Steps in Political Action
1. Determine what you want. 2. Learn about the players and what they want. 3. Gather supporters and form coalitions. 4. Be prepared to answer opponents. 5. Explain how what you want can help them.
From Sullivan, E. J. (2013). Becoming influential: A guide for nurses (2nd ed.). Upper Saddle River, NJ: Prentice Hall. Reprinted by permission.
CHAPTER 7 • UNDERSTANDING POWER AND POLITICS 95
In order to influence public policies, nurses need to know how to work with the public officials who enact those policies. Table 7-3 lists guidelines for working with public officials.
First, be respectful. Public officials have many constituents and demands on their support. Build relationships with officials. Don’t just contact them when you have a request. Keep in touch at other times.
Communicating with Elected Officials Nurses often wish to contact elected officials to support or oppose legislation. You can call, e-mail, tweet, or write to public officials. (Links to state legislators and contact information for federal government officials are listed in the Web resources for this chapter.)
Here’s how to contact state or federal elected officials. Call the official’s staff and ask to speak to the person who handles the issue that concerns you. Tell the aide that you support or oppose a certain bill and state the reasons why. Name the bill by number.
USING ORGANIZATIONAL POLITICS FOR PERSONAL ADVANTAGE Juanita Pascheco has been nurse manager of medical and surgical ICUs in a large, urban, for-profit hospital for the past seven years. Two years ago, Juanita completed her master’s degree in nursing administration. Her the- sis research centered on the acceptance of standardized and computerized documentation methods for critical care units. Juanita is well respected in her current role and is a member of several key committees addressing the need for a replacement health information system (HIS) for the hospital. She reports directly to the director of critical care services.
Although Juanita enjoys her work as nurse man- ager, she believes she is ready to assume additional responsibilities at the director level. Through her work on the hospital’s HIS selection team and as the nursing representative to the physician’s technology committee, Juanita identifies the need for a clinical informatics di- rector role. One of Juanita’s responsibilities on the HIS selection team is to identify talent from clinical areas who could support the HIS implementation. Juanita has also agreed to chair several working committees that will assist in determining required clinical functionality for the HIS.
During her tenure at the hospital, Juanita has cul- tivated solid working relationships with several key de- cision makers within the organization. The human re- sources director, Ken Harding, has worked with Juanita on several large projects over the past two years, in- cluding implementation of multidisciplinary teams in the ICUs. Juanita schedules a lunch with Ken to discuss growth opportunities in the information technology department, the process for creating new roles, and in particular, who will determine the need for and ap- proval of new information technology positions. Using this knowledge and her experience on the HIS selection
team and the physicians’ technology committee, Juanita develops a proposal for the clinical informatics director position.
As the HIS selection team draws closer to selecting a final vendor for the computerized health information system and an implementation timeline is established by the information technology department, Juanita ap- proaches her supervisor, Sherrie Wright, with her pro- posal. Juanita also provides Sherrie with an overview of the clinical support that will be necessary for successful implementation of the HIS product. Since the critical care units are targeted for the initial phase of imple- mentation, Sherrie is aware that Juanita’s high interest in technology and her clinical expertise in the ICU would be invaluable for successful implementation. As a strong manager, Juanita can build acceptance of this change among the nurses, physicians, and other members of the health care team.
Sherrie agrees to take Juanita’s proposal to the chief nursing officer for formal consideration.
Manager’s Checklist The nurse manager is responsible for:
● Knowing and understanding the formal lines of authority within the organization.
● Identifying key decision makers and understanding their priorities and how those priorities affect any new initiatives.
● Recognizing the importance of timing when initiating change.
● Being ready to take advantage of new opportunities. ● Building strong and credible working relationships
with decision makers. ● Being willing to take on new and challenging tasks
that may lead to more responsibility.
CASE STUDY 7-1
96 PART 1 • LEARNING KEY SKILLS IN NURSING MANAGEMENT
E-mail or write directly to the official. Identify the bill in question, state your position on the bill, and explain why you support or oppose it. Keep your comments brief, and address only one issue per correspondence. Hand-written letters get more attention than form letters distributed by organizations.
