A COMPARISON OF THE VIEWPOINTS OF DIFFERENT LEVELS OF NURSE MANAGERS ON EMPOWERMENT IN THEIR WORKPLACE

Dijj'ererzces of opirziorz befilieen tlze tliree levels of riurse iiiuizugers ori the .subject of eiirpotverrirerzt exist arizorzg nurses irz lzealtli services. It was urzclear Izow to]^, nziddle and functiorial lei,el managers view tlzeir owiz role iiz tlze eriipolveriizerit of tlzeir subordirzates. Tlze air11 oftlze study was to iderztifjl tlie elements tliat are es.serztia1 for the different levels of iiurse niaizagers to erzsure an enipon~ered rzurse. A descriptive explorative study was urzdertakerz in 1997 in Gauteng. A corzceptual fraiizeivork was evolved by aizalysiizg liter-rrture orz tlze coritributirzg elerizerzts of ezirpoivenizerzt iiz izur.sirzg niarzageiizeizt. Aiz instruri?ent was develol~t.d, based on tlze elenzents, and was distributed to a sanzple of 487 top, nziddle arzd .furzctional level izurse iizanagers of 37 bistitutioizs, izuiizelj, pi-ovirzcial arzd private izospitals, as ~vell us nzunicipalities uizd clinics iiz Gauteizg. Aiz iieriz analysis was used to test tlze reliabilit\. o f tlze iterns izz tlze questiorznaire (CrorzbaclzS alplza 0,919) arid a ,factor arzalysis izzdicated tlze i)alidit). of tire instruirierzt to iiieasure tlze coricel~t of e~~il~oiver~izeizl. The data arzalj~sis, by iiieans of the chisquared test, indicated tlzat sigiiificarit dijfereizces of opinion existed hehveen the tlzr-ee iizaizagerizeirt groups regardiizg tile corzce1,Jt of einpowernzerit. Tlze results ilzdicaled differelices of opiizio~z between tlze tlzree groups with izgurd to a11 ejyective o~garzisational structure of u lzeultlz service, tlze .rhariiig of power with suhordirzates, the decisionnzakirig process, riianagerizent skills tlie rzurse iizanager: iizotivatioiz and reward strategies aizd characteristics of an enipowered rzurse iizurzager irz tlze eri~~~oweriizent of riurses. Tlze corzclusiori is iizade tliat tlie Iziglzer a per.soiz/r~urse is situated in the izur.siiig lzierarchy of a service, tlze n?or-e eiizl~oweniieiit Ize/slze e.\-l,erierzces.

Tlze results ilzdicaled differelices of opiizio~z between tlze tlzree groups with izgurd to a11 ejyective o~garzisational structure of u lzeultlz service, tlze .rhariiig of power with suhordirzates, the decisionnzakirig process, riianagerizent skills tlie rzurse iizanager: iizotivatioiz and reward strategies aizd characteristics of an enipowered rzurse iizurzager irz tlze eri~~~oweriizent of riurses.lNTRODUCT1ON AND GENERAL BACKquality nursing care that they should deliver.Rapid GROUND changes take place continuously in, for example, the patient care delivering system in health services.In Emnpower~nent is a key ingredient in achieving a mofuture, better qualified and equipped health staff are tivated and successful staff members in any to the more extensive health organisation.However, the current situation tasks in their working To fulfill the last menin health services indicates a situation in which nurses tioned need and to meet the challenges of the future_ experience a lack of empowennent in their work situmanagers should possess the necessaly managelial ation.According to Klann (1992:20) the tendency over skills and responsibilities and be empowering towards the last twenty years is the decreasing of authority nurses.and autonomy of nurses in health services.Ernpowered and motivated llurses are needed to actively it, however, seelns that nurses worldwide are of the participate in organisational activities to ensure qualopinion that they have a lackof in their ity nursing care, cost-effective senrice rendering, high management practice, This leads to low work promorale and work productivity.
ductivity and morale among nurses.Some hospitals are not prepared to reduce their control measures The empowerment Of nurses has for the over nursing actions.Yet management of health sering profession.Nurses who are empowered, show it vices gives us to understand that they are by putting forward their creative ideas, accepting to empower nurses, This approach sends confusing delegated responsibilities, promoting open discussions messages to nursing staff, This again leads to miswith colleagues and supervisors and being receptive trust in management and a general resistance to new ideas.The result is that nurses become active the managelnent of the (Manthey, 1991:16), participants in the future planning of the service.promotes lhe of prospec-the different definitions on ,nanagement em.tive nurse leaders who will be prepared for their task powement, the following is an example: (Booyens, 1993:21).
ment is the interpersonal process of providing proper tools, resources and environment to build, develop and Havens and Mills (1992:62) are of the opinion that increase the ability and effectiveness of others, to nurses should be empowered in future by means of set and reach goals for individual and social ends,.greater participation in the decision-making that di- (Gibson, 1991:355), This definition is rectly affects them, that is participation in decisions but does not outline the specific elements and regarding issues in their working environment and of the concept of in the man-  (1997:198)

