Participation of nurse managers in the health policy process: a qualitative study of barriers and facilitators

Abstract

Aim To explore the barriers and facilitators concerning nurse managers’ participation in the health policy‐making process. Background Despite encouragement for participation in policy‐making, nurse managers are seldom involved in this process. Methods A qualitative descriptive research design based on purposive sampling was conducted. Semi‐structured one‐to‐one interviews were conducted with nurse managers and key informants (n = 16). Interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The Standards for Reporting Qualitative Research (SRQR) checklist was applied to study reporting. Findings Three levels of barriers were found to nurse managers’ participation in health policy‐making. The individual level included weakness in characteristics of nurse managers, and the organizational level constituted the inefficient structure. In addition, the environment‐related level encompassed external barriers to the organization. Finally, three facilitators with the potential were identified for improving nurse managers’ participation in the policy‐making process, including improvements in collaboration and communication, governmental and non‐governmental organizational activities, and reforms in the health policy‐making process. Conclusion Nurse managers need to use the window of opportunity to participate in health policy‐making. More importantly, they should be informed about health policy in order to meet the demands of the rapidly changing healthcare environment. Drawing upon their professional organizations and positions, nurse leaders require to network and make a space to stimulate their participation in the policy. Implications for nursing policy and health policy Nurse managers need to develop political skills and utilize strategies to help their participation in health policy‐making, leading to better implementation of policies, efficiency, and effectiveness in the health system.

Clustering the engagement of Brazilian nurses in political advocacy

“…Corroborating this study's findings, a study indicates that nurses with master's degrees or higher levels of education are more politically active than those with lower levels of training (18) , also recognizing that professional nursing organizations give greater freedom to more qualified professionals to influence the construction of institutional policies (1,4) . This translates into a need for nurses to engage in health policies since the beginning of their training, to influence health and public policies (8) . Therefore, building effective and coherent ways to act in political advocacy is considered an essential component of nursing education, at the undergraduate, master's and doctoral levels (18) .…”

“…Additionally, nurse managers who are in key positions should be a model, qualifying and motivating nurses to become involved with health policies, by establishing healthy and ethical work environments, organizing actions focused on health policies, providing training and continuing education in order to facilitate the understanding of workers with regard to their skills in the development of health policies and strategies influencing political decision-making. With this in mind, the International Council of Nurses proposes that nurses significantly contribute to develop efficacious health policies based on their knowledge and experience (8) .…”

“…It is worth noting that, through leadership, nurses can reconcile organizational objectives with the objectives of the nursing staff in order to improve professional practice and the quality of care delivery, which is an element that facilitates the work of health teams (21) . Another important facilitator in cluster 2 is related to these individuals' professional experience, the longest experience among the four clusters, which consequently means greater experience with political performance, knowledge of health systems and research, and involvement in political issues, possession of leadership skills, qualification, having structural support and greater knowledge, availability of resources, and a positive image of nursing, as reinforced by an international study (8) .…”

“…Several factors encourage the ability of nurses to be politically active and influence the development of health policies; in particular, professionals need to plan collective activities that culminate in strengthening groups, producing and sharing relevant knowledge on political issues, and affecting health care and the nursing profession (7) . The political influence of nurses becomes apparent from their ability to impact health-related issues through their competencies and political knowledge, the exercise of power, advocacy, efficient communication, and collaboration with the remaining health team members (8) .…”

Insecure Employment Contracts during the COVID-19 Pandemic and the Need for Participation in Policy Making

“…Increased exposure to and engagement in policymaking issues during nursing education is one factor that can empower nurses [ 105 ]. Therefore, nursing faculties should focus on the preparation and engagement of nursing students into healthcare policymaking discussions [ 106 ].…”