Nurses comprise the majority of health personnel in most countries. However, their involvement in health policy development is still low, both in the developed and developing world. The International Council of Nurses and the World Health Organization posit that nurses can and should be involved in policy development since they are the health professionals closest to clients (International Council of Nurses 2008; World Health Organization 2002). Given the close nature of their interaction with clients and their families, nurses are uniquely positioned to provide crucial policy information. Furthermore, health policy often has a direct effect on nurses and it is in their best interest to be engaged in its formulation.
The goal of policy is to put directions into action, while the goal of health policy is to promote the welfare of the public (Mason et al. 2007). The policy process is composed of three phases: policy formulation, policy implementation and policy modification (Longest 2002).
A study in Thailand of nearly 2000 nurses across the country showed that nurses had no to low involvement in health policy formulation and modification, although they showed slightly more involvement in policy implementation (Kunaviktikul et al. 2010). Laddaphan (2006) found that fewer than half of nurse administrators in hospitals in Thailand were involved in hospital policy development. Similar findings have been documented in the USA with only 59% of nurse practitioners participating in political activities (Oden et al. 2000).
Why aren't nurses involved in the policy development process? In my experience, nurses most commonly say that they are too busy providing bedside care; do not have time to participate or do not understand why they should; or feel it is not their role. Nurse administrators or leaders have told me that they are too busy with routine responsibilities to be involved, especially if they are not given policy work as a direct assignment, and/or do not see any benefit to being involved.
How can we encourage nurses and nurse administrators to be involved in policy development? Educational institutions should educate students, from the bachelor through doctoral level, about the importance of involvement in policy development as an arena for demonstrating their thoughts, abilities and practice. Nursing students should understand the importance of being involved in policy as a citizen, a nurse or a leader. They must be empowered. Educational institutions must rethink, redevelop and use new teaching and learning strategies to develop leadership skills. These skills include assertiveness, critical and creative thinking, decision-making, and negotiation and conflict management.
Nurse faculty should serve as role models and show that engaging in policy is part of their professional and civic obligation. Faculty should participate on policy committees at their educational institutions, and serve as representatives of professional and national and/or international organisations.
Educational institutions should support and facilitate faculty to conduct policy research by developing a policy centre. Establishing a centre sends a clear signal of the institution's commitment to policy involvement, as well as creating a mechanism for funding and resources. Research in Thailand has shown a severe limitation in the number of policy and planning research studies. Of nearly 2000 nursing administration research studies conducted in Thailand from 1989 to 2009, only 12 (0.47%) were related to policy (Kunaviktikul et al. 2012).
Equally important is to create an open participatory environment for faculty and staff to propose their ideas and comments regarding policy development and improvement from a practical perspective.
An open participatory environment in healthcare organisations is also critical in creating a cultural shift emphasizing the importance of policy. Nurse administrators should understand and be aware of how important it is to be involved in policy development at all levels. They should volunteer as representatives in health policy formulation within their organisations, participate in professional organisations and serve as leaders in the political arena. They can suggest changes to policy based on evidence from policy research studies, thus providing important inputs to policymakers.
Nurse administrators should actively encourage staff to be involved in policy and politics, and provide them with time, budget, resources and opportunities. They can organise policy and political conferences, workshops or training programmes so that nurses can better understand their role and influence on policy and politics. Organisations without the resources to organize these events themselves should provide support for staff to attend policy-related events and trainings.
In summary, it is imperative for nurses at all levels and in every setting to understand and have knowledge about nursing, policy and politics, and to be involved in the policy process. A cultural shift must occur within the nursing profession to emphasize the importance of policy and nurses' role in setting and implementing it. A clear understanding of how policy affects nurses as well as how their unique knowledge regarding client care is crucial for policy development must be embedded at the institutional level. This cultural shift must begin in nursing educational institutions where the integration of policy in practice must be emphasized in the classroom. In healthcare settings, nurses must be encouraged to take part in setting organisational, national and international policy. Likewise, faculty must be given the proper support to develop and carry out policy research so that policy-makers and administrators can draw from the evidence base when developing policy.
This cultural shift will rely on an organisational culture of open and participatory engagement, as well as faculty and nurse administrators serving as role models who actively engage in policy discussions as part of their professional and civic duties. If organisations are serious about promoting the role of nurses in policy-making, they must allocate resources to support them, both financially and time wise, to research, propose and implement policy changes. Ultimately, the greater engagement of nurses in policy-making will demonstrate the impact of nurses and improve quality of care, which will benefit clients, their families and society as a whole.
Wipada Kunaviktikul PhD, RN, FAAN is Professor and Dean of the Faculty of Nursing, and Director of the Nursing Policy and Outcome Center at Chiang Mai University in Thailand.