PROBLEM DESCRIPTION AND PURPOSE OF THE STUDY
The concept empowerment is presumed in different forms by various persons and in different contexts (Perkins, 1995:777).Empowerment can thus not be described in a single way.The need exists that it should be described by the different role players involved with it (Gibson, 1991:355).
In the setting of a health service the systems of coordination and control exist within a hierarchy (Hall, 1990: 113).The higher the position of a person in the command order, the bigger is herihis power basis and chances of being involved in critical activities and decision-making on the organisation (Hoelzel, 1989:ll).Depending on the urgency of a decision that should be taken, a nurse manager can determine how much power she herself should maintain and how much power should be assigned to nurses for making the decision (Hall, 1990: 114).Power sharing is thus related to the diminishing of the power exertion by a nurse manager.A manager or nurse lacking power can only deliver limitedinput in their work situation (WiUey, 1990:189).It wasnotknown if allnurse managers viewed and enacted their roles similarly in the sharing of power with nurses that is essential for the empowerment process.
According to Brown and Schultz (1991:37), strict control measures by top management in a service increase the potential for suppressing the ideas of lower level managers and nurses.This leads to high stress levels, which contiibute to a lack in creativity.

RESEARCH QUESTIONS
From the main problem regarding the empowerment of nurses, the following research questions were stated for the top, middle and functional level managers: . Which roles do managerial structures in their workplace play in the empowerment of nurses? .Which role do managers play in power sharing of nurses?
. To what extent does participative decision-making contribute to the empowerment of nurses? .Which managerial skills and responsibilities in the daily management task and task design contribute to the empowerment of a nurse? .IIow do motivation and incentive systems contribute to the empowel-n~ent of a nurse? .Which personal and leadership traits are characteristic of an empowering llurse manager?

GENERAL RESEARCH HYPOTHESIS
Arising from the research problem and research questions, the following comprehensive hypothesis was formulated: Tlze lziglzer a nurse iilalzager is positio~zed in the lzierarclzy of a lzealtlz service, the more empowerriielzt is experie~zced in Ize~.//zis workplace to en?power subordirzaies tlzan managers on tlie middle arzd furzctioizal levels of tlze rzursiizg Izierarcl~y.
The research questions were re-formulated in the form of the following null hypolhesis: There is no relation betweell managerial structures and the position of the nurse manager in the hierarchy. .There is no relation between the extent to which participative management take place and the position of the nurse manager in the hierarchy. .There is no relation between power sharing with nurses and the position of the nurse manager in the hierarchy.
There is no relation between the managerial responsibilities of thenurse managerin herhis daily managenlent task and task design and the position of the nurse manager in the hierarchy.There is no relation between the use of motivation and incentive systems that contribute to the empowerment of a nurse and the position of tile nurse manager in the hierarchy.
There is no relation between the personal aud leadership traits that are characteristic of an empowering nurse manager and the position of the nurse manager in the hierarchy.

