Civic engagement refers to both individual and collective actions that are aimed at identifying and addressing matters of public concern. Health care especially in the United States is a key area of concern for the public requiring both individual and concerted action on the part of several persons. Indeed, civic engagement embodies the principle of democratic governance which is to the effect that sovereignty reposes in the people or the citizenry and that they should thus have a say in such matters. It encompasses the right of the citizenry to define what is the public good as well as form the policies through which the public good will be achieved. The civic engagement process may take many and varied forms such as volunteering by individuals, involvement by an organization or participation in the ballot process. The concept of civic engagement, therefore, has the effect of obligating the citizenry to have personal responsibility of ensuring that the public good is pursued and attained. It is in that breadth that healthcare advocacy by nurses is a welcome idea and would form the subject of the ensuing discussion.
Health care in the United States has been the subject of criticism for a long time. As a consequence, there have been several concerns and issues coming up towards having health care reforms in a bid to change the situation. The reforms clamored for have been a result of several advocacy programs by various persons and organizations who felt the personal and collective responsibility of the sovereign towards ensuring that the affairs of the health care system are streamlined. There have been recent enactments of the law that have since been put in place to kick start the reform process. This paper explores the advocacy of health care in the United States by different players with a bias on the nursing department of the health care system. Next, the paper shall seek to examine the impact that these advocacy programs have had on the health care policies.
In the nursing literature, the meaning of advocacy is not as clear cut as it should. An overview of several literatures on nursing indicates that advocacy is neither perceived as either negative nor paternalistic by patients who receive attention from the nurses. This literature also fails to enumerate the rights appurtenant to patients to which they are entitled and those which need to be anchored by the nurses through advocacy. A vexing question which has failed to go away is the issue of whether it is a moral or a professional duty for nurses as health care professionals, to advance and show support for changes in policies and advocate for reforms. This again, the reviewed literature does not give an answer to. The apparent confusion over whether the role of advocacy among nurses about a patient’s rights is a professional or moral duty weighs negatively on the role of advocacy and creates ambivalence. Nurses need to gain confidence in collective action so as to confront this very challenging but satisfying role. A civic engagement process is a political role that requires boldness so as to ensure that the rights of the citizenry are safeguarded. In this respect, it is important to examine the role of the mother of nursing, Florence Nightingale. Beginning with Nightingale, there are ample examples of individual figures in the nursing profession who have shown great capacity to change and shape health. These nurses and other health care professionals have been able to achieve this through the process of civic engagement. In particular, they have initiated policy proposals for consideration, changed or vetoed other’s proposals and also influenced the implementation of these policies in a substantial way. Recent years have witnessed an increased tendency by health care professionals such as nurses to take on some advocacy in a bid to effect changes in the existent health care policies, laws, regulations and rules that straddle the entire heath care system.
It is beyond dispute that the health care system in the United States is in dire need for change. Indeed, this is reflected in the increasing number of nurses and other health care professionals who are taking to advocacy in a bid to cause change which they deem necessary owing to their experiences at the health institutions. Without doubt, this kind of advocacy on the part of nurses obliges them to move out of their traditional clinical setting into the harsher world of politics and policies. Owing to the grueling nature of politics and formation of policies, most of the nurses feel that they are inadequate to handle such matters and thus fail to engage in the noble civic engagement process. Indeed, both health care policies and politics are interlinked and almost inseparable.
Usually, an issue relating to health care moves through a number of phases of a policy process. Its initial stage is a proposal to a program which is enacted, evaluated and then implemented. As a result, it may well be said the policy process is affected in a big way by elected officials, individual persons, organizations as well as special interest groups. As such, this policy process is usually interwoven with politics. Abood has defined politics as the process through which an authoritative allocation of scarce resources is done. Persons who make decisions in these crucial sectors concerning laws, regulations and policies rely on the political process to come to a determination as to the course of action that is acceptable across board amongst individuals who have conflicting demands, proposals and values. These kinds of statements are arrived at through compromises while special interest groups and individuals usually get their way through intense and deft negotiation, communication and conflict management.
Why are we concerned with nurses and advocacy on policies in the health care system and not the other health care professionals? One may ask. We focus our spotlight on the nurses as health care providers for the simple reason that they constitute the largest group of healthcare professionals and as such, wield great power in the event that they engaged in advocacy. Despite this otherwise encouraging fact, the reality on the ground is that this numerical advantage has not been taken advantage of, so far. Being the case that the nurses have a numerical advantage, it is imperative to examine the sources of power for the nurses from which they can draw from, in order to perform effective advocacy on policy changes in the health care system.
A central source of power for nurses in advocacy lies on their expert power. This power emanates from their very knowledge and skills they are possessed of, as nurses. This is because expert power arms the nurses and indeed any other professional on the health care field, with the much needed credibility to comment and speak out on health care issues. Indeed, it is nurses who are better placed than anyone else to explain the challenges that beset them in their work such as staff shortage or poor facilities. As a consequence, nurses are usually in a unique and vantage position to explain and educate the relevant power players and stakeholders and spur them to action. It is this power that they have owing to their knowledge and skills that allows them to bring their knowledge of health care to bear on the enactment of their policy goals. The second source of power attendant to the nurses is legitimate power which borrows from their license as granted by the professional body regulating their profession. In the case of nurses in the United States, the State Board of Nursing grants licenses which authorizes the nurses to practice nursing in the respective areas. The rights and responsibilities following from the licenses as bestowed upon the individual nurses give them a leg to stand on and speak authoritatively on health care issues. Further, the American Nurses Association publishes the Code of Ethics for Nurses with Interpretive Statements and Nursing’s Social Policy Statement which avails additional sources of the legitimate power. This enables the nurses to speak on the socio-economic, legal and political factors within the health care system.
