Flogging the dead horse: the myth of nursing empowerment?

With the move towards a more 'open' National Health Service, a new deal for staff, and greater staff involvement the way ahead for nursing seems bright. The proposals in the governmental White Paper (1997) The New NHS: Modern, Dependable reflect the need for greater co-operation and for a greater empowerment of nurses. If the aims of such major change in the NHS are to be achieved we need to consider both the real effects of nursing empowerment from past history, and the problems involved in greater nursing involvement in the NHS as an organization. As such our discussion may throw some light on the possible ways to progress during such fundamental change. It is from such lessons that positive future progress may be made. Firstly a discussion of the concept and its relationship to health and effective self-image is considered. Opportunities in respect of changing environments, and a move to more transformational change within the NHS could allow greater empowerment and feelings of self-efficacy. Such large scale change is essentially cultural and attitudinal; central to governmental proposals for NHS reform. The authors consider the real effect of nursing empowerment; based in part on the work of Kanter (1993) in the USA and work on empowerment and the role of nursing; and of power relationships within the organization. The links with the nurse's role in primary care groups and clinical governance are strong, with subsequent lessons for the British nurse during these initial changes. The potential for positive benefit is high; but coupled with this is a discussion on the relationship of NHS management, and a brief analysis of managerial practice and attitude, which may mitigate against empowerment. The authors put the case that structural changes are not sufficient to allow greater empowerment; which in its present form may only be an ideal. A greater effort by all is required if the myth is to be made a true reality.