Modern nursing is a challenging profession that puts significant demands in front of nurses. In particular, nurses are expected to set positive examples and exhibit the leadership necessary to promote change in today’s dynamic conditions (Scully, 2015). Registered nurses serve on the frontline of healthcare and face its problems on a daily basis. Consequently, one can conclude that nurses are in a prime position to demonstrate initiative and share their experience with higher ranks of the national healthcare system in order to refine its features. This assessment examines various factors that affect Australian nurses’ ability to influence the path of national health policy development. While the sources reviewed in the assessment are mostly related to the specific areas of care, their analysis provides insight into potential factors that may facilitate nurses’ participation in policy development or thwart it.
Facilitators of Nurses’ Participation in Health Policy Development
For the purposes of this section, the facilitator is defined as a factor that assists in attaining a particular goal. This assessment utilizes an approach applied by Barber et al. (2015), who used discovered facilitators to early mobilization in intensive care to widen the scope of discussion. Likewise, the common facilitators encountered by Australian nurses in various healthcare settings are examined from the standpoint of how they may help nurses participate in national health policy development. Overall, the source review made it possible to list six potential facilitators of nurses’ participation: leadership, organizational support, professional education, skills, and knowledge, frontline role, legislation, and available resources. Nurses possessing these facilitators are more likely to produce a meaningful impact on the national level of policy development and change Australian healthcare for the better.
Several articles highlighted nurses’ leadership skills as a facilitator of successful policy implementation in various areas of care. For instance, Barber et al. (2015) interviewed 25 healthcare professionals from the intensive care unit (ICU) at the Alfred Hospital, Melbourne, and found that strong leadership was among the common facilitators of patient mobilization. In particular, the respondents frequently mentioned the importance of champions who defend beneficial practices and advocate for their wider promotion (Barber et al., 2015). In this regard, one can conclude that nurses with well-developed leadership skills may contribute beyond their position and spread their ideas to the national level.
Transformational leadership (TL) was found particularly beneficial in regard to national health policy development. Cheng (2016) surveyed 201 Australian registered nurses and found that transformational leadership improves team climate and reduces nurses’ burnout. In addition, TL strengthened the nurses’ social identity, turning them into highly motivated professional force (Cheng, 2016). As such, transformational nurse leaders may not only participate in health policy development themselves but also encourage their team members to join the process.
In fact, Australian nurses have already demonstrated the positive impact of leadership on national health policy development. According to Delaney (2018), nurses have displayed transformational leadership to promote patient-centered care. Such practices as respect for patients’ choices and a collaborative approach to the care process serve as evidence of nurses’ active participation in policy development. In this example, leadership facilitated the paradigm shift toward a more humanistic perception of care that goes beyond nurses’ medical competence.
Finally, a recently defined connective leadership style may serve as an even more powerful facilitator of nurses’ participation in national-level health policy development. Connective leadership influences individuals to work toward the goals of the community (Scully, 2015). In the context of nursing, this definition means that nurses would become inclined to help larger-scaled communities in Australia. Consequently, the adoption of a connective leadership style in Australian healthcare organizations would likely facilitate nurses’ participation in health policy development at the national level.
Support from healthcare organizations was found to be the second important facilitator of nurses’ activities. For instance, such support is vital for the success of nurse-led research. According to Curtis et al. (2017), nurse-led research is recognized as one of the critical pathways to hospital error reduction in Australia. Nurses frequently obtain valuable evidence through first-hand experience from patient cases. In this regard, organizational support allows nurses to conduct research and disseminate valuable scientific and practical knowledge. In turn, this knowledge may serve as a foundation for new health policies at the national level.
In addition, organizational support may encourage health practitioners to dedicate more effort to developing and improving nationwide health initiatives. Esbati et al. (2019) interviewed twelve maternity care practitioners from several Australian healthcare organizations to gauge their perceptions of the Baby Friendly Health Initiative (BFHI) implementation. The survey participants expressed the need for more significant organizational support in terms of resources for staff and breastfeeding mothers (Esbati et al., 2019). In this example, one can see that healthcare organizations may boost nurses’ participation in national health policies development and implementation by demonstrating the seriousness of their intentions through organizational support.
