Iran Journal of Nursing

Introduction
Medical centers are important settings for providing medical services and play an important role in maintaining or promoting the physical and mental health of patients. Therefore, special attention should be paid to empowering health service providers, including nurses. Employee empowerment is an important element of management effectiveness in organizations. In this method, managers use effective behaviors to provide employees with autonomy and more control in their work or participation in making work-related decisions. Empowerment is considered as an important goal of nursing education, and it is necessary that nurses and nursing managers develop their management skills. The present study aims to determine the effect of a nursing manager empowerment program on the management skills of nursing students of Tehran University of Medical Sciences (TUMS).

Methods
This interventional study was conducted in Imam Khomeini Hospital in Tehran, Iran. Participants were 84 nursing students of TUMS in the eighth semester in the nursing management internship course in the academic year 2017-2018 and 19 nursing managers of Imam Khomeini Hospital including 9 head nurses and 10 supervisors who usually participated in the education of nursing management for students. The nursing students were divided into two control (n=42) and intervention (n=42) groups. The nursing managers were divided into two control (n=9) and intervention (n=10) groups. The intervention was a psychological empowerment program that was performed for nursing managers interested in participating in the program. Managers who did not want to participate in the program were included in the control group. Thus, nursing management students who were supervised by these two groups and in the relevant departments were classified as students in the intervention and control groups. 
The criteria for selecting nursing managers in the intervention group were the willingness to participate in the clinical education of nursing management for students and active participation in empowerment programs. The criteria for selecting students in the control group  were having internships in the departments where the head nurses had declared a consent to cooperate in providing nursing management education, and a consent to assess the management skills of their students. The criteria for students in the intervention group, in addition to the two criteria mentioned for the control group, was the desire of their supervisors to participate in the empowerment programs. After implementing the empowerment program for nursing managers in the intervention group, the management skills of students were assessed using a checklist by observation and interviewing the supervisor. Spreitzer and Mishra’s psychological empowerment scale was also used before and after the intervention. Data are analyzed in SPSS software, version 16.

Results
The mean pre-test score of psychological empowerment in nursing managers was 62.33 in the intervention group and 59.50 in the control group. In the post-test stage, the mean score was 68.777 and 60.700, respectively. The empowerment program had a significant effect on increasing psychological empowerment of nursing managers. The mean pre-test score of management skills for the nursing students was 2.066 in the intervention group and 1.940 in the control group. In the post-test stage, the mean score was 2.340 and 1.939, respectively. According to the results, the empowerment program significantly increased management skills of nursing students by 0.274(13.2%).

Conclusion
The psychological empowerment of nursing managers can improve the nursing management skills of nursing students. The results of this study can be used to persuade nursing managers to participate in empowerment programs, which can ultimately lead to improvement of nursing management skills in nursing students. Nursing managers should pay attention to the managerial skills nursing students and pave the way for increasing their empowerment by giving them autonomy and allowing them in making career decisions. It is recommended to conduct studies on the factors affecting the empowerment of nursing managers and the managerial skills of nursing students.

Ethical Considerations
Compliance with ethical guidelines
Ethical approval was obtained from the Ethics Committee of Tehran University of Medical Sciences (Code: IR.TUMS.FNM.REC.1396.4276).

Funding
This article was extracted from a research project, funded by Tehran University of Medical Sciences.

Authors' contributions
Study design: Hormat Sadat Emamzadeh Ghasemi and Abolfazl Sobati; Collecting data, writing, editing & review: Hormat Sadat Emamzadeh Ghasemi and Fatemeh Hajibabaee; Data analysis and interpretation: Hasan Khosravi and Hormat Sadat Emamzadeh Ghasemi; Performing intervention: Hormat Sadat Emamzadeh Ghasemi, Fatemeh Hajibabaee, Zahra Najm Zadeh, and Abolfazl Sobati.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all nursing managers of Imam Khomeini Hospital and the nursing students of the School of Nursing and Midwifery, Tehran University of Medical Sciences, for their cooperation.


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