I have been pondering nursing’s attitudes towards and interactions with the media, especially the news media—within the context of advocacy. Advocacy at its simplest is speaking up, “to plead the cause of another.” Public policy advocacy “rests on a three-legged stool; to be effective, all three legs must be in place.” (Nancy Amidei, So You Want to Make a Difference: Advocacy is the Key, OMB Watch, 2010) The three legs of advocacy are: 1) the capitol leg (anywhere the laws and policies are made), 2) the community, grassroots leg, and 3) the media leg (anything we do to spread the word/influence more people). In general, nurses do not do well at any of these three legs, but probably do worst with the media leg. Why?
Nurses know advocacy at the individual patient level. Nurses as the fearless defenders of patients is an image deeply rooted in nursing history. Florence Nightingale and Nurse Hawthorne are cut from the same cloth. When nurses are shown in a positive light in the popular media, it is usually as patient advocate superhero. People resonate with that role for nurses, and it is a nursing role modeled for new nurses and included in their basic education. Many nurse leaders maintain that patient advocacy is the exclusive purview of nursing, as if nurses have to protect patients from doctors, social workers, and hospitals. Taken too far, it can be a paternalistic and anti-teamwork frame of mind.
Nurses know advocacy at the self-interest level, through professional nursing organization policy platforms, and through nurse lobby and collective bargaining groups. Nurse patient staffing ratios, expanded scope of practice for nurses, and longer uninterrupted breaks for hospital nurses (see “The Nurse Lobby Day that Wasn’t” blog post, 2-15-11). In addition, much of nursing research is self-interested advocacy of various aspects of the nursing role.
Nurses don’t know public (political) policy advocacy—for the most part. Public health nurses have more experience in and knowledge of this area than do other nurses. They have to, since they work within the socio-political determinates of health. Elite nurse leaders know and use public policy advocacy, and there are a few advanced nursing degrees in public policy advocacy. But elite nurse leaders and public health nurses make up a small fraction of the nursing workforce in our country. They are also viewed as zealots and crazies by many nurses: public health nurses are bleeding-heart progressives, and nurse leaders are out of touch with ‘real nursing.’
So what prevents more nurses from being involved in public policy advocacy? Some people maintain that it stems from nursing school socialization into a risk-averse, conflict-averse role for nurses. Being an advocate of any type—but especially of public policy—means sticking your neck out, taking risks, and dealing with conflict. Other people point out that many front line nurses are overworked and are largely powerless employees of a hierarchical hospital system—and these factors contribute to the lack of policy advocacy involvement by more nurses. And then there is the lack of education for nurses on policy advocacy, and a lack of role models and “best practices.” I teach a public policy and politics of health care graduate nursing class, but my own education and background for this came from my public health involvement, and not from nursing. The National Health Care for the Homeless annual conference I attend always has hands-on training sessions on working with the media in policy advocacy. The American Public Health Association annual conferences generally have many sessions on working with the media and other aspects of influencing public health policy. I have never heard of any such sessions at a national nursing conference.
Working with the media is essential for good policy advocacy because, as Amidei writes, “politicians pay attention to the media (it provides a way to check the community pulse); media can be used to reach other voters; and misinformation that appears in the media needs to be challenged.” Many front line nurses are afraid of interactions with the news media, of speaking out on issues affecting their work—for good reason—since they can be fired for doing so if they haven’t gone through approved channels, or if they say something negative about their workplace. Most hospitals now have policies for all employees on interacting with the media, and even on use of social networking media. This level of institutional control and intimidation has always been present, but has accelerated with the advent of hospital ratings and increased competition for business.
I was reminded of the contradictory messages given to nurses about interacting with the media in the panel discussion this past May in the aftermath of the suicide of Kim Hiatt. One of the panel members, Joanne Silburner, a longtime NPR health policy reporter, encouraged nurses to speak up more—to get to know trustworthy news reporters and to tell them their stories. I imagine that there were at least a few nurses present who did just that—or who first talked with their nurse managers who supported them in talking with the media. They are all my heroes.
Nurses already have many of the essential tools for being an effective public policy advocate. They know firsthand how power is wielded, how people are motivated, and how those with power are influenced. They see these every day in their work. With some additional Civics 101 and media- savviness brush-up—and some good modeling from a seasoned public policy advocate—they are on their way. There are some wonderful nurse policy advocates. One who comes to mind is Ruth Lubic, founder of the Family Health and Birth Center in Washington, DC. We need more. I do not presume to be a seasoned public policy advocate—but I know one. Not a nurse—a social worker. I’m having lunch with her tomorrow and hope to cook up some ideas for advocating for nurse policy advocacy, including how to work with the media.
