Abstract
In this article, the author presents a review of the 8th edition of Policy & Politics in Nursing and Health Care edited by Mason and colleagues (2021). The book provides comprehensive insights into policy and politics in nursing and healthcare with a foundation of extensive practical information, highlighting the significance of nursing leadership. It prompted the author to reflect on the crucial role of nursing knowledge in shaping nursing policy, and to explore nursing leadership and policies through the distinct lens of the humanbecoming leading-following model.
In the reviewed book, Mason and colleagues (2021), hold the esteemed status of a classic in nursing literature. For more than 3 decades, it has been serving as a fundamental resource for nursing students and nurses to understand and engage with policy and politics in nursing and healthcare, placing a strong emphasis on the role of nurses in promoting the health of individuals as a societal responsibility. This book is edited by Diana J. Mason and three other editors, and features contributions from over 120 nurse scholars and experts from diverse settings. In the preface, the editors articulate the shared values and assumptions of the 8th edition, which are reflected in most chapters:
Health care is a right, not a privilege; health disparities persist in American society and must be reduced; social factors play a larger role in shaping the health of families and communities; and nurses are the most trusted profession by the public and must live up to this honor by leading change in the communities where we live, work, play, and learn. (Mason et al., 2021, p. xx)
The clarified values and assumptions that guide this book offer innovative and novel perspectives on policymaking and politics across a wide range of topics. The authors highlight the potential impact of nurse leaders’ evidence-based policy changes to improve the quality and access to healthcare and promote the health of individuals, families, and communities.
This book is organized into six units. In Unit 1, Mason and colleagues (2021) provide a comprehensive introduction, offering overall frameworks for action, historical perspectives, and in-depth discussions on the ethics, process, and research related to policy and politics in nursing and healthcare. Moving forward, Units 2 to 6 delve into specific and critical issues concerning healthcare delivery, financing, and policies and politics based on four essential spheres of nursing: the government, the workplace and workforce, associations and interest groups, and the community. With a total of 83 chapters that offer a wealth of information, the contents of this book motivate nurses and nursing students to comprehend the significance of nurse leadership, and empower them to engage with policy matters to effect positive changes in the community.
The editors of this book emphasize the leadership role of nurses and call for their effective use of power, which “requires a great degree of knowledge, along with humility, a problem-solving attitude, and a patient-centered lens” (Mason et al., 2021, p. 14) to improve healthcare and the health of communities. Mason and colleagues (2021) also shed light on the historical perspectives of nurse leadership and advocacy, evolving from the visionary contributions of Nightingale who “reflected her commitment to health, healing, and acting in the best interests of patients” (p. 25). Additionally, the editors introduce numerous professional organizations that foreground the significance of nurses’ leadership and advocacy roles. As an example, the book references Nursing’s Social Policy Statement: The Essence of the Profession (American Nurses Association [ANA], 2010), which explicates nursing’s leadership role in guiding the public and political leaders in essential health-related areas. The statement explicitly recognizes that “the relationship between the nurse and patient occurs within the context of the values and beliefs of the patient and nurse” (ANA, 2010, p. 4).
When contemplating nurse leadership, it becomes evident that nurses are expected to actively engage in policy issues to advocate for the health and well-being of individuals and the nursing profession, so policy changes must consider the values and beliefs of both nurses and patients. In this context, it is essential to conceptualize nurse leadership within a nursing theoretical framework. Nurse leadership should be viewed as a process that involves leading and following with evidence and theory-based nursing practice while aligning with a chosen nursing philosophy. By grounding nurse leadership in a theoretical framework, nurses can better follow underlying principles that guide their decisions and actions, and it encourages them to be more deliberate and thoughtful in their approach to policy issues.
Parse’s (2007) proclamation, “the uniqueness of nursing’s disciplinary knowledge is essential to healthcare delivery systems that honor the dignity and freedom of people,” (p. 105) foregrounds the distinctive role of nursing knowledge in healthcare systems to fortify the living quality of individuals. Nurse leaders bear the responsibility of ensuring that health policy changes are to make a difference in the living quality of citizens by honoring dignity and choice (Parse, 2007). This assertion prompts a fundamental question to consider: “What is nurse leadership?” This author believes that the answer to this question is influenced by nursing theoretical perspectives that guide the direction of nursing policy decision-making. Nurse leadership, when viewed through the lens of nursing theoretical frameworks, takes on a more comprehensive understanding of ways to influence policy that is beneficial to people and society. Notably, the humanbecoming paradigm provides a unique and distinctive perspective on nurse leadership, incorporating the humanbecoming leading-following model. The model conceptualizes leadership as leading-following with three essentials of “commitment to a vision, willingness to risk, and reverence for others” (Parse, 2021, p. 164 ), and contains unique assumptions, essences, and processes that arise from the humanbecoming paradigm. Leading-following is defined as “deliberately innovating with potent engaging in persistently pursuing excellence” (Parse, 2021, p. 165). Comprehensively exploring healthcare issues with the overarching goal of promoting the health and well-being of citizens, some chapters in the reviewed book present innovative and transformative perspectives on nurse leadership. However, alongside these progressive views on nurse leadership, the book also includes chapters that adhere to the traditional and conventional view of leadership. To fully understand nurse leadership and gain a comprehensive understanding of this book’s contents, this author embraces the humanbecoming leading-following model that stands in contrast to the traditional and predominant views of leadership. It is expected to enrich perspectives on nurse leadership and policy development.
