Blogs

July / August 2025

Nurse Policy Entrepreneurs: Leading with Curiosity, Drive, and Integrity

Nursing is built on altruism: caring deeply for others, advocating for patients, and striving to make healthcare better. Beneath this shared ethos lies an entrepreneurial impulse in nearly every nurse: a desire to take meaningful action, to innovate, to question assumptions, and to persist—qualities essential for leadership and systems change.

Nurse entrepreneurs are self‑starters. They set their own goals, persist through obstacles, and take proactive action rather than waiting for direction. In organizational research, this is called personal initiative - future-oriented behavior that overcomes barriers to achieve goals. In nursing contexts, this translates into driving new projects, innovations, or policy efforts even without formal support. They also maintain a spirit of inquiry - asking 'What if … ?' and seeking fresh perspectives or experimenting propels nurse entrepreneurs beyond routine care. Curiosity, especially in social contexts, benefits group innovation and shared learning. Rather than accepting “that’s how we’ve always done it,” nurse entrepreneurs question systems and behaviors that cause inequity, inefficiency, or burnout. Entrepreneurial leadership in nursing supports proactive challenge, enabling others to redefine roles and drive change across care systems.

Innovation rarely succeeds on the first try, but is often born out of necessity in failing systems. Persistence in iterating, learning from setbacks, and maintaining momentum is central. Resilience is a critical entrepreneurial trait, enabling sustained action even in complex environments. Nurse entrepreneurs maintain clarity of purpose, connecting daily tasks to broader goals: improving equity, system quality, or health outcomes. Integrity ensures nurse entrepreneurs act transparently, center patient and community needs, and maintain credibility. Especially in policy or advocacy work, a strong ethical compass builds trust and sustains impact. Having a vision helps sustain effort over time, symbolize leadership, and inspire others.

Our community facilitates this psychologically safe space for NPEs around the world to lead with curiosity and integrity when approaching issues and addressing wicked problems.

Despite almost 30 million nurses globally, these entrepreneurial qualities often remain underutilized, festering as pent up energy. Nurses collectively embody vast potential as changemakers. Change is happening, yet still too often, the ecosystem fails to recognize or support their entrepreneurial qualities. Even professional bodies undervalue policy and systems leadership relative to our expertise and lived experience. Traditional training emphasizes clinical skills and protocols but rarely fosters initiative, systems thinking, or innovation. Structural barriers like rigid institutional hierarchies, lack of leadership pathways, and limited recognition of non-clinical contributions stifle nurses’ agency and influence without authority. Insufficient support in both education and workplace settings means that nurses who are curious and driven often lack coaching, network access, or opportunity to apply ideas. Persistent internal motivation is essential for nurses to act on new opportunities, transforming system changes into entrepreneurial roles.

Our community offers group mentorship for NPEs to learn from each other and open access resources to build the knowledge, skills, abilities, and confidence that refine them as transformational leaders.

Nurse entrepreneurs don't always start businesses - many work as intrapreneurs, policy advocates, or innovators within existing systems. Regardless of setting:

• Develop a clear vision: Identify policy or systems gaps aligned with your values. Define your 'why'.

• Use your curiosity: Ask questions, test small pilots, seek peer feedback. Plan-Do-Check-Act are natural to our evidence-based practice.

• Act proactively: Reach out, volunteer, or offer solutions even without formal roles - you can't assume you'll be invited. Trailblazers and transformative leaders create opportunity where it doesn't yet exist.

• Build resilience: Treat failures as learning, not evidence to quit. Use your 'nurse instict' and trust your gut.

• Model integrity: Share your journey transparently, anchor actions in ethics, and center collaboration over ego. Be the mentor for those who follow you!

Every patient interaction, every community engagement, every policy conversation is an opportunity. With intentional nurturing of curiosity, resilience, drive, and ethics, nurses can transform healthcare systems and advance equity - not as exceptions but as expected leaders.

