How To Lead Change in Nursing Through Political Action

Despite our roles as patient advocates, many nurses shy away from political advocacy. Our tradition as a female-dominated occupation and gender role norms from the dark ages have contributed to our silence. We can no longer afford to be silent.

In the current age of big healthcare business models, there is more emphasis on the business case for justifying our presence. Like it or not, we have got to be able to articulate our value to those making the decisions around healthcare. We need to show them that it is a good business decision to have enough nurses.

Nurses have been viewed as an expense and we need to make sure they understand that our presence adds value to the service we are delivering. Business dislikes regulation, but regulation is one way to keep business interests in check, especially when unchecked practices can harm public health.

We nurses are pushing for national legislation to mandate evidence-based safe staffing levels in all hospitals. We need legislation because if there is no law, there will be nothing to hold business interests accountable to public health and safety. Despite the sharp political divisions in the country at this time, the biggest threats to public health around nursing care are fear and apathy.

Fear

Let's look at fear from different angles. From the side of those who will fight us, including business interests, the hospital industry, many of our professional nursing organizations, executives and administrators, or those who want less regulation, those who believe profit is the sole reason to be in business, what do they stand to lose?

CEO bonuses might not be as big, profit margins might not be as big, decision-making will need to be shared, more transparency will be necessary, more two-way communication will have to exist, and measures of "productivity" and "efficiency" (in other words, profitability) will take a hit. They stand to lose power and money. Don't they have enough already?

Management needs to lose their fear. It would make their jobs easier if they were not held to enforcing dangerous standards of productivity and efficiency that squeeze their staff to burnout, having to be the bad guy making cuts all the time.

When the executives are receiving bonuses that are equal to the salary of several full-time nurses, isn't it time to call them on it? Why should patients have to place themselves in harm's way so executives can pad their pockets?

From the nursing angle, fear is what has traditionally held us back and landed us in the compromising, overpowered, and dependent position we are in now. Gender norms have contributed to our weak leadership skills. We shortchange ourselves by deference to authority, by not insisting on representation, and by self-deprecation, a strategy that devalues us, erodes our self-esteem and belief in ourselves. Many nurses are afraid speaking out or getting involved in political action, a fear that is valid based on our current labor-hostile climate but is completely preventable and must be eradicated.

Pam Robbins, MSN, RN, who presented the talk on political nurse advocacy at Nurses Take DC, tells us that if we want to be effective leaders we must overcome these fears, valuing and believing in ourselves. We need to be making a business case for nurse staffing in a way that we are seen as valued assets, not a labor expense. Too many nurses are terrified they will lose their jobs for speaking up. But if we don't speak up, it means patient safety is compromised. We cannot afford to risk their lives.

Pam gave many useful tips on being effective in communicating with legislators. The process is slow, she explained, it takes patience, time, and many visits when building a relationship with a legislator. When getting your message across and in negotiation, it is helpful to having one of your team members present to back you up in case you forget an important point or need to elaborate.

Pam's presentation contained tips on effective negotiation, how to use your voice as a nurse constituent, how to prepare your elevator speech to communicate your message when you visit your legislator, how to focus on the key points that legislators will want to know, and places to become active in your community to contribute and lead as a nurse. Leaders are visible, known and recognizable by the public. When people know you and what you stand for, you will be influential.

Apathy

We live in a democracy, but few of us take full advantage of the power it affords us. As citizens, we have the right to vote and make our voices heard, yet only a small percentage of the voting-eligible public votes! Only a miniscule proportion ever gets involved in the legislative process.

If you saw something being done to your patient that would cause them harm, you wouldn't hesitate to stop it and speak up on behalf of the patient. But when it comes to our country, and public health, safety, and well-being, few nurses use their advocacy skills.

If nurses would think of our country as their patient, insist on only the highest quality care being given, and protect the public from harm, we would make great strides.

What We Need to Do

• Lose your fear. There is power in numbers, and by banding together, we can help each other deliver a stronger message. When a colleague expresses a need to change things, don't treat them as if they were radioactive. Instead, get behind them, support them, and bring others on board. Don't downplay the achievements of your colleagues. Don't put them or yourself down.
• Stop making it about political affiliations. Nurses don't refuse care based on a patient's political views. This is about everyone, we are all potential patients. It doesn't matter if you are a Democrat or Republican, pro-union or anti-union, or from a red, blue, or purple state. This is about the public's best interest—that’s all of us.
• Nursing education must start preparing nurses with skills on political advocacy, negotiation, and articulating the value of our profession to the public. If we can get the public to understand what we do, and articulate that clearly, we can show that healthcare is not all about medicine and physicians. The holistic approach to nursing care is what moves patients away from illness and toward wellness.

In Pam’s presentation, she discussed the results of polls of public opinion leaders conducted in 2009 as reported by the Robert Wood Johnson Foundation (2010). According to those findings, while opinion leaders perceive nurses as the most trusted profession, they also perceive nurses as having little influence over healthcare reform in the near future. Nurses were not perceived as important decision makers or revenue generators, or that we have a single unified voice on national issues.

To paraphrase Pam’s lesson based on the poll findings cited above, the public views nurses as carrying out the instructions of doctors and other higher status players-rather than being informed by education, evidence and experience, or being deliberate, thoughtful, and strategic in our actions.

I ask you to look at the different nurse staffing bills in front of Congress. Compare them. They are similar in many ways, but note the American Nurses Association's bill (S. 2446 and H.R. 5052) does not include a mandate for employers to commit to a staffing plan for their employees, in writing.

The Nurses Take DC bill (S. 1063 and H.R. 2392) does have such a mandate. Employers would not be able to avoid the staffing plan mandate. This protects both nurses and patients.

In both bills, both are based on evidence, but unless you have a regulation that holds the employers accountable, you have nothing. We must also hold our employers, as well as our professional organizations, accountable, and demand transparency.

This is the second of a two-part post about my experience attending and speaking at the Nurses Take DC rally in Washington DC. Read part 1 here.