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A healthy democracy needs voting nurses

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By: Stacey Bevan BS, BSN, RN

Nurses are patient advocates, providing compassionate and effective clinical care. We center wellness and justice, and we contend with social factors that cause health disparities. But when it comes to representing these ideas in America’s most important policy conversations, the otherwise confident nursing voice softens. Nurses are among the least likely health professionals to vote. How is it that we can so boldly support patient needs within clinical spaces but not outside of them? To build a healthy society nurses must connect key ideas, such as patient advocacy, to voting and include civic engagement as part of our practice. For those who are eligible, a commitment to regularly vote in local, state, and federal elections is consistent with core nursing values.

Patient advocacy

Nurses understand the science of the human body, why the clinical interventions we provide work, and how to partner with patients to meet their health needs. We know that the policies put into place by our political infrastructure directly cause, ameliorate, worsen, and improve the conditions we treat. Our clinical care is patient centered and emphasizes partnership, equity, and holistic wellness. Yet, nursing as a profession does not extend these key tenants into societal health through political representation and participation.

Patient advocacy has an extensive tradition in nursing. American nurses like Lillian Wald, Clara Barton, Dorothea Dix, and Mary Eliza Mahoney transformed our understanding of how social conditions impact health. They extended clinical walls into communities, built organizations to respond in humanitarian crises, advocated for mental-health parity, and moved the profession toward antiracism. These nurses considered the political infrastructure as part of their clinical practice and demanded it align with patients’ right to health. Nursing has long been political.

This foundation evolved into the social determinants of health framework, and modern nursing is engaging more deeply with the social etiology of illness. As the discipline fights against the idea that categories like race, gender, disability, and legal status are disease-causing in themselves, our clinical practice will increasingly orient toward social hierarchies. Providing comprehensive healthcare means acknowledging and extracting power from structures that reinforce racism, sexism, ableism, and xenophobia. Social oppression and injustice are not tangentially related to health, they are primary drivers of unequal outcomes. To be patient advocates, nurses must respond to the root causes of health disparities through civic engagement

Over the past decade, a body of work has emerged that positions the nursing profession within social justice. These ideas have culminated into the framework of emancipatory nursing praxis, which, according to Kagan and colleagues, calls for “a critical awareness of social structures and processes that systematically disadvantage the health of people, with the purpose of changing those structures and processes to promote health.” These ideas are articulated in The Nursing Manifesto, a set of principles that brings nurses to the forefront of transformational change toward a healthier society. The Manifesto is based in philosophies like pragmatism, critical theory, and postcolonialism. This grounding makes emancipatory nursing praxis practical, centered on structural contributions to inequity, and situated in history. Innovations in nursing theory provide an even stronger foundation for nurses to consider clinical care in the context of societal transformation.

Civic engagement

Despite the tie between health and policy, nurses consistently vote less than other professionals who provide social services, such as teachers, social workers, and lawyers. In fact, nurses have a poorer voting record than the average American. Nurses see the ills of society documented in clinical records and manifest in diagnoses every day. Yet, we are less willing to engage politically to change these conditions. There is enormous potential for nurses to shift the political narrative toward equity and health. Nursing practice is defined by embracing innovation, managing complex systems, participating in relational health, communicating clearly, and developing comprehensive plans of care. We have a unique ability to distill a macro-perspective on health to deliver safe and effective clinical care to patients with their individual needs. This perspective could significantly contribute to American politics.

The American Medical Association recently approved a resolution that considers safe and equitable access to voting as a social determinant of health. Building on research that demonstrates voter suppression is associated with negative health outcomes, it resolves to collaborate with others to connect voting participation to health. Consistent with these ideas, thousands of healthcare providers across the country are asking about voter registration status during clinical encounters. Many healthcare institutions have encouraged these conversations, understanding that providing patients to voter registration resources is non-partisan. Organizations like VotER make this process easier by providing scannable badges that direct to state-specific ballot previews, polling place directions and voter registration websites. For nurses who work at institutions that have approved these additions to clinical care, encouraging civic engagement and representation with patients moves us towards a healthier democracy.

Voting is not only about representing patient needs and promoting societal health, but also includes key professional challenges that are sensitive to policy changes. Many nurses experience chronic burn out, large staffing ratios, workplace violence, limitations on scope of practice, and insufficient resources to provide safe clinical care. These issues are not well addressed by policy due to the low percentage of nurses who vote and the fewer than expected nurses in public office; we are underrepresented in every level of government. As part of a comprehensive approach to civically engaged clinical practice, nurses must consider how their unique training is well positioned for public service. There are currently three congresswomen providing a roadmap for nurses to run for office. Lauren Underwood (IL- 14), Cori Bush (Mo-1), and Eddie Bernice Johnson (TX-30) are leveraging their experience in clinical care at the policy table.

The loss of the nursing voice in politics is tangible, not only because of our nuanced perspective but also the size of the profession. There are nearly 5 million American nurses; we exceed the population size of 26 states. Civic participation, including voting, is in the profession’s best interest consistent with the foundations of nursing practice. Nurses must extend the reach of core disciplinary concepts such as advocacy into civic engagement. Activities like volunteering and voting allow community members to contribute to the wellness of their neighbors and protect public values. The latter is critical to a healthy democracy and one of the most important forms of civic engagement. Voting is so aligned with nursing practice that it must be integrated into standard clinical care. It is a professional obligation for those who are eligible to cast a ballot.

Register and plan to vote

Politics are intrinsically related to health outcomes. Healthcare cost, access, and eligibility are on the ballot this November. Beyond this direct link, economic opportunities, safe neighborhoods and schools, and equitable access to housing and food are all determined by policy. If we believe that nursing practice promotes equitable human flourishing, it is our profession’s responsibility to participate in democratic processes. Emancipatory nursing praxis calls for a transformation of social hierarchies, so health is accessible to all and the structural contributors to poor health outcomes are dismantled.

For nurses who are eligible, it is their professional obligation to be represented in local, state, and national elections. Health is on the ballot and nurses are patient advocates. Join us by talking about civic engagement with patients, registering to vote, and turning in your ballot this November.

References

Baptiste D-L, Turner S, Josiah N, et al. Hidden figures of nursing: The historical contributions of Black nurses and a narrative for those who are unnamed, undocumented, and underrepresented. J Adv Nurs.2021;77(4):1627-32. doi:10.1111/jan.14791

Brown CL, Raza D, Raza AD. Voting, health and interventions in healthcare settings: A scoping review. Pub Health Rev. 2020;41:16. doi:10.1186/s40985-020-00133-6

Kagan PN, Smith MC, Cowling III WR, Chinn PL. A nursing manifesto: An emancipatory call for knowledge development, conscience, and praxis. Nurs Philos. 2010;11(1):67-84. doi:10.1111/j.1466-769X.2009.00422.x

Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Ann Rev Sociol. 2015;41:311-30. doi:10.1146/annurev-soc-073014-112305

Solnick RE, Choi H, Kocher KE. Voting behavior of physicians and healthcare professionals. J Gen Intern Med. 2021;36(4):1169-71. doi:10.1007/s11606-020-06461-2

Velasco RAF, Reed SM. Nursing, social justice, and health inequities: A critical analysis of the theory of emancipatory nursing praxis. Adv Nurs Sci. 2022. doi:10.1097/ANS.0000000000000445

Walter RR. Emancipatory nursing praxis: A theory of social justice in nursing. Adv Nurs Sci. 2017;40(3):223-41. doi:10.1097/ANS.0000000000000157

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