Policy and politics are intertwined, and some would say that nursing and politics do not mix. But this is the very mix we need in order for Nursing to have an equal place at the table of health decision-makers today and, as well, to be setting tomorrow's agenda. To understand, influence and utilize policy as a tool requires nurses to be more politically astute and active. The mechanics of government under which we function, both at state and country level, is key to us all citizens but also is key to nurses’ ability to influence health care.
Questions that unfold as we study public and health policy are about how decisions are made, who makes them, who influences them, whose advice is taken, how agendas get set, and what power structures are working, both formal and informal. Doesn't this sound fascinating? Why is it then that many of us had little knowledge of policy from our nursing education? Perhaps because nurses and nursing were not articulating policy issues and experiences through publication, or because of our political under-development as a profession (Hughes 2001, 2002). But over the last few years new interest and an increasing literature on policy has been emerging.
Involvement in policy is not just for those of us in managerial or policy positions. It is a process for us all and once you engage in the learning and practice of policy you will never be the same again. Ask anyone who has been involved in lobbying, drafting submissions, analysing options for solutions to key health problems or contributing to government committees or bodies. They will tell you of the complexity of policy processes; the importance of strong leadership; the frustration of missed opportunities for nursing; but, as well, the delight when articulation of issues, responses and strategy results in positions, policies, regulation and legislation being changed for the better. The synergy of combined political action, visionary leadership, policy astuteness and articulate policy development has brought benefits for nurses and, in turn, better health care for their clients, for example in prescribing privileges and pharmaceutical and diagnostic subsidies.
Networking and relationship building is key to the success of policy development and implementation, and also to agenda setting in nursing. The steps in policy analysis are not dissimilar to the nursing (or problem-solving) process – central to both are problem identification, gathering information and identification of options or strategies; and so it should come naturally to nurses to extend from problem-solving in relation to patient care issues to policy formulation at local or state level. It shapes and sharpens our minds to ‘think outside of the box’, to see the big picture and to drill down into solutions through careful analysis.
Nurses need to be involved in policy development because our consumers, patients and clients need us to be. Who better than nurses understand the practical reality of health care that spans numerous settings, involves people at their most vulnerable and provides a view of health from multiple perspectives? Nurses effective in policy describe their mastery of ‘people skills’, high on the list being skills in communicating with multiple stakeholders representing different interests while keeping the overall priorities clear. The ability to juggle competing and unpredictable demands in a political situation is similar – indeed, perhaps easier! – than juggling day to day with the complex patient demands in an intensive care unit. In my experience nurses’ vivid anecdotes from first-hand involvement in health care are extremely powerful – politicians love them – and, of course, argument based on evidence is a vital part of policy development too.
Policy development does require brainpower, but it is not a mere intellectual activity, confined to papers or obsessed with theories. Yes, policy has its own theoretical underpinnings but most of all it is a practical tool for change for nurses in practice, education and research. It is as much a part of our ever-increasing toolbox as diagnostic techniques are for clinical practice, adult learning principles are for teaching, and analytical techniques are for research. The challenge is to ensure that policy skills become a skill for all nurses and not just for those of us who occupy policy posts.