A Brief History of the National Institute of Nursing Research
After the Institute of Medicine report recommended a federal nursing research entity as part of the mainstream scientific community in the early 1980s, nursing leaders in the United States began promoting establishment of a nursing institute at the National Insti- tutes of Health. This effort involved lobbying Congress, the Reagan administration, and the other institutes at NIH—a formidable task. A few members of Congress were interested in the potential that nursing science had for improving health, but the administration was not in favor of another institute at NIH, and the other institutes seemed puzzled as to why nursing would need its own institute to do research. Couldn’t nurse researchers receive funding through existing institutes? Medicine did so without a separate institute.
Step by step, nursing leaders persuaded (harassed?) institute directors and Congress, insisting that nursing research would improve human response to illness and assist in maintaining and enhancing health. A bill was born. Concern about cost and increasing bureaucracy emerged and was overcome. The bill passed only to be vetoed by President Reagan. Then a funny thing happened. Nursing made an unprecedented move. The profession came together, united with one goal: to override President Reagan’s veto (none had been successfully overridden before).
One by one, across the country, nurses called their senators and congressional represen- tatives urging support for a nursing institute, explaining that nurses were represented only among a few funded researchers at other institutes who did not understand the impact of nursing interventions on health and recovery. A modest investment, they explained, would yield exponentially greater results. Thanks to a few persuasive members of Congress, a compromise was negotiated and the National Center for Nursing Research was estab- lished in 1985. Through a statutory revision in 1993, the Center became an Institute.
Similarly, Georgia nurses successfully changed that state’s practice act to include prescrip- tive authority for advanced practice nurses, overcoming fierce opposition from the medical as- sociation (Beall, 2007). Working in concert with each other and with consumers and the media, they generated a letter-writing campaign that countered every obstacle the medical association tried. Georgia became the last state to grant prescribing privileges to nurse practitioners.
Policy, on the other hand, is the decision that determines action. Policies result from political action.
Using Political Skills to Influence Policies Political skill, per se, is not included in nursing education (nor is it tested on state board exams), yet it is a vital skill for nurses to acquire. To improve your political skill:
● Learn self-promotion—report your accomplishments appropriately. ● Be honest and tell the truth—say what you mean and mean what you say. ● Use compliments—recognize others’ accomplishments.
94 PART 1 • LEARNING KEY SKILLS IN NURSING MANAGEMENT
● Discourage gossip—silence is the best response. ● Learn and use quid pro quo—do and ask for favors. ● Remember: appearance matters—attend to grooming and attire. ● Use good manners—be courteous. (Green & Chaney, 2006)
Health care involves multiple special-interest groups all competing for their share of a limited pool of resources. The delivery of nursing services occurs at many levels in health care organizations. The effectiveness of care delivery is linked to the application of power, politics, and marketing. Nurses belong to a complex organization that is continually confronted with limited resources and is in competition for those resources.
How politically savvy are you? Ask yourself the following questions:
● Do you get credit for your ideas? ● Do you know how to deal with a difficult colleague? ● Do you have a mentor? ● Are you “in the loop”? ● Can you manage and influence others’ perceptions of you and your work? ● Are you able to convert enemies to friends? ● Do your ideas get a fair hearing? ● Do you know when and how to present them? (Reardon, 2011)
To take action, first decide what you want to accomplish. Is it realistic? Will you have supporters? Who will be the detractors? The steps in political action are shown in Table 7-2.
Try to find out what other people involved, called stakeholders, want. Maybe you could piggyback on their ideas. Members of Congress do this all the time by adding amendments to proposed bills in an attempt to satisfy their opponents.
Start telling your supporters about your idea and see if they will join with you in a coalition. This is not necessarily a formal group but allows you to know who you can count on in the discussions.
Find out exactly what objections your opponents have. Try to figure out a way to alter your plan accordingly or help your opponents understand how your proposal might help them. Political action is never easy, but the most politically astute people accomplish goals far more often than those who don’t even try.
A case study that exemplifies a nurse using organizational politics is shown in Case Study 7-1.
Influencing Public Policies What happens in the workplace both depends on and influences what is happening in the larger community, professional organizations, and government. Developing influence in each of these three groups takes time and a long-range plan of action. Although the nurse’s first priority should be to establish influence in the workplace, the nurse can gradually increase connections and in- fluence with other groups and, later on, make these other groups a priority.