LITERATURE REVIEW
The way in which the managerial structures of health services appear, as well as the process through which these structures change and are maintained, influence each nurse in the organisation, as well as the organisation as a whole.The concept organisational structures refer especially to the allocation of tasks to individuals and sections, hierarchical relations hetween managers and subordinates and communication lines between members in the service (Noorderhaven.1995: 13 1 ; Kinlaw, 1995: 19).It is de- An empowered work place is where a teal11 or group of individuals work effectively together to complete a task and are involved in participative management (Scott & Jaffe, 1991:16; Sorie; 1990:24).Real einpowennent occurs where the manager is prepared HEALTH SA GESONDHEID Vo1.5 to provide the subordinate with the freedom and can care for nurses by the establishment of a helpful power to perform the task effectively (Keller & relationship, based on cooperation, support,   Dansereau, 1995: 130).Empowerment takes place by acknowledgement of uniqueness, focus on strong means of relationships in which one person, through points, help to overcome weak points and assistance power sharing, creates the opportunity for another to in stress situations (Gordon, 1991: 15; Gutierrez et al. act effectively and the other party accepts this op-1995535;Minnaar, 1994:96-97;Mokgohloa, 19953).portunity (Brown, 1991:ll).In traditional hierarchi-It therefore seems that the manager should be sensical health services the majority of decisions about tive towards the needs of others, before empowerstrategic changes in the service are taken by only a ment can actually take place.
few at the top level (Vogt & Murrell, 1990:29).Also, the problem solving and decision-making authority for METHODS USED clinical and management issues is centralised within the top management level (Manthey, 1991 : 16).Al-A quantitative descriptive explorative study was done though this managerial style is economical, the rewithin the South African context by means of an sults are passive and unenthusiastic workers, as well analysis of literature on the contributing elements of as slow adaptation to changes (Booyens, 1993: 122).empowerment in nursing management.A conceptual framework for the study on management em-Managers are responsible for the implementation of powerment evolved with six main key concepts, empowering strategies from top to functional level which were identified, to direct the study.The six and should therefore possess certain managerial skills key components identified from the descriptions and to accomplish empowerment (Keller, 1994:2; definitions regarding empowerment evolved as: Mdongo, 1995:14;Wallace, 1993: 13).The manager (a) The organisational structures of the health care should effectively apply her managerial skills, daily, organisation.to create opportunities for nurses to improve their (b) Participative decision-making in the empower skills and knowledge and to participate in the man-ment of nurses.agement of the service.
(c) Motivation and reward strategies contributing to wards empowerment.Managers should create a ~notivational environment (d) The role of power sharing in the enlpowenllent that empowers nurses (Chandler, 1991:36).Employ-of nurses.ers are, inter alia, motivated by incentive and (e) Attributes that are characteristic of an empowacknowledgement systems that build pride and selfered nurse manager.
value (Drew, 1992: 18).Other factors that contribute (0 The management skills and responsibilities of the to task motivation, are greater work ownership and nurse manager in her daily task design and man identification of nurses with the organisation in which agement contributing to the empowerment of they work (Klann, 1992:20).The manager should nurses.
assist and support nurses to believe in the importance of their work (Kanter, 1989:91).Effective leaders VALIDITY ANDRELIABILITY inspire others with the enthusiasm of their vision and in this way cany forward the feeling of an objective A questionnaire was developed, based on the six comthat should be obtained and pride in their work.ponents which addressed the issues of empowering behaviour of all levels of nurse managers, and the The nurse manager as leader should personally be ideal characteristics of, and elements in an empowempowered before she can empower others (Byham, ering  Chi-quakate tests were done to determine if signifi cant differences existed between the three levels of

POPULATION AND SAMPLING
nurse managers regarding the responses on the items and to reject the stated null hypothesis.When com-Eighty-two (82) provincial and private hospitals with paring the three management groups regarding their 100 beds or more, as well as mullicipalities and clinresponses on the different statements,items of the ics within health service departments, in the Gautenga significant level of 0,01 was used, area in South Africa, represented the population.The appropriate hospitals were ideutified from the Hospi-FINDmGS, CON^^^^^^^^ AND ~C O Mtal Yearbook, 1993.

