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The Nurse as an Incremental Policy Reformer: Advocacy for Healthcare in the Community

By Michael Polacek posted 05-09-2023 11:35 AM


Nurses have long been engaged in influencing healthcare through policy. Although when considering the number of nurses, the profession is sadly underrepresented. I realized this in 2014 while developing a personal knowledge base for suicide prevention and searching for policy-making entities in a Western state. The state-level department directing policy development and implementation strategies developed a 2015-2018 Behavioral Health Strategic Plan (Do not get me started on that label “Behavioral Health”). 

The eighteen-member workgroup included a wide range of disciplines primarily administrators, three physicians, two attorneys, and a patient advocate. It struck me that there were no nurses. This state allows advanced practice nurses to practice with full and independent authority. Currently, there are nearly the same number of PMHNPs as licensed psychiatrists and are becoming more engaged in state-level policy-making entities.

This is not unique to state-level strategic planning entities. When the President established the White House Coronavirus Task Force in March 2020 and then followed by the White House COVID-19 Response Team in January 2021, no nurses were members from what I can tell. Recently the U.S. Surgeon General’s office released Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. Of the forty-nine reviewers of this report, one was a nurse practitioner.

Although nurses became a primary face of heroism during the pandemic, that face seemed to be confined to the bedside. This is not to say nurses are not involved at the state or national levels. However, it does suggest that the perspective of the nursing profession is not considered critical. Why would the most trusted profession not be a critical voice of policy development?

Nine years ago, Kathleen Delaney pointed out that, “. . . as the movement to patient-centered care builds momentum, we need nursing leaders who can effectively deliver the perspective of PMH nurses on interpersonal relationships, how they build them, draw from them, and partner with individuals to achieve their health and wellness goals. Leaders such as these will help define what PMH nurses bring to health care, the interprofessional team, and the national agenda for accessible, effective services.” (Delaney, 2014). The profession has a critical, yet underrepresented perspective on policy reform.

It seems that nurses have yet to take on the challenge to the degree that is possible. My take on this is that while the nursing profession is by far the most trusted profession, other disciplines do not consider nurses' perspectives as valuable or even necessary. Yet, it may not be that other disciplines intentionally overlook the nursing perspective. Perhaps it is that most nurses do not identify themselves as being able to perform as policymakers. 

My belief is that nurses care about policy and even have a quiet desire to become partners with physicians and other disciplines in healthcare reform but are not prepared. Nurses like to be prepared because the thought of failure is anathema. If that is the case, then one must ask what can be done to empower the nurse to step into the policymaking playing field.

First off, forget about politics and politicians. Instead, let us focus on the community as an entry-level gateway to learning how to become a full partner in healthcare reform. Participating in shared decision-making processes within a hospital is a common experience for many nurses. Preparing for a meeting, contributing ideas and opinions in a respectful and productive manner, then implementing action items is neither new nor uncomfortable.

Although this process is a little different from what takes place among board members of the local Chamber of Commerce, the Boys and Girls Club, or speaking to the school board, nurses lack presence. Stepping onto the playing field of community policymaking is not a big step, but it may appear to be more of a leap because it is outside the comfort zone of many nurses. Sitting next to a police chief, a wealthy business owner or a well-known attorney might feel different, but it is not.

In fact, the nurse will be bringing in perspectives and experiences that not only are unique but are welcomed because society trusts the nurse more than any other profession. Additionally, the nursing profession has a social contract to advocate for community wellness, and this is not limited to providing excellent clinical care. Some of the most important healthcare policies were championed by what can be termed policy entrepreneurs like Florence Nightengale, Dorothy Dix, and Clara Barton.

When I first became involved in community suicide prevention activities, I presumed that I would have to convince people that I belonged. I thought that since I had not been invited, I would not be respected as a partner.
On the contrary and without exception, I was welcomed and found that my opinion was regarded as valuable. It was not that the social workers, psychologists, and administrators intentionally excluded the nurse. But I got the feeling that they did not realize nurses were interested. Considering nurses were rarely present, that is not an unreasonable presumption. Out of sight, out of mind. Dr. Delaney pointed out ten years ago that we were at a tipping point. If that was the case then, where are we now?

This experience led me to think about how nurses could be supported and increase their skill set and perceived self-efficacy to become engaged as full partners with physicians and other disciplines to reform healthcare. A group of nurses has been meeting monthly in a small café style online since August 2022 to address just that. We do not discuss issues, but rather how we might design a roadmap to guide nurses who feel compelled to become a full partner. 

These chats and workgroup are not affiliated with APNA or any other organization. It is just a couple of nurses getting together for a conversation and brainstorming how to support the nursing profession to become full partners with physicians and other disciplines in the reform of healthcare. Personally, I love listening to the experiences of other nurses so that I can better understand my own journey. Feel free to email me if this sounds interesting.

R. Delaney, K. (2015). Psychiatric mental health leadership at the tipping point. Issues in Mental Health Nursing, 36(5), 320-325. doi.10.3109/01612840.2014.994688

1 comment



07-15-2023 04:32 PM

So well said, Michael.  Not a new concern but unfortunately one that we have not, as a profession, addressed as change-agents.

I would be interested in joining your café-style discussion group!