Nursingʼs Agenda for Health Care Reform: Policy, Politics, and Power Through Professional Leadership

Abstract

This article is an eye witness account of nursing's participation in the health care reform debate from 1991 to 1994. In that debate, the nursing profession achieved high visibility and recognition for the cogency of its policy positions as developed in Nursing's Agenda for Health Care Reform and for its united voice through the leadership of the American Nurses Association, the Tricouncil for Nursing, and the Nursing Organization Liaison Forum. While comprehensive health care reform failed to pass the 103rd Congress, nursing and nurses gained much in the process of their participation.

Policy Advocacy and Nursing Organizations: A Scoping Review

“…Most papers focused on organizations’ advocacy efforts related to a specific policy issue or topic including: nurse training and education ( Fondiller, 1980 ; Hall-Long, 1995 ; Hardy, 1985 ; Hardy, 1988 ; Leurer, 2013 ), advanced practice or nurse practitioner practice ( Hansen-Turton et al, 2009 ; Jones, 2004 ; Madler et al, 2014 ; O’Brien, 2003 ; Sampson, 2009 ; Sharp, 1994 ; Young, 1983 ); nursing shortages, salaries, and staffing issues ( Birnbach & Orr, 1993 ; Eaton, 2012 ; Green et al, 2004 ; Hundemer & Durando, 2014 ; Kishi & Green, 2008 ; Wieck et al., 2004 ), healthcare reform ( Rubotzky, 2000 ), women’s suffrage ( Lewenson, 1989 ), registration status ( Birnbach, 1982 ), nursing legislation ( Brekken & Evans, 2011 ; Young, 1983 ), insurance for the aged and enactment of Medicare ( Woods, 1989 ), community health ( Cho & Kashka, 2004 ), primary healthcare ( Whyte & Stone, 2000 ), continence services ( Thomas et al, 2004 ), cancer care ( Rieger & Moore, 2002 ), environmental health ( MacDonald, 2012 , Sattler, 2003 ), lesbian, gay, bisexual and transgender health and equality ( Keepnews, 2011 ), and key legislation such as the Canadian Health Act ( Dick et al, 1986 ). Of the 37 papers, six were focused on examining nursing organizations’ policy advocacy agenda in a more evolutionary and holistic manner and described their engagement in multiple policy issues over an extended period of time ( Bednash, 2015 ; Betts, 1996 ; Chiu et al, 2020a ;…”

“…Some papers were focused on discussing strategies more broadly while others focused on the strategies used by specific organizations. Commonly identified strategies included interorganizational collaboration and coalitions ( Baumgart, 1993 ; Bednash, 2015 ; Betts, 1996 ; Birnbach & Orr, 1993 ; Brekken & Evans, 2011 ; Chiu et al, 2020b ; Cho & Kashka, 2004 ; Dick et al, 1986 ; Fyffe, 2009 ; Green et al, 2004 ; Hall-Long, 1995 ; Hardy, 1985 ; Hansen-Turton et al., 2009 ; Jones, 2004 ; Kenner, 1995 ; Kishi & Green, 2008 ; MacDonald, 2012 ; Madler et al, 2014 ; Miyamoto & Cook, 2019 ; Mosley, 1996 ; O’Brien, 2003 ; Rieger & Moore, 2002 ; Rubotzky, 2000 ; Sampson, 2009 ; Sattler, 2003 ; Sharp, 1994 ; Thomas et al, 2004 ; Wieck et al, 2004 ; Whyte & Stone, 2000 ), meeting with policymakers and government ( Betts, 1996 ; Brekken & Evans, 2011 ; Cho & Kashka, 2004 ; Green et al, 2004 ; Hansen-Turton et al, 2009 ; Hall-Long, 1995 ; Hardy, 1985 ; Kishi & Green, 2008 ; Macdonald, 2012 ; Madler et al, 2014 ; Miyamoto & Co...…”

“…One paper examined the perceptions of policy and political leadership of nursing organizations in New Zealand ( Donovan et al, 2012 ). The other 28 papers included mention of organizations’ policy advocacy impact on specific issues ( Bednash, 2015 , Betts, 1996 ; Birnbach, 1982 ; Birnbach & Orr, 1993 ; Cho & Kashka, 2004 ; Dick et al, 1986 ; Eaton, 2012 ; Fondiller, 1980 ; Freitas, 1986 ; Green et al, 2004 ; Hansen-Turton et al, 2009 ; Hardy, 1985 ; Hardy, 1988 ; Hundemer & Durando, 2014 ; Jones, 2004 ; Kishi & Green, 2008 ; Koehn, 2020 ; Leurer, 2013 ; Madler et al, 2014 ; Miyamoto & Cook, 2019 ; Mosley, 1996 ; O’Brien, 2003 ; Rubotzky, 2000 ; Sattler, 2003 ; Sampson, 2009 ; Thomas et al, 2004 ; Wieck et al, 2004 , Young, 1983 ).…”

“…While some of the papers made mention of the impact of organizations’ policy advocacy initiatives ( Baillie & Gallagher, 2010 ; Bednash, 2015 , Betts, 1996 ; Birnbach, 1982 ; Birnbach & Orr, 1993 ; Cho & Kashka, 2004 ; Dick et al, 1986 ; Donovan et al, 2012 ; Eaton, 2012 ; Fondiller, 1980 ; Freitas, 1986 ; Green et al, 2004 ; Hansen-Turton et al, 2009 ; Hardy, 1985 ; Hardy, 1988 ; Hundemer & Durando, 2014 ; Jones, 2004 ; Kishi & Green, 2008 ; Koehn, 2020 ; Leurer, 2013 ; Madler et al, 2014 ; Miyamoto & Cook, 2019 ; Mosley, 1996 ; O’Brien, 2003 ; Rubotzky, 2000 ; Sattler, 2003 ; Sampson, 2009 ; Thomas et al, 2004 ; Wieck et al, 2004 , Young, 1983 ), greater empirical research is needed to evaluate and examine the relationship between specific advocacy strategies and outcomes such as changes in public awareness and perception, legislation, policy, and practice. Advocacy and policy change evaluation is an important area of inquiry as advocacy organizations are increasingly expected to demonstrate the value of their work to their membership, stakeholders, and funders ( Gardner & Brindis, 2017 ).…”