The Policy Entrepreneur
The concept of entrepreneurship is not unfamiliar to nursing professionals. Societal changes have been initiated by individuals who have observed a problem and figured out how to disrupt the status quo and equilibrium to improve something. Thomas Jefferson and the leaders established the US, creating a government unlike any other. Henry Ford did not invent the car, but rather the improvement of industry with the assembly line and a five day, 40-hour workweek. Elon Musk created a reusable rocket which was something that NASA bureaucracy simply could not envision.
The notion of an individual shaping the process of policymaking (a policy entrepreneur) was first popularized by Kingdon and Stano. Since then, there has been much written about policy entrepreneurship, but very little about nurse policy entrepreneurship. Although politicians as a profession are trusted nearly as much as car salesmen in a Gallup Poll, they are responsible for much of all healthcare related public policy through legislation. Conversely, nurses have maintained their status as the most trusted profession for decades yet are rarely engaged in the process of healthcare policymaking and reform.
When a student nurse becomes a registered nurse, they simultaneously engage in a social contract to improve the state of wellness and care for the individuals and populations in need. This is not a suggestion but a duty in our Code of Ethics. But what does that mean and why does the nursing profession seem to be missing from the policymaking process and as thought leaders?
Understanding the concept of a policy, the process of policymaking, and the act of policy entrepreneurship is the first step. A policy is “a set of ideas or a plan of what to do in particular situations that has been agreed to officially by a group of people, a business organization, a government, or a political party.”
Nurses first encounter workplace policies by following their facility’s procedures for daily tasks. Local healthcare policies might look like a school district establishing masking and other infection control guidelines during a novel pandemic. State and provincial policies might resemble mandated incident reporting and response of workplace violence cases and creating a plan for prevention. Policy at the national level could be expanding universal health coverage or basic income. Globally, the United Nations’ establishment of the 17 Sustainable Development Goals (SDGs) defines targets and indicators to address social, biological, ecological, political, and all other determinants of health.
Policymakers require less skills or experience at the local level. Virtually anyone can be active when testifying at a school board meeting or becoming a director on the Boys and Girls Club Board of Directors. But as the complexity of policy increases, such as with an elected official testifying to a legislative committee, or becoming a member of a state level advisory group, a higher degree of expertise and skill set becomes more important. It becomes harder for individuals to influence policy at higher levels and organizations are more effective in influencing policy. Nurses are well positioned to incorporate health in all policies. We are first witnesses to all determinants of health and keenly understand that health system strengthening expands beyond our traditional direct care roles.
Policy does not always mean politics, and driving effective change does not always mean running for office. For the nurse and healthcare policy reform, we are all aware of how Florence Nightingale restructured the practice and processes of healthcare. She implemented those innovations and disrupted the omnipotent military industrial complex of the mid-1800s British Empire. She was emotionally driven to act with compassion, used her scientific skill set to develop best practice, and mastered the artistry of gaining social and political capital to achieve her vision. She was driven not by ambition or personal gain, but as Simon Sinek says, “Start with why.” First comes the why, then creativity and focus on developing a plan for achieving that why.
We initiated the Nurse Policy Entrepreneur Café because of a Sigma webinar that discussed the immediate and critical need for nurses to become active in healthcare policymaking. Since then, the café has met every second Saturday at noon Eastern Time with open-ended and thoughtful discussion. The goal of the café is to become the location for education and resources helpful to support the professional development of any nurse interested in becoming a nurse policy entrepreneur (NPE).
How to Get Started
In addition to presentations given by content experts, the café has been identifying some foundational elements and suggested skill sets that would help a NPE to be successful. Here are our suggestions:
- Clarify your why and develop an expertise—Read and write about it. Create your own literary review of scholarly articles, governmental, and NGO grey literature so that you can not only talk about your why but articulate the problems and best practices in a way that is easily understood. Write essays about what you have learned and what you believe so that the words and concepts come together while you are sharing with others.
- Create a personal professional development plan—Write it down and expand upon it throughout your career journey. It might look something like this:
For more information about a professional development plan visit https://miro.com/app/board/uXjVPe1i-DQ=/
- Find organizations that share your why and join them—Get on a board as soon as possible so that you can become familiar with the process and social environment. Or if you don’t want to be on a board, attend community, city council, or legislative committee meetings.
- Learn everything you can about how to be a competent board member—Learn Roberts Rules of Order. Watch how decision-makers act and figure out what to mimic and which behaviors to avoid. Explore different leadership styles, take a personality test, and study team dynamics.
- Develop your social and political network—It’s important to find a few mentors. No one person represents all the attributes that you aspire to, so look for multiple mentors. Being a mentor is also a great way to learn and be a model. Purposefully seek out people with the skills, knowledge, or networks that you need to learn and advance your why.
- Practice speaking whenever you can, knowing it might be rough initially—Join Toastmasters International or take an improvisation (improv) class. Listen carefully to how people speak. Keep practicing and try recording yourself until you stop using filler words (e.g., uh, erm, well, etc.), trite phrases (e.g., at the end of the day, as it were, having said that, etc.), and distracting behavioral ticks or mannerisms. Like leadership, public speaking skills are learned skills like throwing or hitting a baseball.
- Present your why in every venue possible—Teach it and present it at conferences. Prepare and continually use an elevator speech to express it.
Becoming engaged as a thought leader and policy influencer is an element of the nurse’s professional identity, and if we leave it to other disciplines to determine healthcare policy, reform will be marginalized. We must become known more than the most trusted profession, but as the most influential when it comes to policy. Society is waiting for our voices and leadership.
If you have any questions or are interested in learning more about the Nurse Policy Entrepreneur Café, please send an email to: nursepolicycafe@gmail.com or visit the website.
Michael J. Polacek, DNP, RN-RET, PMH-BC, is retired and living in Panama, where he is partnering with Indigenous peoples to raise awareness of trauma science and community building. He is a member of Sigma’s Alpha Beta Alpha Chapter.
Grace Kistner, MMHA, PgDip-c, BSBA, BSN-RN, CCRN, CSSLHPM, is a critical care nurse and a member of Sigma’s Phi Gamma Chapter.