Network for Consultant Network for Consultant Nurses and Health CareNurses and Health Care

PractitionersPractitioners

Influencing the policy and Influencing the policy and political agenda as a political agenda as a

consultant nurseconsultant nurse

Abigail Masterson MN, BSc, RN, PGCEA

Abi Masterson Consulting Ltd… helping you make it happen

AimsAims Evidence baseEvidence base

– Writings on policy, politics and Writings on policy, politics and leadershipleadership

– Wessex Consultant Nurse EvaluationWessex Consultant Nurse Evaluation– Evaluation of RCN Political Leadership Evaluation of RCN Political Leadership

ProgrammeProgramme

FormatFormat

""Nurses are virtually never involved Nurses are virtually never involved in concrete policy decision-making in concrete policy decision-making

processes; what may pass as a processes; what may pass as a nursing decision is in reality nursing decision is in reality acquiescence to other's prior acquiescence to other's prior

formulationsformulations""

(Robinson 1991)(Robinson 1991)

Consultant nurses/therapists: a Consultant nurses/therapists: a ‘professionally-led’ policy outcome?‘professionally-led’ policy outcome?

Making a difference (DoH, 1999)Making a difference (DoH, 1999) NHSE (1999) Nurse, midwife and health visitor consultants. NHSE (1999) Nurse, midwife and health visitor consultants.

Establishing posts and making appointments. HSC 1999/217 Leeds, Establishing posts and making appointments. HSC 1999/217 Leeds, NHSENHSE

NHSE (1999) Agenda for change: modernising the NHS pay system. NHSE (1999) Agenda for change: modernising the NHS pay system. London, DoHLondon, DoH

UKCC (1999) A higher level of practice: Report of the consultation UKCC (1999) A higher level of practice: Report of the consultation on the UKCC’s proposals for a revised regulatory framework for on the UKCC’s proposals for a revised regulatory framework for post-registration clinical practice. London, UKCCpost-registration clinical practice. London, UKCC

NHS Plan (DoH, 2000)NHS Plan (DoH, 2000) NHSE (2000) nurse midwife and health visitor consultants – second NHSE (2000) nurse midwife and health visitor consultants – second

tranche CNO/PL 2000/4tranche CNO/PL 2000/4 A health service of all the talents: developing the NHS workforce A health service of all the talents: developing the NHS workforce

(DoH, 2000)(DoH, 2000) Meeting the challenge: A strategy for the allied health professions Meeting the challenge: A strategy for the allied health professions

(DoH, 2000)(DoH, 2000)

•less involved than doctors.

•the profession generally has seen being political as inappropriate

“Many nurses are uncomfortable with the word “politics”. It belongs to a world that they do not feel, nor want to be part of, Politics is for others. Politics is a deviant activity in which

no self-respecting professional should indulge”.

(Dunn, 1985)

Nursing and politics: an historical Nursing and politics: an historical perspective (1)perspective (1)

“Nursing has several ancestries that represent competing values and ideals. For example, the gentle, angelic, selfless woman epitomised in many portrayals of Florence Nightingale and the militant trade unionism which emerged from the asylums and poor law institutions”

(Owens and Glennester, 1990)

Nursing and politics: an historical Nursing and politics: an historical perspective (2)perspective (2)

World Health Assembly resolutions have urged member states to:

“…encourage and support the appointment of

nursing/midwifery personnel in senior leadership

and management positions to facilitate their

participation in planning and implementing

their country’s health activities.”

An international perspectiveAn international perspective

 

“[Consultant nurses will]… exercise leadership to support and inspire colleagues, to improve standards and quality and to develop professional practice. Wider general or corporate management responsibilities would detract from this. Setting standards and developing and promoting best practice will be a key part of the consultant practitioner role and will demand

leadership and change management skills of the highest order. Consultant practitioners are likely to have a crucial

role in clinical governance, providing expert input and working to secure quality improvement, including influencing

other disciplines, the wider organisation and across organisational boundaries, to help deliver better services”

(NHSE, 1999 p.7)

Legitimate focus of consultant Legitimate focus of consultant nurse activity or …?nurse activity or …?

““[studying politics and policy-making] … we [studying politics and policy-making] … we believe can enable nurses to gain a greater believe can enable nurses to gain a greater understanding of the processes by which understanding of the processes by which

decisions are made and implemented at the decisions are made and implemented at the macro policy level and the consequences of macro policy level and the consequences of

that decision-making on individual that decision-making on individual practitioners. Through such study nurses practitioners. Through such study nurses

individually and collectively may become more individually and collectively may become more able to influence the decision-making process able to influence the decision-making process

itself and not merely react to an agenda that is itself and not merely react to an agenda that is controlled and set by others”controlled and set by others”

(Masterson and Cameron, 2000)(Masterson and Cameron, 2000)

Insights from the literature (1) Literature mainly from the US

Political leadership programmes most commonly developed to support elected representatives perform their functions more effectively or to help prepare those who wish to seek such office.

Insights from the literature (2)

Content of programmes practical politics

policymaking processes

policy analysis

personal leadership development

running a successful campaign (for election).

Teaching methods high theoretical content v spending time with people who are already actively

engaged in politics.

