1. Schroeter, Kathryn PhD, RN, CNOR

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What do you think of when you hear the word "empowerment"? Do you think of control, influence, authority, command, or domination? Or do you think of "ethics"? Can being empowered reflect a nurse's ethical practice?


If we limit our focus of the term "empowerment," we limit our ability to understand and define empowerment on a conceptual level. Empowerment is more than controlling others and our surroundings. Empowerment can support our ethical practice as nurses by reinforcing the power that is inherent to our role as patient advocate as well as to our professional integrity and accountability.


We as individuals are empowered by our role, our licensure, our knowledge and expertise, and by our relationships with our patients and other healthcare providers. Empowerment should not be a destination that we strive for, but rather a journey that develops as we mature and evolve in our personal lives and professional practice. Thus, there should be no final stage in which further growth and change is unnecessary.



Being empowered is acting with integrity to create the environment in which we and others can develop character, competence, and synergy.1(p238) It is a balance of autonomy and dependence. When we take a stand or advocate for some aspect of our nursing practice as something we want, we are creating a vision. We are willing, therefore, to take a risk for it. Advocating "for" something implies advocating "to" someone in order to bring about the vision. Advocacy as ethical practice means taking some sort of action on behalf of someone or something that we believe in.


To do this, we must work together with each other and with those whom we practice. Teamwork and interdependence, however, are most effective when we operate out of a position of strength. Our own dependency grows out of a reluctance to take a risk or to take responsibility for the future. Ethical practice, then, supports individuals taking responsibility for their own believes and resulting actions.


Thus, how can we as nurses, managers, educators, and clinicians become empowered? And why should we? The ANA Code of Ethics for nurses identifies that nurses promote, advocate for, and strive to protect the health, safety, and rights of the patient.2 Therefore, as nurses, we need to advocate for our patients and ourselves. To advocate requires some level of power to do so. To do this we must choose to become empowered and then begin with a vision of ourselves as empowered. This first step in choosing empowerment implies that, like it or not, leadership to achieve our vision is solely up to us. The added benefit of having a vision is that we have given meaning to what we are doing.



As nurses, we have innate power by virtue of our licensing and our professional practice. However, we are also empowered via our capacity for decision making, advocacy, shared governance, committee participation, and the taking of responsibility and accountability that is inherent to our practice.


As professionals, we have decision-making power by virtue of our knowledge and responsibility. However, we cannot become independent unless we take the opportunity to make important decisions within and about our personal and professional lives. We need to be assertive and be able to clearly state our concerns and be able to stand up for ourselves. We need to believe that we can make a difference.


Another aspect of achieving empowerment is the group dimension. It is necessary to recognize that empowerment does not occur to the individual alone, but has to do with experiencing a sense of connectedness with other people. It also has to do with the corresponding fact that individuals have rights. By understanding our rights, we increase our sense of power and self-confidence. When a person brings about actual change, he or she increases feelings of proficiency and control. As individuals become more empowered, they develop more confidence and competence. This can create a positive impact on a nurse's personal and professional self-image.


Empowerment is a process that challenges our basic assumptions about power, helping, achieving, and succeeding. It takes courage to seek out and accept empowerment. It takes courage to stand up for patients' beliefs and wishes. It takes courage to be a patient advocate. As professional nurses, we must continue to advocate for our patients and ourselves. Achieving empowerment is a means to this end and a means to ensure ethical patient care.




1. Covey SR, Merrill AR, Merrill RR. First Things First. New York: Simon and Schuster; 1994. [Context Link]


2. ANA Code of Ethics for Nurses With Interpretive Statements. Washington, DC: ANA Publishing; 2001:7. [Context Link]