POLITICS

INTRODUCTION

Broader issues affecting the nursing profession are political in nature.

The nurses need power commensurate with their knowledge and expertise as the care
givers closest to patient and proportionate to their numbers. They need power and
politics to provide competent, humanistic and affordable care to people and also
enormous decision making power within the health care system for improve nursing
profession in health care and health policy. FLORENCE NIGHTINGALE, the
founder of modern nursing was the first nurse politician. Politics is a vital tool
that enable the nurse to “ nurse smarter.” involvement in a political process gives an
individual nurse a tool that augments his or her power-or clout-to improve the care
provided to client.
DEFINITION:

It is a process through which one tries successfully or unsuccessfully to reach a goal.

The process of mobilizing power is the process of politics.

Politics: Merriam Webster‘s Collegiate Dictionary (1994) defines politics as “the

art or science concerned with guiding or influencing guiding policy‟ and „the art or
science of winning and holding control over a government”.
Politics : “ The process of influencing the allocation of scarce resources”[Mason
and Colleagues]
“Politics is the way in which people in any society try to influence decision making
and allocation of resources(money, time and personnel).

Political nursing: Political nursing is defined as the use of knowledge about power
processes and strategies to influence the nature and direction of health care and
professional nursing. Anderson, Anderson & Glanze, 1998

Political Action Spheres: The process of influencing others in order to achieve ends
can be seen in relation to four arenas, spheres or domains. These spheres are-

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The workplace:
Nurses work in organizations with varied characteristics private or public; profit, non-
profit or charitable,large, small or medium; and in large or small cities, towns, small
towns, or rural areas. In the work place there are many issues with which nurses are
involved. Power and politics may be necessary to resolve issues. Some issues that may be
found m some workplace include the following:
1. Mandatory overtime work requirements

2. A nursing clinical ladder program that rewards excellence with promotions and pay
incentives.

3, Work scheduling length of shift, evening and night rotation, vacation priority.

4. A smoking ban in the entire facility; designation of smoking areas.

5. Visiting hours in special care units.

6. identification and security procedures.

7, Authority to delay discharge from or admission to special care units based on

professional nurse assessment.

8. Decisions regarding substation of unlicensed personnel for Registered Nurses to

provide care.

PROFESSIONALORGANIZATIONS;

Professional organizations have been essential to the “professionalization” of

nursing. The modern nursing movement began in 1873 in response to the changing role
of women. Pioneers of this movement worked for a new profession for women and for
better health for the public. These women used political power to open nurse training
schools, organize professional associations, and participate in social issues such as
women’s suffrage. public health, and integration. Professional organizations have made
significant contributions in developing nursing practice. They have set standards of
practice, advocated for change in the scope of practice and passage of nurse practice acts.
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and advocated for nurses in collective action in the Workplace. Such organizations have
an ever-increasing role in the health policy development. A strong
professional or organization can identify issues that concern nursing and health care,
bring them to public, and take a leadership role in advocating for development of policies
that improve health and ensure high-quality nursing care. To achieve this, organizations
need support of nurses through their membership and through their political acumen.

1.Community:

Community is defined as a population, a neighbourhood, a state. a nation, and the

world. Nurses are members of a community with the responsibility to promote the
wellbeing of the community and its members. in exchange. the community provides
important resources for nurses’ work in health promotion and health care-delivery. Many
of the people who live in a community, such as health care administrators, corporate
managers, industrial leaders, elected and career government officials, and patient have
power. These people can, and do, participate in community activities; they have status,
expertise, and connections. By building relationships with community members, nurses
can gain supporters to achieve goals. The connections they make can transform into
networks, and the people in the networks can be asked to support agendas. in exchange,
nurses should support community agendas to work to improve community life. Nurses
can help mobilize communities on issues such as recycling, environmental clean-up,
safety, energy conservation, health screening. This can affect professional life with
increased skills, knowledge, experience, and power development. in addition, nurses who
are active and form connections in their communities become role models and represent
the wholeprofession.

2.Government:

Government affects most aspects of our lives. We must document births. deaths,
marriages; and mandatory childhood immunizations. Government is needed to ensure
that what we need to get done is accomplished.

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Government plays an essential role in nursing and in health care. Government influences
and supports the current managed care arrangement. which provides for reimbursement
for health and nursing care. To a great extent. government determines who has access to
care and to what type of care. Federal. state, and local governments make decisions about
major health issues in our society.

Recent decisions include:

1.The kinds of foods and snacks available to children at schools.

