Engaging in health policy—easier said than done, right? But amid this pandemic, the need for nurses to influence public health policy has never been more urgent. The reports of staff caring for coronavirus patients without adequate personal protection equipment (PPE) is, at its very core, frightening beyond measure. We see and hear their cries for help, but are they being heard? I’m left wondering, could government leaders continue to ignore the calls for change if all nurses and healthcare providers, along with their family and friends, advocated together? It can be done—and has been done—simply utilizing something most of us have direct, easy, and free access to: social media. We have a real opportunity, right here and now, for nurses from a grassroots perspective to engage the public and stakeholders in a conversation about health policy needs.
Few people would fail to recognize the incredible social activism created by #MeToo, which uncovered shared stories of sexual harassment. Closer to our healthcare home, however, the viral 2014 #IceBucketChallenge aimed to raise essential funding for the Amyotrophic Lateral Sclerosis (ALS) Foundation. It is likely the most recognizable example of healthcare hashtag activism, where participants dumped a bucket of ice water over their heads in a communal effort to raise awareness about ALS. When researchers were unable to secure the US $1 million they needed for an innovative project from the US government, the hashtag was their "Plan B." Today, it is credited with engaging over 17 million people, who uploaded over 10 billion videos. These videos were then viewed by over 440 million people internationally, with donations exceeding US $220 million. An extraordinary outcome that monumentally dwarfed their original ask of US $1 million. And that success is directly attributable to their well-heard voice via social media. Those researchers credit new gene discoveries, new stem-cell models, and a better understanding of proteins involved in the fatal disease to the viral social media campaign. Could a similar strategy be useful to advocate for PPE and other resources nurses need to stay safe?
With social media, nurses can bypass the bureaucracies of hierarchy and put into the public forum what they stand for, their values, and their message as it pertains to their renewed capacity as a health experts. As we build an audience, armed with authority as an expert and the trust that comes with being nurses, we are well-positioned to be influencers.
It is not without its risks, though. Anecdotal stories are the enemy of evidence-based practice. Privacy and confidentiality risks exist. Conflict may occur when non-verbal communication is misunderstood. Oversharing is possible. All of these give rise to the potential for unprofessional conduct.
But none of these risks are unmanageable for the professional nurse who maintains devout commitment and cognizance to their licensing body's regulations and ANA Code of Ethics as well as principles of evidence-based practice. And I’d argue, this is nowhere near as risky as caring for patients without the proper protective gear.
All that said, here are some guidelines I can offer:
- Make sure the intent of your message is clear and consistent.
- State who you are and where you are from. (Do not give your employer’s name unless you have permission to do so.)
- Include a brief synopsis of your qualifications as a nurse expert.
- Explain what you wish to discuss around an issue, such as PPE.
- Let others know why they should support or not support your issue.
Situational knowledge of the nursing experience should not be underestimated, so offering your targeted audience a patient example is what nurses can uniquely provide. Obviously, being aware of the importance of de-identifying for HIPAA compliance is essential, yet this expert advice can be enormously persuasive.
Ged Kearney, who once led clinical nursing education in a large Australian health service, successfully made the transition from nurse to a politician. Now an Australian Member of Parliament, she reflects, "I look back on my career, and I have always been an advocate; as a nurse, I advocated for patients, in the union for our membership and the health system" (Dragon, 2019). Kearny exemplifies the internal struggle nurses have where the dilemma of the health system has directly impacted how a nurse can deliver care yet have a limited opportunity to participate in the public debate. That lack of participation belies an ethical duty of concern that the nursing voice has in scrutinizing reform, regulatory changes, care coordination, and health information technology that directly impacts our ability to deliver safe and optimal patient outcomes. As Kearney said, "You have to speak up. Sometimes it is challenging, sometimes it is tough. As a nurse, I would walk into a room of physicians and health administrators, and I would think my voice was not that important. Now I look back and know that was not true. As a nurse, you develop an excellent ability to assess a situation, and I do that now. I think nurses are excellent listeners, and they can see the hidden messages" (Dragon, 2019, p. 33).
The nursing voice is undeniably powerful. Let’s use that.
Robert L. Anders, DrPH, MS, ANEF, FAAN, is a retired US Lt. Col. and a Professor Emeritus at the University of Texas at El Paso. He is a member of Sigma’s Delta Kappa Chapter at the University of Texas at El Paso.