0.56
2.53
2.56
2.53
0.50 0.634
0.47
0.50
2.72
2.75
2.80
Working district
Surgical
Medical
Psychiatric

p-Value
p-Value Mean SD
p-Value Mean SD
p-Value Mean SD
p-Value Mean SD
p-Value Mean SD
p-Value Mean SD
p-Value Mean SD
Background variables Mean SD

Table 3 (Continued)

Environmental
forces

Position

Role

Resources

Communication
competency

Goals/outcome com- Nursing supervisors

petency
power competency

Power perspective

Nursing power as viewed by nursing professionals

585

particular study, the respondents perceived a high level of

group power in relation to the item that addressed whether
the organizational regulations facilitated the achievement of
the nursing groups desired outcomes. This is contrary to the
study by Hagbaghery et al. (14), whereby organizational
regulations were seen as barriers against nursing power. The
respondents (98%) also perceived a high level of group
power in relation to the item that addressed whether the
relationships between the organization and the nursing
group are well maintained and this facilitates the nursing
groups desired outcomes. Krairiksh and Anthony (25),
Tschanne (26), Raymond (27), Tervo-Heikkinen (28) and
Scott (29) have presented similar findings.
Respondents to the present study perceived a high level
of group power in relation to the subscale goals and
outcome competency. There was a significant correlation
between the respondents type of employment (full-time/
part-time) and their perceived level of group power to
achieve nursing goals and outcomes. Achieving nursing
goals and outcomes, for example effective use of resources
and clinical competence, was more important issue for fulltime nurses than for part-time nurses. A review of literature by Lankshear et al. (30) revealed that education and
skills are related to better patient outcomes. Apker et al.
(31), Hintsala (21) and Ponte et al. (32) achieved similar
results, that is, the importance of self-development and
education. In the present study, nearly all of the respondents stated that the only way to obtain successful outcomes is to clearly define what they are.
Nursing group power was lowest perceived in resources.
As ascertained in previous studies, for example Aiken et al.
(33) and Hintsala (21), respondents in the present study
perceived a low level of group power in relation to the item
that addressed whether the amount of available nursing
staff (8%) and financial resources was inadequate (9%).
Half of the respondents (53%) perceived a low level of
group power in relation to the item that addressed whether
the nursing supervisor maintained adequate resources.
One-third of the respondents (32%) perceived a high level
of group power in relation to the item that addressed
whether their units computer data processing system met
the groups changing needs for information. This result is
supported by Asikainen et al. (34) where one-third of the
respondents received the necessary information where
they needed it and when they needed it.
The results in this study pertaining that nurses perceived
low levels of group power also in relation to subscale of
communication competency. Registered nurses perceived a
lower level of group power, than PN, in relation to the item
that addressed whether nurses had voting privileges granted in organizational decision-making. However, over half
of the respondents (60%) perceived a high level of group
power in relation to the item that addressed whether
nursing groups had voting privileges in organizational
intergroup committees. Krairiksh and Anthony (25),

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586

P. Katriina et al.

Mrayyan (35), Attree (20) and Hintsala (21) also obtained

similar results, that is, nurses have the independence to
carry out nursing measures and make decisions concerning
practices at their workplace, but they are not included in
the decision-making on the organizational level.
The respondents also perceived a low level of group
power in relation to the subscale outcome attainment
competency for nursing supervisors power competency.
The type of employment (full-time/part-time) and amount
of work experience in nursing had a statistically significant
correlation with the scores on this subscale. Nurses who
work part-time and have less work experience perceived a
high level of group power in relation to the items that
addressed the collaboration, decision-making and support
of the nursing supervisor than full-time nurses who have
more work experience.
More than half of the nurses (67%) stated that the
nursing supervisor works in collaboration with other
executives. Indeed, collaboration with other executives
and other professionals is considered a positive, necessary
aspect of nursing (36, 37). One-third of the nurses (33%)
perceived a low level of group power in relation to the item
that addressed whether the nursing supervisor had the
support of the key people representing the nursing staff.
According to various studies, employees do not have a
sufficient amount of knowledge about the duties of the
executives, and they are not readily available or visible
(21). One-third of the nurses (36%) stated that the nursing
supervisor is included in the decision-making processes.
Fradd (38) and Viinikainen (37) achieved similar results in
their studies, that is, nursing supervisors have power and
the right to make decisions in issues related to nursing,
such as budgeting and human resources.

