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Politics is the way in which people in any society try to influence decision making
and the allocation of resources. Because resources (money, time, and personnel)
are limited, it is necessary to make choices regarding their use. There is no perfect
process for making optimum choices, because whenever one valuable option is chosen,
some other option must be left out. Politics is a part of every organization and a
part of government at every level. In a democratic society, all individuals can choose to be
involved at some level in this decision-making process. This chapter presents the political
process, discusses some of the current issues in regard to political decisions, and describes
how you can play a role in the political arena and in nursing organizations.
Nurses always have been involved in politics. Florence Nightingale used her contacts with powerful men in government to obtain supplies and the personnel she needed to care for wounded soldiers in the Crimea (Woodham-Smith, 1983). Hannah Ropes was able to fight incompetence and obtain decent care for wounded Civil War soldiers because she understood who the influential people in Washington were and who would be receptive to her efforts on the soldiers’ behalf (Lienhard, 2002.) Isabel Hampton used the buildup and excitement of the World’s Fair and Columbian Exposition to bring together nurse leaders to form the first nursing organization.
Modern times are no different. With many voices competing to be heard in the decisionmaking
circles of any nation, the person who understands power and politics is the one most
likely to obtain the resources needed to accomplish desired ends.
Health care is costly, and public dollars can be and are spent in many ways to provide
health care. What part of the federal budget should be allocated to health care? What part of
the state budget? The local governmental budget? Of the money allocated, what part should be
used for preventive health programs? What part for research? What part for care and treatment?
What part for education? What diseases or conditions should be targeted for investigation?
Who should receive those dollars? Where can more dollars be obtained? These questions are
answered by legislation and by administrative decisions of governmental agencies.
Decisions also must be made in health care agencies. What positions will be funded? What
equipment purchased? What programs should be adopted and which of the current programs
should be dropped? These questions are answered by committees, managers, and governing
boards. Nursing organizations are confronted with similar questions. What is the role of the organization? Should resources be spent on benefits for members? On activities relevant to the nursing profession as a whole? On activities related to general health care? In the political arena? How can nurses affect decision making? What is the individual’s role as a nurse in the organization? These questions may be answered by representative assemblies, committees and commissions, and elected officers.
Knowing where the decision making occurs, who makes the decision, and being familiar
with how you can influence that process is critical. Each governmental entity, agency, and
organization has its own mechanism for operating. However, they have many similarities that
can help you plan your activities.
Your practice as a nurse is controlled by a wide variety of governmental decisions. One
of the most basic is the Nurse Practice Act of your state. In that document, nursing is defined legally, and the scope of nursing practice is outlined. This document affects what you do each day that you practice. All of the philosophic discussions about the role of the nurse must return to the reality of the nurse’s role as legally defined in the state’s practice act. Do you care what that role is now or what changes are made in it? Does it make any difference to you what education that law requires, or if that law requires continuing education? Answering “yes” to any of these questions emphasizes the relevance of the political process for you.
Many decisions are made in the various nurses’ organizations. These organizations speak
for nurses in many settings. Are you happy with the way they are spending funds paid in dues?
Do you agree with all of the public statements they make? Do you support their mechanisms
for decision making? Are you happy with the image of nurses and nursing the public receives
from these organizations? Do you care what these organizations do with their resources? The
political process is an important part of their functioning, too.

Safe staffing is a priority issue for nurses in all practice settings – and for one vital reason: to ensure the delivery of safe, high quality health care. The nation’s public schools represent one such setting that faces serious compromises to student safety and wellbeing due to a shortage of school nurses.

The important role of professional school nurses cannot be overstated, given the prevalence of chronic health conditions and other health-related needs among today’s student population. The National Association of School Nurses (NASN) defines school nursing as “a multifaceted area of practice that promotes student health and safety as well as academic achievement.” In addition to monitoring and treating a variety of health conditions, school nurses typically provide health education, first aid and emergency services, medication administration, immunization tracking, state-mandated health screenings, and many other services.

A growing body of evidence supports positive links between school nurse availability and improved health, school attendance and performance among students. Unfortunately, there are not nearly enough school nurses to care for the growing numbers of children with serious health problems. The current shortage of school nurses is due in large part to the lack of federal legislation mandating safe staffing plans and entry level requirements for school nurses. Although federal laws require that school districts provide services to students with special needs, they do not require that such services be provided by school nurses. Consequently, states show wide variations in school nurse-student ratios and many states resort to the use of unlicensed personnel (e.g., school secretaries, attendants, assistants) to provide health care services.

The American Nurses Association (ANA), along with the U.S. Department of Health and Human Services, the NASN and several state organizations, recommends a minimum school nurse:student ratio of 1:750 for general school populations. Many states stipulate more stringent ratios for students with complex health care needs requiring frequent interventions. The central premise for recommending these ratios is that students have a right to safe, high quality health care while in the school setting. The registered school nurse is the health care professional best suited to providing and coordinating the full range of health care services for student populations.

Adverse effects of school nurse staffing have prompted legal action by the nursing community. In 2007, the ANA and the ANA/California filed a lawsuit in the Superior Court of the State of California, claiming that the State Department of Education had violated the State Nursing Practice Act by calling upon unlicensed school personnel to administer insulin in the absence of a true emergency. Not only are children being placed at risk, but RNs, who are charged with providing training and oversight to unlicensed personnel, risk disciplinary action by the State Board of Nursing as a result of this directive. California has one of the highest school nurse to student ratios (approximately 1:2700). The ANA has called upon the Superintendent of Public Instruction to ensure that medications are administered to students only by persons legally authorized to do so, in accordance with California law.

For those who either function in this role or who have children in K-12 educational programs, you may want to view ANA’s recently adopted position statement on School nursing for children in these educational settings.

A nurse—whether working in a family clinic or large hospital—is responsible for a majority of patient care. Nurses perform some of the most important duties during a patient’s stay at the hospital, from monitoring vital signs to administering necessary medications. Nurses also provide a human face to what can sometimes be a cold, sterile environment. However, in recent years there has been a vast shortage of nurses in the healthcare industry. In fact, this shortage is expected to increase dramatically over the next few years.

Estimates show that approximately 72 percent of hospital supervisors reported a nursing shortage at their facilities in October 2004. A previous report also estimated that in the year 2000, approximately 30 states experienced a nursing shortage. Unfortunately, these numbers are only increasing. One startling statistic estimates that by the year 2020, over 44 states and the District of Columbia will be experiencing a shortage of registered nurses, or RNs.

Some statistics also show that the number of nursing school graduates has decreased quite significantly. Since nurses play such a large and important part in today’s medical care system, it is a worthy endeavor to investigate the causes behind these shortages. Although it can be difficult to pinpoint exactly why there is such a dramatic nursing shortage, examining the trends and statistics can provide clues. Investigating these clues is key to understanding how to combat the nursing shortage. Further, as hospitals and clinics struggle to recruit nurses, some nurses are seeking other avenues of employment or ways to perform their duties.

Hospitals and clinics have begun to investigate other methods for attracting nurses to their environments. Exactly how these facilities are addressing the shortage can provide insight into the larger problem of the nursing shortage, and it can provide clues to the trends of the nursing shortage in the future. If the statistics show the shortage growing worse, what can be done to stop it? Or will the nursing shortage continue to grow until the trends reverse themselves? A thorough examination into the shortage itself can provide some hints.