2. Prohibition of smoking in some public places Provision of meals for the poorest
children
3.The health services available at schools and whether schools may provide sexual and
reproductive information.
4.Whether public funds can be used to distribute clean needles to intravenous drug users
to reduce the spread of HIV and AIDS.
5.Whether women can receive full information about reproductive rights and who can
provide that information.
6.Whether violence is treated only as a crime or also as a public health issue and whether
to regulate the use of hand guns.
7.Allocation of funds for housing development and maintenance.

THE FOUR STAGES OF POLITICAL DEVELOPMENT FOR THE PROFESSION OF

NURSING: (a model by Cohen, Mason, Kovner, Leavitt, Pulcini, and Sochalski, 1996)

1.Buying: Recognizing the importance of activism.

2. Seif-interest: Developing and using political expertise to further the profession’s self-
interests.

3.Political sophistication: Moving beyond self-interests, recognizing the need for

activism on behalf of the public.

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4.Leading the way: Providing true leadership on broad healthcare interests.

With the addition of an initial stage identified by Kallsch and Kallsch (1982), this model
can also be applied to the political development and activism of individual nurses related
to both professional and legislative political arenas:

Apathy:
No membership in professional organizations; little or no interest In legislative
politics as they relate to nursing and healthcare.

Buy-in:
Recognition of the importance of activism within professional organizations and
legislative politics related to critical nursing issues.

SeIf-interest.:
Involvement lin professional organizations to further one’s own career; the
development and use of political expertise to further the profession’s self-interest.
Political sophistication:
High level of professional organization activism (e.g., holding office at the local
and state level) moving beyond seIf-interests; recognition of the need for activism on
behalf of the public.
Leading the way:
Serving in elected or appointed positions in professional organizations at the state
and national levels; providing true leadership on broad healthcare interests within
legislative politics, including seeking appointment to policy-making bodies and election
to political positions.

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 FRAMEWORK FOR POLITICAL ACTION:-

Although most people associate the word politics with government,

it pertains to every aspect of life that involves competition for allocating
scarce resources or influencing decision making. As such, it is relevant to
what Nurse do in their daily practice, whether as a Nurse in a home heath
agency, a Nurse practitioner in a clinic, or a Nurse Manager in a hospital.

What nurse do in their every day practice is influenced by, and in Turn
influences. What governments do, what professional organization do. These
are over all political power

1.Politics in work place

Politics in the work place is often regarded with disdain, as

reflected in the Remark, “She plays politics”. This statement is used to imply
that the individual got what he or she wanted because of personal connections
rather than on Marit Ehrat(1983) pointed out that politics is inherent in heath
care delivery because heath care involves multiple special interest groups all
competing for their piece of a limited pool of resources.

2. Politics in Government

Politics in government can influence who gets what kind of

heath care, where, and why. Inspite of many efforts to limit heath care costs,
they continue to rise much faster than inflation in general.

In an attempt to control cost and Medicaid programs are

anticipated. Towers in 1995 suggested Nurse Take Responsibility for
educating and communicating with new legislators. Nurses must use their
authoritative voices and political muscle to shift resources to expend

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community Based services that promote greater access to and availability of
health care.

3. Politics in financing:-

Which individual qualifying to be cared for by a Nurse in an

organization is, to a certain extent, determined by the politics of heath care
financing in the United States.

Finance also influences where patients receive their care. In

metropolitan Regions, one can find at least two tiers of heath care. One for the
poor (Public Hospital) and one for the middle and upper classes (Private
Institution and Private Physician). Although public heath care institution and
agencies can often provide excellent care, they frequently are underfinanced
and have limited resources (Staff, Equipment, Medication).

4. Politics in organization:-

Once a patient gets into a hospital bed, the kind and quality of
nursing care he or she receives also can be influenced by politics.

Politics decides policies of government; they also determine the shape

and focus of nursing organizations. These organizations are an important
forum for nurses to learn, develop, and apply their political skills.

5 Politics in the community:-

The workplace, government and organization all interact with the

community, whether local, regional, national or international. One nurse
found that her leadership in a community effort to eliminate improper garbage
dumping in her town enabled her to develop important connection to
government officials on both the state and local levels.

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POLITICAL ANALYSIS
Effective use of power and politics to facilitate strategy development for the policy
process requires systematic analysis of the issues.

COMPONENTS OF POLITICAL ANALYSIS:

1.Identify and analyze the problem:

Identification and analysis of the problem or issue is the first step. The problem
must be understood in order to frame it in ways that will move elected officials to action.
It must be carefully crafted in terms that make sense. To frame the problem adequately.
state the scope, duration, and history of the problem. An important point is to be explicit
about whom this
problem affects. Then collect a“ data that are available to describe the issue and its
implications. identify any gaps in the data‘ Identify whether more research might be
useful and. if so. what types would help.

