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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.