Grace Kistner, RN, DTN, MMHA, BSBA, BSN, CCRN, CSSLHPM

May / June 2025

The NPEC through the lens of Complex Adaptive Systems Thinking

Recently after viewing the virtual 2025 Cornell University International Systems Thinking Conference held by Drs. Derek and Laura Cabrera and team, we find ourselves increasingly fascinated by the concept of reality as an intricate series of interrelated complex adaptive systems (CAS). There are numerous approaches to explaining systems thinking, but Cabrera’s book Systems Thinking Made Simple: New Hope for Solving Wicked Problems (Cabrera and Cabrera, 2015) serves as a thinking cap. The authors describe wicked problems as a, “. . . mismatch between how real-world systems work and how we think they work.” The NPEC team continues to share contemplations with frequent checking and adjusting to adapt our content and format.  Cabrera’s notion of systems thinking is an emergent property always on the hunt for more accurate thinking that reflects the real world. Parse’s theory of Human Becoming leans on the emerging now (the paradox of a never-ending passage beyond the moment, while always in the now).

If the NPEC is to create an effective professional development platform, then we must accurately understand the problem sans bias to achieve the best outcomes. Bias is a killer to this because it erects a hard stop to alternate possibilities and unpredictable solutions to wicked problems. Thinking about thinking - or metacognition - and avoiding bias through authentic critical thinking is a vital act for problem solving. Doing a ‘thing’ with expert skills is only half of the solution, and is not enough to address complex issues such as developing effective healthcare policies. Skill sets are part of a ‘thing’, but it takes understanding a 'thing' at a higher level to slip into the realm of becoming.

As Cabrera and Cabrera point out, one of the troubles with traditional problem solving is that there is an innate human desire to reduce a problem to a single cause in a linear hierarchy. While inconvenient, real-world problems exclude the whole and the dynamic relationships between causal nodes. This becomes a wicked problem when there is a mismatch between our mental model of how the world works and how it actually works. A complex adaptive system (CAS) is different from a complicated system in that a complicated system is stable. Complexity is not only about the number of parts, but the easy adaptability and vast variability of a ‘thing’. For example, DNA is composed primarily of only four nucleobases (adenosine, thymine, guanine, cytosine) but there are virtually infinite variations and adaptations of life. Add the epigenetic component and the simple components become outrageously complex. So is the reality of policymaking.

The NPEC continues to grow and curate relevant, meaningful, and easily applicable content to support nurses on their journey to become an agent of change and thought leader for healthcare reform. This requires accurate thinking about what content to curate and how best to disseminate substantive material. Nurses continue to be the most trusted profession yet are not substantially engaged as thought leaders and full partners with physicians, other disciplines, and others in civil society in the reform of healthcare. As we read more about systems thinking, it has become clear that we have not recognized this as a wicked problem. Since the nursing profession has not significantly become full partners, then the current interventions are either inadequate or erroneous. 

The NPEC aims to address three problems. The first is how to improve individual nurses’ perceived self-efficacy to perform as an agent of change in the real world of policy making (regardless of level or context). The second problem is more practical in that we must recognize and perhaps classify the entire compendium of knowledge that an NPE requires to perform as an agent. Finally, the NPEC must determine the methods, means, and approaches to organize and disseminate that knowledge in ways that are attractive to the learner and easily and readily available. The NPEC is addressing all three problems concurrently. The original image of essentials and elements is a list that in application, each element, or node, can be applied concurrently with another one or more. During an instance, the behavior of Building Social Capital can occur at the same time as Networking, Demeaner, Raising Awareness, and the Elevator Speech. 

Just learning skills and getting into the fray as a full partner is simply not enough. The change is in altering how the problems are modeled so they reflect the real world—that’s thought leadership. We must lead change and that is a higher level of innovation and solutions-focus than possible with the current thinking. Wicked problems can only be solved through an accurate understanding of reality. This can only be achieved through systems thinking. Those who are cognitively ready to think deeper and disruptively incite folks to start to see the world through the lens of systems thinking. Becoming engaged as a thought leader and policy influencer is an element of the nurse’s professional identity and if we leave it to other disciplines to determine healthcare policy reform, it will be marginalized, because no other discipline has the proximity that we do to the lived reality of the communities we care for and in such a comprehensive way. We must become known more than the most trusted profession, but as the most influential when it comes to policy. We must become students of policy making as a CAS and not just learning skills. We will change the world not by choosing to have this skilled voice, but by refusing to stay silent.

