Learning Outcomes
By the end of this section, you should be able to:
- 34.2.1 Discuss the nurse’s role in health policy formation.
- 34.2.2 Explain how nurses can influence social policies to promote justice, fairness, and health equity.
- 34.2.3 Discuss the importance of nurses’ contributions as leaders in policy issues.
Nursing is the single largest health care profession in the United States, with almost 5.2 million registered nurses in 2023 (American Association of Colleges of Nursing, 2023). With such an incredibly large number of members of the profession, nurses have the potential to impact health policy at all stages—from policy formulation through adoption and evaluation. To effectively influence health care quality, nurses must capture the attention of community partners and policymakers to make nursing care issues visible. Nurses have the advantage of strength in numbers. To benefit from this advantage in creating and changing policy, using a coordinated approach is helpful. Nursing advocacy groups, also called special interest groups, combine the voices of their members to draw attention to the problems or issues they wish to change.
An example of a nurse advocacy group that works within the nursing profession to spark positive changes in those around them is Healthy Nurse, Healthy Nation (HNHN). Created through a collaboration between the American Nurses Association (ANA), the American Nurses Foundation, and the American Nurses Credentialing Center, the goal of this advocacy group is to have nurses engage in personal care activities to avoid burnout, stress, and fatigue (HNHN, 2023). By modeling these self-care actions, nurses can influence their friends and families to do the same. Joining an advocacy group that represents an issue of personal importance is an excellent way for an individual nurse to become a part of policy change.
The separate areas of focus in which nurses play a role in shaping health policy have been described as four spheres of political action in nursing and include (de la Sablonnière, 2017)
- the nursing workplace,
- the government,
- professional organizations, and
- the local community.
In the workplace, nurses can serve on committees that evaluate current policies and create new ones, such as school nurses advocating for the removal of soft-drink machines from the cafeterias to occupational health nurses working to make the grounds of a facility a nicotine-free zone.
On a local or state level, nurses can use the power of the media to obtain support for community initiatives directed at improving the health of the area, such as advocating for changes in property zoning to keep businesses that release chemical fumes or particulate-laden smoke away from schools (Deschaine & Schaffer, 2003).
Membership in professional nursing organizations such as the ANA is an excellent way for nurses to use a united voice in lobbying governmental officials to change health policies (Muetzel et. al, 2022). In addition, nurses can lobby their legislators directly through telephone calls, letters, and meetings with their elected representatives. Although each nurse has the power and potential to use their individual voice in each of the four spheres to influence health policy, collective action can bring transformational changes that can improve clients’ health throughout the nation. Advocating for Population Health describes the nurse’s role as an advocate in more detail.
In addition to the ideas already listed, another way that nurses can present their questions and concerns at any management level is through writing a policy brief. There are four types of briefs that can be used to share public health evidence, as shown in Table 34.1.
| Type of Brief | Description |
|---|---|
| Information Brief | A concise summary of the current research on a policy method, approach, or other related concerns |
| Issue Brief | A summary of the best available evidence on a public health problem with no current solutions |
| Policy Brief | Builds on an issue brief to include the most current evidence-based best practices or health regulation options that could be used to address the public health issue |
| Policy Impact Brief | The most in-depth briefing document; provides a summary of the best available evidence on health, economic, or budgetary impact of one or more policies for a public health problem; appropriate when evaluations and evidence exist on the health or economic impact of the policy |
A well-written policy impact brief completes all of the following: clearly describes the concerns, the effects of the issue, and why it matters to the policymaker’s constituents. The steps of writing a policy impact brief are much like those of preparing to give an SBAR shift report. Rather than providing just the situation, background, assessment and recommendations, a policy impact brief will begin with a title and summary before describing the problem and any research or policies related to the problem. The impact brief then ends with recommended solutions along with the references and sources used to prepare the brief. The Centers for Disease Control and Prevention (CDC) provides resources and information on writing briefs.
The Role of the Nurse in Public Health Policy
In this video, Dr. Bialous of the University of California San Francisco School of Nursing discusses the role of nursing in shaping public policy.
Watch the video, and then respond to the following questions.
- How can nurses position themselves at the early stages of the policy process rather than at implementation only?
- What are some ways to make yourself visible as a nurse when seeking policy change?
- How do nurses influence health policy statements?
Social justice is the fair and equal treatment of individuals. Social justice in nursing happens when client rights are protected, resources are distributed fairly, and treatment decisions are unbiased (Abu, 2020). Health equity is “the state in which everyone has the opportunity to attain full health potential, and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance” (National Academies of Sciences, Engineering, and Medicine [NASEM], 2017, p. 32). Nurses can increase social justice in their daily lives by being strong advocates for their clients (NASEM et al., 2021).
As has been discussed throughout this text, health is affected by a wide range of social determinants of health (SDOH), including housing, transportation, nutrition, physical activity, education, income, laws and policies, and discrimination (CDC, 2020b). Because nurses work with clients in a wide variety of settings, such as inpatient, outpatient, school, correctional, and occupational health, they can play a major role in addressing the underlying causes of poor health. Nurses are uniquely positioned to drive social justice and equity in health care due to the level of trust they hold with clients.
Nurses can influence social policy to improve health equity through four approaches (NASEM, 2021):
- Addressing social needs in clinical settings
- Addressing social needs and SDOH in the community
- Using interdisciplinary collaboration to meet multiple needs
- Advocating for policy change
The depth of knowledge that nurses gain through their interactions with clients allows them to recognize and understand the variety of factors that influence daily wellness and longevity. Nurses can use this client-specific knowledge to promote justice by creating individualized interventions and working with other disciplines and health allies to acquire the resources the client will need to implement those solutions (Timmons, 2021).
Case Reflection
Advocating for Individual Clients
Read the scenario, and then respond to the questions that follow.
To return to the scenario from the beginning of this chapter, at Alex’s health department, some of the clients being treated for active TB are required to take each dose of medication in the presence of a health care worker. This process is called directly observed therapy (DOT) and is implemented when a client is at high risk for noncompliance, such as with clients who lack a permanent address. Alex has noticed that the policy in their department currently requires every client to come to the health department daily to obtain medication doses. One of the current clients uses a wheelchair and struggles to make the daily trip to the health department due to their mobility issues. Alex is concerned that this situation is not equitable for that client and works with the clinic managers to send an outreach worker to client’s residence each day instead of requiring the client to make the difficult journey to the clinic.
- Why is asking the client’s family to give them their medication instead of a health department worker not a viable solution to this problem?
- How could the TB clinic staff build rapport and trust with their clients?
- How does using DOT for clients with TB help limit the spread of the disease?
Nurses can influence local, state, and national social justice policies (Figure 34.4). For example, nurse administrators can create policies to increase diversity in the workplace, encourage multilingual staff to become certified medical translators, increase diversity in hiring, and offer virtual clinical services through telemedicine. Table 34.2 provides other ideas of how nurses can participate at these three levels.
| Local Level |
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| State Level |
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| National Level |
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