On June 27, 2024, nurses from across the United States convened in the nation’s capital to attend the American Nurses Association (ANA) Hill Day. As one of the largest displays of advocacy, ANA Hill Day combines the power of individual voices into the power of one voice. The voice of four million nurses advocating for health care policy change. Policy changes that impact the health and well-being of our colleagues, profession, and the patients and communities we belong to and serve. It is a call to action. A call to action to each of us to tell our stories not only on Hill Day but every day we are given the opportunity to use our voice.
There are other opportunities to engage in advocacy efforts in addition to participating in Hill Day. Opportunities exist on the national, state, and local levels. On a national and state level, nurses have been elected to the legislature. In 2023, 72 nurses in thirty-six states served as legislators in their respective states. Although this is an impressive number, there are fewer nurse legislators in fewer states now as compared to 2013. In 2013, it is reported there were ninety-seven nurse legislators in thirty-nine states (Curley& Stone, 2024). Six nurses served in the Maryland State Legislature, these include: former senators Rosalie Silber Abrams, Paula Hollinger, Shirley Nathan-Pulliam, Adelaide C. Eckardt, and former delegates Marilyn R. Goldwater and Geraldine Valentino-Smith (Maryland Nurses Association [MNA],2024; Maryland State Archive [MSA], 2001, 2024 (a), 2024 (b) ).
Maryland nurses have made their voices heard by their lobbying efforts. Opportunities exist to join work groups, committees, participate in the annual Maryland’s Nurses Night, and provide testimony. During the 2024 legislative session, eight nurses provided testimony to members of the Maryland legislature, and the majority testified more than once the testimony of these nurses impacted the outcome of proposed legislation. A powerful positive change because of the voice of these nurses. The impactful outcomes of this small group of nurses raises the question as to what are the barriers and facilitators to nurses’ participation in health care policy efforts?
Barriers and facilitators to nurses participation in health policy advocacy efforts
As nurses we have the privilege and responsibility to be the voice for our individual selves, the profession, and for all those we serve. The commitment to patients, the profession, and to engage in advocacy efforts is evident in nursing practice. However, barriers exist that prevent nurses’ active participation and engagement in health care policy activities. A brief review of the literature found several studies that discuss the reasons nurses do not engage in health care policy efforts. These studies include results from international and national nursing communities and from nurses of different practice settings, including nurse leaders. Some identified barriers are the following: lack of formal education and training, inadequate policy creation skills, lack of confidence to address and approach policy makers, and lack of resources and organizational support to engage in the policy process and advocacy efforts (Barzegar Safari et al., 2020; Haizadeh et al., 2021; Jurns, 2019; Lewinski & Simmons, 2018; Shariff, 2014). Knowledge deficit appears as a consistent theme in these studies. Strategies to address these self-report barriers will prove helpful to increase the number of nurses who engage in health care policy advocacy activities.
Factors that motivate nurses and nurse leaders to engage in policy advocacy and development activities are revealed in the literature. Participation in organizational policy development and advancing the image of nursing were reported motivators for nurse leaders (Shariff, 2014). Further research is needed to identify facilitators to nurses’ participation in health care policy efforts.
Implications for nursing practice
Addressing the barriers self- reported by nurses is crucial to their participation in health policy advocacy efforts (Barzegar Safari et al., 2020; Haizadeh et al., 2021; Jurns, 2019; Lewinski & Simmons, 2018; Shariff, 2014). The authors suggest that providing nurses opportunities to gain new knowledge and skills by offering continuing education, training and empowering programs may lead to increased confidence and competence and participation in policy development and advocacy activities (Haizadeh et al., 2021; Lewinski & Simmons, 2018).
Nursing and health care organizations should increase resources, funding, and support as well as collaborate with nursing educators to encourage nurses to participate in health policy and advocacy efforts (Barzegar Safari et al., 2020; Inayat et al., 2023). The age and limited number of studies found in the literature suggest that further research is needed to identify facilitators to nurses’ participation in health care policy efforts.
Conclusion
Successful policy change and sustainability is based on the relationship of power, influence, and competency. Relationship building, and collaborative efforts between nursing professional organizations, health care organizations, and nursing education are crucial to remove the barriers and nurture the facilitators to nurse’s participation and engagement in health care policy and advocacy efforts, development, and other activities. A nurse’s voice is the most powerful asset we possess to display our power, influence competency.
Josephine Fava Hochuli DNP, RN,
Assistant Professor, Director of Clinical Practice,
Johns Hopkins School of Nursing
Email: jfavaho1@jh.edu
