In the American Nurses Association’s Code of Ethics, it is clearly designated that nurses must be first obligated to their patients and providing respectful, fair, and equal care to all people. In the Code’s latest revision, there is special reinforcement of our obligation to social justice and the profession’s responsibility to integrate principles of justice into nursing and health policy. In today’s environment, it is especially important for us to be involved in the dialogue and offer explicit and authentic voice to the policy decisions that will affect our nation.
The impact of policy on patients is unmistakably evident, but the enormity of the issue can feel overwhelming and lead nurses to question what difference they can make. There are more than 3 million nurses in the United States, and through our voice of reason, clinical and systems expertise, and close relationship with patients, we should not take for granted our contribution, and we should have the courage to step up claiming what we do and what we know.
We are in a time of complex health care reform, and nurses are ideally situated to put real-life context to the decisions being made. I encourage us to:
- Systematically document the impact of policy decisions on the people we serve. Nurses see first-hand the realities of decisions at the national level on the people affected at the point of care. Real life examples shift the dialogue from faceless policies to the stories of vulnerable Americans.
- Constructively share our observations and insights with nursing and organizational leaders, policy makers, and elected officials
- Become involved and/or assume leadership positions in professional nursing organizations that have structures and mechanisms where our voices can be heard
- Work in community agencies or organizations that focus on our specialties and are already addressing issues of interest
- Exercise our rights of citizenship by voting
- Communicate and write letters to elected officials
- Organize colleagues to think about specific strategies and messages we can employ in a constructive way
If we want to be contributors to the future of our health care system, we must be specific about what is needed, understand the purpose of our communication, and recommend solutions to the problems. And importantly, we must appreciate that the exercise of our moral agency isn’t dependent on the outcome. Integrity can be preserved even when the desired outcome is not achieved. What matters is that we pause to notice an opportunity, take the time, exert the effort, and not remain silent.
Being involved in policy is not necessarily easy, but keeping the health and well-being of our patients at the forefront will make it worthwhile. Without our voice, the policy dialogue is incomplete. Small, courageous steps can make a difference!
ABOUT THE AUTHOR: CYNDA RUSHTON, PhD, RN, FAAN
Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics in the Johns Hopkins Berman Institute of Bioethics and the School of Nursing, with a joint appointment in the School of Medicine’s Department of Pediatrics. Her current scholarship in clinical ethics focuses on moral distress and suffering of clinicians, the development of moral resilience, palliative care, and designing a culture of ethical practice.