Nurses have opinions and are unhesitant about sharing them. To be a nurse requires an elevated level of clinical and emotional intelligence together with strong internal motivation, which is expressed through advocacy for injustice and the protection of the vulnerable. While some may restrain the practice of nursing in the hospital and other clinical environments, the power of nursing must also be exerted to influence healthcare policy if there is any hope of reform.
Although this notion is not new, the Institute of Medicine (IOM) found that for various reasons, the nursing profession was simply not performing to its full capacity as a keystone discipline in the healthcare system. Their report on The Future of Nursing: Leading Change, Advancing Health was conducted in response to a suboptimal healthcare system and specifically to “transform the nursing profession” to improve the wellness of the nation (Institute of Medicine, 2011, p.2). This led to the partnership of the IOM and the Robert Wood Johnson Foundation (RWJF) and the establishment of the Initiative on the Future of Nursing.
The future of nursing consists of supporting exemplary practice to the fullest reaches of education and preparation, ensuring seamless pathways for academic progression, and improving information and data collection structures to support workforce capacity. Central to healthcare reform is the development and implementation of policy that directs all care providers to identify and implement best practices leading to an excellent healthcare system. "Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States" (IOM, 2011, p.4). Engagement in policymaking is an important part of nursing practice.
Policy is the driving force in a system and unless the nurse is an active full partner with physicians, administrators, elected officials, and all other stakeholders, the system of healthcare will be missing a critical perspective leading to ineffective reform strategies. One can determine a stakeholder by those who would be impacted if the healthcare system pulled up stakes and went away. With that in mind, every human being regardless of age, gender, race, religion, or political affiliation is a stakeholder. One should ask, “How well are the stakeholder’s needs and wishes currently represented?” The nurse is well-trusted by society and can represent unheard stakeholder voices as an advocate when the unheard is excluded.
As nurses, we are well acquainted with policy in the form of organizational policies and procedures that guide practice within a healthcare organization. But when one broadens the perspective to include local, state, and national healthcare policy, nurses are sometimes without a frame of reference, confidence, or skillset, and do not become engaged. With that in mind, there is a gap to close, and unless we address this like a bear, the nation’s wellness will continue to deteriorate.
But why the label “Nurse Policy Entrepreneur?” Roberts and King define policy entrepreneurs as, “. . . people who seek to initiate dynamic policy change. . . through attempting to win support for ideas for policy innovation.” (Roberts and King, 1991, p. 739). When individual nurses take it upon themself to jump into the fray of policymaking at the local, state, or national level, they act as Nurse Policy Entrepreneurs (NPE).
One may be tempted to only conceptualize the role as a financial entrepreneur like Elon Musk or Steve Jobs. The nurse practitioner or consultant who puts up a shingle and conducts business is a nurse entrepreneur while Florence Nightingale and Dorothy Dix were NPEs. They saw a deficit in how healthcare policy development and implementation ineffectively treated people and acted. They used the nurse mindset of advocacy and innovation to influence the system and close that gap. They were unable to sit still or simply complain to colleagues or in public protests, but they figured out how to effectively make powerful and lasting changes within the system.
The political process does create policy through elected officials and their governing entities such as city councils, county commissioners, school boards, and state and national legislators. However, there are numerous other powerful policymaking bodies. They don’t have to be a health care organization to support health and wellness such as the Boys and Girls Clubs, the humane society, and an endless list of NGOs that tackle specific issues (e.g., American Foundation for Suicide Prevention, Mental Health America, National Alliance on Mental Illness, etc.). One may but does not have to participate in the political process to reform policy.
In August of 2022, with nurses from three different countries, I co-presented a webcast that was sponsored by Sigma Nursing. Our team shared views and experiences about how nurses might become engaged as NPEs at the local, state, national, or international levels. For the past nine months, we have had monthly online cafés to discuss the topic of how to encourage and support nurses who wanted to participate in policy reform as a full partner with physicians and other disciplines.
Using the nursing process as a guide, we have shifted from assessment and diagnosis to planning. We are now developing an infographics sheet to describe a pathway. We will also be interviewing nurses at various stages of their journey. This project is not founded on expertise, but rather an exploratory attempt to develop a supportive process to gain that expertise. There is much to do, and all nurses are welcome to join our chat regardless of experience or academic preparation.
Please feel free to contact me if you have any interest.
Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. National Academies Press. http://hdl.voced.edu.au/10707/249309
Roberts, N. C., & King, P. J. (1991). Policy entrepreneurs: Their activity structure and function in the policy process. Journal of Public Administration Research and Theory, 1(2), 147-175. https://www.researchgate.net/profile/Michael-Mintrom/publication/247200471_Policy_Entrepreneurs_and_the_Diffusion_of_Innovation/links/59e07921aca272386b73e10b/Policy-Entrepreneurs-and-the-Diffusion-of-Innovation.pdf
Michael Polacek, DNP, RN, PMH-BC, NPD-BC
fetchwood@gmail.com