1. POWER, POLITICS & INFLUENCE

2. Learning Outcomes 1. Discuss the history of power in nursing. 2. Define different types of power as they relate to nursing leadership. 3. Explore professional & legislative politics. 4. Discuss strategies to exercise power in the workplace and in political arenas. 5. Look at Health Care Policies.

3. POWER – ability to influence others in an effort to achieve a goal. Nurses had no power in nursing’s formative years. POLICY – plan for action related to an issue that affects a group(s) well being.

4. Health Care Policy: Is a set course of action(s) undertaken by government or health care organizations to obtain a desired outcome. Such as a specific hospital’s plan to report errors in patient care.

5. Public Health Policy: Refers to local, state, federal, regulations and resource allocation related to health, health care service delivery, coverage, workplace and reimbursement. Example: Mandatory requirement for licensure to practice professional nursing. Sheppard-Tower Act – funding for maternity and child care and health centers staffed by public health. nurses.(1921) DRGs Medicare

6. Health Policies Increase cost of care: US most expensive in the world. Institute of Medicine – health care needs changing *provide care that is evidenced-based *provide care that is patient-centered * new roles and responsibilities for patients and families 2009 -54% of the people limited their health care due to costs 21% did not fill prescriptions 15% cut the pills in half

7. Health Care Policies Disparity in Health care – IOM report on unequal treatment, 2002 bias, prejudice and stereotyping Seen in cancer, cardiovascular disease, HIV/AIDS, diabetes and mental illness. 2010 – legislation to monitor disparities What is Needed? Education of all health care providers!

8. Institute of Medicine 2010-Future of Nursing: Leading Change, Advancing Health Recommendations: 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education through improved education system that promotes seamless academic progression. 3. Nurses should be full partners with physicians and other health professionals. 4. Effective workplace planning and policymaking require better data collection and information infrastructure.

9. IOM 50-80% of U.S. nurses will hold a bachelor’s degree. Nurses need to stay alert for new and proposed legislation that affects nursing care. APRNs filling a range of new roles in primary care, prevention and care coordination.

10. Nursing, Women & History Nursing was female dominated. Profession developed when women had limited rights. Could not vote or own property. Wealthy cared for at home by “private nurses”. The poor were cared for in hospitals with poor conditions.

11. Modern Nursing U.S. women have equal rights (legally). 3 million registered nurses in U.S.(2.6 employed) Largest segment of healthcare professionals. Potentially have a STRONG voice. Nursing schools fail to expose students to political action and public policy. Silence to Voice, Buresh & Gordon, 2006

12. Organizations That Have Power Nursing: 20 th century National League for Nursing (NLN) American Nurses Association (ANA) American Association of Colleges of Nursing (AACN) Quality & Safety Education for Nurses (QSEN)

13. Organizations That have Power Department of Health and Human Services(DHHS) Center for Medicare and Medicaid (CMS) Centers for Disease Control and Prevention (CDC) Food and Drug Administration (FDA) Occupational Safety and Health Administration (OSHA) Veteran's Administration (VA)

14. Power American Medical Association (AMA) Exerts most influence over healthcare in general. Proposed “registered care technologist”. Replace nursing during “shortages”. Less education requirements. Proposed “med techs” to administer drugs.(this has passed). Lobbies against APN independent practice.

15. Politics A process of human interaction within organizations. (Yoder- Wise, 2011) Professional politics Within a healthcare or professional organization. Legislative politics Law and public policies Local, state, federal levels

16. Making Process Public Policy – reflect the needs of the public Policy-Making process – identify the problem (access) specify criteria (gather data, diagnose) generate options (plan) implement monitor and evaluate (p. 40) Looks like the Nursing Process

17. Types of Public Policy Social Regulatory – abortion, gun control Comprehensive Policies – Medicare, Medicaid, HC reform Incremental – changes in reimbursement, prospective payment system and DRGs in the 1980s Procedural – Oregon’s rationing of Medicaid Distributive – educational funding APN Regulatory – standards of practice, self-regulatory Redistributive – take from one and give to another, cut Medicaid to give Medicare

18. Show Power Through Activism 1. Apathy – no action 2. Buy-in – recognize the importance of activism. 3. Self-Interest – involvement in an organizations, without active participation to further one’s own career. 4. Political sophistication- holding office at the local, state or national level. 5. Leading the way – serving in elected or appointed positions, such as policy-making organizations.