Use this format to address members of the U.S. Senate:
The Honorable (full name of senator) __(Rm.#)__(name of) Senate Office Building United States Senate Washington, DC 20510
Dear Senator:
To contact the member of the U.S. Congress, use a similar format.
The Honorable (full name) __(Rm.#)__(name of) House Office Building United States House of Representatives Washington, DC 20515
Dear Representative:
Meeting with Elected Officials To meet in person with an elected official, make an appointment, arrive on time, and come pre- pared. Understand the pros and cons of the issue you are bringing to the person’s attention. Be a constructive opponent. Argue for your position and be prepared with additional information and alternative suggestions. Still, be realistic. What you want may not be possible, or it may not be likely at the present time. Always be helpful. Show how your issue benefits the official’s constituents and, thus, the representative.
The American Association of Critical-Care Nurses suggests pointers for working with public officials (AACN, 2010). In addition, the American Nurses Association (ANA) has legislative and government information for nurses (ANA, 2011). (See links to these organizations in the Web resources for this chapter.)
Using Power and Politics for Nursing’s Future Kelly (2007) suggests that apathy prevents nurses from using their political skills. Becoming active in professional associations, learning the legislative issues that affect nursing, gaining political skills, and being willing to advocate for nursing’s causes are necessary for the profes- sion to flex its considerable political muscles. All nurses can participate to some extent in these activities.
Nurses can have a tremendous impact on health care policy. The best impact is often made with a bit of luck and timing, but never without knowledge of the whole system. This includes
TABLE 7-3 How to Work with Public Officials
1. Be respectful. 5. Understand the issue. 2. Build relationships. 6. Be a constructive opponent. 3. Keep in touch. 7. Be realistic. 4. Arrive informed. 8. Be helpful.
From Sullivan, E. J. (2013). Becoming influential: A guide for nurses (2nd ed.). Upper Saddle River, NJ: Prentice Hall. Reprinted by permission.
CHAPTER 7 • UNDERSTANDING POWER AND POLITICS 97
knowledge of the policy agenda, the policy makers, and the politics that are involved. Once you gain this knowledge, you are ready to move forward with a political base to promote nursing.
To convert your policy ideas into political realities, consider the following power points:
● Use persuasion over coercion. Persuasion is the ability to share reasons and rationale when making a strong case for your position while maintaining a genuine respect for an- other’s perspective.
● Use patience over impatience. Despite the inconveniences and failings caused by health care restructuring, impatience in the nursing community can be detrimental. Patience, along with a long-term perspective on the health care system, is needed.
● Be open-minded rather than closed-minded. Acquiring accurate information is essential if you want to influence others effectively.
● Use compassion over confrontation. In times of change, errors and mistakes are easy to pinpoint. It takes genuine care and concern to change course and make corrections.
● Use integrity over dishonesty. Honest discourse must be matched with kind thoughts and actions. Control, manipulations, and malice must be pushed aside for change to occur.
By using their political skills, nurses can improve patient care in individual institutions, help organizations survive and thrive, and influence public officials.
What You Know Now • Power is the potential ability to influence others. • Power can be positional or personal. • Types of power include reward, coercive, legitimate, expert, referent, information, and connection. • Image is a source of power. • Power can be overused, underused, or used inappropriately. To be effective, the power used must be appro-
priate to the situation. • Shared visioning is an interactive process in which both leaders and followers commit to the organiza-
tion’s goals. • Politics is the art of influencing others to achieve a goal. • Policy is the decision that determines action. Policies result from political action. • Nurses can use political action to influence policies in the organization and to influence public policies.
Tools for Using Power and Politics 1. Learn the formal lines of authority within your organization. 2. Identify key decision makers and build strong and credible relationships with them. 3. Identify decision makers’ priorities and how those affect any new initiatives. 4. Learn the rules for using power and put them into practice. 5. Offer solutions to problems and take advantage of new opportunities. 6. Exhibit a willingness to take on new and challenging tasks that may lead to more responsibility. 7. Pay attention to people who are influential and adopt their strategies if appropriate. 8. Learn strategies for working with public officials.
Questions to Challenge You 1. Consider a person you believe to have power. What are the bases of that person’s power? 2. Evaluate how the person you named uses his or her power. Is it positive or negative? 3. Have you observed people using power inappropriately? Describe what they did and what happened
as a result.