Nursing is the largest medical profession in the country, with more than 3.1 million registered nurses practicing nationwide (Princeton University, 2018). Nurses have the immense potential to greatly impact policy and politics on a national and global scale. The American Nurses Association Code of Ethics for Nurses Provision 8 states:
“The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.”
In addition to advocating for the rights of others, nurses also need to self-advocate for nursing scope of practice (Desai, 2015). Regrettably, nurses historically have had little involvement in policy. There is a call on nurses now to get even more involved so that competing interests in healthcare will not be the only ones heard by lawmakers (Abbott, 2017; Oestberg, 2013). Little is known on the political makeup of nurses on a national level and how these views have changed over time. An exploratory study was undertaken to examine registered nurses’ and other nurse professionals’ political beliefs and positions. Using assistance (financial aid) to other countries, contraception availability for teenagers, and sex education in public schools as outcomes, we aimed to determine 1) what are the attitudes of nurses on these two issues and 2) if these attitudes are significantly different from other healthcare professionals.
Methods:
The GSS (General Social Survey) is a national survey that monitors the beliefs, attitudes, and attributes of the American people (NORC, 2018). This information is used to inform policymakers and scholars in trends on a variety of areas from health care to religion. The survey is administered to the American people every two years. Individuals complete the survey with an interviewer who administers and codes the responses. Responses can vary from levels of agreement/opposition to not applicable where the interviewer instructed the respondent to skip the question. 683 survey responses were extracted from respondents who answered the survey from 2006-2016 who were designated as healthcare practitioners and technicians according to 2010 census occupation codes. Registered nurses, nurse practitioners, nurse anesthetists, nurse midwives, and licensed practical/vocational nurses were coded into one category. All other healthcare professionals were coded as non-nurses. Survey questions that were analyzed include:
- Are we spending too much, too little, or about the right amount on assistance to other countries?
- Do you strongly agree, agree, disagree, or strongly disagree that methods of birth control should be available to teenagers between the ages of 14 and 16 if their parents do not approve?
- Would you be for or against sex education in the public schools?
Associations between categorical variables were analyzed using Chi-square and Fisher’s Exact tests. Longitudinal trends in political positions and beliefs were analyzed by percentage of respondents who reported a specified answer (e.g., agree, disagree, etc.).
Results:
Of 683 respondents, 165 were included due to data completeness. Participants were a mean age of 49, 83% were Caucasian, 75% were female, 58% were married, and 47% were nurses. In the overall sample of nurses and other healthcare professionals, 33% identified as Democrat, 39% were Independent or Other Party, and 28% were Republican. 73% felt the US spent too on assistance to other countries, 64% thought that contraception should be available to teenagers if their parents disapprove, and 97% agreed that sex education should be taught in public schools.
Of nurses, 34% were Democrat, 38% were Independent, and 29% were Republican. In response to the three survey questions, 75% of nurses thought the US spent too much on assistance to other countries, 62% thought that contraception should be available to teenagers if their parents disapprove, and 99% thought that sex education should be taught in public schools. Chi-Square and Fisher’s Exact tests did not find any significant differences in responses between nurses and non-nurses. From 2006-2016, there was an 18% increase (from 57% to 75%) in the proportion of those nurses who thought the US spent too much on foreign assistance, a 24% increase (from 43% to 67%) in the proportion who thought that contraception should be available to teenagers, and a 4% decrease (from 100% to 96%) in the proportion who thought that sex educations should be taught in public schools. Chi-Square and Fisher’s exact test found no significant difference in responses from before 2012 and after 2012.
Conclusion:
Findings suggest that the number of healthcare professionals, especially nurses, are supportive of sound policy on significant health issues. The increase in those who thought that the government spends too much on assistance to other countries, alludes to the need for more transparency from government leadership and stakeholders. Despite no significant difference found between professions and over time, this is good news in that the healthcare profession as a whole can advocate together on these issues. However, this project raises multiple ethical questions about the role of nurses’ political beliefs and advocacy. Divisions along party lines were relatively even around 1/3. Additionally at least a quarter of nurses thought that contraception shouldn’t be available to teenagers if they disapprove and the US spent too much on foreign assistance. In order to promote unified political action, do nurses need to advocate for theory in practice despite their political objections?
All of the issues examined require urgent solutions. The fact remains many countries depend on aid from the United States to remain politically stable. Sexual education in public schools is one of the essential institutions for informing the public on sexual health. The nearly unanimous support by nurses and other healthcare professionals, suggest that advocacy can be made in making sex education more medically accurate than just simply being required. Lastly, there is a need for political and procedural safeguards to protect adolescent autonomy because of the stigma regarding adolescent sexuality (Behmer Hansen & Arora, 2018). The relatively even split among this sample along party lines (some favorable, some not) has implications for continuing to obstruct women’s, including adolescents, access to contraceptives (Bijlmakers, de Haas, & Peters, 2018).
In conclusion, there is a substantial number of nurses who hold political beliefs in opposition of each other and theory. We cannot infer that these political beliefs and positions are only informed by science, morality, or religion. Research has shown that informational messages can shift scientifically unfounded views on health issues such as vaccines and abortion (Nyhan & Reifler, 2015; Nyhan, Reifler, Richey, & Freed, 2014; White, Grossman, Stevenson, Hopkins, & Potter, 2017). However, with nurses being one of the most learned professions in the nation this might not hold. With the healthcare and political landscape rapidly changing, there is an uncertainty if moving forward the nursing profession will speak united or divided.