How can nurses 'get political' in election year?
I look back on the past eight years and wonder how I became be such a "political animal". When I first entered primary health care (PHC) in 1999, as a very quiet, anonymous, unassuming practice nurse, the PHC Strategy was just a whisper on the Independent Practitioners' Association (IPA) wind, and boy, were the doctors getting their wind up! They certainly knew how to get political. But then, historically, docs have always been very good at using the political wheel to drive their own agenda.
Putting my head above the parapet and asking those interminable questions "why?" or "why not?" is what keeps getting me into more political activity. "Why can't the nurses have some support for education?", in the old IPA days in general practice. "Why can't I see patients for half an hour, if I have the skills and education to meet their needs?" "Why does the PHC Strategy say nurses are crucial to its successful implementation but the Ministry of Health does not back up that rhetoric and policy with sound legislative changes?"
So, as you do when prescribing geriatric medication, I started low and went slow. Once I had done two years on an IPA and then a primary health organisation (PHO) board, and then became chair of the New Zealand College of Practice Nurses[NZNO] and started becoming more confident about what I was saying, it was all on. Why so long? Because it took me two years to speak confidently at board meetings. Because it is very scary to put your hand up and be noticed, particularly if what you are saying is not popular with major stakeholders in an argument. Because I had postgraduate education knowledge to assimilate and use. Because I finally realised I was an expert on nursing and that I had knowledge that needed to be heard in policy forums, to ensure people got services that would work for them, and for nursing.
A recent conference in Auckland, "Providing solutions for vulnerable populations" heard very good examples of what can be achieved for patients when nurses "get political". New models of nurse practitioner (NP) practice overseas--nurse-led, nurse-managed and patient-centered--are providing health care solutions. Moreover, they have legislative backing which supports funding and practice models that we can only dream of at this stage in the evolution of NPs here. Why is New Zealand moving so slowly with NP development when there is clear evidence it works and is good for people? Because nurses must overcome the political agendas of interest groups. Which nurses? All of us, as it is our practice and our patients who are disadvantaged by the tack of progress.
Policy without practice is nothing. Policy and practice without supporting legislation is worse than nothing. The nurse prescribing debacle is an example to note. Where would nursing be in this battle without nurses pushing their political barrow on the national front? Not even on the agenda and way behind the times. Having said that, we now have many well educated nurses in positions where they could make a difference to population health but are unable to use those skills, because legislation has lagged behind both policy and practice.
American nurse scholar Donna Diers says nursing can't be confined to nursing issues. (1) Nurses have a social responsibility to be advocates for those people we serve, the communities in which we live. Nurses know how the whole health system works--we are with people in their journey through the health system, all day, all night, on weekends and public holidays. We know when a policy or a political agenda does not make sense. So why don't we speak out? It's a question many have tried to answer, but only nurses know why. Susanne Gordon is a well known writer on nursing issues and the invisibility of nursing. She has even written a book to teach nurses how to get visible and political. (2) It's not rocket science--a letter to the editor of a local paper is a good start. Being political means having the courage of your convictions and using your nursing knowledge to debate the issues. It should be a well-built, sound, evidence-based argument, not a personal attack on the other side. When do you start? Well, a good time would be this year's general election. How do you choose? How about by looking at the different political parties' health policies? It a good chance to exercise your critical thinking. NZNO has already responded to one of the party's health policy. You can find the submission on the website (www.nzno.org.nz) to give you ideas on what to took for in such a policy.
Finally, I wish to salute all those nurses who are giants in the politics of nursing and who have been working for years on the political "front" --those who are in the media spotlight and those who, although not so visible, are still working within the politics of health to improve nursing services and patient care. I salute your passion, your perseverance and your unending patience and belief that one day it will be different and nursing will have what it needs to do an excellent job in New Zealand.
As for me, well I have a two-year compulsory holiday coming up, as my husband takes a job in the Falklands Islands. I may work in the National Health Service--I can't imagine two years on holiday really! I will be watching the health and nursing scene here from afar and rebuilding my reserves to re-enter the fray on my return. Go well and vote wisely.
(1) Diets, D. (2004) Speaking of nursing ... Narratives of practice, research, policy and the profession. Boston: Jones and Bartlett Publishers Inc.
(2) Buresh, B. & Gordon, S. (2006) From silence to voice: What nurses know and must communicate to the public. (2nd ed) Ithaca : ILR Press/ Cornell University Press.
Rosemary Minto, RN, PGCert(practice nursing), MHPrac(Hons), works as an advanced practice nurse at the Katikati Medical Centre and works as clinical leader for a Maori mobile nursing service.