Today in the chart

Why Nurse Engagement in Health Policy Matters

Despite policy’s daily and direct impact, nurses question why they must be involved in policy-making and political activity.

Nurses are busy members of the community. They are called on to lead and problem-solve in their employment setting as well as in their community setting. Additionally, the practice of nursing is directly impacted by health policy initiatives. Everything from how a nurse is licensed to how care is evaluated can be traced to a policy. 

Despite policy’s daily and direct impact, nurses question why they must be involved in policy-making and political activity. The answer is simple: our lives and the lives of our patients depend on that involvement.  

Patients Trust Nurses

As America’s most trusted profession for over 22 years, patients and communities have looked to nurses with questions about the impact of policies discussed during elections. Because nurses are positioned at the patient’s side throughout the healthcare experience, they provide insight and expertise that other professions do not have the opportunity to observe. 

Nurses may participate in health policy through their employer or health care facility, local or national government, or professional organizations.

Nurses Know What’s Going On

Nurses provide valuable insight into the development of health policies because they see the tangible consequences of those policies. As the largest healthcare provider sector, nurses spend the most time with their patients. Therefore, they are uniquely situated to understand critical issues such as nurse-to-patient ratios, healthcare access and equity, affordable treatments and medications, workplace incivility, bullying, and workplace violence, the scope of practice and barriers to practice, funding, and support for ongoing nursing education and training, disaster planning, mental health support, and environmental health, to name a few. 

As such, the voice of nursing in crafting the policies that shape healthcare delivery and reimbursement must be strong, constant, and bold. However, nurses are routinely turned off by political rhetoric and grandstanding. Many nurses ask whether engagement in policy makes a difference. It does! 

Why Policy Matters

At the state level, nurses who participate in health policy have significant influence in championing the passage of legislation through concerted efforts with other nurses and stakeholders. Initially, the voice of nurses brings attention to an important issue, prompting its consideration as a proposed bill by the state legislature. 

Subsequently, through ongoing advocacy and testimony during legislative hearings, nurses underscore the significance of the proposed legislation and emphasize the need for urgent passage. 

Where Nurses Come In

Nurses often collaborate with organizations, other professionals, labor unions, and advocacy groups that share a common interest in advancing the bill. Nurses also engage in educational campaigns to raise awareness about an issue through presentations, town halls, and other outreach efforts to inform legislators, employers, and the general public. 

Additionally, nurses communicate directly with legislators through letters, calls, and in-person meetings to illustrate the critical need for legislative action. It’s crucial to recognize that legislators, like most members of our communities, may not possess the same level of knowledge about a healthcare issue as nurses do. Therefore, it falls on nurses to inform and educate legislators effectively. Here are just a few compelling examples of the transformative changes achievable at the state level when nurses unite in advocacy efforts to change health policy.  

Nurses provide valuable insight into the development of health policies because they see the tangible consequences of those policies.

For Example…

In response to deteriorating nurse-to-patient ratios in California, posing a risk to patients and nurses, the California Nurses Association dedicated years to advocating for health policy changes to improve these ratios. In 1999, they were successful. That year, California became the pioneer state in establishing minimum nurse-to-patient ratios in acute care, acute psychiatric, and specialty hospitals with the passage of California Assembly Bill 394 (CA AB 394)

Additionally, the bill required an appropriate number of nurses to be assigned as necessary using a patient classification system that accounts for patient acuity and complexity of nursing care, among other patient safety-focused regulations and restrictions (CA Nurse-to-Patient Ratios). Despite the finalization of regulations to enforce CA AB 394, until 2003, bedside nurses in California have enjoyed safer staffing for 24 years. 

However, it was not an easy road to get there. Nurses and other stakeholders provided extensive testimony during numerous public hearings, alongside public comments such as letters submitted to public officials, expressing support in the face of opposition to the bill. While other states have proposed or implemented nurse-to-patient ratio legislation, none have replicated the specific measures of California’s AB 394. 

Scope of Practice Policy

Nurses advocate for the scope of practice issues, whether it involves changes in or pushing back against barriers. For example, several states have passed laws to expand advanced practice registered nurses’ scope of practice to allow them to practice independently without a collaborative agreement with a physician. 

Supporters assert that legislation giving APRNs full practice authority is essential to improve access to care (especially in rural areas), alleviate the demand for and foster collaboration with healthcare providers, including bedside nurses, and optimize healthcare delivery to improve health outcomes for patients and communities. 

Policy for Better Working Conditions

Furthermore, besides advocating for patient safety and changes to the scope of practice legislation, nurses also push for health policy reforms to improve workplace conditions. Workplace Violence Prevention legislation seeks measures to protect healthcare workers from violence in the workplace, a growing issue for nurses. 

For example, in 2019, Illinois enacted a Healthcare Violence Prevention Act requiring hospitals to develop violence prevention plans to protect employees. Illinois State Representative Stephanie Kifowit is quoted as saying, “We spent over a year crafting the law and got true input from nurses on the ground that are experiencing these acts of violence every day.” These are merely a few examples of nurse advocacy success at the state level. 

How Can You Weigh In?

There are many places for nurses to weigh in on policy issues. These include advocating for policy in board seats, sharing their opinions in letters to elected officials to give policy brief contributions, testimony at local, state, and federal proceedings, and community education and awareness activities (Cleveland et al., 2023; Patton et al., 2019). 

Many nursing organizations offer information on how to become involved in policy. One place nurses can get active in learning about policy involvement is The American Association of Nurse Attorneys (TAANA). With over 225 active members, the organization is a resource for nurses who want to learn more about how policy impacts their practice (, n.d.). 

You Can Use Your Nursing Voice

Nurses champion health policy daily, primarily through direct patient care or active engagement. Advocacy is at the heart of nursing practice. Although nurses tirelessly advocate for better work conditions and improved patient outcomes in their places of employment, “nurse engagement in shaping public policy at the regulatory or legislative levels is not as evident” (Hajizadeh, et al, 2021)

But that can change. 

For nursing students, nurses considering involvement in health policy, and those already engaged who may question the impact of their actions, remember: your insights are invaluable because they reflect frontline experiences, can bridge the gap between theory and practice, and may directly shape the future of health policy and nursing practice. That’s truly empowering.

Our voices carry weight, whether in the workplace or at local, state, and national levels. As our nation's largest and most respected healthcare workforce, nurses wield unparalleled influence to shape health policy to improve the quality of life for all.

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