CHAPTER FOUR Power, politics and gender
Issues for nurse leaders and managers
INTRODUCTION
Nursing is the most strongly gender segregated of all occupational groups. The beginnings of modern nursing were strongly feminine and the traditional view of nursing work has been that it is women’s work, and that the knowledge associated with it is somehow innate to women (Evans 1997). Though nursing has also attracted men, it remains strongly female dominated. This means that one of the key features of the health care industry is its strongly polarised occupational segregation (Kaye 1996). This polarisation positions gender, politics and power as central to nurses and nursing. The effects of this polarity are seen in aspects of workplace culture, such as occupational violence, workplace oppression, and in current debates such as those addressing the education of nurses and recruitment into the profession. Occupational segregation also has an effect on nurses’ pay and potential for career advancement, especially for female nurses (Clare et al. 2001). Men are greatly over-represented in leadership positions (Brown 1998; Sharman 1998). This means that gender, particularly aspects pertaining to disadvantage and privilege, needs to remain firmly on the nursing agenda.
If we consider the structure of health care organisations such as hospitals, it is evident that nurses represent a high proportion of employees. However, this dominance does not transform into significant organisational power. Nurses are not necessarily appropriately represented in political processes. For example, Robinson-Walker (1999) points out that though nearly one-third of management roles are filled by women, most of these roles are positions of little power or authority. Furthermore, though nurses are active on committees, they tend to be well represented in labour-intensive committees, such as quality improvement committees, which focus on collection and analysis of data (Clare et al. 2001). They are less well represented in powerful decision-making forums such as financial committees. One of the effects of this is that nurses are subject to imposed change, as important decisions may be made with little regard for their effects on nurses and nursing. Imposed change is recognised as a contributing factor to nurses’ job dissatisfaction and ultimately to retention of nurses, especially where the change impacts on nurses’ workloads and their ability to provide adequate care (Jackson, Mannix & Daly 2001). This chapter considers the concepts of power, politics and gender within the context of nursing practice, management and leadership, and the continued development of the discipline of nursing.
GENDER AND LEADERSHIP IN NURSING
Female nurse leaders are confronted with many barriers (Graybill-D’ercole 1998). Notwithstanding the influence of feminism on nursing, female nurses still earn less than male nurses (Dale 1998; Gray 1995), and are still under-represented in leadership positions in nursing (Brown 1998; Evans 1997; Sharman 1998). Despite the female dominated nature of nursing, ‘patriarchal gender relations which reflect a high valuation of all that is male and masculine, play a significant role in situating a disproportionate number of men in administrative and elite speciality positions’ (Evans 1997, p.226). It is noteworthy that women have slower rates of achieving promotion than men (Brown 1998; Graybill-D’ercole 1998; Sharman 1998), with some findings suggesting that attainment of a senior position in nursing takes an average of five years longer for women than it does for men (Gray 1995).
The literature suggests that this differential is due to male privilege, particularly in domestic matters (Evans 1997; Gray 1995), as well as the fact that feminine characteristics are seen as undesirable and inappropriate in leaders, while male characteristics are highly valued (Evans 1997). Findings by Dale (1998) indicate that male and female nurse executives are similar in terms of attributes, but he makes the comment that ‘executive characteristics are generally associated with masculine characteristics’. This view is also evident in the general management literature (Fulop & Linstead 1999; Robbins et al. 2000; Sinclair 1998). These characteristics include ‘aggression, competition, dominance, ambition, decisiveness’, whereas women supposedly value quite different qualities, including connectedness, inclusivity and relationships (Robinson-Walker 1999, p.30). This perceived focus on relationships is supported by Gilloran (1995), who noted that women seemed to form closer relationships with subordinates than men. This was seen to cause some difficulties in disciplinary matters (Gilloran 1995). There is also evidence in the literature to suggest that women leaders and managers in nursing may feel they are judged against male or ‘macho’ values (Markham 1996).
