The expected change also carries a the potential for many positive events to produce lasting benefits on the system. Change will happen enthusiastically or reluctantly. It can be painful and divisive or positive and collaborative. Who has the keys to unlock opportunity for health care transformation?
Nurses do.
Nurse may not be aware that they have great power. They may not have considered that they could shape health care instead of having change handed down to them to execute without questioning, input, or participation. But in fact the opposite is true.
The first and foremost reason nurses have power is because they are one of the most trusted professions outranking even clergy and teachers.(1) Trust enables dialogue to begin because of the high esteem that the public has for nurses. There is even a fancy word for that type of power that comes from others trust and admiration.
It is called referent power.
Nurses also have power because they number in the millions. There are more nurses that any other health care professional. Were nurses to act collectively their voices could not be ignored. The effectiveness of the nursing voice should be directly correlated with their vast numbers. Yet so far in the US this has not occurred.
Nurse numbers are a large part of the health care situation, but more importantly they are the health care professionals that execute the majority of direct care and are in a position to best evaluate how policy changes impact patients.
They also deal with a large part of the bureaucracy or documentation in effecting policy change. Their concerted feedback can go a long way in implementing high quality health care. Policy makers are slowly realizing that changing nurses’ work environment will be the one action that has lasting and meaningful results. This realization can be accelerated if nurses provide feedback in the early stages of any policy changes that affect their care.
In the past nurses voices have not been considered in any policy changes. For example, in 2006 the Quality Alliance Steering Committee was looking to improve health care quality by examining performance measures to improve efficiency. The committee did not include any nursing representation until pressured to do so by nursing organizations.
So enough of theory what does nurse involvement look like on the ground?
Fast forward to today and we see that the head of the HRSA is a nurse and there are 3 nurses in Congress. Also a nurse led initiative the Nursing Alliance for Quality Care has as their goal to work towards the highest quality, safety and value health care for every citizen. The alliance stresses the importance of a unified strong nurse advocacy role. Funded by Robert Wood Johnson Foundation and located at George Washington University it is a partnership of stakeholders including consumers.. The NAQC will also facilitate recognition of nursing contribution to health care especially in the areas of performance and public reporting. Their goal is to quantify nurses’ contribution to health care, and influence federal policy.
Ideally, policy change should result in practice change, in a positive fashion. Nurses need to respond to any policy change and provide feedback on how that affects patient care. One way nursing organizations be they state or specialty organizations get nurses involved is through state legislative days, internships or fellowships, policy workshops and mentoring new advocates.
One example is the Legislative Coalition of Virginia Nurses whose members are individual or professional specialty nurse organizations. The coalition’s aim was to have one nursing voice and to collaborate to influence legislation affecting nurses in that state. Their successes include increased prescriptive authority for APNs, workforce data collection facilitated by the VBN, third party reimbursement for nurse midwives among other accomplishments.(2)
One author has noted that a downfall of professions is that technical and specialized knowledge and skill is emphasized ahead of fiduciary duty and social responsibility. Although this may not be a big deal in a profession such as nuclear physics, any profession that that involves helping people must understand the reason they are in a people oriented occupation. The intangible human qualities are as important as knowledge. For nurses political advocacy means they can put a human face on health care to help policymakers realize that there is more to health care than numbers and dollars. Nurses can also balance the overrepresentation of medicine and insurance in the health care paradigm.
Other commentators in the nursing profession have also expressed that one responsibility of professionalism is to be aware and have greater influence on one’s workplace. The recommendation is the importance of influencing policy be included in nursing education as part of the curriculum as part of acquiring professionalism.
One thing is certain. Many nurses speaking with confidence that comes from education and experience can definitely have a positive impact and bring about health care transformation instead of mere reform. Federal policy makers need to realize that real change must both involve and engage nurses.
To what extent do nurses have social responsibility that goes beyond the bedside?
How much should clinical challenges become part of policy discussion?
Each nurse must answer those questions for her or himself. But part of the answer can be found in the lives of 2 women that set historical precedents. The first is the founder of modern nursing Florence Nightingale. She was a strong advocate of her innovative solutions in a male dominated society who persisted in spite of many barriers. Similarly Lilian Ward used her determination and influence to better the lives of many of America’s children in the early 1900s. Were they here today what would their message be to present day nurses in the health care challenge that lies ahead?
Sources: (1) Journal Of Nursing Administration Vol.39 No. 2 Feb. 2009
(2) MEDSURG Nursing Vol. 18 No. 3 May June 2009Nurse Educator Vol. 15 No. 3 May June 2010.
http://www.gwumc.edu/healthsci/departments/nursing/naqc/resources.cfm
American Journal of Nursing Vol. 110 No. 1
© Young Lion Incorporated 2011
