Careers in Healthcare: Power and Influence? Yes, Nurses Have Them – Part I

healthcare8Power and influence have been the subject of research, philosophy and debate for years. The pursuit of power and influence is common for many reasons, not the least of which is to control and effect change.

Nurses have a significant amount of power and influence; recognizing and utilizing them is often the challenge. That’s because power and influence are terms often attributed to people who are in administrative or leadership positions, not necessarily to individuals “in the ranks.”

I believe that is a false perception. I’ve seen nurses apply leadership principles every day, by prioritizing their work, delegating & supervising to ancillary staff, and negotiating the timing of patient treatments or tests with non-nurse colleagues.

Five types of power

While frequently construed as negative, power in and of itself is merely a capacity. Power is the ability to make action possible. But what are the sources of power?

In a classic study, social psychologists John R. P. French and Bertram Raven identified five sources of power1:

  • Positional power: Also called “legitimate power,” it is the power of an individual assigned by the relative position and duties of the holder of that position within an organization.
  • Referent power: Referent power is the power or ability of individuals to attract others and build loyalty. It’s based on charisma and interpersonal skills.
  • Expert power: Expert power is an individual’s power deriving from the skills or expertise of the person and the organization’s needs for those skills and expertise.
  • Reward power: Reward power depends on the ability of the person who holds power to confer valued material rewards.
  • Coercive power: Coercive power is the application of negative influences.

The strategy of power is key

Having the capacity to make action happen is not enough to make the action happen. It requires strategies and tactics to affect a person’s thinking and actions to make action happen. While a spectrum of strategies and tactics – from force to influence – can be used to effect change, influence is generally the most successful and sustainable strategy.

Characteristics of influence

Influence is the ability to affect a person’s thinking or actions. Morton Deutsch and Harold Gerard2 describe two psychological needs that lead us to conform to the influence of others: our need to be right and our need to be liked.

What enables one person to influence others? Or, said another way, what makes you open to be influenced by another? The answers are many: individual characteristics, such as charisma and reputation; and strategies, such as the use of a bully pulpit, peer pressure, and psychological manipulation, are proven to be effective.

Harvard psychologist, Herbert Kelman3 identified three types of influence:

  • Compliance: People appear to agree with others, but actually keep their dissenting opinions private.
  • Identification: People are influenced by someone who is liked and respected, such as a famous celebrity or a favorite uncle.
  • Internalization: People accept a belief or behavior and agree both publicly and privately.

A nurse’s challenge

Given a greater understanding of power and influence, consider your own position in your work group and examine your position of power and influence. Use the following questions as a beginning point for your examination:

  • In what situations can you use your power to influence others?
  • Who has power and why? Do they always have it?
  • When do they and do they not have power?
  • How do they use it? Are they successful?
  • What is your power base?
  • When have you influenced others? Why were you successful? When were you not?

Power is the ability to influence an individual or a group to act in a specific way. You have it. Start thinking about how you can embrace it.

1French, J.R.P., & Raven, B. (1959). ‘The bases of social power,’ in D. Cartwright (ed.) Studies in Social Power. Ann Arbor, MI: University of Michigan Press.

2Deutsch, M. & Gerard, H. B. (1955). A study of normative and informational social influences upon individual judgment. Journal of Abnormal and Social Psychology, 51, 629-636.

3Kelman, H. (1958). Compliance, identification, and internalization: Three processes of attitude change. Journal of Conflict Resolution, 1, 51-60.

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