More Nurses in Decision Making Roles – Prospects and Challenges

Nurses have always been at the front lines of the “healthcare battle field” more so than anybody else. They are the ones in close touch with patients and their families. They are the ones who are holding the pulse of the healthcare system on a day to day basis.

Thus it is also natural that there is an increasing demand in the nursing community to have a more say in the formulation of healthcare policies as well as in the way the system itself is run and governed.

In theory, this is a good thing too since no doubt it will bring much needed invaluable input from the trenches and make sure the best possible solutions reach those in direst need through the most efficient channels possible.

Compared to the situation ten or twenty years ago, nurses today do participate in healthcare decision making in increasing number of course. There is no doubt about that. But, despite all the qualified undergraduate and master’s nursing programs across the nation and many professional development programs, there is still long ways to go.

The chief challenge and issue with the expanded participation of the nurses in decision making is that it involves nothing less than the very same leadership and management skills that the movers and shakers in any industry must possess.

That is, when it comes to decision making, strategic planning and policy formulation, it is not enough just to be a highly qualified nurse well versed in medical technology and skills.

One must also be, for example, an excellent coalition-builder in order to build common fronts with other governmental and non-governmental organizations in society in order to influence the decision making process. Basically, it is a political as much as a technical role.

Among other things, our nurses must also master advanced mass communication skills in order to work the media and get the appropriate messages across as wide a cross section as possible. In this day and age of hourly news cycles and instant Internet communication, nurses in such leadership roles must have the skills to understand and manipulate the way the news is created, distributed and consumed. They need to plan their strategies by leveraging such comprehensive media expertise.

Again related to that is the necessity for the nursing community as a whole to get involved in better public relations and explain at a higher level the crucial role they play in the national health system.

A case in point — go to Google News for example on any given day and make a news story search with the key word “nurse” and you would be surprised at the number of stories returned about nurses taking advantage of their patients or getting involved in one or other type of vice and character weakness that none of us associates with our dignified profession.

That goes to show that image building and maintenance is a public process that should be tended to with the same care that goes towards our patients and our own professional development. A solid positive image, a “market brand” if you will, that clearly communicates the precious “value added”  that the nursing profession represents is an invaluable ingredient for all nurses climbing up the proverbial ladder of decision making. It’s the “water” that raises all the “boats” effortlessly.

In a recent paper, the International Council of Nurses (ICN) headquartered in Geneva, Switzerland has summarized the various dimensions of increased decision making by nurses as follows: strategic planning, budgeting, efficient resource planning and utilization, and the planning, management and evaluation of programs and services.

The ICN has again stressed that the position of the nurses as the “point guards” of the whole health care system who are in close touch with what’s really happening out there uniquely qualifies them for coordination of health services and strategic planning and the efficient utilization of resources. Who can argue with that?

One hopes that through such expanded participation in the decision making process at all levels, the trend for moral and ethical stress among nurses that has been covered by the recent literature might be countered as well, at least to a certain extent.

The recent research by Mary C. Corley, PhD, RN., Associate Professor at Virginia Commonwealth University found that a large percent of nurses interviewed would not want family members treated in their own hospitals.

The same study also showed a larger percent (25%) of nurses had left a position in the past due to moral distress compared to 13% in 1995 — that is, the distress of disillusionment with the various managed care systems. Increased political participation in decision making should be expected to work in the other direction and increase job satisfaction among nurses at large. It would help not only the patients, their families and public at large but the nurses themselves too.

The most systematic framework of nurses’ participation in decision making process has been developed by the American Nurses Credentialing Center (ANCC), the same organization that confers on US hospitals the prestigious designation of magnet hospital. To earn the distinction, hospitals usually invest two to five years of work to change their structure to one that complies with the ANCC criteria.

Some of the magnet hospital criteria directly address increased decision making participation for nurses like decentralized, shared decision-making processes prevail throughout the nursing operations of the organization, or  the rehabilitation nurse participates in decision-making regarding allocation of resources used by or for the patient.

Clearly, such expansion of nurses’ administrative, leadership and political roles is here to stay thanks to the wide-spread consensus that it would only increase the efficiency, rationality and fairness of our existing healthcare system.

Now it’s up to us to run through this portal of opportunity and make the best of it. The decades ahead will be an exciting one for our nursing community, full of fascinating professional challenges and growth opportunities. It’s a good time to serve as nurses again.

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