The humanbecoming leading-following model comprises three essences. The first essence of the humanbecoming leading-following model is that “Deliberately innovating is committing to a vision with vigorous energizing” (Parse, 2021, p. 165). Several chapters in this reviewed book (Mason et al., 2021) exemplify this essence of deliberately innovating with processes of committing to a vision and vigorous energizing by “being passionately present with something of value” (Parse, 2021, p. 166) such as patient engagement (Chapter 20), a new vision of primary care (Chapter 31), and evolving policy for community-based care (Chapter 34) and by “enlivening commingling,” (Parse, 2021, p. 166) to support innovation and growth of the policy. For example, in Chapter 20, the authors commit to a vision of improving patient engagement to better meet the needs of patients and vigorously energize, finding diverse ways to improve patient engagement such as providing care based on the patient’s needs and values, and having the patient in control of health care decision. It is “inspiring the moment” (Parse, 2021, p. 166) with a value and vision, and “forging a path” (Parse, 2021, p. 166) passionately, as “meanings unfold with deliberately innovating” (Parse, 2021, p. 165).
The second essence of the leading-following model is that “Potent engaging is willingly risking in living with ambiguity” (Parse, 2021, p. 165). The reviewed book affirms the nurses’ active engagement in developing nursing policy and politics to innovatively enhance the healthcare system, which is understood as indicating the second essence of potent engaging with processes of willingly risking and living with ambiguity by “daringly venturing forth and moving with the vague” (Parse, 2021, p. 166). As highlighted in Chapter 15 of the reviewed book, nurses, being the largest group of health professionals in the United States, are in an influential position to contribute significantly to the U.S. healthcare system. The vast numbers and extensive expertise of nurses give them power in shaping healthcare policies. However, nurses face numerous challenges and barriers in their effort to engage actively in policy development for many different reasons, such as bureaucratic obstacles, resistance from other stakeholders, or a lack of recognition of their leadership capabilities. Despite these challenges, willingly risking, nurse leaders are expected to persistently advocate for policy changes and actively participate in policy development to make a difference in the lives of individuals, holding up their needs and values. By actively engaging in policy development with certainties-uncertainties, nurse leaders contribute to advancing and enhancing healthcare outcomes as well as nursing’s interest. Living with ambiguity, nurse leaders play a crucial role in policy development by utilizing their nursing knowledge (Chapter 10), media (Chapter 12), communication, and conflict management (Chapter 9), and by actively engaging with nursing associations, organizations, and educational institutions. It is “advancing on the edge,” (Parse, 2021, p. 166) with a commitment to innovation and positive change even with risks to take, while “propelling with the not-yet known” (Parse, 2021, p. 166) in the emerging now, as “changing patterns surface with potent engaging” (Parse, 2021, p. 165).
The third essence of Parse’s leading-following model is that “Persistently pursuing excellence is revering others with vigilantly attending” (Parse, 2021, p. 165). Revering others, Mason and colleagues (2021) advocate for various issues of diverse individuals and addresses the question of “Why do nurses act to influence policy?” (p. 11) recognizing several reasons, including to improve human health, access to care, the safety of care, and the quality of care, to remove disparities in care, and to reduce the cost of care. Indeed, “honoring uniqueness,” (Parse, 2021, p. 166) the various authors advocate the living quality of a diverse public, and discuss many issues regarding health disparities (Chapter 22), indigenous peoples (Chapter23), immigrants/migrants (Chapter 24), LGBTQ+ health (Chapter 26), rural healthcare (Chapter 54), and contemporary issues in communities (Chapter 73). Vigilantly attending in leading-following situations, nurse leaders are “cautiously witnessing” (Parse, 2021, p. 169) uncertainties in new endeavors, suggesting diverse supportive actions to take, and innovate policies to develop, in order to promote the living quality of the individuals. It is “celebrating the novel” (Parse, 2021, p. 166) with respect and cherishment of the contextually construed pattern preferences, “guarding with wisdom” (Parse, 2021, p. 166) with strength and integrity, as “infinite possibilities emerge with persistently pursuing excellence” (Parse, 2021, p. 165).
Assuredly, unique nursing philosophical perspectives offer distinct approaches to nurse leaders with unique lenses through which they can understand and address healthcare issues and policy changes. By integrating nursing philosophical perspectives into nurse leadership, nurse leaders can adopt a nursing theoretical knowledge-based and evidence-based approach to making decisions. Eventually, it will contribute to developing nursing policies designed to improve nursing practice and the living quality of individuals, and to foster patient-centered healthcare systems, where policies address the unique needs and values of individuals. Ortiz (2023) also emphasized the role of nursing theory and frameworks that serve “as a motivating, inspirational force for nurses to be imaginative and view situations in innovative ways” (p. 299) and, in the long run, contribute to “inspiring opportunities with communities and healthcare agencies” (p. 302) to develop policies consistent with nursing’s theories and models.
In conclusion, this reviewed book serves as a comprehensive and valuable resource that provides a strong foundation for understanding nursing policy and politics. It offers practical insights into various healthcare issues and policy challenges with the knowledge and tools to navigate policy and politics in nursing and healthcare. The dedication of the editors and contributors is commendable. Their efforts will empower nurse leaders to shape policies corresponding to the core values of the book and to promote the health of individuals through policy development. With all the extensive information presented, this book will also help both nursing students and nurses to be prepared and take active leadership roles in healthcare settings. Although the book does not explicitly emphasize the importance of nursing theoretical perspectives in developing nursing policy, the readers need to recognize the significance of integrating nursing philosophical perspectives and theoretical frameworks in policy development, ensuring that nursing policies, guided by unique vision, values, and beliefs from nursing theoretical perspectives, will ultimately lead to improving the living quality of individuals in the community and developing nursing policy that leads to patient-centered healthcare systems.