Lastly, organizational support may facilitate the nurses’ participation in health policy development via enhanced collaboration with other healthcare professionals. In particular, healthcare organizations can improve multidisciplinary collaboration by enhancing communication, building shared views, and providing long-term funding to such medical teams (Supper, 2015). As a result, nurses may acquire new knowledge, which may prepare them for advocacy and policy building on a national scale. In this scenario, organizational support equips nurses with new perspectives and competencies, thus increasing their strength as potential policy champions.
Professional Education, Skills, and Knowledge
Sufficient professional education, skills, and knowledge is the third major facilitator of Australian nurses’ participation in national health policy development. Results of several studies imply that nurses may become more active and confident in talks about national-level policies if they receive additional training and upgrade their skill sets. For example, Hossain et al. (2017) reviewed 29 articles on the implementation of community pharmacy service in Australia and found that nurses perceived knowledge and skills as one the key policy facilitators. This finding seems logical since sufficient professional preparedness improves one’s confidence, making delivering a meaningful contribution to the new initiative easier. Therefore, one can expect that nurses with better education and training would be more active in discussions related to national health policies.
The Australian nurses’ perception of skills and education as an important facilitator of participation in health policies’ development is evident from the survey on the transition to advanced nursing roles in general practice. McKenna et al. (2015) interviewed 23 healthcare practitioners and found that general practice nurses were particularly concerned with the necessity to undergo additional education. Additionally, the nurses believed that education should include elements dedicated to raising awareness about the nurses’ capabilities and true potential (McKenna et al., 2015). Given these findings, one can claim that additional education and subsequent acquisition of new professional knowledge and skills act as valuable facilitators of nurses’ participation in national health policy development. A well-educated and trained nurse would identify potentially valuable elements of the care process and present their opinion to the healthcare organization’s leadership without hesitation.
The frontline role of Australian registered nurses within the healthcare system hierarchy serves as the fourth facilitator of participation in health policy development. Nurses represent the vanguard of national healthcare as they spend significant time with patients. Due to this fact, nurses get an excellent opportunity to obtain valuable first-hand evidence on various care-related matters. For example, nurses working in cancer wards play an important part in the Clinical Oncology Society of Australia (COSA), a national body uniting professionals deployed in cancer control and care (Cormie et al., 2018). Their feedback allowed COSA to develop a nationwide list of recommendations for multidisciplinary cancer teams (Cormie et al., 2018). Likewise, Australian registered nurses may contribute to the development of national health guidelines and policies in other areas of healthcare.
For instance, Australian nurses participated in developing national antimicrobial stewardship practices. According to Monsees et al. (2017), nurses play a crucial role in healthcare operations due to their unique clinical positioning. In particular, nurses can serve as advocates, educators, communicators, and coordinators of newly developed care policies (Monsees et al., 2017). Nurses’ proximity to the patients opens the way to increased patient participation in the care process (Tobiano et al., 2015). Overall, the profession of nursing offers access to first-hand medical evidence, thus granting the nurses substantial credibility. Given this information, Australian nurses’ position in the healthcare system provides a solid foothold for participation in the development of national health initiatives.
In certain cases, regional and national legislation may act as the fifth facilitator of nurses’ participation in health policy development. For example, a patient-centered approach to care is manifested in several Australian state- and nationwide documents. In South Australia, the patient-centered strategic approach is reinforced by the Caring With Kindness: The Nursing and Midwifery Professional Practice Framework (McCormack et al., 2017). In addition, the patient-centered approach is taken in Western Australia, New South Wales, and Tasmania in regard to such matters as disability, palliative, and dementia care (McCormack et al., 2017). In Victoria, the Department of Health developed a guide for implementing and evaluating person-centered approaches to caring for older people (McCormack et al., 2015, p. 5). In these cases, the regional and national legislation provides Australian nurses with frameworks that can be used to adjust existing approaches to care or develop new health policies. As such, Australian nurses can operate within an already established legal field. In this regard, the national and regional legislation acts as a facilitator of Australian nurses’ creative activity within the country’s healthcare system.
