Background: The advocacy role of nurses has been formalized in seminal documents from nursing organizations like Sigma Theta Tau International (STTI), the International Council of Nurses, and national nurses associations. STTI in its Policy Position Statement reiterates the individual nurse’s responsibility for policy as well as the importance of STTI in helping nurses locally, nationally and internationally in advancing policy. Likewise, documents such as the American Nurses Association’s Nursing’s Social Policy Statement and Code of Ethics emphasize the role of nurses for shaping policy. With over 29 million nurses and midwives globally, there is great potential for advocacy and policy influence and power. However, individual nurses may not recognize their responsibilities as global citizens or understand nurses’ global interconnectedness and in society nurse nurses may not be easily recognizable for their role in health policy (Mason, Nixon, Glickstein, Han, Westphaln, & Carter, 2018).
Furthermore, nurses may not realize the critical importance of honing their existing skills and developing new policy competencies to leverage nursing’s potential power to impact healthcare and nursing practice locally and globally. Often they do not know where to start (Haebler & Fitting, 2018). Yet, nurses because of their education and expertise have the skill sets to be successful in policy as the fit between nursing and policy advocacy is a natural one. Therefore, the analysis of one’s skills and competencies is an important foundational step in building capacity to influence policy. For example, the ability to analyze problems, grasp the whole picture, communicate with persons holding diverse viewpoints, and organize are all skills that can be applied to the policy arena.
Purpose: The purpose of this presentation is to describe a policy self-assessment process and then guide the audience in an evaluation of their skills and subsequent action steps that can be taken to develop policy competencies. Completing this policy assessment will help nurses to extend their real word advocacy and policy influence from the local community to the world stage.
Conceptual Framework: Health policy competencies are multidimensional and can be analyzed within a framework of assessing one’s capital or ability to exert influence. This framework can be applied regardless of one’s position across the broad spectrum of nursing. The framework for the assessment is based on four types of capital: intellectual, social, political and financial assets and how these overlapping broad categories can be developed in advocacy and policy making. These can be analyzed at the big “P” (e.g., congressional agenda) and little “p” (e.g., policies where you work and live) levels.
Intellectual capital is knowledge held by an individual or shared knowledge of a group. Social capital is the benefit that one gains from relationships and social networks and in its simplest form is sometimes called “who you know.” Financial, as implied in its name is the economic resources that can be used in the policy making processes. Political capital in its simplest terms is influence. The model of building capital is used as the framework for policy skill assessment because it is a strategy designed to help nurses develop assets that are important for being engaged and successful in policy work.
Individuals may be at different levels regarding their capital assets and have different competency levels at each step of the policy process. Completing an assessment will identify areas of strength, opportunities to leverage expertise, and areas for growth. Included are four levels for rating the strength of one’s capital assets based upon Miller’s Pyramid moving from cognition at the base and to skill and practice in the real world. “Knows” or being at the knowledge level is reflective of entry level skills with limited understanding of civics and policy processes, and membership in an organization without participation in its policy activities. “Knows how” might include participation in an organization’s activities such as a lobby day, participating in grass roots activities such as letter writing campaigns or being a member of a healthcare system’s committee. “Shows how” can refer to chairing a committee, or leading a policy initiative within an organization. “Does” refers to using one’s talents at a leadership level and having significant influence in a specific policy arena to make a difference in healthcare outcomes, for example, serving on a legislator’s healthcare committee. The locus of one’s activities can be further differentiated to facilitate planning for professional growth in health policy advocacy. Health policy competencies are multidimensional and therefore the assessment should include the little “p” level (e.g. one’s own healthcare organization or community) and the Big “P” level (a state, national or global).
Once a detailed analysis of policy competencies is completed, the next step is formulating an action plan to enhance capital assets and competencies with the goal of strengthening policy influence. An action plan should include short and long-term goals. Identifying activities for immediate action, for example, within the next six months to one year, has the potential to position oneself in a policy arena. This in turn may yield opportunities to develop long-term policy leverage and influence. The goal is to focus on moving from knowledge to action by beginning at the level identified in the self-assessment, then taking on more substantive responsibilities at a higher level and across settings, and then broadening the circle of involvement by mentoring friends and colleagues in one’s policy work.
Conclusion. “Never underestimate what you as a nurse brings to health policy” according to Mary Wakefield, PhD, RN, FAAN, former Acting Deputy Secretary of the Department of Health and Human Services, and former Administrator, Health Resources and Service Administration (Patton, Zalon & Ludwick, 2019, p. 464). Nurses have tremendous expertise and talent that can be harnessed to expand the profession’s collective influence on healthcare policy. Personal assessment of health policy competencies can be used across a variety of practice settings and policy arenas and by nurses in different roles. Nurses in practice, educators socializing their students to professional roles, and nurse leaders desiring to impact broader changes in practice can use this assessment.
This session provides a systematic strategy to assess individual competencies to strengthen nursing, improve health, fulfill the profession’s contract with society, and advance progress on the Sustainable Development Goals. As individual STTI members, nurses can make a difference as global citizens and support the Sustainable Development Goals and other issues of global concern (Thompson, 2016).