Evans (1997) presents evidence to suggest that although men represent a minority in nursing, they do not experience the hostility and lack of support that women can encounter in male-dominated professions. Rather, she suggests that men are advantaged, with their minority status according them special power and privileges, and this is why they are over-represented in elite power positions in nursing (Brown 1998; Evans 1997; Sharman 1998). Though it is sometimes postulated that attracting greater numbers of men into nursing would elevate the prestige and status of nursing, Evans (1997) suggests that there is the possibility that female nurses might become increasingly subordinate to yet another layer of male dominance. Increased numbers of men in nursing could merely make it more difficult for women to achieve leadership roles. The literature also suggests that a lack of role-modelling and mentoring for potential female nurse leaders may contribute to the under-representation of women in leadership positions (Graybill-D’ercole 1998; Robinson-Walker 1999).
Discrimination against women as leaders can be subtle, with stereotypes and insinuation being used to devalue women and make it more difficult for them to move to leadership positions (Simmons 1996). Furthermore, Robinson-Walker (1999) suggests that women may feel it inappropriate to be openly ambitious. Phrases describing nurse managers as ‘petticoat governments’ (Gilloran 1995) or similar, devalue the skills of women nurse leaders, and imply that women are frivolous and not fit to lead. Moreover, stereotypes that portray women as domineering and controlling, and dismiss women’s talk as whining, gossipmongering or bitching, also perpetuate the idea that women are not appropriate for leadership positions (Evans 1997; Robinson-Walker 1999). The effects of stereotyping were also found to be evident, as men were perceived to be more logical, rational, intellectual and ready to take responsibility than women, and thus more suited to supervisory and leadership roles (Gilloran 1995).
In addition to stereotype advantages, social institutions such as heterosexual marriage also represent career advantage to men (Evans 1997), and there is evidence that women who reach leadership positions are more likely to be single and not responsible for the care of children (Gilloran 1995). This implies that women who have family responsibilities are disadvantaged when aspiring to leadership positions, which is supported by evidence that women consider family responsibilities a barrier to career progression. Female leaders are under scrutiny, and Graybill-D’ercole (1998:1152) advises that gender politics means ‘there is a narrow band of acceptable behaviour for women’. In this case, behaviour includes personal presentation such as dress, accessories, make-up and hair style. Many women are quite used to having aspects of their appearance commented on and criticised in their professional lives, whereas male managers are not subjected to the same level of personal scrutiny. Women’s ways of interacting with others may also be the subject of comment in the workplace; for example, women may be accused of being flirtatious or using their femininity to unfair advantage (Sinclair 1998).
POWER
Power is a necessary aspect of management and leadership (Marquis & Huston 1996), and can be defined as the capacity to produce effects on others, change their behaviour, or influence others. There is a difference between power and influence, in that power has the capacity to cause change, whereas influence is the degree of actual change that occurs in the person over whom we have either power or influence. Power can exist in leaders, followers and in situations, and is an important aspect of the working landscape, although the literature suggests women may be ambivalent about power (Robinson-Walker 1999). Leaders can influence their followers, and conversely, followers can affect the leaders’ behaviours, as well as their attitudes.
Power may hold negative associations for women, ‘for women, power is viewed as dominance versus submission; is associated with personal qualities, not accomplishment; and is dependent on personal or physical attributes, not skill’ (Marquis & Huston 1996, p.167). They also point out that many of the attributes associated with holding and using legitimate power—for example, assertiveness, decisiveness and autonomy—are more commonly associated with male than female socialisation (Marquis & Huston 1996).
Sources of power
Power relationships can be observed between individuals by non-verbal behaviours or what is called ‘dominance/submission’ behaviour (Hughes et al. 1999; Reardon 1995). These behaviours consist of stylised rituals, including staring, which typically dominant individuals do, while submissive individuals do not; pointing, where again, powerful individuals point, while those without power do not; touching is often done by the more powerful to demonstrate the power differential; and interrupting is more often done by powerful individuals, while less powerful individuals are those who are interrupted. Research indicates that women tend to be interrupted more often than men (Tannen 1994). Does this mean that men are more powerful, generally speaking, than women?
