Nurses and politics—laurels for the hardy

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Keywords: Politics, Nursing, Nightingale

Just because you do not take an interest in politics doesn’t mean politics won’t take an interest in you! (Pericles 430 B.C.)

Nursing is the largest healthcare profession with the greatest amount of contact with the public. However, it is a truism that we are not the most powerful, the most respected, the best paid, or the most politically active. While Florence Nightingale is often perceived as the founder of modern nursing, she was, according to her sister Parthe, a terrible nurse (Smith, 1950). However, she was politically astute and the support she had from senior politicians such as Sidney Herbert enabled her raise the profile of nursing. It was not unknown for her to have regular afternoon tea with Queen Victoria and drop in on 10 Downing Street to advise the prime minister on issues of relevance to military or health reform. In her latter years Nightingale took to her bed and it was from there that she held court with the leading policy makers of the day. It is remarkable that from her sick room she was able to influence the future of nursing worldwide. She did so, not by practising the art and science of nursing, but by exercising her political influence.

Fast forward to the 21st century where politics is a word and a movement that holds little interest for most nurses. This is not surprising considering its absence from the curricula. Nurses have not been taught to be politically astute or to enhance the profession through politics. In 1989 Clay stated that the idea of nurses being involved in politics was perceived by many to be distasteful. There is no evidence that much has changed in the interim and even today, we do not encourage the widespread teaching of nursing and politics.

Perhaps it has something to do with politics being perceived as an unsavoury pursuit. According to the Roget's thesaurus the following terms are synonymous with politician: bureaucrat, manipulator, machinator and influence peddler. The press present politicians as liars and cheats and in many parts of the world politicians have spent time in prison. In contrast, nurses have been perceived (often to our detriment) as caring angels.The scale, direction and development of nursing is firmly under the influence and guidance of politicians whether this be about pay and conditions, the funding of research and education, or the reform of the profession. Worldwide, nursing makes up the bulk of the healthcare workforce and pay bill. This ensures that it will always be of interest to politicians and policy makers—often for cost cutting reasons.

The prerequisite for effective political participation is to speak with one voice—to have unity. In nursing, sectional interests ensure that this is difficult to achieve. To paraphrase George Bernard Shaw “Put a nurse on a spit and you will always get another nurse to turn it”. The sectional interests are even seen in our professional designations. In a study into primary care in Northern Ireland, I noted eleven different types of nurses that work in the community yet there is one General Practitioner (McKenna et al., 2004). Each type of nurse jealously guards their own professional territory. Woe betides if a practice nurse undertook a duty that was normally the remit of a district nurse or vice versa. The inability of nurses to have unity among themselves and unity in their roles is a key reason for our political ineffectiveness.

Paradoxically, nurses do have power but they use it vicariously. Community nurses get general practitioners to countersign their scripts even when the nurse make the diagnosis, community mental health nurses get social workers or psychiatrists to admit patients and clinical hospital nurses get doctors to prescribe medications they recommend. Here nurses are influencing care but hiding behind other professionals.

Throughout history the nursing profession has never known true togetherness and true partnership among its members. We have never known the power that this would bring to the professions nor what this power would be capable of—but I am sure it would be a force for good. If nurses began to speak with one voice, the power emanating from such a unified workforce would move political mountains. The government and society has never experienced this power and due to turf wars and infighting it probably never will.

Nursing has got what politicians want and need but nurses have not yet convinced politicians of this because nurses have not yet convinced themselves. Being political conjures up images of dark rooms, manoeuvring, use of power to one's own advantage. But being political in nursing should mean an awareness of what influences and constrains care and the ability to know how to change these. To do this nursing must decide on which of the following roles they have to adopt to survive in the 21st century.

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Conflict of interest 

None.

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References 

1. Clay S T . Nurses, Power and Politics. London: Heinemann; 1987;
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2. McKenna HP, Keeney SR, Bradley S M. . The role of community nursing in primary care led commissioning. Primary Health Care Research and Development. 2004;5:77–86
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3. Smith FB. Florence Nightingale: reputation and power. London: Constable; 1950;p. 17
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