MENDATIONS
Top managemelit of these health services was re-A discussioll on the viewpoints levels of quested in writing to participate in the study.37 Instinurse on illlportant items of the six tutions of which 17 private hospitals, 12 provincial ponents of empowernlent, follows, hospitals and 8 municipalities indicated their willingness to participate and therefore formed the acces-

Contact witlz key figures
The findings indicated an interesting sequence, showing that the higher the position of the nurse manager in the hierarchy of the organisation, the more contact they have with important contact persons in the service.(x5 (2, N = 485) = 29:9, p 1.01)

Coizcertzs re policy
The lower the position of the nurse managers in the health service hierarchy, the less they felt free to forward their concerns regarding policy matters.They may have felt that they did not have the necessary power and say to influence the policy making process.(x5 (2, N = 477) = 9,36, p 1.01)

Iizjormation flow
The higher the position of the nurse manager in the organisational structure the more information was available to himlher.It seemed that on each level of nurse managers certain information was not forwarded to the next level.Functional level managers therefore felt excluded from important information.

Decisio~z-making
Like information flow it was evident that, the higher the position of the nurse manager in the organisational structure, the more she was involved in decisionmaking.Only 47.06% of functional nurse managers experienced involvement in decision-making.for innovation and a two-way info~mation system are necessary to empower nurses.Managers need contacts and networks, such as admission and interaction with important persons in the service (Chandler, 1991b:36-37;Kinlaw, 1995:89;Vogt & Murrell, 1990: 102).Managers with sufficient contact and interaction with top management possess the necessary managerial knowledge to support nurses effectively, by advising them about types of behaviour aud contributions that are needed in nursing practice.Significant differences of opinions were found in the responses of managers in all the services with regard to the managerial expertise of the nurse manager, the advocacy role of the nurse manager for staff at higher authority and the distribution of responsibility and authority to the lowest possible level.

Setting objectives
The statement was made that "power sharing oc-

Listening actively
The middle and top level nurse managers indicated that they paid attention to the proposals of enthusiastic nurses by actively listening to them, whereas functional nurse managers were in much lesser agreement than their seniors about this matter.Power sharing is thus needed at the functional management level.

Undermiizirzg power
It was found that 47.64% fullctio~lal level managers were of the opinion that superiors felt threatened if they permitted nurses to make too many decisions regarding important matters by themselves.Alternatively 32.12% middle and 25.0% top level nurse managers were of the same opinion.(x? (2, N = 483) = 14,56, p c.01) It is concluded that the higher the position of the nurse manager in the hierarchy of the health service the more power sheke may share with subordinate man-agers and nurses.Hoelzel(1989:ll) confirms this by stating that the higher the position of a person in the charge order, the greater is herhis power basis and chances to be involved in critical activities and the decisions of the organisation.The null hypothesis regarding the power sharing of the nurse manager with nurses and herihis position of the nurse manager in the hierarchy is thus rejected.According to Helton (1992:14) nurses and lower level managers can only be empowered if top level managers are willing to share power with them.
In the future power sharing should contribute to employee satisfaction and increasedresponsibility needed for the empowerment of nurses.Power sharing should involve effective advocacy of the manager, fair distribution of power, and effective distribution of responsibilities and authority to lower levels in the hierarchy.Nurses gain through power sharing by being more motivated, knowing that their work performances are recognised and contribute to improved service deliveq (Kinlaw, 1995:43).Ha11 (1990: 117-118) emphasises that power should be fairly distributed between two parties to colnplete a task.The parties will then view one another as equals and both will accept the full responsibility for effectively performing the task.