References

Cabrera, D & Cabrera, L (2015). Systems Thinking Made Simple: New Hope for Solving Wicked Problems. (2nd ed.) Plectica Publishing.

Cabrera Lab on webs of causality: "Web of Webs: A Systematic Literature Review of Causal Interconnections in Policy"

Michael J. Poláček, DNP, RN-RET & Grace Kistner, RN, DTN, MMHA, BSBA, BSN, CCRN, CSSLHPM

March / April 2025

Policies to Balance the Science & Art of Nursing: 

Leveraging AI Innovations to Refocus on the Humanity in Care Delivery

Enhancing Mental Health Care through AI: A Nurse Practitioner’s Perspective

As a mental health nurse practitioner, my priority is to ensure client confidentiality, efficiency, and trauma-informed care. In short follow-up appointments, it's vital that clients feel heard, but providers can easily get caught up in documentation. Since effective communication is crucial in mental health care, the clinician-client relationship greatly influences treatment outcomes.

To improve client interactions, I use a HIPAA-compliant AI scribe. It allows me to focus on listening and engaging with clients rather than typing notes. This automation helps me maintain eye contact, observe non-verbal cues, and foster a safe space for clients to express themselves. The ability to chart during the session means I typically complete notes the same day, reducing time spent documenting after hours and freeing me up for case consultation, care coordination, and other essential tasks. This reduces burnout and enhances care quality.

Ensuring Security in AI Scribe Technology

Concerns about privacy are paramount when using AI. From my interaction with experts at Nabla, I learned that they employ industry-standard technologies to safeguard health information. Their HIPAA-compliant AI scribe captures and transcribes audio in real time, discarding it after the session and generating structured transcripts quickly to meet documentation standards. They also limit data storage to 14 days and utilize strict encryption protocols. Audio recordings are never retained. Some AI scribes offer customization features, allowing clinicians to “train” them by identifying preferences for phrasing or content—such as noting specific psychotherapy interventions used.

With security measures like staff training, role management, and third-party audits, Nabla ensures confidentiality and integrity across its system, helping clinicians use AI confidently.

AI’s Role in Nursing and Policy Advocacy

Beyond documentation, AI supports clinical decision-making. AI-driven analytics help assess medication adherence, track client progress, and identify areas needing intervention. For example, when prescribing medications, AI alerts clinicians of interactions, but the final decision always relies on professional judgment and clinical expertise.

AI is also being integrated into clinical settings to detect early warning signs of deterioration, such as sepsis or stroke risk, providing timely alerts that support intervention. These tools do not replace clinicians—they extend our capabilities.

Nurse policy entrepreneurs have a unique opportunity to use AI in advocacy. AI can analyze large datasets to identify healthcare disparities, inform resource allocation, and forecast the impact of policy decisions. It also streamlines research and evidence synthesis, empowering nurses to support data-driven changes that advance equity and patient-centered care.

Balancing AI and Human Connection

Integrating AI into mental health care presents exciting opportunities to improve efficiency, reduce burnout, and enhance patient experiences. HIPAA-compliant scribes help clinicians reclaim valuable time and prioritize human interaction. Still, while AI enhances workflow, the irreplaceable value of human connection and clinical expertise must remain at the core of care.

As we embrace these tools, let’s ensure they enhance—not replace—the compassionate care our clients deserve. By striking the right balance, we can leverage innovation while protecting the heart of nursing: empathy, presence, and connection.

Further Resources

Webinar on AI in Nursing

AI in nursing: Priorities and opportunities from an international invitational think‐tank

Nursing and AI Leadership Collaborative

Ruthy Lindvall, MSN, PMHNP, RN

January / February 2025

NPEC Essential Focus: Communication

Alan Rickman was a unique actor and expert at using his appearance, body language, energy, and voice qualities to embody his characters with verisimilitude. He is quoted as saying, “Acting is mostly about listening. If you just focus in on what the other person is saying, acting takes care of itself to quite a large extent.” Even though an actor has lines and a “motivation,” delivering those lines is only authentic when they are convincingly in response to the collaborating actor. 