I am a nursing student in Alabama just learning all about nursing involvement in public policy. From lectures, articles and textbooks I have been reading, I agree with your viewpoint regarding the need for nurses to be aware of public policy changes, and to get involved in the political process of change. My comment is that before we can expect more nurses to “follow suit” with the small percentage of nurse leaders and political activists, we need to empower each other and show teamwork within our own profession. All levels of nursing practice have an influence in public policy. For instance, are nurse managers encouraging and enforcing best practices in their units? Are nurses informed about healthcare decsions going on in their own facilities? Do they even have access to that information? Are nurse educators serving as role models for novice nurses regarding public policy? One thing I’ve learned is that role ambiguty is a barrier to implementing change and nurses feeling empowered. I don’t believe its realistic to expect all nurses or even I hate to say it, but a large majority of nurses to be in the forefront of healthcare reform (the legislative arena). Our own governemnt isn’t even set up that way. There are leaders, and groups, sub-groups and then leaders within those groups. Even further there are those in “the field” who are the hands and feet, implementing the changes that leaders are fighting for. If nursing exemplifies and prides itself on teamwork then we have to remember that even when discussing policy advocacy. Some nurse professionals may be the risk takers, political activists, or change agents, or nurse managers. However, some may be the hands and feet. We are all implementers of change though. So I think what we should be striving for is making a way through media mediums to make sure all nurses are informed of changing policies and that they have the resources necessary for informed decision making. I don’t think that nurses aren’t involved b/c they don’t care. I think for the most part it’s just ambiguity. There is a lack of understanding of what’s happening at the top of the political food chain and how that affects hands-on, point-of-care, and vice versa. How can all levels of nursing practice be informed, engaged and empowered to be a part of public policy change?
Excellent points Kristina. It is important for us to acknowledge the very real barriers to more political/health policy and media involvement by the ‘hands and feet’ nurses working within hospital and other health care systems. Not just potential sanctions/job loss for nurses sticking out their necks/voicing an opinion on policy issues, but also the limiting effects of sheer exhaustion from long hours and difficult work. As a nurse educator I’m aware of my duty to do a better job at teaching health policy and advocacy within a realistic framework. My social work colleague and grand political/public policy advocacy guru Nancy Amidei encourages people to start with small doable things, like linking to an advocacy organization for an issue/cause and keeping updated through their e-mail alerts, etc. Then it’s not a huge time commitment but you can stay informed and even step in and get more involved as time and passion permit. I work with people who are homeless, so I’ve linked in with some national and local organizations who keep me updated on policy issues. They make it easy to send off a quick e-mail (on my non-work e-mail address and computer and time, of course!) to my state legislators or local city council members.
As a student of The Auburn University School of Nursing, I am currently learning about the nurse’s role in public policy; though the ideas and concepts of healthcare policy are new to me, the concept of patient advocacy is not. Patient advocacy is the very reason I chose to become a nurse. While working my way through school and earning my first degree in Psychology, I found that I truly love interacting with people and helping them. Nursing provides me with those opportunities on a daily basis.
To be the best patient advocates we can, we must utilize every resource available to us. The best way to be familiar with public policy is to further develop our skills in the media leg you mentioned. This includes correctly and legally utilizing social media sites such as facebook and twitter. In most hospitals, the mere mention of facebook sparks whispers of HIPPA violations. However, if correctly utilized these resources and other media outlets can help us to become more familiar with current policies, spread the word about needed change, and even help express ideas to those higher in the food chain.
Nicely stated. As you and your classmates graduate and go out into whatever clinical or other nursing practice you decide upon, having discussed these issues in the ‘safe space’ of nursing courses will serve you–and your patients–and all of us well. Staying aware of politics and policy at all sorts of levels, of knowing your rights and responsibilities within the policy arena–it’s good stuff! Don’t give it up no matter how big and large-mouthed those higher up fish are!
Currently, I am pursuing my bachelors degree in nursing. At the same time I am transitioning from acute care nursing to community based nursing. This article along portions of my curriculum have helped reinforce the importance of my role in public policy advocacy. Healthcare policies are rapidly changing. It is important as a professional nurse to understand our roles in public policy to better serve out patients.
