Nurses, Policies & Politics…How Comfortable Are You?
From Nightingale to Now: Why Nurses Must Engage in Politics
Florence Nightingale believed “nursing should be controlled by nurses” (Chaffee, Leavitt, & Mason, 2012). Historically, nurses were rarely involved in policymaking decisions, even when those decisions directly impacted on their profession, their patients, or the patients' caregivers and families. Without input from those deeply engaged in healthcare delivery, nurses and their patients could find themselves subject to decisions driven solely by hospital administrators, insurance companies, and government regulations.
Sophia Palmer felt “advancement for nurses and their profession could only be successful if they had a united front” (Chaffee, Leavitt, & Mason, 2012). She sought to unite the nursing profession through journalism and became the first editor-in-chief of the American Journal of Nursing. Through this mode of communication, her writings supported advancement of the profession through state registration and promoted the legislation that ultimately protected the title of nurse for all (Chaffee, Leavitt, & Mason, 2012). Throughout history, there are numerous examples of nurses leading advancements in their field, championing initiatives such as the hiring of school nurses, enhancing public health and home care, and advocating for equality during a time dominated by male authority (Chaffee, Leavitt, & Mason, 2012).
Organizations such as the National League for Nursing (NLN), the American Nurses Association (ANA), the National Association of Colored Graduate Nurses (NACGN), and the National Organization for Public Health Nursing (NOPHN) emerged in the early 1900s, during a time when most nurses—predominantly women—did not yet have the right to vote. The absence of voting rights significantly hindered early nurses' ability to become a powerful force for driving meaningful change. These pioneers in nursing, who strived to improve the profession along with improving outcomes for their patients, showed a great level of courage. They demonstrated the importance of courage and active participation in shaping health policies and regulations by the strategic use of persuasion and skillfully evaluating any stumbling blocks that might impede the ultimate goals. (Chaffee, Leavitt, & Mason, 2012).
In today’s era of nursing professionalism, do we still possess that same courage? Or do we fear loss of employment, alienation of our colleagues, increased stress, or loss of licensure, if we advocate for ourselves or our patients? Are we fully utilizing the voice our predecessors fought so hard to secure? Is there a lack of unity in our views among the professional organizations, nursing sororities, student groups, and alumni associations that have emerged since Florence Nightingale sparked the modern nursing movement in 1860? How many of us have political involvement on the institutional, local, state, or national level?
Ohio State Senator, Sue Morano, who is also a registered nurse, said at one time that nurses “have the skills effective for public office” (Chaffee, Leavitt, & Mason, 2012). Those skills include setting priorities, leadership, conflict resolution, collaboration, communication, and an ability to have conversations about difficult issues (Chaffee, Leavitt, & Mason, 2012). We do not think of ourselves as being gifted in this way, but we are, and yet very few of us are involved in political action and policy making. Nurses are busy individuals, and most often there is not a surplus of energy and/or minutes in the day to add yet another item to his/her day. However, if the approach to policy involvement were framed in a way that didn’t seem overwhelming, more of us might feel empowered and willing to engage.
The Health Policy Pathfinder (HPP) (Nannini, 2009) is a strategy used to teach nursing students the concept of interest group politics. This approach could help those of us who struggle with understanding the complexities of the political arena, including the definitions of key terms, the mechanisms behind program funding, and identifying who holds the authority to enact policies or programs. HPP assists in analyzing the arguments from different stakeholder groups and helps to identify ways these stakeholder groups can collaborate (Nannini, 2009). It then helps to examine how these interest groups influence the policy-making process and what evidence is in the media on the problem topic itself (Nannini, 2009). This evidence would then be evaluated for its strength and credibility during what is called the Predesign Phase. Within the next phase, the Design Phase, a policy issue of interest would include a title, scope, purpose, overview of the policy problem, key policy questions needing to be addressed, and the stakeholders’ views (Nannini, 2009). In the Execution Phase, nurses could choose a mock stage in which to present the information, such as a state review board, legislative hearing, or town council meeting (Nannini, 2009).
This approach could be used for novice participants to help them become more comfortable with acquiring the information they would need to advocate for their cause. The Health Policy Pathfinder could replace other agenda items at meetings nurses currently attend, such as staff meetings, nursing sorority gatherings, or state nursing association meetings and conferences. In order to be effective in promoting legislation that affects nurses and their patients, they must be comfortable with the process. Utilizing the HPP might offer the answer to the hesitation most nurses feel in becoming more involved. It may help nurses to facilitate the change they believe needs to happen for their own well-being and that of their patients.
Resources
Chafee, M. W., Leavitt, J.K., & Mason, D.J. (2012). Policy & politics: In nursing and health care. (6th ed.). St. Louis, MO: Elsevier Saunders.
Nannini, A. (2009). The health policy pathfinder: An innovative strategy to explore interest group politics. Journal of Nursing Education, 48 (10).