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Advocating Change and Developing Policies in Practice
by Sharon Y. Fleming, M.S.N., R.N., C.P.N.P.-P.C. Minority Nurse Writer
Today's nurses face the challenge of how to position themselves to be most effective in orchestrating policy changes in their surrounding communities and workplace. But we can look to one of our most effective leaders and political activists for inspiration: Florence Nightingale. We should emulate and develop the skills practiced by Nightingale and other leaders of the past, and with their collective power, modern nurses can make a huge difference in our society's health care system by participating in policymaking.
Because of persistent high unemployment rates and reform, the health care industry has had a tumultuous past few years. Families that once had commercial insurance are faced with difficult choices regarding compliance with primary, dental, and preventative care decisions. Many nurses recognize the severity of the problem, yet, due to lack of experience in the political realm, often take a backseat on such issues. Nurses can draw strength to make bold attempts at policy change by following Nightingale's (and many other nurse leaders') example.
Nightingale became an activist when she recognized the need for reformation in the prisons, hospitals, army, and English workhouses in Europe and India. When she went to the Selimiye Barracks hospital in Scutari (Istanbul) during the Crimean War, she encountered staggering fatality rates, but started developing the theories of sanitation and organization that eventually reformed health care. Although exhausted, and at times ill herself, she fought for humanity and the education of future health care advocates. As a mentor, Nightingale taught her students proper observation and assessment skills. How did Nightingale—a frail, young, inexperienced activist—make the kind of difference that continues to be recognized today? She relied on what she knew and maintained her commitment to humanity. As a nurse, she recognized the need for change and set an agenda to put those changes in motion. When engaging with military commissions, Nightingale used the power of listening and observation, recognizing body language and conversation stoppers. She became a leader, respected not only because of her caring spirit, but also because of her brilliance in tackling problems. Nightingale also became well known and influential in her new uses of applied statistics to bring about social change, presenting data to politicians and government officials through visually stimulating graphics.
Florence Nightingale wrote countless letters, 147 books and pamphlets, and even more reports concerning sanitation and health. She is an example of how we can use writing and communication skills via networking and by forming coalitions of people with common interests to support our goals. Nurse practitioners must become passionate about the issues they find in their communities, giving a voice to the voiceless and advocating inside the health care system.
We must recognize the issues in society today and imitate the examples of past nurse leaders, those who have accomplished their goals in changing policy and procedures. We must realize that we may face rejection, that implementation of policy is generally unpredictable, and that change does not happen overnight. We must be incremental in our attempts to implement new policies, by positioning ourselves in positions of authority, such as agency leaders in government offices. Though we may encounter resistance, such as when convincing an organization to try a pilot plan, we can arm ourselves with evidence and examples to illustrate to others the effectiveness of the innovations being introduced.
Nurses must recognize the influence they can be in current health care dilemmas by exposing themselves to policymaking opportunities. Imagine a world in which Florence Nightingale failed to act on her beliefs—critical changes regarding sanitation and hygiene could have been delayed, and many lives might have been lost. Nightingale was a force in the nursing profession and in society. Today's nurses must use her as our example, imitating her dedication and tenacity to influence changes that will improve our health care system.