Mlddle level
A 1 lop level Significant differences of opinions were found in the responses of managers in all the services with re-

Discussiofz with all
opinion that managers limit the participation of nurses It was mainly the functional and middle level manag-in decision-making, because of the risks involved.
ers who disagreed with the statement that "before However, nurses should make decisions about the top management implements a policy that affects priority needs of their patients that include nursing nurses directly: it is first discussed at all levels in the care plans.
service".It seems that the top level managers have the final say in decision-making and that their subor-Chiles and 2 0 1 1 1 (1995:6) argue that managers should dinates need more responsibility and decision-making power regarding policies affecting their daily work activities.(x5 (2; N = 483) = 936, p <.01)

Iderztib problerns
It was found that especially the lower level of nurse managers felt that nurses can identify problems, but are not responsible for the solution thereof.

Freedom to air views
The multiple levels of bureaucratic approval for the The higher the level of the nurse manager in the hiessolution of problems should be diminished, because it archy, the more they experienced that nurses revealed is necessary for the worker to react quickly to the the freedom to air their views, on decisions that they disagreed with. (x5 (2, N = 481) = 17,10, p 1.01).Hidden opinions or conflict may result in low employee motivation and increased anger (Dienemann. 1998:119).

Makirzg mistakes
Nurse managers on the lower levels of the hierarchy are not exposed to the testing of alternative solutions as empowered behaviour, but must subject themselves to the policy statements in the service. (x5 (2: changing and unpredictable needs of clients and patients.Speedy responses to problems diminish the loss of tiine and money for the health service (Alcom, 1992: 13;McGraw, 1992: 16).Nurses should actively participate in the decision-making process: whereas managers should act as facilitators and suppotters rather than supervisors and controllers (Hibberd et al. 1992: 13).

--
The conclusion made is that the higher the position of the nurse manager in the hierarchy of the health ser-

Evaluation of Nurses
vice the more empowered sheke is to make deci- authority of the tasks (Booyens, 1996:5).Nurses need constmctive feedback to correct their behaviour in
The first and middle level managers, experienced a lack of opportunity for feedback on their experiences regarding the managerial style of the nurse manager.

Shared visiorz
The lower level managers did not value the vision of the services to the same extent as the top managers.

Emphasis of plarzrzing
It was interesting to note that especially the lower level of the nurse managers was of the opinion, that the emphasis on planning is the attainment of greater when asked for (Booyens, 1996:5).

Promotion system
It seemed that the lower the position of a nurse manager in the organisational structure, the more negatively sheihe reacted towards the existing prolnotion system.(x5 (2, N = 479) = 9,78, p <.01)

Support systein
The lower the level of the nurse nlanagers in the

Compensatioiz systein
Only a small nu~nber of first and middle level management ;md only approximately 50% of the top level managers were of the opinion that when nurses perform better than expected, they received the appropnate cotnpensation.This clearly indicates the absence of a significant cotnpensatio~l system that contributes to the feeling of powerlessness among nurses.

Zizcerztive systein
The same tendency was found in the item regarding areward system.More top level managers than lower level managers were of the opinion that a reward system existed, where nurses who aim at the attainment of organisational goals rather than fulfilling personal goals, were acknowledged.(Kanter. 1989:91).@ Functional level used.The null hypothesis regarding the use of moti-

