The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.
Importance of Stewardship
The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).
The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.
Improving Nursing Through Shared Governance
Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government. Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.
The Leader and Advocacy
Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care; therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007). However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.
Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.
Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.
The National Black Nurses Association (NBNA) has rolled out two major health campaigns for Black nurses under the auspices of their new wellness initiative, NBNA Resilient Nurse Resource™.
The first campaign, RETHINK, launched on December 7, urges Black nurses to trust the science behind vaccines and safeguard their health by getting annual flu/pneumococcal vaccinations. The site provides essential facts on the viruses that kill tens of thousands of Americans every year and seeks to counter vaccine hesitancy.
The RETHINK site also features a short video filled with evocative images of Black nurses vaccinating Black adults and children. (The video will be available to a variety of institutions, hospitals, schools of nursing, managed care organizations, and other places where nurses work). Anchored by strong, positive depictions of African American healthcare providers, the imagery shows Black nurses availing themselves of life-saving public health initiatives to stay healthy as they work toward a future that consigns America’s dark history of medical mistreatment of Black bodies to the past.
In fairness, that dark history casts a long shadow. The subjection of enslaved people to brutal experimental surgeries and treatments was followed by further inhumane practices after emancipation. And, although the notorious 1930-72 Tuskegee experiments might have been the last deliberate, organized program of medical abuse, numerous academic studies and countless patients attest to the present-day neglect, dismissal, ignorance, bias, and indifference displayed by many White HCPs. Renee Mahaffey Harris, president and CEO of the Center for Closing the Health Gap in Cincinnati, recently told CNN that people tend to place more trust in leaders who look like them than White officials from the CDC or FDA. Harris said, “It must be a Black person talking to a Black person. You’re not going to all of a sudden trust a group of people that you have [long] mistrusted just because the science says this.”
The NBNA RETHINK campaign calls upon Black nurses to get vaccinated to protect their health, and by looking after themselves, it is to be hoped that their example inspires other people of color to “rethink” their attitudes toward vaccination. In addition to the video, the site features an interactive “Test Your Flu IQ” quiz on the flu and flu vaccines, and a vaccination locator to find flu/pneumococcal vaccine providers throughout the US. To visit the site, click on www.nbnaRETHINK.com.
Mental wellbeing is the focus of the second Resilient Nurse Resource™ program, RE:SET, rolled out on December 15. RE:SET offers a wide range of free mental health services to support NBNA members as they navigate the stressful environment of the pandemic at work and at home. With support from the Pfizer Foundation, RE:SET provides members and their families with access to free HIPAA compliant therapy sessions (with the option to choose African American therapists), 24/7 telephone support, text-based therapy, behavioral health programs, and work-life services. Other complimentary resources include a special webinar series on mental health issues, and wellness podcasts featuring Joe Clair, MC Lyte, and others, to aid NBNA members in maintaining their mental wellness throughout the pandemic.
RE:SET is also designed to encourage Black nurses to combat the stigma in the Black community surrounding mental health. This, in addition to the lack of providers from diverse racial/ethnic backgrounds and culturally competent providers, contributes to only one-in-three African Americans receiving mental health treatment. RE:SET addresses members of an underserved population at a time when nurses are experiencing unprecedented levels of burnout, anxiety, and uncertainty. Dr. Martha A. Dawson, NBNA President, said, “It is crucial that we protect our nurses’ physical and mental wellbeing during such an unprecedented time in our country. With RE:SET we are able to provide them with the tools necessary to recover from the daily stresses of exhausting working conditions and challenges. It is essentially PPE for their mental and emotional health, which will help to impact their physical health.”
To learn more about the RE:SET free tools and other resources, visit, www.nbnaRESET.com.
To become a member of the National Black Nurses Association and learn more about the services NBNA provides, visit www.nbna.org.
In Part Two of the DailyNurse interview with Texas Nursing Association (TNA) CEO Cindy Zolnierek, PhD, RN, CAE, we discuss the importance of including a nursing perspective when forming healthcare policies and the TNA’s goals for the coming year. (Click here to read Part One, which covers the impact of Covid-19 on the Texas healthcare system.)