Other rituals or non-verbal messages of power in the workplace include placement of furniture, size of office space, displaying symbols of achievement or power (diplomas, awards, etc). Choice of clothing can also affect power and influence. Uniforms are a classic example, as they have been shown to influence people who are in crisis, which results in instructions being more likely to be followed. A person’s appearance is an important aspect of leadership, and has led to the ‘power dressing’ phenomenon that is evident, especially in the business world (Brewis et al. 1997; Hughes et al. 1999). Technology has created the capacity of ‘virtual politicking’ within organisations—political players increasingly use email for political means, creating significant new challenges and risks for the organisation (Waters-Marsh 2001). Other sources of power by which an individual can potentially influence others are expert, referent, legitimate, reward and coercive power (after French & Raven 1960—see Table 4.1).
| Expert power | Represents the power of knowledge such as the nurse, surgeon or medical specialist may have. This has implications for leadership that is based on the value of followership, because increased knowledge in general means that followers have much expert power to contribute. Leaders in this situation will respect and listen to followers. |
| Referent power | The political influence a leader has due to the strength of the relationship between the leader and followers. This power is demonstrated in loyalty towards the powerful person, who may be considered charismatic. If you admire, respect or like someone, you will be favourably disposed towards doing what they want; you will be influenced by them. Ask yourself: who has the referent power in your ward/nursing group/organisation? |
| Legitimate or positional power | Depends on a person’s organisational role, rather than on the person in that role. It usually follows formal or official authority—the higher the rank, the more power that can wielded. While the role is an important component of this type of power, followers also grant power to the person occupying the role. |
| Reward power | Involves the potential to influence others due to one’s control over both intrinsic and extrinsic resources. These resources can include the power to give raises, bonuses, promotions, tenure or to select people for special assignments or desirable activities. Reward power can produce compliance, but does not necessarily produce commitment. Overuse of reward power may lead to resentment building up in subordinates, who might begin to feel manipulated, particularly when inconsistencies of reward occur on a regular basis. |
| Coercive power | That power which is founded on punishments, rather than rewards. It has the potential to influence others, often through the administration of negative sanctions, such as refusing a promotion, or the removal of positive ones, such a desired transfer to another part of the organisation. Coercive power is therefore the opposite of reward power. Some other examples include speeding tickets, punitive behaviour you direct at your children and the coercive power built into legislation, such as that of wearing seatbelts, and preventing or punishing sexual harassment. |
Source: French & Raven 1960
Note that leaders and followers can use all of these types of power and that effective leaders generally work to increase their sources of power. In addition, Marquis and Huston (1996) describe charismatic power, which, as the name suggests, comes from personal dynamism and charisma; information power, which comes from having information needed by others; and, feminist or self-power, which comes from personal maturity and self-confidence.
Leaders vary in the degree to which they share power with subordinates. Some leaders view power as a fixed amount, so the more they give away, the less they have. Leaders who subscribe to this view are less likely to share power because it makes them nervous (Bradford & Cohen 1998). However, there is an argument for increasing one’s power by delegating it to others and encouraging more participative approaches in the work setting.
Empowerment is an essential aspect of transformational leadership (Marquis & Huston 1996), and gives responsibility, accountability and authority to others to undertake the work that needs to be done (Naish 1995). Empowerment is thus an abstract concept that is fundamentally positive, referring to solutions rather than to problems (Kuokkanen & Leino-Kilpi 2000). Empowerment of staff also helps to develop them and build their skill base (Morrison et al. 1997), which, in providing wellbeing at both the individual and organisational level, will reinforce staff self-image and cooperation networks (Kuokkanen & Leino-Kilpi 2000). However, empowerment will not work in every setting, as it requires the professional to have capability, initiative, commitment and independence in decision-making, which organisational structures may impede. Using empowerment as a leadership strategy is more democratic and participative than using power-based strategies (Tappen 2001). Leaders who rely on power-based strategies to achieve their own ends will generally work to increase their sources of power, be they referent, expert, reward or legitimate.
Leaders who rely most on referent and expert power have teams that are more motivated and satisfied, and who perform better (Wood et al. 2001). In general, this suggests that leaders who take advantage of all their sources of power and influence are the most effective; the type of power they use depends on the situation in which they are placed. Further, while leaders have strong influence and power over their staff, those who are in turn influenced by their team tend to be most successful (Hughes et al. 1999). This type of reciprocity provides opportunities for optimum functioning of their organisation because it requires participation based on empowerment.
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