Advocacy

What does advocacy mean? For many it means the act of speaking or writing on behalf of someone or something. Certainly, the concept of advocacy is imbedded in the foundational documents of our profession. The definition of nursing as found in the American Nursing Association (ANA 2010) Nursing’s Social Policy Statement the essence of the profession: “Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill and caring in improving the health status of the public and ensuring safe, effective, quality care.” Ensuring safe, effective, quality care requires advocacy.

The Code of Ethics for Nurses (ANA, 2015) provision 3 indicates, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient” (p. 41). Provision 6 in the Code says “The nurse, through individual and collective effort establishes, maintains, and improves the ethical environment of the work setting and conditions of employment, that are conducive to safe, quality health care” (p. 95). Then Provision 8 states, “The nurse collaborates with other health care professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities” (p. 129). Lastly, the Code provides further direction by “The profession of nursing, collectively through its professional associations, must articulate nursing values, maintain the integrity of the profession and integrate principles of social justice into nursing and health policy” (p. 151).

Policy

Policy is described as the choices that a society, or an organization, makes regarding the goals and priorities, as well as the ways in which resources are allocated. Social policy pertains to decisions that promote the welfare of the public. One example is local ordinance such as zoning law that prohibits certain kinds of businesses within a designated distance from a school. Health policy includes the decision made to promote the health care of individual citizens. Examples include Medicare and the Patient Protection and Affordable Care Act of 2010.

Politics

Policy is accomplished through politics. Politics is about influencing, which implies some capacity to make a difference in the outcome of a decision. Even though competing stakeholders cannot get all of the limited resources, they still should come to the table where decisions are made. Nurses cannot be part of the decision if they are not present. Nursing values and needs may not even be considered.

Nursing, Policy, Politics

The relationship between policy and politics has been recognized by some of the most notable nurses in the history of our profession. Florence Nightingale was one of the first to recognize the interplay. She was able to collect the data required to influence policy and transform the British health care system. Lillian Wald was the driving force behind the establishment of the federal government’s Children’s Bureau. Mable Staupers led the efforts to integrate African-American Nurses into the armed services in World War II.

Voting

Participation in politics can vary a great deal. At the very least, the individual nurse’s participation should include voting, the most basic form of civic engagement.

We live in a representative democracy and it is our elected officials who are part of that decision making process that governs us all as citizens. Government at the local level determines how the trash gets collected and whether or not it includes recycling. Local government is responsible for police and fire protection. State governments determine how schools will be funded and to what extent private schools are allocated tax payer dollars. State governments determine the legal definition of nursing and scope of nursing practice. The federal government decides what portion of the budget is spent on defense and how much is allocated for programs to care for citizens.

Nurses should vote in all elections, not just the general election. To have input into whom the general elections candidates will be nurses must vote in the primary. Ohio has an open primary. This means that every two years, voters can choose either a Democratic Party or a Republican Party ballot in the primary. Voters can also choose to vote an issue-only ballot (if there are issues), when they do not wish to vote for candidates in the primary. You do not have to vote the party in which you are registered for the primary.

Being an Informed Voter

Check with your county Board of Elections or https://www.vote.org/ if you do not know the location of your polling place. You can also verify that you are registered to vote. In Ohio, voters may be purged after six years of inactivity.

There are a variety of ways to be an informed voter. Candidates have platforms and share their views with voters through campaign appearances or media. Understanding candidate platforms and views provides insight into how the candidate may be likely to respond to issues of concern. Elected officials at the state and federal level have official government websites, which usually contain email addresses. These official websites and email addresses should not be used for campaign questions or issues about their individual campaigns. Instead, voters should use the candidate website email address for this purpose. Many officials have newsletters to inform voters about their activities. Federal officials have staff in both Washington and in the local area to provide information. State Senators and Representatives have staff in Columbus who can be helpful in providing information.

Interest-based organizations such as the League of Women Voters, Centers for Responsible Politics and some professional nursing associations are another source of information. These entities may track voting records and convey that information to their members. Some offer tool kits and a variety of resources to assist the voter in understanding issues and navigating processes. They may also have a Political Action Committee (PAC) and may endorse candidates based upon their records or platforms for office.

Political parties are also sources of information about candidates. Usually the party has a platform (policies they stand for) though individual candidates may not espouse every position of the party platform. Keep in mind that no candidate is going to agree with any individual voter on every issue. The essential question becomes, to what extent this candidate shares your own individual values.

Supporting Others in Voting

The American Medical Association (AMA) passed a policy resolution in 2022 declaring voting a social determinant of health. The relationship between voting and health outcomes is due to a variety of factors. It has been noted that people from marginalized backgrounds are more likely to be affected by poor health and decreased access to voting has been associated with worse health care outcomes. Not only do nurses have a responsibility to vote but also, nurses should facilitate the voting process for patients.

One way to help is volunteer to register voters. Health care providers and others can sign up with Vote-er.org to register voters at your institution or anywhere else. A “Vote-er” badge can be clipped on an ID badge. Patients and others use their personal devices to scan the QR code on the badge. Voters can register to vote or request a ballot through this non-partisan platform. A voter helpline is available 24/7.

Nurses may help others to vote through volunteering for Election Protection at ohiovoterrights.com. This organization spreads the word about the Election Protection Hotline (888-OUR-VOTE) by distributing post cards, palm cards, and yard signs. Election Protection also provides poll monitors to help voters at the polls. Training is provided for the above activities as well as other assistance.

Votefwd.org provides support by writing letters in a non-partisan fashion. Volunteers download the pre-printed letters with addresses and add a personalized message about why voting is important. The volunteer provides the envelopes and stamps.

The American public trusts nurses more than any other professional group. For 22 years in a row, the Gallup Poll has found this to be true. The health of our community and our country is greatly influenced by nurses. Nurses have the power, if only they fully use it through civic engagement. Voting and assisting others to vote is the very least of that civic engagement.

References

American Nurses Association. (2015). Code of ethics for nurses. American Nurses Publishing.

American Nurses Association. (2010). Nursing’s social policy statement the essence of the profession. Nursesbook.org

American Nurses Association. (2024, January 22). America’s most trusted: Nurses continue to rank the highest. https://www.nursingworld.org/news/news-releases/2024/americas-most-trusted-nurses-continue-to-rank-the-highest/

Mason, D., Leavitt, J., Chaffee, M. (2022). Policy & politics in nursing and health care. Saunders.

Milstead, J. (2013). Health policy and politics: A nurse’s guide. Jones and Barlett Learning.

Rahul, V., Reddy N., Giron,N., Bai, E., (2023). The social determinants of health -moving beyond screen-and-refer intervention. New England Journal of Medicine Catalyst Innovations in Care Delivery. Massachusetts Medical Society.