Advocacy: Civic Engagement Among Nurses

Sunday, 17 November 2019

Carrie Rewakowski, MS, RN
Decker School of Nursing, Binghamton University, Binghamton, NY, USA
Maria MacPherson, MPH, RN
New York State Department of Health, Syracuse, NY, USA
Helen Clancy, DNP
SUNY Upstate Medical University, Syracuse, NY, USA

Statement of the problem: The American Nurses Association (ANA) declared 2018 the Year of Advocacy (Haebler & Fitting, 2018). This declaration emphasized the capacity of nurses to elevate voices of vulnerable people and to influence the direction of healthcare (Haebler & Fitting, 2018). Advocacy is defined in the ANA Code of Ethics as “the act or process of pleading for, supporting, or recommending a cause or course of action. Advocacy may be for persons (whether as an individual, group, population, or society) or for an issue.” (ANA, 2015, p. 41). Civic engagement, such as voting and volunteering (Robert Wood Johnson Foundation, 2015), is a way to advocate for persons and for health-related issues. Ehrlich (2000) defined civic engagement as the process of “working to make a difference in the civic life of communities and developing the combination of knowledge, skills, values and motivation to make that difference” (p. vi).

Significance: As the largest group of health professionals, nurses are in a unique position to participate in civic engagement to impact meaningful change to health policy for the purpose of advancing the health of the individuals, families, and communities. According to the NCSBN (2019), in 2019 there are over 4.6 million active registered nurses across the United States. In the sentinel Future of Nursing Report, the Institute of Medicine ([IOM], 2011) posited that nurses in the United States will be critical contributors to “transform the health care system to provide seamless, affordable, quality care that is accessible to all, patient-centered and evidence based, and leads to improved health outcomes” (p. 1). Nurses, according to the IOM (2011) have the capacity to lead change to advance health by implementing wide-reaching changes in health care systems (IOM, 2011). Despite the strong urging for nurses to engage civically, there is sparse evidence of frequency and types of civic activities in which nurses engage.

Purpose: The purpose of this poster is to present answers to the following questions: (a) What are the frequencies of types of civic engagement activities in which nurses and non-nurses participate, and (b) what is the relationship between being a registered nurse and level of civic engagement?

Study design and sampling method: Using a cross-sectional design, data was collected with an electronic survey tool from a convenience sample of adults. This 17-question ad hoc survey was administered by nurse volunteers to all interested adults (n = 727) who visited the NYS Action Coalition Future of Nursing informational booth at the 2018 NY State Fair during the 13-day event. The sample included both nurses (n = 232) and non-nurses (n = 495).

Variables examined: Independent variables were demographic in nature and operationalized as (a) status as nurse or non-nurse, (b) age, and for nurses only, (c) level of education and (d) primary type of nursing practice. Dependent variables were civic engagement activities related to health issues, and were operationalized by asking respondents to respond nominally about participation in the following activities in the past year: (a) written an email, letter, or signed a petition, (b) volunteered for a group, board, committee, or council, (c) contributed time or money to make community a healthier place to live, (d) contributed time or money to prevent or cure a specific disease, and (e) voted for or against a candidate because of a position on health care. Participants also were asked about if they voted in the last presidential election. An index for the combined civic engagement score (CCES) was constructed using the sum of each positive answer for these questions. This yielded a minimum CCES of zero and a maximum CCES of six.

Findings: The frequency in which both nurses and non-nurses participated in each activity of civic engagement was examined using frequency statistics. For the prior year, at least half of all nurse respondents reported participating in each of the six civic engagement activities. The most common activity for nurses to engage was voting in the last presidential election (82.3%). Non-nurses also reported the highest percentage of participation related to voting in the last presidential election (79.4%). Similarly, both nurses and non-nurses had lowest participation rates related to having written an email, letter, or signed a petition for a health-related issue (nurses = 53.0%, non-nurses = 31.1%). The range of positive participation for each activity among nurses was 53.0 to 82.3%, while the range for non-nurses was 31.1 to 79.4%.

This study analyzed the relationship between being a registered nurse and participating in civic engagement activities by t-test for independent samples using the CCES index as the dependent variable and status as a registered nurse as the independent variable. This analysis found the relationship to be significant (p=.000) and revealed that those respondents who reported being a registered nurse had higher CCES than non-nurses. Mean CCES for nurses was 4.01, while mean CCES for non-nurses was 3.15. This analysis revealed that nurses are more civically engaged than non-nurses.

ANOVA analysis for age demonstrated significantly significant differences for both nurses (F = 7.896, p = .000) and non-nurses (F = 5.708, p = .000). ANOVA analysis also demonstrated significant differences in education (F = 4.646, p = .001) and field of practice (F = 5.843, p = .000) in the sample of nurses.

Conclusions: The results of this study are useful to address the gap in literature about the frequency and types of civic activities in which nurses engage. This study provided statistical evidence that age, level of education, and field of practice all influence civic engagement among nurses. Finally, findings in this study revealed that nurses are more engaged than non-nurses. This may reflect positive movement by nurses towards answering the call to advocate for health-related issues that impact individuals, families, and communities.