Finally, Australian nurses’ participation in the development of national-scale health policies depends on the resources available to their healthcare organizations. For example, Barber et al. (2015) found that practitioners frequently express the need for sufficient staffing and appropriate equipment. According to McKenna et al. (2015), funding of support infrastructure was suggested as a means of facilitating nurses’ transition from general to advanced roles. From this evidence, one can explain the correlation between the availability of resources and nurses’ participation in national health policy development. The presence of sufficient resources, such as well-trained staff and good-quality equipment, allows nurses to work more efficiently and perform their main professional duties without significant pressure. Consequently, the allocation of sufficient resources to the nurses’ needs saves their time and energy. In turn, registered nurses can direct the newly-found time and energy to advocacy efforts and participation in the development of national health policies. Therefore, one can consider resources available to healthcare organizations as the sixth major facilitator of Australian nurses’ activity in health policies’ development.
Barriers to Nurses’ Participation in Health Policy Development
The definition of barriers to nurses’ participation in national health policy development logically stems from the definition of facilitators. In general, academic sources define barriers as factors preventing the effective development, implementation, and adjustment of healthcare policies and technologies (Hemsley et al., 2019; Heale & Buckley, 2015). Similarly to the approach applied to facilitators, the section dedicated to barriers examines particular issues in various healthcare settings from the standpoint of potential interference with Australian nurses’ participation in health policies’ development. Overall, the assessment revealed five common barriers: lack of knowledge, education, and skills, understaffing and excessive workload, insufficient resources and employer support, legislation, and nurses’ mental health conditions. These barriers significantly hinder Australian registered nurses’ ability to influence the development of national health policies.
Lack of Knowledge, Education, and Skills
The lack of knowledge, education, and professional skills produces an adverse effect, turning the facilitator of nurses’ participation into one of the most common barriers. Hemsley et al. (2019) reviewed 24 studies and 93 articles related to advance directives (ACD) implementation in several countries, including Australia, and found that the lack of adequate knowledge and skills undermines ACD development. As a consequence, nurses tend to become confused and resist the implementation of the new policy. Inadequate levels of professional knowledge, education, and skills may result in nurses’ inability to notice valuable discoveries and bring them to attention of healthcare system.
A similar picture emerged in the research of advanced practice nursing regulation. Heale and Buckley (2015) found that inadequate education of advanced practice nurses (APNs) was a common theme at the international level, including Australia. The lack of skills and knowledge renders APNs useless, stopping them from being competent and comfortable within their role. Likewise, nurses who lack education, professional skills, and knowledge become unable to participate in developing and implementing national health policies. According to Kitson et al. (2018), Australian nurses delivered appropriate care only 57% of the time. Moreover, the flaws in education resulted in nurses’ inability to accumulate and translate useful knowledge.
As a result, the lack of education, skills, and knowledge become embedded into the healthcare system. For instance, Ronaldson et al. (2008) surveyed registered nurses of palliative care units in Sydney. The participants demonstrated a mean score of 11,7 out of 20 on the Palliative Care Quiz (as cited in Ayed et al., 2015, p. 93). In addition, nurses with a lack of professional skills face difficulties in adhering to evidence from systematic reviews (Tricco et al., 2015). Given this information, one can conclude that inadequate education, knowledge, and professional skills may act as a significant barrier to Australian nurses’ participation in the development of national health policies.
Understaffing and Excessive Workload
The excessive workload associated with understaffing presents the second barrier to nurses’ participation. In particular, the nursing staff becomes forced to multitask and spend additional time on patient care duties and work with documentation (Baumann et al., 2018). According to Buchan et al. (2015), Australia faces a perspective of workforce shortage in nursing, which can be mitigated by the wider implementation of advanced practice nursing. Australia’s suburban, remote, and rural areas were found to be particularly underserved (Buchan et al., 2015). Given this situation, Australian nurses’ participation in the development of national health policies may be hindered, as nurses would have to focus on their primary duties at the expense of research and advocacy efforts.