A key reality in human experiences is that we are nearly always on a stage—other’s see or hear what we do, write, or say. For better or worse, even silence can communicate one’s personage. Arguably, the first nursing theory was Peplau’s theory of interpersonal relationships identifying effective communication as the key to rapport building and best outcomes. Active listening and utilizing motivational interviewing skills are not isolated to a clinical setting and can propel an interaction from chatter to influencing thought and beliefs.

The Nurse Policy Entrepreneur (NPE) leans heavily upon communication to advance their agenda. Without the support of others, whether that means influencing the opinion of those who hold the keys to change, informing those who have a knowledge deficit, or inspiring collaborators. We have all seen examples of how one sentence can destroy a career or degrade respectability. There are also examples of a person making a career out of a successful instance of effective communication. 

On the Development tab of this website, we have listed seven NPE Essentials with elements to distinguish some of the skill sets or competencies that contribute to the qualities necessary to successfully performing the role of healthcare reformer and thought leader. Each Essential is exactly that, essential, however, we all may be more adept at one that another. As with the Nurse Process (ADPIE), and arguably any first step in learning, is curiosity and assessment. There is a paradoxical relationship between curiosity and a human’s tendency to jump enthusiastically to solutions and conclusions. Focus on these Elements of Communication to be a successful NPE. 

Public Speaking can be broadly envisioned as anytime you are talking with others but is typically related to a podium presentation or a webinar. The tone and demeanor depend on the milieu and a key to success is being mindful of situation and environment. Toastmasters International is a keystone to gaining skills and confidence. Studying how others speak, and present their thoughts, body language, and the way that they impact or inspire you.

Elevator Speeches are concise and compelling summaries of yourself and a solution to your chief concern, typically delivered within the timeframe of an elevator ride (30-60 seconds or 100 words). It's a powerful tool for networking and career advancement. This succinct format forces you to prioritize key information and articulate your value proposition clearly and concisely. By practicing your elevator speech, you become more confident and articulate in communicating your goals to potential employers, investors, or collaborators. It helps you quickly build rapport and leave a lasting impression, making it easier to initiate meaningful conversations and explore opportunities.

Leadership Styles are important to understand how people present themselves as an advocate or leading teams. While there are numerous interpretations of leadership style (I’ve seen between four and ten), Goleman’s list seems to resonate with me.  1) Coercive leadership style; 2) Authoritative leadership style; 3) Pacesetting leadership style; 4) Affiliative leadership style; 5) Democratic leadership style, and 6) Coaching leadership style. People often switch styles based on social circumstances. Unless you are self-aware, the style becomes compulsory rather than intentionally used to best meet the situation and result in suboptimal communication.

Interviewing Others is not as easy as it seems. On TV dramas, you might have seen detectives “grill” the accused, but in real life, the best interviews are conversational that establish a relationship with the goal of getting the best picture possible of the person, what they believe, and what they have done. Media interviews that are confrontational full of strawman “I gotcha’s” are cringeworthy and slam shut the door to discovery and drawing out the interviewee’s deeper thoughts.  

Being Interviewed can be intimidating and unless one’s thoughts are already formed, one can sound confused, uninformed, or vacuous and marginalizes respect. Being prepared consists of knowing what you know in a way that can be crisply articulated verbally. Creating an elevator speech and clarifying the topic by writing an essay are both valuable. Knowing the interviewer and what questions they will be asking would also be helpful. As with everything, practice makes perfect, so push through the anxiety and fears and seek out opportunities!

Press Releases are valuable to the work of promoting an issue or project. Clarifying the fundamental concepts in journalistic style will simplify the journalist or work of understanding and sharing the content in various mediums. Radio stations, newsprints, television, websites, etc., will all translate the information into their format. There are specific conventions to use, so ensure that how you write it will be well received.

In the end, Rickman said it best, “And it's a human need to be told stories. The more we're governed by idiots and have no control over our destinies, the more we need to tell stories to each other about who we are, why we are, where we come from, and what might be possible.” Becoming an engaging communicator who tells the story of how to improve the world will make all the difference when acting as a healthcare reformer and thought leader.

Michael J. Polacek, DNP, RN, PMH-BC, NPD-BC

December 2024

Demystifying Nurses' Health Policy Involvement

Actionable Steps to Achieve the Elusive

Nurses’ Health Policy Involvement: Is it the Scarlet Pimpernel Syndrome?

