“Nurses Call the Shots”

1. “Nurses Call the Shots” A Political Action Framework for Nurses C. Avolio March 2011

2. Objectives • At the end of the learning session the nurse will be able to: • Discuss the importance of political activity • Define advocacy and community • Discuss the morale, ethical role of the RN in relation to addressing health, health policy and nursing for individuals and populations • Identify determinants of health pertinent in the Windsor/Essex community • Begin to develop a personal position statement on a health issue of concern

3. Political action/knowledgeSignificance for nursing: • Nurses have first hand knowledge of health and social disparities • Responsibility to address social, economic and political issues that impact health • Advocacy is a core value of nursing • Nurses possess the right skills; communication, decision making, problem solving and critical thinking • Use of the nursing process-assess, plan, implement and evaluate our actions • RNAO “Framework for political action” 2006

4. Challenges: • Not sure how to utilize our skills in the political arena • Language of policy and legislation is complicated • Lack basic education to prepare us for political action • Power struggles-history • Image of nursing-caring profession. Does this conflict with the aggressiveness of politics? • Work-life balance

5. Curriculum • Political science not a mandatory course in undergraduate studies • Most graduate programs have core courses in population health • Limited research about the contents and delivery method • Moral education Gehrke, 2008, p. 54 • Nurses have called for educational preparation in policy advocacy, and beginning research suggests that educational preparation enhances competencies in political advocacy. Reutter & Duncan, 2002

6. Advocacy Definitions • “The act or process of advocating or supporting; one that pleads the case of another” Webster Dictionary, 1998 • ”A combination of individual and social actions designed to gain political and community support for a particular goal”. WHO, 2005 • “Pertains to both clinical situations on behalf of patients and social circumstances on behalf of the general public.” Beu, 2005

7. College of Nurses of Ontario Advocacy is identified as a core value throughout the Standard of Practice Guidelines: • Therapeutic Nurse-Client Relationship • Professional Standards • Informed Consent • Ethics • Leadership www.cno.org

8. History of Nursing Advocacy • Florence Nightingale-linked health to social and economic inequalities. Reduced mortality rates of British soldiers, addressed poor sanitation, overcrowding, ventilation and the welfare state. • Lillian Wald-Founder of the public health nursing, lobbied for improved social conditions for the poor, introduced both school and rural nursing, addressed child labour and welfare issues. Falk-Rafael, 2005

9. Reflection • “Health policy advocacy is an important part of nurses’ health promotion role, and it is considered an aspect of sociopolitical caring.” Primomo, (2007, p. 263)

10. Community Defined • “A group who share common characteristics, but may not interact with one another.” McKay & Segall, 1983 • “Persons who reside in an area, space and time, which includes a community history and environment and purpose.” Shamansky & Peaznecker, 1981 • “Shared interests, ethnicity, sexual orientation, or occupation.” Fellin, 2001 • “A social unit where people come together politically to make changes.” Parker, 1994 As cited in Glanz, Rimer & Viswanath, (2008)

11. Local Health Issues • The health of those in the Erie-St. Clair region is affected by: • Smoking, alcohol misuse, lack of physical activity, poor nutrition/diet and obesity. All greater than the Ontario average • Significantly high incidence of chronic diseases; cardiovascular, cerebrovascular, diabetes, hypertension, COPD and arthritis • Greater than average rate of hospitalization, years of life lost and death due to tumours and circulatory disease • Low income, high cost of medications http://www.esclhinihsp2.ca/mha/mha.html; retrieved March 2011

12. Analysis of Windsor Essex Community • Over 408,000 residents • High senior population, decreased number of 25-39 years • Slightly more females than males • Many lone parent families, predominantly female with an average income of 31,000 • Culturally diverse, immigration and visible minorities • Most residents have a high school diploma or less • Unemployment rate is 9.5% Statistics Canada, Windsor Essex Census 2006

13. What Determines Health? • Healthy public policy is aimed at achieving equity and can positively affect many of the determinants of health. Reutter & Duncan, 2002

14. Key Determinants of health • Income and social status • Social support networks • Education • Employment and working conditions • Social environments • Physical environments • Personal health practices/coping skills • Healthy child development • Biology and genetic endowment • Health services • Gender • Culture Pangman & Pangman, 2010 p. 67-8