Middle level
1 -1 Top level vation and incentive systems that contribute to the Significant differences of opinions were found in the empowerment of a nurse and the position of the nurse responses of managers in all the services with remanager in the hierarchy is rejected.According to gard to the characteristics of an empowered nurse Du Rand & Vermaak (199599) individuals who exmanager.perience inadequate incentives feel a lack of empowerment.In a research study by Koch (1992:244)  ing hierarchy the more they agreed that the nurse manager behaved in the same way that she expected It is reconlmended that the future empowering mannurses to behave.This could be ascribed to the fact ager should possess the characteristics of a role that a nurse manager becomes more aware of her model, fairness, expert behaviour, trustwoflhiness, be responsibilities and behaviour as she climbs the career ladder. (x5 (2, N = 478) = 6,42, p <.01)

Righteousness
Nurse managers at the functional and middle level experienced it less than top level management that, equal opportunities existed for each nurse to maximise her potential.(x5 (2, N = 480) = 8,0, p <.01)

Self coizfuleitce
The top and middle level managers showed considerably more insight than the functional level managers regarding entrusting tasks to nurses who lacked self confidence, in order to empower them. (x5 (2, N = 479) = 25,07, p 1.01)

Self development
Top level managers agreed more than functional level nurse managers that the nurse manager should work actively towards her ow11 self development by using the appropriate strategies for career progression.Self development with regard to skills and knowledge is an attribute that is characteristic of an empowered nurse manager (Boyadjis, 1990). (x5 (2, N = 475) = 733, p 1.01) It is concluded that there is a relation between the personal and leadership traits that are characteristic of an empowering nurse manager and the position of the nurse manager in the hierarchy.The higher the nurse managkr is positioned in the health service the more empowering characteristics can be associated with her.Bemidenhout (1994:242) confirms that power acquired by means of knowledge and skills, is one of the strongest forms of power.The more knowledge a manager possesses, the more power is possessed, which leads to the more effective empowerment of nurses.It thus seems that functional level hard working, caring and open to criticism.According to Minnaar (1994:96-97) all managers should be role models who demonstrate caring by means of a helping relatiollship in which they accompany their subordinates with self confidence to professional maturity.
From the above discussion and rejection of the null hypotheses it is apparent that the higher a person is situated in the nursing hierarchy of a service the more empowerment helshe experiences.

CONCLUSION
Every nurse manager should have the opportunity to promote challenging situations for each nurse in her service and should realise their fullest potentials.Ail nurses should have the opportunity to he empowered.
The discussion on viewpoints of the three levels of nursing managers outlines the current scenario of empowerment of nurses in health services in Gauteng and serves as guidelines to improve the working situation of lower level managers and nurses.Every nurse manager should create a new future for hislher organisation.In our rapidly changing health environment, pro-active planning of empowering nurses, is the best option offered for avoiding a society of unmotivated and dissatisfied nurses.
new ideas and motivation of staff members.A lack in empowerment leads to an unmotivated nursiug corps and in turn to dissatisfaction of the users of health services.All levels of nurse managers should play active roles in the enlpowerment of nurses ill their working situation.However, it seems that the hierarchy of a service influences the empowerment process.The main problem is that insufficient enlpowerment is experienced on the lower levels of the nursing hierarchy.Different levels of nurse manag ers will therefore view their roles in the empowerment of nurses, differently.The purpose of the study was to identify the different opinions of top, middle and functional level nurse managers on their roles in ensuring empowerlnent of nurses in the daily work situation.It was assumed that nurse managers on different levels of the nursing hierarchy had different opinions and views on the empowerment of nurses in health services.The objective of the study was to identify managerial weaknesses in the process of empowerment of nurses.Essential at-eas for the advancement of empowerment of nurses were identified.The viewpoints of nurse managers regarding the role of ~nanagerial structures, power sharing.decision-making, managerial skills, motivation and incentives, and charactenstics of ~II empowering manager, were determined.HEALTH SA GESONDHEID V01.5 N0.3 -2000 Empowerment was viewed as a ~uultidimensional concept, which can enhance work satisfaction of nurses aud the quality of patient care.
sirable that persons nearest to the point of delivering are consulted, because they know best what is feasible or not.Organisational management structures play a crucial role in the empowerment of nurses.If elnpowernlent is to be realised, the following organisational changes should take place: less levels of control in a service, the establishment of open conlmunication lines between management and nurses; a better distribution of information and the development of new ideas and expertise of all staff.
environment for nurses.Fifteen expert nurse 1992: 12; Gunden & Crissman, 1992:7).A manager managers as well as a statistician critically evaluated HEALTH SA GESONDHEID V01.5 No.3 -2000 the instrument in a pretest.These nurse managers Figure Feedback On questionaires did not take past in the main study.validity were ascertained by ex-500 perts in the field of tertiary nursing education that 400 critically viewed the questionnaire and recommended improvements.Content validity was tested by the items represented in the conceptual franlework of the study.Construct validity of the measuring i n s ~u -100 .-. ..ment was done by the process of factor analysis.The factor analysis displayed six factors that corre-Send out Received back Unusable Used sponded with the six initial constructs of the measuring tool and therefore confirmed that the instrument DATA A N ~~~S I S complied with the requirements for construct validity (Polit & Hungler, 1993:252).

