NUR 514 Week 4 Discussion Organizational Leadership and Informatics

International context on nurses’ participation in health policy

National health policies impact on nursing profession and health care. Studies reviewed from USA, Australia, New Zealand, and Canada, revealed that national health policy reforms were often related to budget cuts. These reforms resulted in downsizing nurse staffing, and, in turn, created ripple effects on nurses and patient care. The impact largely took the form of negative consequences for nurses and patients in terms of: decreased staffing, increased workload, decreased job satisfaction, job insecurity and decreased quality and quantity of patient care, growth in numbers of unlicensed personnel, and ethical dilemmas [5–8]. Some positive effects, such as nurses becoming more assertive and gaining autonomy, ensued [9].

Nurses demonstrate some degree of political participation, although their level of political participation is restricted. Politics in this context is defined as striving to share power or to influence the distribution of power among groups within the state [10]. Political activity refers to being part of groups and participating in activity to influence health policy. In studies undertaken in the USA [9–12], results indicated that most nurses participated in political activities and thought that people like them could influence government activities. Conversely, Chan and Cheng’s [13] study in Hong Kong found that political activism was insufficient and disagreed that nurses had the power to influence government policy. Furthermore, a more recent study conducted by Kunaviktikul et al. [14], explored involvement of nurses, those in hospital based clinical nurses and national nurse leaders, in health policy in Thailand. Reported findings indicated that the majority of the former were not involved in national health policy development. Nurse leaders’ were not involved in policy formulation or modification stages but were involved in the policy implementation stage. These findings suggest that whilst nurses are not apolitical, they appear to be at various levels of political engagement in different countries. There is no clear consensus on nurses’ political efficacy in relation to whether or not they believe they are able to influence government health policy.

Numerous factors influence nurses’ ability to be politically active in influencing health policy development, such as finding needed time and possessing relevant knowledge and interest about how political issues affect health care and the nursing profession [11–15]. Historically, nursing has suffered from a poor public image that it has found difficult to cast off [16–18]. For example, Florence Nightingale’s vision and influence at the national health policy level completely changed society’s views of nursing [18]. Nursing, however, has not since been able to sustain this influence at policy level, and the image of nursing has remained low compared to other professions such as medicine. Moreover, medical technological advances and medical and curative dominance within health care has moved nurses’ focus from preventive and promotive care to individual care and cure. This has resulted in significant withdrawal of nursing from social and political activism and in the lessening of the reputation of nurses as a social change agent; as a result, there has been a loss in nursing power as regards policy making [19]. Although the need for political action and policy influence has been recognized, nursing education has been slow to respond to this call [20]. The preparation imparted by nursing education, does not adequately equip nurses with the knowledge and skills necessary for involvement in policy development [21–23]).

Studies reviewed reveal that it is possible for contemporary nurses to influence health policy. Certain factors can enhance nurses’ ability to participate in the policy development process. Factors include: being involved and gaining experience in policy development, having role models, being educated and knowledgeable about health systems and policy development process, political activism, conducting research to expand knowledge, being supported by professional organizations and developing leadership skills [13,24–27]. When nurses are involved and successfully influence health policy development, there are clear benefits to the patient, the profession and the nurse.

Nurses’ involvement in health policy development ensures that health care is safe, of a high quality, accessible and affordable [28]. Nurses have made progress in political participation and they exert influence in health policy development in some industrialized countries such as the United States of America (USA) and the United Kingdom (UK). In studies conducted by Latter and Courtenay (2004), While and Biggs (2004) and Bradley and Nolan (2007) in the USA and UK indicate that nurses’ involvement in health policy development and reform positively influences health care. These studies indicated that when nurses participated in policy development they were able to make valuable contributions and positively influence areas that include: access to health services; suicide prevention in adolescents; development of guidelines for the care of pregnant women and their children; child abuse policy; authorizing nurses to prescribe medication within the framework of the Nurse Prescribers Formulary (NPF); and improving continence services. Whilst there is a gap in literature with regards to the impact of these policies on patient care some literature from the UK with regards to Nurse prescribing indicates that: patients were generally satisfied, received quicker treatment, nurses’ experienced enhanced job satisfaction, nurses perceived enhanced quality of their practice, and skills, enhanced nurse self-esteem, enhanced autonomy and enhanced professional role [28–30]. These studies indicate that nurses’ influence on policy can have a positive impact in this regard.