2.Outline and anaIyze proposed solution:

Present possible solutions to public officials along with the identified problem. It
is best to develop more than one solution because costs, effectiveness, and durability
differ from approach to approach

3.Understand the background, including its history and attempts to solve the problem:
It is important to understand what attempts have been made to address an issue.
The history, including why and how previous attempts failed, will provide an estimation
of the potential success of the current proposal. Even in a workplace context,
understanding the background of an issue is important. If one beIieves that the staffing on
a unit needs to be changed to improve patient care, efficiency, and nurse satisfaction, one
must assess how the staffing was structured, why it was done in that particular way, and
why and how that format is outdated before one present one’s proposal to the nurse
manager or appropriate committee.

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4.Locate the political situation and its structure:

After the problem and solutions have been delineated. assess and choose the
appropriate political venues. The choice is between the private sector and government. If
the decision made is to approach government, decide on the level and branch. There are
times when both the public and private sectors are involved, but in that case, only one has
the decision making responsibility. When all sectors have equal power. no one sector has
the responsibility to make decision nor the vested interest to prevent a decision. Be sure
to identify the political setting accurately, because making an error can cause you a loss
of credibility and a loss of power. For example, if nurse are concerned about an aspect of
patient care. the employer must be approached through the organization structure. It is
unfair and impolitic to go to public officials before internal mechanisms have been
exhausted. It is also imprudent to exclude the nurse manager and go directly to the chief
nurse executive or a supervisor. Again, so doing will cause loos of face, credibility, and
power.
5.Evalu0ate the stakeholders:

The next step is to identify the stakeholders. Stakeholders are those who are
affected by or have influence over an issue or who could be recruited to care about it.
Stakeholders include policy makers who have proposals related to the issue, special
interest groups, and those with a position on the issue.
6.Conduct a values assessment:

All political issues have or moral aspects, Human rights, international health law,
the right to health, genetic engineering, embryonic stem cell research, genetic
technologies, terrorism, abortion, and the death penalty are among the most visible moral
issues today. Issues necessitate that stakehoIders assess their own values and those of
their opponents.

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 POLTICALSTRATEGIES
There are several political strategies. The individuals and subunit who want
to exhibit political behaviors can select from a long list of strategies. More
prominent are control the agenda, select the criteria for making decisions, control
access to information use of outside experts, control access to influential people,
form a coalition, co-opt the opposition, manipulate symbols by re-defining them
and manipulate people through persuasion or integration.

1. Control the Agenda.

2. Select the Decision Criteria.
3. Control Access to Information.
4. Use Outside Experts.
5. Control Access to Influential People.
6. Form a Coalition.
7. Co-opt the Opposition.
8. Manipulate Symbols.
9. Use Interpersonal Manipulation.

1.Control the Agenda

The decisions made in most committee meetings depend not only on the
opinions of the committee members but also on whether the committee has time to
make the decision.
Decisions can be stalled by removing items from the agenda or they can be
manipulated by placing them in particular places on the agenda.
The items at the beginning of an agenda are typically discussed in greater detail,
allowing greater tolerance for ambiguity and broader consideration of empirical
information than items placed at the end of the agenda. Many items at the end of
the agenda are either superficially decided or completely overlooked.

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2.Select the Decision Criteria
People generally try to make decisions according to some type of objective
criteria.Therefore, individuals who can change the criteria for making the decision
can control the decision as well. Decision making can be easily manipulated by the
selective use of objective criteria. In any decision-making situation, multiple
measures are available for assessing alternatives. Rather than arguing for one’s
preferred alternative, a much more effective political strategy is to suggest that the
decision should be based upon the criteria favoring the preferred alternative.
3.Control Access to Information
Information is a powerful weapon in a fight for power, and those who have
access to information or who have the capacity to filter or manipulate information
can often succeed. in controlling decisions.Sales projections, salary information,
quality reports, and many other items of information are frequently treated as
confidential information in order to increase the political power of those
possessing the information.Labor management negotiations are also filled with
distrust because each side attempts to manipulate the information to increase its
power.Although information is frequently manipulated intentionally as a political
power strategy, this process occurs most frequently in an innocent way.
4.Use Outside Experts
Outside experts can usually be found to support any point of view,
regardless of the issue.Therefore, individuals can influence the outcome of the
decision by carefully selecting the right outside expert and providing a forum for
that individual to express an opinion.The use of outside experts as a political
strategy is particularly obvious in jury trials, where the names and reputations of
the experts are more important than the substance of the testimony.
5.Control Access to Influential People
Many great ideas and quality suggestions are killed or ignored because they
never reach the people who have the capacity to do anything with the new ideas
often rock the boat and threaten people’s jobs.

