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Chapter 1 Nursing and the Political Arena INTRODUCTION What is the future of nursing as a profession? What will its role be in the health care delivery system and on the social and political stages? These questions for many a year have provided a basis for discussion. In this debate, overwhelming calls of pessimism issued by members of the profession have been heard loud and clear. In the words of one practitioner: Is this the beginning of the end of nursing? Impossible some will say. Impossible because of the numbers of nurses and the invaluable service they render to society. Think again. Peter Drucker points out that at the turn of the century the largest populations of workers were farmers and live-in servants. Ninety years later, these groups barely exist. Although farmers and domestic servants were everywhere , as a class, they were invisible. Drucker attributes their invisibility to the fact they were not organized as a group. As a class, nurses may be more visible inasmuch as they are organized. However, they remain vulnerable. Their work remains invisible to far too many. The invisibility of nurses may lead to our profession’s demise. (Gottlieb , 1996, p. 4) 1 These strong words present a desperate situation. Yet we all know that this knowledge-based group, being essential to the operation of the health care delivery system, will survive. The important question is: In what form will it survive? The response, in part, will be decided, like other professional issues, by the interplay of political forces and the resulting public policies. Nurse leaders are in general agreement that nursing’s continuous evolution as a truly autonomous profession is inextricably bound to its ability to influence policy development and to evidence a positive public image of nursing as an essential societal service. The concept of power and its distribution and use are concerns of many groups, including professions. It is generally acknowledged that the most important part of the professionalization process, “. . . an attempt to translate one order of scarce resources—special knowledge and skills—into another—social and economic rewards” (Larson , 1977, p. xvii), is gaining and maintaining power and control. Power is defined as the ability to influence or persuade decision makers to act in a way congruent with desired outcomes. Professional power has dual aspects. It may be sought and exerted at a local or parochial level, that is, internally, or in a national or cosmopolitan setting, that is, externally. The nursing profession has not always enjoyed access to the external, broader, societal dimension of power and, consequently, it was forced to focus most of its efforts in a narrower fashion, internally on the profession. Internal power had to compensate for external power. In comparison to other professionals, especially physicians, little has been written on the topic of power, politics and policy related to nursing. Although the profession has engaged in the power game at the cosmopolitan level, it has been demonstrated again and again that nurses have not been adept at politics. Their political efforts, with rare exception, have been casual, nebulous, and lacking in continuity. There has been a failure to recognize their potential impact on the political arena and the significance of the nursing profession as an interest group. Cathryne A. Welch (1985), a prominent commentator on the profession, has appropriately written: As a profession, nursing has not been a major determinant of health policy in this country. 2 Nurse Educators and Politics Predominantly, nursing has been in a reactionary or responsive state versus the creative role with respect to designing health policy. Frankly . . . nursing has stood on the periphery of both power and politics for so long as a result of its inability to use its own force in the formulation of health policy. (p. 107) This judgment is not atypical. Being the largest of the health care professions and consisting, according to the Bureau of Health Professions, of 2.6 million registered nurses and, thus, representing a significant majority of American health care providers, and accounting for the largest noncapital portion of health care institutional budgets, nursing should have been more influential than it has been in the making of health care policy. In spite of their numbers, nurses have experienced difficulty in channeling their strength to achieve status, recognition and power. Historically , they have had limited power in the health care delivery system as well as in the political arena. They have been isolated from political , social and economic power. Never having been able...


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