15. Health inequality Health inequalities are the differences, variations and disparities in the health attainments of individuals and groups. Examples: Income Gender Disabled persons New immigrants Aboriginal persons

16. Social justice • Social justice is the degree of equality of opportunity for health made available by the political, social and economic structures and values of a society. • Smith (2005) as cited in Pangman & Pangman (2010)

17. Upstream vs downstream processes • Micro-level processes – Social structures that lead to individual health or illness • Macro-level processes - Power relationships and political ideology that dictate the quality of social structures • Downstream carative processes-”directed towards meeting needs of individuals and families.” • Upstream processes-”influencing change in societal structures and relations, by those with power in society.” (Raphael, Bryant & Rioux, 2009; Falk-Rafael, 2005)

18. Common Traits of Nursing Leaders • Vision • Risk takers • Contacts with people in power and positions of authority • Sought to influence government • Work collaboratively to achieve their goals Beu, 2005

19. Dimensions of Political Competence • Nursing expertise • Networking • Persuasion • Collective action • Broad perspective • Perseverance Rains-Warner, 2003

20. 5 Cs Of Political Influence • Communication • Credibility • Collective action • Collaboration • Cash Leavitt as cited in Beu, 2005

21. Moral responsibility • Are nurses morally obligated to respond to the inequities that affect people and/or our communities? • Reflect on your own personal/professional values. • Political action can mobilize change

22. Getting started • Identify a question or concern-something that is important to your patients, community and SELF • Assessment of the problem-evidence, research, talk to nursing experts, call RNAO • Plan your action-i.e. write a letter to your MP, call the media, respond to an action alert, support RNAO position statement • Act-Have a colleague review your response, important to act in a timely manner. Provide a possible solution(s) that are congruent with those that support positive health outcomes, healthy public policy or support nursing roles.

23. Continued • Evaluate-What is the response or outcome to your action? Satisfied? • Reassess the need to act further, develop a coalition, focus group, monitor progress, etc.

24. Media Relations RNAO Political Framework-Taking Action! (2006)

25. Lobbying Senior Administrators & Politicians RNAO Political Framework-Taking Action! (2006)

26. Resources • http://www.cna-nurses.ca/CNA/issues/matters/default_e.aspx • http://www.rnao.org/Page.asp?PageID=1224&SiteNodeID=117

27. Reflection • “Nurses who practice at the intersection of public policy and personal lives, are, therefore, ideally situated and morally obligated to include political advocacy and efforts to influence health public policy in their practice. The health of the public and future of the profession may depend on it.” Falk-Rafael, 2005

28. EXERCISE • Following the presentation, in your opinion does the RN have a commitment to act on behalf of the community as a community/political advocate? • Have you identified any areas within your community or work environment that requires action to improve the healthcare delivery system and/or population health through addressing the determinants of health?

29. REFERENCES • Beu, B. (2005). Internship links practice and politics. Health policy issues, 81(2), 421-422. • Canadian Nurses Association. Retrieved March 26, 2011. www.cna.ca • College of Nurses Standards of Practice. Retrieved March 26, 2011. www.cno.org • Falk-Rafael, A. (2005). Speaking Truth to Power: Nursing’s Legacy and Moral Imperative. Advances in Nursing Science, 28(3), 212-223. • Gehrke, P.M. (2008). Civic Engagement and Nursing Education. Advances in Nursing Science, 31(1), 52-66. • Health Canada, www.gchc.on.ca • International Council of Nurses, • LHIN, ISHP 2, 2010 • Primomo, J. (2007). Changes in political astuteness after a health systems and policy course. Nurse Educator, 32(6), 260-264. • Rains Warner, J. (2003). A phenomenological approach to political competence: stories of nurse activists. Policy, Politics & Nursing Practice, 4(2), 135-143. • Raphael, D., Bryant, T., & Rioux, M. (2006). Staying Alive: critical perspectives on health, illness, and healthcare. Toronto, Canadian Scholars’ Press Inc. • RNAO (2006) Taking Action! Political Framework • Stats Canada retrieved March 26, 2011 • World Health Organization (2005). “Introduction to Toolkit”. From Health Service Planning and Policy Making: A Toolkit for Nurses and Midwives. p. 4