A grounded theory study of nurse advocacy in health policy
Dollinger, Marilyn Longo
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The purpose of this study is to explore how effectively nurses function as advocates in the federal health policy process, understanding their perspectives, their strategies, and tactics. This study examined how nurses in legislative and administrative positions advance health policy or regulatory issues that are important to health care or the nursing profession. Although nurses have a long history of social and political activism, little is known about their effectiveness in achieving favorable policy outcomes. The researcher interviewed 11 registered nurses who had experience as staff in government offices, committees, or federal agencies to learn what processes, tactics, and strategies nurses in these positions use in their work and how these influence the way that issues and problems pertinent to nursing and health care appear on the policy agenda and move through the political and policy process. The interviews were done in person, audiotaped, and then transcribed. Grounded theory methodology developed by Glaser and Strauss (1967) guided the sampling, data collection, and analysis throughout the study. The core category of GIVING VOICE that emerged from the data consists of six strategies: learning the culture, selective self-disclosure, translating, creating access, invoking others , and careful truth . One of the strategies, selective self-disclosure appears to be unique to nurses based on their lack of status relative to other players in health care policy. The study determined that having nurses working inside the policy and political system was a strategic advantage when policies and regulations were directly related to the profession such as nursing workforce issues. Being "on the inside" offered little strategic advantage in moving issues that were related to health care in general. Significant barriers were identified related to the dominance of the medical model and the lack of recognition of the expertise and focus of nurses on broader health care issues by those in government. It is important for nurses to continue to create and use opportunities for influence within the system to support culture change but also important to continue to build the power of the profession as a special interest group that can wield influence in traditional ways.