Overview and Summary: Nurses’ Impact on Advocacy and Policy

Five years ago I earned my Graduate Certificate in Health Policy and Media Engagement from The George Washington University School of Nursing. The National Councils of State Boards of Nursing (NCSBN) supported the inaugural class and this experience provided the opportunity to gain experience from some of the most powerful and prestigious nurse influencers in this nation. This deep dive into health policy strengthened my ability to advocate for nursing in a variety of venues and helped me build communication strategies that included preparing persuasive oral testimonies and publishing opinion pieces and blogs that focused on health equity. This transformational experience built my confidence as a change agent and influencer. As a result, I became laser-focused on ensuring my students, at all academic levels, would begin to develop competence in advocacy and policy setting to bring the nurses’ lens to the policy table.

Regrettably, most nurses are not familiar with or actively involved in the policy arena. Some reasons include poor nursing images, feelings of inefficacy in influencing political decision making, perspectives of public policy advocacy as not in the scope of the nurse’s professional role, lack of confidence and mentorship, and insufficient knowledge of policy making strategies (Rasheed et al., 2020; Taylor, 2016). Yet, with 4.2 million registered nurses in the United States, the largest group of health care professionals in the nation, working collectively, nurses could wield enough political power to reform the nation's healthcare system (Smiley et al., 2020).

The need to strengthen the advocacy and policy influence of the nursing profession cannot be overstated. The Future of Nursing Report 2020-2030: Charting a Path to Achieve Health Equity (2020), outlines a strategic approach for the profession to support our nation in creating a culture of health, in reducing health disparities, and in improving the health and well-being of the population in the 21^st century. This report challenges nurses to effectively mobilize their collective capacity through education, mentoring, and sustained engagement and to develop a shared agenda for healthcare policy that focuses on achieving health equity. The report stresses the necessity of including nursing expertise when health-related policy reform is being advanced.

It is especially important that we recognize this window of time is our opportunity to influence the future of health in this nation. The introductory articles in this topic are timely and a present a robust appeal for nurses, in all spheres, to engage in advocacy efforts and policy action. These articles provide a context for nurses to engage in advocacy and policy whether supporting social justice, promoting policies that combat inequities, or designing educational strategies that foster development of advocacy competencies in new graduates. These commentaries will be of significance in establishing a foundation for a burning policy platform regardless of the role or setting you are employed.

Cleveland, Motter, Rudsill, and Benson, in The Affordable Care Act: Considerations for Leveraging the Power of Nursing, follow-up on the 2019 publication, Affordable care: Harnessing the power of nurses serve as a reminder of the unique contribution nurses make in solving complicated policy issues. Opportunities for engagement outlined by the authors include informing elected officials of their experiences and perspectives with the Affordable Care Act (ACA), elucidating how nurses address cost, quality, and equitable care, and methods to prepare the workforce to meet the challenges still at the forefront of healthcare, 12 years after the implementation of the ACA. The authors also endorse strategies to impact policy, including continuing to support nurse appointments on community boards, ways to increase the diversity of the nursing workforce, approaches to establishing robust Academic-Practice Partnerships, and methods to address the quadruple aim by supporting the well-being of nurses.

Health equity is a cause long championed by the profession. Jolly and Peck, in Diversity, Equity, & Inclusion Policies of National Nursing Organizations, analyze the availability of policies and clinical resources on Diversity, Equity, and Inclusion (DEI) through National Nursing Organizations’(NNO) to engage, educate, and equip nurses to deliver patient-centered, culturally responsive care and to effectively recognize and respond to implicit bias in healthcare settings. Their work provides a prescribed approach for nursing organizations to offer nurses the resources to advocate for racial equity and to mitigate health disparities in the United States through the consideration of data, policies, and clinical tools needed to create DEI policies to better serve their membership.

Research finds that New Graduate Registered Nurses (NGRN’s) advocacy, communication, teamwork, and collaboration skills need to be stronger to effectively function in the professional role. The authors of the article, Improving Communication and Collaboration Skills in Graduate Nurses: An Evidence-based Approach, share their intervention to improve NGNs communication skills by incorporating advocacy, teamwork, and collaboration development using simulated scenarios practiced with peers in a residency program. Leonard, Whiteman, Stephens, Henry, and Swanson-Biearman argue that developing these skills serve as a foundation for future engagement in advocacy by increasing self-efficacy and confidence.

In Saudi Arabia, school children experience social, emotional, and physical issues that influence health and academic success. Alharbi describes in “Establishing a School Nurse Program in Saudi Arabia through Policy Development”, the design and development of a new policy to improve and prevent health issues, bullying, and violence among these students. The stepwise process used provides a detailed context to adapt for other advocacy concerns in their practice or community situations.

In the article Exemplar: Social Media as a Format for Nursing Advocacy, Cogan describes her journey in becoming an advocate for school health nursing using social media. She describes advocacy as the intersection of social media and nursing policy development, and how her blog, The Relentless School Nurse, grew into a platform for social justice and nursing advocacy. This article inspires nurses to unite, with one voice, in influencing policy in this country.

Nurses must leverage their respective expertise in leading this nation in policy agendas that engage the profession in upstream social determinants of health, that is, the factors that influence health and health systems, and government policies. This topic of the Online Journal of Nursing (OJIN) will support nurses in all settings in moving the needle toward that aim.

The journal editors invite you to share your response to this OJIN topic addressing Nurses’ Impact on Policy and Advocacy either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.

Patricia A. Sharpnack, DNP, RN, CNE, NEA-BC, ANEF, FAAN
Email: psharpnack@ursuline.edu
ORCID ID: 0000-0002-1690-6099

Dr. Patricia Sharpnack is Dean and Strawbridge Professor at Ursuline College, The Breen School of Nursing and Health Professions. She was a three-term past-president of the Ohio Board of Nursing and currently is Chair-Elect to the National League for Nursing. She has extensively published and presented at national and international conferences. She is a Fellow in both the Academy of Nurse Educators and the American Academy of Nursing.