Guest Contributor: Ann M. Stalter
Community/Public Health Nurse Educator

Local governments make decisions daily that shape the health and well-being of communities, yet nurses rarely serve on the boards and councils where these decisions occur. The absence of nurses in such political spaces is significant because they comprise the largest sector of the health care workforce and are consistently recognized with public trust. Although nurses are well-positioned to contribute to policy discussions, few hold elected or appointed roles at the local level. Could this be because such professional activity is seen as extracurricular, personal interest, or service?

This blog invites nurse leaders, academicians, and educators to consider local governance as a legitimate setting for community/population health nursing (C/PHN) practice, particularly when viewed through the lens of nursing praxis as described in Nursology. The premises, assumptions, inferences, and conclusions of the Russell and Fawcett Conceptual Model for Nursing and Health Policy (Fawcett & Russell, 2018; 2021; 2025) provide the theoretical foundation for this invitation.

A central premise of the Russell–Fawcett Model is that policy is not something that happens to nursing; rather, it is something that nurses help shape. This premise positions nurses not as passive recipients of policy, but as active contributors to its development, enactment, and evaluation. A second premise embedded in the model is that health policy discourse often benefits state and federal arenas, dismissing the cumulative, upstream effect of local-level decision-making. Together, these premises expand conventional understandings of where nursing belongs and where nursing practice occurs, especially in the context of improving community/population health.

The first premise assumes that nursing knowledge is discipline-specific—distinct from and not reducible to medical, economic, or political viewpoints. Nursing brings unique insight into health, environment, and human response, particularly in relation to lived human experiences and population-level consequences. The second premise assumes that health policy extends beyond legislation to include decisions made in organizational, community, and local governance contexts. Budgeting priorities, zoning decisions, and procedural rules can be better understood as health policy actions because they create the conditions that facilitate or inhibit health.

Underlying these premises is the assumption that health is shaped upstream, consistent with Nursology’s emphasis on social justice and social determinants of health. Health outcomes are influenced by social, environmental, and structural conditions; acute clinical care alone is insufficient to produce community/population health. Policy decisions establish the context in which health becomes possible or remains constrained. Guided by this reasoning, nurses are understood as moral and social agents whose ethical obligations extend beyond individual encounters. Advocacy and justice are not ancillary activities but are inherent to nursing’s social mandate.

Under this conceptual lens, the limited presence of nurses on local policy-making boards and councils represents more than a gap in participation. It reflects a silence of nursing’s unique voice in policy formation. That is, a total absence of nursing knowledge in the political spaces where decisions with health consequences are routinely made. When nurses are not present in these settings, policies shaping housing, transportation, environmental safety, and access to services proceed without the benefit of nursing’s population-focused and justice-oriented ways of knowing.

Logically extending the model’s premises and assumptions leads to several inferences. If nursing knowledge is essential to understanding and promoting health, then nurses should be present where policy decisions are made. If local governance shapes the upstream determinants of health, then exclusion of nurses from these arenas weakens the potential for health-promoting outcomes. Policy-making, therefore, is not a departure from nursing practice but a legitimate site of nursing praxis—where nursing knowledge is enacted to influence health at the community/population levels, aligning with Nursology’s conceptualization of health policy as a domain of nursing inquiry and action.

These inferences carry important implications for nursing leadership, education, and scholarship. Nurse leaders are more than invited, but rather have a social duty, to step into local policy roles as expressions of professional accountability rather than personal interest. Nurse academicians are challenged to recognize service on community boards, councils, and elected offices as legitimate enactments of nursing practice rather than peripheral activities. Nurse educators are urged to prepare graduates who are policy-ready and capable of translating nursing knowledge into governance contexts that shape health long before clinical care is required.

Within the Russell–Fawcett Model, the conclusion is clear: If nursing knowledge is essential to health, and health policy shapes the conditions under which health is realized, then nursing must be centrally involved in health policy. This conclusion legitimizes nurses serving on boards and councils and holding appointed or elected offices as authentic expressions of nursing practice. When nurses frame policy through nursing values and ways of knowing, they enact the discipline’s social mandate in visible and consequential ways. Thus, the model supports a vision of C/PHN that is policy-engaged, theory-informed, and accountable to the health of its people.

In final reflection, this discussion invites inquiry into nursing’s relationship with local governance and health policy. Guided by the Russell–Fawcett Model, I pose the following questions for consideration. If policy shapes the conditions under which health is realized, what does it mean for nursing to remain peripheral in local governance spaces? What might change in nursing’s understanding of community and population health practice if local governance were fully recognized as a site of nursing praxis? How might nursing education shift if service on local boards and councils were understood as legitimate enactments of nursing knowledge rather than extracurricular or service activities? What are the implications for nursing’s social mandate when local health policy decisions are made in the absence of nursing’s disciplinary voice, particularly in relation to social justice? Together, these questions invite ongoing dialogue about how nursing knowledge is enacted and sustained in the policy contexts that shape community and population health, including through frameworks that recognize health policy as a domain of nursing inquiry.

References

Fawcett, J., & Russell, G. (2018). Conceptual model of nursing and health policy. Nursology.net. https://wp.me/Pa13op-6V

Fawcett, J., & Russell, G. (2001). A conceptual model of nursing and health policy. Policy, Politics, and Nursing Practice, 2, 108-116. https://doi.org/10.1177/152715440100200205.
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Russell, G.E., & Fawcett, J. (2005). The conceptual model for nursing and health policy revisited. Policy, Politics, and Nursing Practice, 6, 319-326. https://doi.org/10.1177/1527154405283304

I used an AI tool for editorial support and conceptual refinement, similar to working with a writing consultant. The ideas, framing, and theoretical application are my own.

Also, I included Nursology.net content (emancipatory praxis, social justice categories, and the model of nursing & health policy) because they were conceptually justified and based on established links.

About Ann M. Stalter, PhD., RN., M. Ed.

Dr. Stalter is a seasoned community/public health nurse and educator spanning a 43-year career. She has led the Association of Community Health Nurse Educators (ACHNE) Research Committee for many years and has contributed to the Policy Committee from its inception. She has served on numerous local boards and works to educate her community on local issues. Recently she ran for office, lost but wants to share her lessons! She has a number of videos and photos that address her journey.  Feel free to reach out to her (drannmariestalter@gmail.com).

Here election page is here:https://electannstalter.com/