Let us assume that you are a school nurse in a high school.

Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet.

What is the issue?
Is it my issue, and can I solve it?
Is this the real issue or merely a symptom of a larger one?
Does it need an immediate solution, or can it wait?
Is it likely to go away by itself?
Can I risk ignoring it?
What are the possible solutions? Are there risks to these solutions?
What steps would you need to take in order to solve the issue?
Does anyone else at the school need to be involved in the solution?
Where is the power leverage in the school to reach the preferred solution?

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Reaching a solution requires the use of power vested in the nurse. Review the list below (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.

1. Legitimate (or positional) power is derived from a belief that one has the right to power, to make decisions and to expect others to follow them. It is power obtained by virtue of an organizational position rather than personal qualities, whether from a person’s role as the chief nurse officer or the state’s governor.

2. Reward power is based on the ability to compensate another and is the perception of the potential for rewards or favors as a result of honoring the wishes of a powerful person. A clear example is the supervisor who has the power to determine promotions and pay increases.

3. Expert power is based on knowledge, skills, or special abilities, in contrast to positional power. Benner (1984) argues that nurses can tap this power source as they move from novice to expert practitioner. It is a power source that nurses must recognize is available to them. Policymakers are seldom experts in health care; nurses are.

4. Referent power is based in identification or association with a leader or someone in a position of power who is able to influence others and commands a high level of respect and admiration. Referent power is used when a nurse selects a mentor who is a powerful person, such as the chief nurse officer of the organization or the head of the state’s dominant political party. It can also emerge when a nursing organization enlists a highly regarded public personality as an advocate for an issue it is championing.

5. Coercive power is based on the ability to punish others and is rooted in real or perceived fear of one person by another. For example, the supervisor who threatens to fire those nurses who speak out is relying on coercive power, as is a state commissioner of health who threatens to develop regulations requiring physician supervision of nurse practitioners.

6. Information power results when one individual has (or is perceived to have) special information that another individual needs or desires. For example, this source of power can come from having access to data or other information that would be necessary to push a political agenda forward. This power source underscores the need for nurses to stay abreast of information on a variety of levels: in one’s personal and professional networks, immediate work situation, community, and the public sector, as well as in society. Use of information power requires strategic consideration of how and with whom to share the information.

7. Connection power is granted to those perceived to have important and sometimes extensive connections with individuals or organizations that can be mobilized. For example, the nurse who attends the same church or synagogue as the president of the home health care agency, knows the appointments secretary for the mayor, or is a member of the hospital credentialing committee will be accorded power by those who want access to these individuals or groups.

8. Persuasion power is based in the ability to influence or convince others to agree with your opinion or agenda. It involves leading others to your viewpoint with data, facts, and presentation skills. For example, a nurse is able to persuade the nursing organization to sponsor legislation or regulation that would benefit the health care needs of her specialty population. It may be the right thing to do, but the nurse uses her skills of persuasion for her own personal or professional agenda.

9. Empowerment arises from any or all of these types of power, shared among the group. Nurses need to share power and recognize that they can build the power of colleagues or others by sharing authority and decision making. Empowerment can happen when the nurse manager on a unit uses consensus building when possible instead of issuing authoritative directives to staff, or when a coalition is formed and adopts consensus building and shared decision making to guide its process.