19. Active Political Role Member of professional organizations. Subscribing & reading professional journals. Attend workshops, conferences, courses. Lobbying legislators Face-to-face, telephone, letter, email, testifying, participate in a campaign.

20. Nurse Legislators & Politicians Current Lois Capps, CA Congresswoman Carolyn McCarthy, NY Congresswoman Eddie Bernice Johnson, TX Congresswoman Bernice Martin Mathews, NV State Senator Mary Wakefield, Administrator Health Resources and Service Administration (HRSA) Women have 17% of the seats in congress http://www.nursingworld.org/MainMenuCategories/ANAPo liticalPower/State/Nurse- Legislators/nurselegislators.aspx#nv http://www.nursingworld.org/MainMenuCategories/ANAPo liticalPower/State/Nurse- Legislators/nurselegislators.aspx#nv

21. Discussion Questions Power The ability to influence others in an effort to achieve goals. 1. Is power a good thing or a bad thing? 2. Give an example of how nurses use power in their work everyday.

22. Influence Process of using power. Coercion Punishment, scapegoating. Collaboration Accomplish complex team goal.

23. Types of Power Personal – reputation or credibility. Expert – skills and knowledge needed by others. Position – one’s position (CON, DON). Perceived – reputation as being powerful. Information – selected information needed by others. Connection – gained by association with people with power.

24. Empowerment The process of exercising one’s own power. The process of sharing power with colleagues & patients Leaders’ roles: Facilitator Coach Teacher Collaborator

25. Taking the First Steps to Serving on a Board. - Susan Hassmiller Hand Out

26. Learning Activity 1. Describe a time when you empowered a colleague or patient. 2. Did this experience change your own sense of personal power?

27. Powerful Image Basic strategy in developing power: Self-image- thinking yourself powerful. Appearance – neat, clean, appropriate Behavior- treating others with respect. Body language - posture, eye contact, confident. Communication- good communication skills.

28. Communication Skills Verbal Listening Nonverbal 90% of communication! More powerful than verbal message Handshake, Smile Posture

29. Networking Identifying, valuing and maintaining relationships within a system of individuals who are sources of information, advice & support.

30. Discussion Question What are some ways to create, expand & maintain a professional network?

31. Mentoring Mentors- competent, experienced professionals who develop relationship with a less experienced professional. Empowering for both parties Advice Support Information Feedback

32. Question What qualities do you think make a good mentor?

33. Other Power Strategies Goal Setting Patients, families or personal Self-goals Short term – go to the gym on day off. Long term – obtaining a ANP degree within 5 years of getting an BSN Developing Expertise Clinical Knowledge Leadership, communication skills High Visibility with in an Organization Volunteering for committees, projects Attending open meetings

36. Powerful? “Ask the doctor when he comes.” “What can I do to help you?” “Let me explain why this is important to your recovery.” “You’d better speak to the charge nurse about that.” “I am concerned about your safety.” “Let’s discuss your plan of care.” “I’m just a nurse.”

37. Nursing Power Profession- Lifelong learning career Education Life-long learning Advanced degrees (DNP) Certifications (CCRN) CEs Conferences, workshops, seminars

38. Nursing Power Professional Organization Membership & Participation ANA, NLN Specialty organizations, Critical Care, Home Health Political Activism Professional Legislative Lobbying Running for office

39. Nursing Power Understand Organization Hierarchy Formal & Informal leaders Philosophy, Mission & Vision Statements Use Collaboration & Collegiality Sense of unity among nurses. Teamwork among other professional & nonprofessional co-workers.

40. Nursing Power Empowering Attitude Professional, positive Introduction- first & last name, credentials “My name is Mrs. Jacobson, and I will be your Registered Nurse to day”. Developing Coalitions Teams that form temporarily to accomplish a common goal- focuses on an effort to effect “change”.

41. Nursing Power Negotiating Bargaining- individual, collective. Important skill in power management. Political Action to influence Policy Professional responsibility. Participate in public comment on new legislation.

42. Developing Political Skills Know your congress-person, senator, governor. Join and be active in professional organization –NNA. Invite a legislator to spend the day with you. Know what nursing legislature is active in congress. Work on a campaign. Visit Washington D.C. Run for office. Enhance the image of nursing in all that your do.

43. Learning Activity Take the Political Astuteness Inventory Yoder-Wise, page 184