Structural empowerment among frontline nurses in Hong Kong: a study of cultural and personality factors

Abstract

Kanter’s theory (1993) maintains that access to empowerment structure would lead to positive organizational behaviour and that individual differences are inconsequential. This study proposed that Chinese cultural value of social orientation needs to be considered when applying the theory to nursing practice in Hong Kong. Based on the perspective of person-situation interaction, it was also hypothesized that need for empowerment and self-esteem would act as moderators in the empowerment process. In this study, job satisfaction and psychological well-being were used as outcome measures to evaluate the empowerment process.

A cross-sectional survey research was conducted to test the hypotheses formulated in this study. Reliability and validity of the measuring instruments were first established in a preliminary study. All measurements were incorporated in a standardized questionnaire which also contained items on sociodemographic characteristics. The participants were Chinese frontline nurses (N = 556) from different areas of practice in an acute hospital, of which 83% of them were aged between 25 and 39. Education of the participants ranged from hospital-based training to Master degree. A great majority (86%) of the respondents were females.

Confirmatory factor analysis supported Kanter’s four-factor model (i.e., opportunity, information, support, and resources) of nursing empowerment. Availability of formal and informal power was found to facilitate access to empowerment structure. Measures of empowerment were of satisfactory reliability and construct validity. Access to empowerment structure was associated with subjective feelings of being empowered. This feeling of psychological empowerment mediated the impact of structural empowerment on outcome measures.

Nurses with higher education or higher nurse rank reported greater access to empowerment structures. They also exhibited greater job satisfaction and better psychological well-being. Less experienced nurses reported greater access to opportunity and supports, whereas more experienced nurses exhibited greater job satisfaction and psychological well-being.

The association of structural empowerment with job satisfaction was less significant among nurses who held stronger view of social orientation, but these nurses enjoyed better positive well-being with greater access to empowerment structures. Structural empowerment was associated with positive outcomes among nurses who reported high need for empowerment, but not among those whose need was low. With access to empowerment structure, nurses with high self-esteem reported a higher level of job satisfaction than did those with lower self-esteem. However, structural empowerment promoted positive well-being among nurses with moderate self-esteem, but not among those of high self-esteem. The impact of structural empowerment was negative among nurses of low self-esteem.

This study confirmed the applicability of Kanter’s theory of structural empowerments among Hong Kong frontline nurses whose ecological culture was predominantly collectivistic. However, to implement structural empowerment effectively, the model needs to be expanded to include cultural-personality factors such as social orientation, need for empowerment, and self-esteem. In view of the substantial contribution of global empowerment to positive outcomes, an integration of structural and psychological empowerment was proposed. Findings of the present study were discussed with reference to relevant issues and compared with findings reported in the West. Limitations of the study were considered and suggestions for future research made.