Contributor: Jeniffer Dolinta MS, RN, PCCN-K, CNE, NPD-BC
As I logged on to my social media on June 24th, 2022, something I do most evenings, I was taken aback by the amount of chatter. On this day, the United States Supreme Court officially reversed the 1973 decision of Roe v. Wade, declaring an end to the constitutional right to abortion. Having been a nurse for over a decade working in various settings, I have a fair share of nursing colleague friends on these platforms. One comment particularly caught my attention, “can we keep politics and nursing separate? They do not belong together”.
Despite Florence Nightingale laying the foundation for nurses as political activists in the 19th century and advocacy being considered a significant component of nursing practice since 1973, advocacy has not always been a clear expectation in nursing (Selanders & Crane, 2012). Advocacy is the act or process of supporting a cause or proposal (Merriam-Webster, n.d.).
The historical background of nursing has actually influenced nurses to avoid political advocacy (Wilson et al., 2022). To better understand the role of nurses in politics and political action, several historical and social factors have been identified as influencing nurses to remain politically neutral or apolitical: (1) as a predominantly female profession, nursing has long been associated with feminine values and, therefore, highly stereotyped (2) In the traditionally paternalistic medical model of health care, nurses have taken a more passive role in the historically doctor-nurse relationship (3) there has a been an absence of professional identity and unity within nursing as a whole (4) historically political behavior by nurses not been considered appropriate (5) there is a general sense of distrust and dislike for the political process (Bertosou, 2019; Salvage & White, 2019). Dickman and Chicas (2021) raise the question, “is nursing ever politically neutral?”. I think the most recent polarizing decision of Roe V. Wade and its detrimental impact on female reproductive rights is further evidence that the answer to that question needs to be a resounding no. A recent Nursology blog (Barroso de Sousa, 2022) explored the role of professional nurses in the context of politics, raising a similar question “is nursing a political thing?”. In her post, Barroso de Sousa (2022) presented recurring themes in the theories of the discipline of nursing that further support the political nature of nursing.
This raises the next question, how do no nurses lead the charge and become change agents in health care and healthcare policy decisions? I believe the answer goes back to Florence Nightingale and her utilization of advocacy as a functional principle (Selanders & Crane, 2012). The Sessler Branden Advocacy Theory (SBAT) is a midrange, pragmatic nursing theory developed to identify, examine, and define the advocacy process as it relates to the nurse’s role as an advocate (Sessler Branden, 2021). The SBAT defines advocacy as “A dynamic process through which the nurse engages in a set of actions with broadly stated goals ultimately effecting a desired change at any level of patient care, health care systems and/pr health policy” (Sessler Branden, 2021). The Sessler Branden Advocacy Matrix diagram (SBAM) illustrates the dynamic process by which nurses can identify, implement, and evaluate the core phenomenon of advocacy. The SBAT comprises conditions or internal and environmental characteristics, the conditional context for the advocacy event, the nurse’s decision to advocate, and the five component actions of advocacy: to identify, strategize, facilitate, empower, and promote. In addition, there are levels at which the advocacy action occurs, beginning with individual, and then group/collective, organization/institution, community, national, and international/global.
Guided by the SBAT, the nurse’s first step in the advocacy process is to identify or recognize internal and external environmental characteristics that may lead to a desire to advocate and successful advocacy. Early life experiences such as school and family-related life events, values, and education are essential to nurses’ political involvement (Wilson et al., 2022). Nurses need to have an environment where they have the opportunity to advocate and have role models and mentors to encourage their advocacy role. These characteristics or conditions make up the conditional context of advocacy. Without identifying these conditional contexts, the nurse cannot move on to the next level and decide to advocate. As the foundation of the advocacy action, conditions must be present as the nurse moves across the advocacy stages.
Once a decision has been made to advocate, the nurse engages in the action to identify in which they gather information and attempt to develop a deeper understanding of the issue, system, or policy. The next step is to strategize. During the strategizing stage, the nurse fosters relationships and coalitions, develops plans, and organizes and evaluates their goals. The goals of advocacy are to facilitate, empower, and promote issues working for social justice, disseminating information, and ultimately effecting change. The SBAT provides a framework to guide nurses at all levels on their path to health advocacy.
“At its core, advocacy seeks to ensure that the needs, rights, and wishes of vulnerable individuals are heard and safeguarded” (Davies, 2021). In response to the social media comment, “can we keep politics and nursing separate? They do not belong together”. My simple answer is that as the largest and most trusted healthcare profession, nurses are in a unique position to lend their voices to advocate for political action moving issues of social justice and health equity forward. Politics and nursing are intertwined.
Barroso de Sousa, L. (2022, April 12). Is nursing a political thing? A brief theoretical reflection. Nursology. https://nursology.net/2022/04/12/is-nursing-a-political-thing-a-brief-theoretical-reflection/
Bertsou, E. (2019). Rethinking political distrust. European Political Science Review, 11(2), 213-230. https://doi.org/10.1017/S1755773919000080
Davies, N. (2021). Advocating for patients. IndependentNurse. https://www.independentnurse.co.uk/professional-article/advocating-for-patients/239940/
Dickman, N. E., & Chicas, R. (2021). Nursing is never neutral: Political determinants of health and systemic marginalization. Nursing Inquiry, 28(e12408), 1-13. https://doi.org/10.111/nin.12408
Salvage, J., & White, J. (2019). Nursing leadership and health policy: Everybody’s business. International Nursing Review, 66(2), 147-150. https://doi.org/10.1111/inr.12523
Selanders, L. C., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. The Online Journal of Issues in Nursing, 17(1). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Florence-Nightingale-on-Advocacy.html
Sessler Branden, P. (2021). The nurse as advocate: The Sessler Branden Advocacy Theory (SBAT). In Morse, J. M., Bowers, B. J., Charmaz, K., Clarke, A. E., Corbin, J., Porr, C. J., & Stern, P. N. (Eds.), Developing grounded theory: The second generation revisited. (pp. 45-77). Routledge.
Merriam-Webster. (n.d.). Advocacy. In Meriam-Webster.com dictionary. Retrieved July 8, 2022, from https://www.merriam-webster.com/dictionary/advocacy
Wilson, D. M., Underwood, L., Kim, S., Olukotun, M., Errasti-Ibarrondo, B. (2022). How and why nurses became involved in politics or political action, and the outcomes or impacts of this involvement. Nursing Outlook, 70(1), 55-63. https://doi.org/10.1016/j.outlook.2021.07.008
About Jeniffer Dolinta
Jeniffer Dolinta MS, RN, PCCN-K, CNE, NPD-BC, is a nurse education specialist with over 10 years of nursing experience. Jeniffer is currently pursing her Ph.D. in Nursing Science degree at Texas Woman’s University. She earned her BS in Nursing and MS in Nursing Education from Texas Woman’s University in 2012 and 2017 respectively. Jeniffer is actively involved in various organizations at the local and national level such as the Hispanic Nurses Associations as well as the South Coast Equity Coalition where she is a strong advocate for health equity. As a profession we need all nurses to speak up for issues and causes they are passionate about. We can make a difference together.