DailyNurse: The TNA seems to be very committed to encouraging nurses to get involved in policy and civic action. You have an annual Nurses Day at the Capitol event, and have been instrumental in getting certain laws passed.
Zolnierek: “We’re very engaged in policy. In fact, that is that’s kind of what we believe our niche is, because there are over 100 nursing organizations in Texas. Every specialty nursing group, school nurses, nurse executives, faculty members, ER nurses, ICU nurses, they all have their own groups. The TNA is more generalist, but we are particularly involved in policy around health care, and specifically nursing. Things that affect nursing and nursing work environments, because if nurses have the right work environment, they can accomplish great things, but often they’re not in charge of their environment. So we work to establish laws and regulations that help support a healthy and positive practice environment for nurses.
That said, we’ve been very engaged. [The TNA is part of] a healthcare industry taskforce with about 14 health care organizations such as the Medical Association, the Hospital Association, US Homecare, long-term care, and other groups. We also work with representatives from the governor’s office and the commissioner of Texas Health and Human Services, John Hellerstedt, who is basically our state COVID czar.
DN: What are your current legislative priorities? Are you also working with nurse practitioners to expand their scope of practice? That would seem to be a no-brainer in Texas.
Zolnierek: [Chuckles] “Yes, we we work very closely with them. In fact, we’re part of an APRN alliance made up of CRNAs, nurse midwives, clinical nurse specialists, nurse practitioners, and the TNA. We all coordinate efforts around advancing nursing and removing barriers to advancement. We’re also part of a Texas coalition for health care access that is trying to remove barriers to advanced nursing practice. Again, it should be a no brainer, all the evidence is there, it’s really more of a power and philosophical issue that doesn’t really serve the public interest.
So, this legislative session, we are going to. . . Click here to read the full story on our TexasNurse page.
A growing number of letters, editorials, and petitions are urging the incoming Biden administration to include nurses in their Covid-19 task force. When the new team assembles to battle the pandemic in 2021, the Emergency Nurses Association, the American Association of Nurse Anesthetists, and representatives from Rutgers and NYU’s Rory Meyers School of Nursing, among others have declared that nurses must have a place at the table.
In a widely published opinion piece for CNN, Caroline Dorsen, PhD, FNP-BC, associate professor and associate dean of advanced practice and clinical partnerships at Rutgers School of Nursing and Lauren Ghazal, a PhD candidate at NYU Rory Meyers College of Nursing stated that nurses are “public health experts who will add a unique and important perspective to this critical work.” They added, “Nurses are vital to meeting the task force’s goals, including making rapid testing widely available, building a workforce of contact tracers, prioritizing getting vaccines to at-risk populations (including people of color that have been disproportionately affected by Covid-19), developing clear and detailed prevention and treatment guidelines, providing necessary resources for schools and businesses to reopen safely, protecting workers and the public and, of course, caring for the sick and dying with skill, kindness and dignity.”
Emergency Nurses Association (ENA) president Mike Hastings, MSN, RN, CEN, wrote an open letter to Biden, pressing for the inclusion of nurses on the task force: “As the surge in cases and hospitalizations are expected to continue in the months ahead, the nursing perspective will be critical as your team prepares to address the crisis. Once a vaccine is approved, nurses will play a critical role in its administration to the public. Accordingly, we respectfully request that you consider placing nurses with experience and expertise in pandemics, the frontline treatment of patients and infectious diseases on the COVID-19 task force.”
Using the hashtag #NurseOnTaskForce, a Change.org petition calling for the inclusion of nurses on the task force stated that “input from nurses is crucial to insure that the recommendations regarding COVID apply to all health care workers.” The petition had acquired over 5,000 signatures by November 17.
While there is some debate over including nurses as task force members, the Biden team’s actual plan for handling the pandemic (click here to see a summary of the plan) has been met with enthusiastic approval by National Nurses United. NNU president Zenei Cortez said, “Not only does the plan address the current crisis, it would begin to rebuild the infrastructure needed to be able to respond to infectious disease outbreaks, that are likely to happen more often due to the climate crisis, globalization, and rapid urbanization in the future.”