Reliability and limitations of the study

The data (N = 289) for the present study were gathered from
11 public specialist healthcare hospital districts in Finland.
The SKAGOAO Instrument, used to analyse the data, is an
instrument used on the international level. It has been backtranslated into Finnish, modified and tested in a pilot study
for use in Finnish healthcare organizations. Cronbachs
alpha coefficients to assess the internal consistency of the
variables varied between 0.41 and 0.71. The alpha coefficient for the entire instrument was 0.61. The variables
goals/outcome competency (0.411) and communication
competency (0.558) had the weakest coefficients. The
instrument was designed in the United States, and therefore,
the Finnish translations of the concepts should be more
closely examined in the future. Data gathered through
surveys pose risks to the reliability of studies because the
respondents may not have a clear understanding of what is
being asked in the questions, but still choose a response
alternative. In the present study, a majority of the respondents had answered do not agree or disagree to some of the

statements, which may have affected the studys reliability.

The study was carried out according to good practice, and
permission to do the study was obtained from all of the
participating hospital districts.

Conclusions
The job descriptions of nursing staff and the entire nursing
process in the organization should be examined and
defined more clearly. The insufficiency of resources for
nursing is a common and well-recognized problem in
health care. Examining the role and duties of nursing staff
would help to distribute the right duties to the right professionals and to utilize resources in this way.
Having influence on the decision-making process and
the resulting decisions concerning nursing issues is significant to the provision of nursing care. The presence of
nursing staff at meetings, where decisions are made and
opportunities to disclose nursing expertise are available,
should be guaranteed. Indeed, opportunities to participate
in even minor activities in the ward, concerning nursing
practices, make it possible for staff members to present
their expertise.
Nursing supervisors supervise an ever-increasing number of wards and nursing staff. For this reason, making
themselves visible and known to all nursing staff is
impossible. Hence, the head nurses on the wards are the
nursing supervisors key persons in communicating
messages between the nursing staff and the executive
management. While traditional management models still
prevail in the healthcare sector, a working environment
that is constantly undergoing change poses many challenges on management. There are also many challenges
ahead in the future in relation to the availability of nursing
staff, an ageing population and the increase of illnesses.
Management practices in the healthcare sector need to
be reformed to ensure nurses are able to cope with these
future challenges. Successfully supervising nursing experts
requires investment in good management strategies in
which nurses actively participate in the decision-making
concerning their own and their units activities. Nursing
power and empowered nurses go closely hand in hand.

Author contributions
Peltomaa Katriina, Viinikainen Sari, Asikainen Paula and
Suominen Tarja were responsible for the study conception
and design. Peltomaa Katriina and Viinikainen Sari performed data collection, Peltomaa Katriina and Rantanen
Anja statistical analysis. Peltomaa Katriina was responsible
for the drafting of the manuscript. Rantanen Anja,
Viinikainen Sari, Sieloff Christina, Asikainen Paula and
Suominen Tarja made critical revisions to the paper for
important intellectual content. Rantanen Anja and
Suominen Tarja supervised the study.

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Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science

Nursing power as viewed by nursing professionals

587

Ethical approval

Funding

Permission to undertake the study was obtained from each

target organization. Permission of ethics committees was
not required for them, because this study didnt use or
create any registers and focus was not on patients.

Competitive Research Funding of Pirkanmaa Hospital

District (9L099) and Satakunta Hospital District (81022)
supported this study.

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