Insufficient Employer Support and Resources
Similar to the education and skills factor, employer support and available resources may become a barrier that prevents nurses’ participation in developing national health policies. The lack of organizational support and resources creates unfavorable working conditions for nursing staff, limiting their ability to engage in research and advocacy for new professional practices and healthcare technologies. For instance, Halcomb et al. (2020) surveyed 637 Australian primary care nurses during the COVID-19 pandemic and discovered that 43.7% of respondents felt the threat of potential employment loss. In addition, only 54.8% of nurses considered support from their healthcare organizations sufficient (Halcomb et al., 2020). In such circumstances, registered nurses may become more concerned with their future in the profession instead of dedicating time and energy to participate in the development of national health policies.
The adverse impact associated with the lack of resources is evident from an example of telehealth implementation during the COVID-19 pandemic. As the percentage of remote consultations increased from 0.2% in February 2020 to 35% in April 2020, many organizations had to compromise on quality by favoring telephone over videoconference (Thomas et al., 2022). In conditions of limited resources, healthcare organizations may stop providing the necessary support to nurse-led research, significantly lowering the nurses’ capacity to participate in national-level health initiatives.
In the Australian case, the strict national legislation may act as a barrier to nurses’ participation in activities different from their primary duties. Most importantly, Australian authorities ensure certain quality standards for patients by establishing national standards for nurse practitioners (NPs). In addition, Australian NPs are legally obliged to have protocols that define the scope of their practice in detail (Kooienga & Carryer, 2015). As a result, Australian nurses become quite restricted in terms of their professional roles and duties. While such a restriction of freedom may force them to improve their patient care skills, Australian nurses may have less time for research and advocacy. Consequently, nurses’ ability to participate in these crucial activities for the development of national health policies may be lowered by the legislative barrier.
Mental Health Conditions
Finally, the impact of such barriers as excessive workload, understaffing, and the lack of resources and organizational support may result in harmful mental health conditions, the fifth potential barrier to nurses’ participation in policy development. Unfortunately, this problem is quite prevalent in the Australian healthcare system. Maharaj et al. (2019) conducted a survey of 102 Australian nurses and found that prevalence rates of depression, anxiety, and stress reached 32.4%, 41.2%, and 41.2%, respectively. One can see that the mental health conditions of nurses may have a significant negative effect on their ability to participate in the development of national health policies. Instead of thinking about professional collaboration, research, and advocacy for positive change in healthcare, the nurses may begin suffering from job dissatisfaction. In this regard, adverse mental health conditions can be considered one of the worst barriers to registered nurses’ participation in national health policies’ development. Moreover, healthcare organizations may face significant difficulties in staff retention and experience an overall decrease in performance and quality of care if the harmful factors are not promptly addressed.
The assessment of academic sources revealed six major facilitators of Australian nurses’ participation in the development of national health policies. Competent leadership was found to be the most common facilitator of participation (Barber et al., 2015; Cheng, 2016; Scully, 2015; Delaney, 2018). Furthermore, participation may likely be facilitated by organizational support, nurses’ skills, education and knowledge, and the frontline role of nurses in the modern-day healthcare system. Legislation and available resources may serve as facilitators or barriers depending on the situational context and conditions inside a healthcare organization. Inadequate education and professional skills and the lack of organizational support and resources may also reduce nurses’ ability to influence health policy development at the national level. Given these findings, one can recommend prioritizing facilitators and barriers that nurses may realistically control. For instance, nurses should actively collaborate in multidisciplinary teams, notify the organization’s leadership of the state of their professional preparedness, and provide regular feedback regarding the workplace situation in terms of workload and resource sufficiency. By following these recommendations, Australian nurses may increase the probability of making a significant impact on the national healthcare system.
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