Another source of power that nurses engaged in policy advocacy may make use of is the referent power that is gained through the admiration and respect from other people. For the case of registered nurses, they are able to command respect and trust that does not easily obtain for other health care professionals. It is also the case that the nurses in the United States are highly valued for their professional honesty and maintenance of ethical standards. As such, the nurses can transfer this valuable trust and respect into action so as to address the malfunctions of the health care system and fix the health care policies. In particular, this power is crucial and of great help in advocacy as it possesses the ability of opening doors for power brokers and other decision makers. Similarly, this referent power is indispensable especially when a nurse advocate is seeking to reach a big number of people so as to enlist their support. Reward power also stands out as one source of power of which nurses can capitalize on to make changes in the health care system. Reward power is that ability to provide people with whatever they wish for and thereby asks them to do something for you in return. It is true that rewards may be used for punishing, normally done through the withholding of a reward. It is also true that elected officials are the ones vested with the power to enact laws and regulations governing the health care system with the involvement of the stakeholders. Since nurses form a big number of voters, they can use their vote to reward those elected officials who are able to deliver and cause positive changes in the health care system.
On the other hand, the voters can punish these elected officials that do not perform through the withholding of their vote to them. Lastly and not in any way the least, is coercive power. This kind of power thrives on fear or the perceived fear of one of the person and is further predicted on its ability to punish. This source of power is usually the ultimate power of all governments. Nonetheless, coercive power is not as effective in this respect; as advocates are usually in an attempt to enable one of the persons see the advocate’s point of view.
Having explored the various sources of power that can be used in advocacy in health care, it is important to state the fact that the understanding and use of all available power by the health professional is essential in the achievement of success in the legislative arena. The advocacy in the health care by nurses and other health professionals has yielded fruits in recent years by influencing health care policies, laws and regulations.
Impact of advocacy on health care policy
Health care policies are sets of courses of action or inaction on the part of government or health institutions to achieve a desired goal or outcome. The policy making process shapes the entire health care system, whether the public or the private sector. This process takes place in varied settings which range from open and public systems to a closed system involving few persons. The impact of advocacy by nurses in health care policy has been felt in recent years.
For instance, the House of Representatives and the Senate enacted a legislation that effectively placed the tobacco industry under the FDA regulation following the expert knowledge and advocacy of the nurses. Through the sharing of the professional and personal experiences of the nurses, the New York State passed a law in July 2009 proscribing mandatory overtime for nurses except in cases of emergency. Secondly, in the sense of the political role and advocacy by nurses is the passage of the Affordable Care Act which has introduced a number of healthcare reforms. Following the passing of the Health Care Bill in the year 2010 and as a testimony to the enormous impact of the advocacy by nurses, President Obama placed a record three telephone calls to the three powerful lobbies that were most vocal in the health care debate. One of the calls was made to Rebecca Patto who was the president of the Americans Nurses Association. This organization had played a critical role in the health care debate by mobilizing its 250,000 members to actively endorse the legislation on health care.
It must be recognized that legislators both at the federal level and at the state level constantly go through numerous bills touching on a broad range of issues. It is humanly impossible for the legislators to have the required information on every major issue so as to debate these bills adequately without the input of health care advocates such as nurses. It is at this point that their expert power is required to enable the correct understanding of every bill which has the potential of fundamentally changing the health care system by introducing changes in the policies and laws. Indeed, it is at this point that health care advocates can wield lots of power while helping their legislators evaluate the health issues and make informed decisions on the same. However, it also need to be noted that in order to achieve this and its resultant effects, both political and professional courage amongst leaders and managers in the nursing profession is needed. This will go a long way in diminishing the dualisms of individual health as against collective health.
References
Abood, S. (2007). Influencing health care in the legislative arena. OJIN: The Online Journal of Issues in Nursing, 60-72.
Bodenheimer, T., & Grumbach, K. (2006). Understanding health policy: A clinical approach. New York: McGraw Hill.
DeLaney, A. (2007). Politics for dummies. New York: John Wiley & Sons.
Mason, D., Leavitt, J., & Chaffee, M. (2008). Policy and Politics in Nursing and Health Care. St.Louis,MO: Elsevier Saunders.
McCartney, A., & Bennion E&D, S. (2013). Teaching Civic Engagement: From Student to Active Citizen. Washington DC: American Political Science Association.
MoveOn. (2006). MoveOn’s 50 ways to love your country: How to find your political voice and become a catalyst for political change. Novato, California: New World Library.
Weissert, C., & Weissert, W. (2006). Governing health: The politics of health policy. Baltimore: John Hopkins University Press.
