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Committing to a new approach to policymaking.

I am concerned for my country as I observe the debates of the Republican candidates for President and the working of the U.S. Congress, read about the failure of the bipartisan "Super Committee" to reach an agreement on a deficit reduction plan, and listen to the various talking heads on the increasingly partisan and shrill evening talk shows. I am concerned about the tenor of our public discourse and that too many are unwilling to set-aside self-interests and ironclad positions for the common good. It is distressing to see an historical confluence of social problems exacerbated by partisan bickering, ineffective government, and policies that are not reflective of the needs and values of most Americans. Our social policies, most of which are in essence health policies, are failing.

As I dissect the layers of dysfunction, the lack of civility and attitudes associated with civility seem to be the core of many of the problems we are experiencing. The definition of civility is elusive. One definition that I keep going back to is, Civility is claiming and caring for one's identity, needs and beliefs without degrading someone else's in the process (1). Civility goes beyond good manners, although common courtesy is important and often neglected, and it does not denote rolling over and playing dead. Civility means being open to hear and respect someone else's perspective even when we have a strong aversion to what is being said. At the heart of civility is a true respect for others, a willingness to separate people from problems, and a desire to seek common ground as the starting point.

I am concerned that the voice of the American public is being drowned-out by divisive public discourse by politicians and pundits. The disconnect between the citizens and the institutions that exist to serve them, including government and other public institutions and the press, is glaring. Recently the approval ratings for the U.S. Congress reached an all-time low of 13%! On this issue Republican, Democratic, and Independent survey respondents are united; there are minimal differences in responses across the political spectrum. Another poll showed that 65% of those surveyed wanted members of the Super Committee to reach a compromise even if it included parts they did not agree with. The American public understands the need for change, why is this being ignored?

The call by President Obama to "sharpen our instincts for empathy" after the shootings in Tucson resonates with me as a nurse. Civility is a reflection of our core professional value of the dignity and worth of every individual regardless of social status or circumstances. In his speech the President asked that we talk in ways to each that heal, not ways that wound. The corollary for policymaking would be political dialogue that fosters the identification of solutions rather than rhetoric that divides us and ignores the suffering of countless citizens. So what does this means to us as nurses in Tennessee as we enter another legislative session and contemplate how we effectively meet our mission to improve health and health care for all Tennesseans and to promote and protect registered nurses and to advance the practice of nursing? How do we exemplify civil behavior as we engage in policymaking at all levels? How do we become, as Gandhi stated, the change we want to see? Below are a few suggestions (2):

* We need to accept and respect that other thoughtful and caring people have different and valuable opinions. Listen!

* As you listen, identify common interests and discuss diverging interests in a respectful and meaningful way. Be genuine!

* Work to focus discussion on the practical, doable, and sustainable solutions, not personal attacks or an endless rehashing of what is wrong. Commit to working together in a meaningful way to produce results.

* Seek win/win solutions whenever possible; refrain from the use of threats and force. Compromise is not a sign of weakness.

* Use relevant and reliable data as a tool to understand problems and forge solutions. Policymaking needs to be informed by facts and research.

* Avoid imputing bad intentions to others (unless it has been shown they truly have bad intentions!). Do not vilify those who have a different perspective than yours.

* Agree and adhere to processes which are equitable to all stakeholders. Be truly inclusive and fair in appearance and fact!

We live in an increasingly complex and pluralistic society. The problems we are confronted with have deep-rooted origins and their solutions are multi-factorial. Conflict is an inherent and essential component of political processes. A commitment to civility does not change the tough issues we face, the hard choices that must be made, or the invariability of differences of opinions. Civility does change the way issues are addressed and how we interact with each other.

Here in Tennessee, 2012 will be an important time of policymaking. As is typical in the even-numbered years, all of the Tennessee Representatives and one-half of the Senators will be up for re-election (and all of this will be played against the backdrop of a Presidential election). Our state continues to be challenged by the economic downturn and tough competition for scarce resources. Decisions about a Tennessee Health Insurance Exchange will be made. Plans for implementation of other provisions of the Affordable Care Act will need to be determined. Health reform, embodied in the Affordable Care Act and The Future of Nursing report from the Institute of Medicine, poses great opportunities for nurses. These opportunities, as they often do, also present significant challenges. At a time when circumstances and research findings support the need for a robust practice of nursing, we are faced with serious threats to current practice. We have a long way to go to respond to a key message of the IOM report, nurses should practice to the full extent of their education and training. We have been confronted with bills in the last few legislative sessions that would curtail nurses' current practice and thwart the efforts for nurses to realize their professional potential to improve the health and health care of Tennesseans. This makes no sense given the pervasive problems associated with the state's low rankings on so many measures related to health outcomes, health determinants and utilization. Resources are scarce. Needs are great. We need to mobilize nurses to meet the opportunities and challenges of health reform. Nurses must be part of the solution.

The path for some of the changes needed passes through the Tennessee Legislature. I am challenging all nurses in Tennessee to heed the suggestions for more civil policymaking. We need a new approach to how we accomplish our mission to improve health and health care for all Tennesseans and to promote and protect registered nurses and to advance the practice of nursing. We need strategies and approaches that are respectful of all parties. Let's commit to a new approach for policymaking for 2012. Let's lead the way in exemplifying civility as we strive to influence policies related to health and health care in Tennessee.


(1.) From Cassandra Dahnke & Tomas Spath of the Institute for Civility in Government.

(2.) Adapted, in part, from The Meaning of Civility by Guy Burgess and Heidi Burgess, Co- Directors of the Conflict Research Consortium of the University of Colorado.

by Carole R. Myers, PhD, RN Chairman, TNA Government Affairs & Health Policy Committee
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Author:Myers, Carole R.
Publication:Tennessee Nurse
Geographic Code:1U6TN
Date:Dec 22, 2011
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