The importance of nursing leadership and nursing’s response to COVID-19 are two dynamics reflected in the theme for International Nurses Day 2021 (IND2021). The main theme for IND2021, announced by the International Council of Nurses (ICN), is “Nurses: A Voice to Lead.” The sub-theme is “A Vision for Future Healthcare.”
International Nurses Day is celebrated worldwide on May 12, the anniversary of Florence Nightingale’s birth. ICN celebrates the day by choosing a theme and producing resources.
The main theme of “A Voice to Lead” has been used for the past few years, notes Howard Catton, RN, ICN Chief Executive Officer, based in Geneva, Switzerland. “Clearly it speaks to the importance of nursing leadership, and the issues and problems around the world that we know that we’ve had with nursing voices not being heard or included at the high tables for health systems and policy decision-making,” Catton says.
The national nurse associations that make up the ICN felt the theme was strong and “resonated, reflected, and aligned with the work that very many of them are doing in their countries,” he says. The theme also connects with the “State of the World’s Nursing 2020,” a report developed by the World Health Organization in partnership with ICN and the Nursing Now campaign.
“A Vision for Future Healthcare”
The sub-theme of “A Vision for Future Healthcare” relates to nursing leadership coming to the fore in many countries during the pandemic, notes Catton. “I think the world is seeing the value of nursing in a way that perhaps it hasn’t before because of the response to the pandemic.”
Catton stresses that the central role played by nursing in the pandemic needs to be maintained in the design of future health systems, as well as discussions on policy and decision making. “Models of care could be much more nurse-led,” he notes. The “hand of the nurse,” he says, should be “on the architect’s pen, drawing, designing the future.” The nursing response to COVID-19 “means that we legitimately own a seat” at the table for health systems policy and decision making.
Nurses, Catton says, not only save lives during the pandemic, but also save and support families and communities. “They are changing the world in terms of what they’re doing in their daily practice.”
The ICN is a federation of more than 130 national nurses associations worldwide. For IND2021, nurses can share their stories in the form of a 1,000-word case study to be a part of the event. Guidelines and templates on how to submit a case study can be found here.
The American Nurses Association’s (ANA) Board of Director’s decision to rescind the 1985 Presidential Endorsement process and replace it with a Presidential Engagement Policy received mixed reviews from the nursing community. Some nurses were appalled that a leading nursing organization would fail to endorse a more suitable candidate during this presidential election. For some, this was particularly disturbing given President Trump’s handling of the pandemic and his ongoing bashing of key experts and agencies who have ably provided science-based guidance to protect the public’s health for decades. As nurses who are committed to advancing the public’s health, I can understand why some nurses were disappointed with ANA’s decision. After all, there is growing consensus that our nation deserves a better and more trustworthy leadership. Further, there is ample evidence that the nation’s health is at stake.
However, it is not surprising that some organizations would shy away from endorsing political candidates. While the ANA represents hundreds of nurses across the country, they do not speak for ALL nurses. In fact, because of its diverse membership, it is inevitable that political affiliations and political perspectives would be diverse as well. Thus, the ability to make an endorsement that reflects the perspectives of such a diverse membership would be problematic, to say the least. Given that voting is also a personal responsibility, the ball will always be in our courts to evaluate presidential hopefuls as individual voters with or without an organization’s endorsement.
In response to this disappointment, a group of nurse leaders moved quickly to organize a “Nurses for Biden-Harris” campaign urging the profession and public to vote for Vice President Joe Biden and Senator Kamala Harris. These organizers believe that a Biden Harris agenda would be more responsive to addressing one of the nation’s most pressing needs, equitable and accessible health care.
“We urge Americans to vote for Joe Biden and Kamala Harris.” “The health and wellbeing of our nation are at stake,” were some of the sentiments put forth by this group. As nurses, we have a personal and professional responsibility to vote on behalf of the health and well-being of those we love and serve. I believe that regardless of the ANA’s position, nurses must and will vote for what is best for health care, the profession, and society as a whole.