The literature echoes nurses’ unfamiliarity with or lack of involvement in the policy arena, like a recurring decimal. This is an unfortunate revelation because nurses, the largest professional workforce worldwide, can collectively apply enough political power to reform the world’s healthcare systems. So, what is missing in this equation: nurses + their collective numbers = healthcare reform? This reminds me of the story of the Scarlet Pimpernel.

The Scarlet Pimpernel, written by Baroness Orczy, tells the story of an English nobleman, Sir Percy Blakeney, who led a double life as a valiant hero. He committed his heroic acts under the guise of “The Scarlet Pimpernel,” who saved French aristocrats during the Reign of Terror in the French Revolution. Sir Percy was a wealthy aristocrat who could be described as having a carefree spirit with a playful streak that borders on the ridiculous. However, at night, he transformed into the courageous and cunning Scarlet Pimpernel, who organized daring escapes for the French aristocrats right under the noses of the revolutionaries. The French officials sought to capture him, but he proved to be an elusive figure, always one step ahead, slipping through every trap set to catch him with an almost uncanny ease. Although nurses can potentially lead the world in policy agendas, like capturing the Scarlet Pimpernel, it is an elusive venture.

Policy Definitions

One approach to address this problem is to define policy to encompass the various avenues by which it can be approached. The Centers for Disease Control (CDC, 2024) broadly defines policy as “A law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions.” The World Health Organization (WHO) defines health policy as “Decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society” (WHO, 2021), and The American Association of Colleges of Nursing (AACN, 2021), in the new essentials states that, “Health policy involves goal-directed decision-making about health that is the result of an authorized public decision-making process.” How can these theoretical definitions be transformed into actionable descriptions that might ignite nurses’ interest in policy involvement? I propose we provide an actionable description to delineate areas of policy involvement. Therefore, Nurse Policy Engagement is the proactive involvement of nurses in developing, advocating, and implementing health policies to enhance clinical practice and healthcare outcomes. Leveraging their  collective power, education, and diverse experiences, nurses are favorably situated to participate actively in local, state, and national policymaking through engaging in policy research, joining professional organizations, educating colleagues and communities, and directly interacting with legislators to influence health laws and regulations. The figure below provides a visual for some levels of policy involvement for nurses.

How to Create Change: Nursing Legislation, Regulation & Policy. From American Nurses Association, California. https://www.anacalifornia.org/post/how-to-create-change-legislation-regulation-policy © Copyright 2022 American Nurses Association\California.

Specific Policy Involvement Ideas Based on Areas/Levels of Nursing Practice 

School Nurses Can:

• Advocate for policies that ensure routine health screening and access to resources for underprivileged children.

• Advocate for more nutritious food for students with the support of national initiatives and local stakeholders.

• Attend board of education meetings to advocate for health-related initiatives, especially in low-income communities where social determinants of health significantly impact children’s health.

Hospital-Based Nurses Can:

• Engage with hospital management and legislators to institute policies that ensure safe nurse-to-patient ratios, reducing burnout and improving patient care outcomes. This is a crucial policy involvement for nurses because inexperienced policymakers make staffing and patient care decisions.

• Sit on hospital committees to participate in initiatives to address workplace safety and reform policies to prevent workplace violence.

• Influence hospital policy for equitable patient care by sitting on hospital committees and engaging with hospital administration on the importance of reinforcing the use of language services and competently cultural care. Many patients need to be afforded language translation to understand their treatment, resulting in inadequate care and poor compliance.

Advanced Practice Nurses (APN) Can:

• Build relationships with state lawmakers or support a local candidate whose views resonate with your passion. This relationship allows the nurse to influence their ideas and beliefs to change policy affecting practice, such as full practice authority and increasing access to care, particularly in underserved areas.

• Subscribe to legislative notifications for upcoming meetings to educate themselves on legislative issues affecting healthcare and nursing practice. One cannot advocate for something one does not know about.

• Participate in research and data collection to influence policies using evidence to shape state and national health guidelines.