Figure 2 :
Figure 2: Organisational structure (x5 (2, N = 484) = 14,40, p <.01) The above four statements and responses on the theme organisational structure.indicate the presence of a strong bureaucratic managerial style in health the functional level nurse lacks the opportunity for individual decision-making (Gunden& Crissman, 1992).The null hypothesis regarding the managerial structures and the position of the nurse manager in the hierarchy was rejected.It could be accepted that top level managers are more empowered to make contact with key figures, give input in policy matters, have access to the necessary information and to paTicipate in decision-making processes, than lower level managers and nurses.Randolph (1995:22)  also agrees that top level managers have access to a broad range of appropriate information in a service that they should give through to all persons, on all levels that fall under their authority.In future, fundamental changes in management structures are needed to establish enlpowennent of nurses.Training in supervisoly skills, an open climate for discussion, collaborative decision-making, opportunities

Figure 3
Figure 3: Power sharing curs because the manager and the nurse set objectives together and then work together to obtain the set objectives".It seemed that power sharing was less of a problem at the top level managers because only a few managers share power at this level.It was at the middle and functional levels where many managers are involved, where the problem occurred (Abdel-Halim, 1993).(x5 (2, N = 484) = 8,02, p <.01)

Figure
Figure 5: Management skills egarding the extent to which participative Formal Feedback management takes place and the position of the nurse o 20 40 60 80 100 manager in the hierarchy is thus rejected.A number Responses of nurse managen in % opinions were found in the personnel.Top level managers do not always give responses of managers in all the senrices with renurses and lower level managers the oppostunity to gard to constructive evaluative feedback about work use the skills and knowledge that they acquire during performances, the existence of a vision for the ser-training, because they would rather handle the issues vice and participation of nurses in the planning of themselves by holdiug on to the responsibility and projects.
cost-effectiveness rather than the development of staff members.(x5 (2, N = 484) = 10,79, p 1.01) In the future all managers should address the existence of a vision and mission in a service, participation of nurses in the planning of projects, setting of objectives collaboratively, constructive feedback, a managerial climate that promotes independence in the workplace and effective supervision and control.The existence of a vision in a service should focus the attention on the attainment of a goal that guides the work performances of nurses and promotes their commitment to the service.Nurses need the presence of managers in their work place who do not interfere with their work performances, only

Figure 6 :
Figure 6: Motivation and reward hierarchy the less aware they were about the fact that nurses who are regularly supported by nurse nlanagers in their work performa~~ce, develop a perceivable feeling of self-worth.(x5 (2, N = 472) = 9,72, p <.01)

Figure
Figure 7: Characteristics it was suggested that attention should be given to the HEALTH SA GESONDHEID V01.5 N0.3 -2000 Role model managers need more empowering characteristics thau The higher the nurse manager's position in the nurs-top level managers do to effectively empower nurses.