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Middle managers often succeed in preventing lower-level members from
submitting creative ideas or constructive criticisms from communicating with top
management.Being able to communicate regularly with members of top
management increases one’s ability to use power, whether the interaction comes
from a scheduled meeting, or commuting to work together.
6.Form a Coalition
When groups of individuals discover they lack the power to influence the
decision process, they can increase their power by forming a coalition with other
groups.Coalitions are typically formed to maximize the rewards or outcomes to the
group and its members.Therefore, most coalitions are comprised of the minimum
number of members required to achieve a successful decision. Coalitions tend to
be unstable and temporary unless there are philosophical or ideological
commonalities that keep the parties together.
7.Co-opt the Opposition
The strategy of co-opting is similar to the strategy of forming a coalition.
However, co-optation generally refers to an enduring relationship rather than a
temporary alliance of a coalition. Co-opting occurs, for example, when a sub Unit
asks a local critic to join their group and work with them in solving their problems.
School systems, hospitals, and other civic organizations use a co-opting strategy of
placing influential citizens on their board of directors as a conscious strategy of
reducing their uncertainty and minimizing outside criticism.
8.Manipulate Symbols
Politics, either in organizations or in government, has a language of its own
that is designed to rationalize and justify decisions by using the appropriate
symbolic , labels. Without this legitimization, the exercise of power would be
unacceptable and would create resistance. Political factors need to use appropriate
language and symbols to generate support when their decisions are made on the
basis of power. Decisions that are largely based on power can often be made to
appear as though they resulted from rational decision making.

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 9.Use Interpersonal Manipulation
Perhaps the most blatant political strategy is when people directly pursue
their goals through persuasion, manipulation, or integration.Persuasion is an overt
attempt to influence others by asking for co-operation and by providing
information that supports the request. There is no effort to conceal the intentions
of the persuader and, for the most part, the information is considered accurate.
There is a difference between persuasion and manipulation. Both involve the
presentation of information designed to obtain one’s desired goal. In manipulation,
however, the intent of the person is concealed from the other person and critical
information is either distorted or withheld to influence the decision.

. LEVELS OF POLITICS IN NURSING:

Three levels of political involvement in which nurses can participate
are:-
1. Nurse Citizens: A nurse citizen brings the perspectives of health
care to the voting booth, to public forums that advocate for health and human
services. Nurses tend to vote for candidates who advocate for improved health
care. Here are some examples of how the nurse citizen can be politically
active:
 Register to vote.
 Vote in every election.
 About health care issues.
 Speak out when services on working conditions are inadequate.
 Join politically active nursing organizations.
 Join a political party.
Once nurses make a decision to become involved politically, they need
to learn how to get started. One of the best ways is to form a relationship with
one or more policymakers.

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 2. Nurse Activists: The nurse activist takes a more active role than the
nurse citizen. Nurse activists can make changes by:
 Joining politically active nursing organizations.
 Contacting a public official through letters, Emails or phone
calls.
 Registering people to vote.
 Contributing money to a political campaign.
 Working in a campaign.
 Writing letters to the editor of local newspapers.
 Inviting legislators to visit the workplace.
3. Nurse Politicians: Once the nurse realizes and experiences the
empowerment that can come from political activism, he or she may choose to
run for office. No longer satisfied to help others get elected, the nurse
politician desires to develop the legislation, not just influence it. Nurse
politicians use their knowledge about people, their ability to communicate
effectively and their superb organizational skills in running for office. The
nurse politician can:-
 Run for an elected office.
 Seek appointment to a regulatory agency.
 Be appointed to a governing board in the public or private
sector.
 Use nursing expertise as a front line policymaker who can
enhance health care and the profession.
SUMMARY

As far we discussed about politics definirion,components,political

analysis,political stregies,professional orgnization and levels of politics in
nursing

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 CONCLUSION

Politics is a vital tool that enable the nurse to “ nurse smarter.” involvement in a
political process gives an individual nurse a tool that augments his or her power-or
clout-to improve the care provided to client. It is a process through which one tries
successfully or unsuccessfully to reach a goal.

BIBLIOGRAPHY

1..Jogindra vati.principles and practice of nursing management.first

edition.Jaypee publication.New delhi,2013

2...Alamelu Venketaraman.Newer trends in management of nursing service

and education.Jaypee publication.New Delhi.2017

3..Deepak K A comprehensive text book of nursing amnagement EMMES

publication.Newdelhi.2017

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