I am a soon-to-be graduate with my BSN. I had never really thought much about nursing and politics/media until recently due to class assignments. It has really opened my eyes how important a nurse’s role is in patient advocacy through politics. When thinking about it recently, I feel that a main barrier of nurse participation in the political arena is due to lack of knowledge. As mentioned in the blog, nursing politics is not something that is taught in undergraduate programs (not mine at least). Therefore, nursing graduates are now aware of the opportunities that are out there for them to participate as patient advocates through politics. I feel if a policy class was incorporated into undergraduate curriculum, there would be a positive outcome and could possibly spark interest in students. I personally do not know much about politics and media currently, but as I enter my professional practice, I hope to gain insight into the world of politics and become a patient advocate in order to speak for my patients when they cannot speak for themselves.
Hi Andrea,
Thanks for your comment. It is a good reminder to me to try to include more of this content in my own teaching at the undergraduate level and to encourage/support my colleagues in other undergraduate nursing programs to include it.
I will soon be graduating with my BSN, and I have to say as a nursing student we are taught from day one to always be a patient advocate but nothing seems to be mentioned about advocating for policies. I do believe all nursing programs should have a course focused on political policies and how be a advocate and get involved. I know in our advanced leadership course we just seem to skim the top of discussing policies. But , it has sparked a interest for me just by skimming it because I feel now it is imperative for us as nurses to voice how we feel. I feel that if we use media correctly it can gain more followers; since media is such a big component in today’s society. I believe its important to start teaching about how to be involved in school. And, to reach nurses in the field try having in-services about the importance and how as a nurse we do have a voice to make a change if we work together as a team; which is key component of nursing.
As a fifth semester nursing student just weeks away from a BSN degree I agree that the lack of public policy involvement is a result of a lack of education. This is a topic we are just being exposed to in the classroom and a topic that is not addressed at all in the clinical setting. I found it interesting that you mentioned conferences which offer training in this area. Perhaps healthcare organizations could model after this concept and offer this type of training to their nurses, while at the same time nursing schools can begin teaching this earlier in the curriculum. If both of these changes were made in the training of nurses, hopefully we could see a rise in nurses becoming involved in political policy and in turn being advocates for our patients in more ways than one.
I am a soon-to-be nursing graduate with a BSN degree. I hope to be employed by an organization that will allow nurses to speak up and work with the media. Learning about political policy from a course in my nursing program, I see the importance in becoming active in politics. I agree that if it were not for this class I am taking I would probably not gain a full understanding of how this process works and would not take an active role, just for a lack of knowledge. As being patient advocates is at the forefront of nursing practice, so should advocating through politics. It is a vital piece in making changes for the betterment of the nursing profession and healthcare consumers. I believe the media is a great window into public policy advocacy but is sadly underused today, because of issues such as HIPPA, fear of retaliation, feelings of powerlessness, lack of resources and peer support, time constraints, and lack of understanding of politics. Hopefully nurses will become educated in this area quicker and we will see a greater participation rate in the future.
Nurses are often the unsung heroes who take pride in their work but do not demand the recognition they deserve. As advocates, we often shout from a crowd without stepping forward to speak into the microphone. Media is that microphone but NURSING needs a voice only NURSES can supply. With so many healthcare issues under fire in the political arena, we must strengthen our stool of advocacy. Right now the three-legged stool is a wobbly and uneven with different levels of support under each foot. Within the three legs of advocacy, I believe nurses take more pride and initiative in the community/grassroots because it is where we see the most activity and receptiveness to change. The capital leg is weak due to the mindset of “politics are for politicians”. This often keeps a nurse from adopting the political role (not to mention it’s foreign soil for many of those who did not do so well in Political Econ class in Nursing school prerequisites). Similar to the capital aspect, the media leg is a very public stance of advocacy lacking the bold support of other nurses to step into the limelight together.
Who wants to jump into a dog fight as the smallest, most inexperienced Yorki? But it’s not the size of the dog in the fight. If anything, nurses are the poster profession of adopting and conquering any role they take on. Like Josephine said, nurses “know firsthand how power is wielded, how people are motivated, and how those with power are influenced.” They are not the corrupt attention seekers in the media or politics. They are the rooted mothers, fathers, sisters and brothers so many politicians and movie stars forget they are before they achieve fame and fortune. This is not to say nurses are perfect but they understand more than most about human error and unselfish motives. Nurses have become scientists, researchers, missionaries, journalists, engineers, and so much more. They adopt other roles and become the most valuable piece to any team because of the view and experience they bring to the table. If a nurse wants to be a politician, then they argue with an unselfish opinion for the issues that matter. If they want to be a voice, then they shout from the mountain tops. But these brazen nursing souls are so sparse that their voices can fall flat or overheard. The more we (nurses, media, politicians, and public alike) work together, the more change we will see but we can’t wait for it because we will all be waiting side by side.