Importance of individual motivation

access to resources including time

effective links to a professional association which can

organise requests for information and offer cues for action

Insights from the literature (3)Insights from the literature (3)

– Evaluation studies mainly evaluate Evaluation studies mainly evaluate ‘real’ political leaders and their impact ‘real’ political leaders and their impact eg presidents, MPs etc. eg presidents, MPs etc.

– Evaluation studies tied to particular Evaluation studies tied to particular leadership programmes tend to involve leadership programmes tend to involve the use of techniques such as 360 the use of techniques such as 360 degree evaluation, or changing results degree evaluation, or changing results on a variety of ‘leadership’ tools.on a variety of ‘leadership’ tools.

  

Insights from the literature (4)Insights from the literature (4)

““There is precious little outcome There is precious little outcome focused work and what there is tends focused work and what there is tends to use a comparison between those to use a comparison between those who have undergone the experience who have undergone the experience

and those who haven’t, project and those who haven’t, project specific outcomes measures or preset specific outcomes measures or preset

measures of performance such as measures of performance such as occupational standards.”occupational standards.”

(Masterson, 2002) (Masterson, 2002)

 

 

“The RCN’s Political Leadership Programme was therefore established with the specific aim of enabling nurses to build the capacity and capability to develop policy and influence

politically, supporting nurses to communicate their collective message on policy issues to policymakers and politicians”

(Antrobus, 2002)

Making the most of the resources Making the most of the resources of the RCNof the RCN

Lessons from theories of Lessons from theories of strategic planningstrategic planning

Broadly strategy is about deciding where you Broadly strategy is about deciding where you want your organisation to go and the working want your organisation to go and the working out how to get there and the resources out how to get there and the resources required.required.

Be careful of Be careful of – overemphasising the degree to which it is possible to overemphasising the degree to which it is possible to

predict the future;predict the future;– manufacturing legitimacymanufacturing legitimacy– developing a flawed ‘security blanket’.developing a flawed ‘security blanket’.

Competing on the Competing on the edge/muddling throughedge/muddling through

“When you are lost on a highway, a road map is very useful, but when you are lost

in a swamp whose topography is constantly changing, a road map is of little

help.

A simple compass – which indicates the general direction to be taken and allows you to use your ingenuity to overcome

various difficulties – is much more valuable”

(Hayes, 1985)

Developing a strategy for Developing a strategy for influencing the policy and influencing the policy and

political agendaspolitical agendas

Agreeing short and long term Agreeing short and long term prioritiespriorities– What are these?What are these?– How do these reflect/contrast with expectations of key How do these reflect/contrast with expectations of key

stakeholders?stakeholders?– What changes are required?What changes are required?– What are the milestones for achievement?What are the milestones for achievement?– How will performance be monitored and measured?How will performance be monitored and measured?

LocalLocal

NationalNational

InternationalInternational

Reviewing the policy Reviewing the policy contextcontext

Policy TrendsPolicy Trends Shift from secondary to primary careShift from secondary to primary care Closer working between health and social careCloser working between health and social care LocalLocal need within broad national frameworks need within broad national frameworks Clinical effectiveness, EBP, quality, governanceClinical effectiveness, EBP, quality, governance LeadershipLeadership Breaking down demarcations, new roles/configurations of staffBreaking down demarcations, new roles/configurations of staff Inter-professional/common learningInter-professional/common learning Education to Education to supportsupport new career pathways new career pathways CPD, LLL and re-validation/re-registrationCPD, LLL and re-validation/re-registration Competence and practice based learningCompetence and practice based learning Patient/user involvement Patient/user involvement Whole systems approachesWhole systems approaches Flexibility, responsiveness, accountability, performance Flexibility, responsiveness, accountability, performance

managementmanagement Cost Cost

Conclusions (1)Conclusions (1)

– most nurses have paid little attention to most nurses have paid little attention to policy and politicspolicy and politics

HoweverHowever

– this aspect of decision-making affects this aspect of decision-making affects nurses' daily work:nurses' daily work:

controls what practitioners can and cannot controls what practitioners can and cannot do do

dictates who receives nursing care and dictates who receives nursing care and where that nursing care takes placewhere that nursing care takes place

Conclusions (2)Conclusions (2)

– The development of a cadre of nurses The development of a cadre of nurses who can competently and effectively who can competently and effectively analyse and influence the formulation analyse and influence the formulation of health policies to support nursing of health policies to support nursing objectives is crucial.objectives is crucial.

– Nursing is a valuable resource which Nursing is a valuable resource which must be actively utilised in health care must be actively utilised in health care policy and planning.  policy and planning.  

Conclusions (3)Conclusions (3)

– if consultant nurses want to have an impact if consultant nurses want to have an impact on access, quality, allocation and the on access, quality, allocation and the delivery of health care they must make that delivery of health care they must make that impact through the policy-making process. impact through the policy-making process.

– an understanding of the key actors involved an understanding of the key actors involved and of the policy process itself is vital to and of the policy process itself is vital to enable consultant nurses individually and enable consultant nurses individually and collectively to influence those decision-collectively to influence those decision-making processes. making processes.