Nurse Administrators Can:

• Use their administrative authority to implement evidence-based policies to ensure hospital or clinic policies reflect the latest best practices in patient care and safety. Nurses should practice from an evidence-based focus to provide better outcomes.

• Develop and enforce policies that foster inclusive hiring practices to promote a diverse healthcare environment.

• Lead quality improvement initiatives to advocate for or implement policies that support continuous quality improvement, such as monitoring patient outcomes and reforming care practices.

Nurse Educators Can

• Incorporate policy education into curricula, including health policy education, to prepare students to understand and influence health policy. Experiential learning assignments such as case studies or simulations are excellent ways to facilitate policy engagement in the academic setting.

• Arrange field trips with students to attend local, state, or federal government legislative sessions to learn how the system works and understand how decisions are made.

• Educate practicing nurses and students on joining national or local nursing organizations like the American Nurses Association. These organizations have lobbyists who lobby legislators to impact healthcare policy.

In each area of nursing practice, nurses can participate in policy involvement, amplifying their voices, individually or collectively, to improve the quality and safety of healthcare.

References

Center for Disease Control. (2024). Definition of policy. https://www.cdc.gov/polaris/php/policy-resources-trainings/definition-of-policy.html

Orczy, B. (1997). The scarlet pimpernel. Puffin Books. World Health Organization. (2021). Health promotion glossary of terms 2021. https://iris.who.int/bitstream/handle/10665/350161/9789240038349-eng.pdf?sequence=1

Sandra Ojurongbe PhD, APRN, PMHNP-BC

November 2024

NPE Connects Cameroon

Spotlight on a Global Nurse Policy Entrepreneur

Ndasi Noubissi Maxel's leadership has had a notable impact on the healthcare system and policy in Cameroon, with a focus on professional development, healthcare accessibility, and policy innovation. Serving in multiple influential roles, including as the National Communication and Relations Officer at the Council of Nurses, Midwives, and Health Technicians, he has spearheaded projects that align healthcare practice with global standards and aim to improve service delivery across Cameroon.

1. Professional Development and Recognition: Through his role as the National Coordinator of the Daisy Award in Cameroon, Maxel has contributed to elevating the status of healthcare professionals, acknowledging excellence, and fostering a culture of dedication within the workforce. His work also includes initiatives to promote nurses, midwives, and health technicians, which align with sustainable development goals and aim to attract more skilled professionals into the healthcare field.

2. Healthcare Accessibility and Expansion: Maxel has been involved in a significant entrepreneurship project aimed at establishing 20 healthcare centers across Cameroon. This expansion effort, set for completion in 2025, seeks to enhance healthcare accessibility throughout the country’s ten regions. Additionally, he organized the creation of a Virtual Reality University for continuous professional development, which will offer European-standard certifications, internships, and a platform for healthcare training, aiming to bridge the skill gap in the workforce.

3. Policy and Advocacy: By organizing forums, hackathons, and diplomacy-driven engagements, he has encouraged policy discussions that emphasize healthcare as a human right. His leadership in the annual healthcare fair, alongside swearing-in ceremonies for healthcare professionals, showcases regional readiness and emphasizes the importance of quality training for universal healthcare coverage in Cameroon.

4. Digital Transformation and Data Management: With initiatives like producing 36,000 attestations through a digital system, Maxel has underscored the importance of digitalization in healthcare administration, paving the way for streamlined processes and more accessible data management in the healthcare system.

Q&A

"What is your greatest purpose for your nursing career?"

My greatest purpose is reinstituting the optimal levels of both the  structural and functional integrity of nursing globally through continuous advocacy, been proactive and assertiveness.

"What is your vision about your career?"

My greatest vision of my career is to be at the center of the  development  and implementation of global health policies.

"Where do you visualize yourself in the next three years?"

In the next three years, I see myself engaging with top global healthcare leaders to regain our autonomy and professional independence.

"What is your optimism about the future of nursing?"

As long as global Nurse leaders invest in collective efforts, I  remain positive and brave for as long as there is life, there is hope.

"How do you deal with issues that scare you?"

I hope for the best and prepare for the worst.

"Where do you see nursing in 10 years?"

I see nursing leaders actively engaging into politics, health policy and boosting the nursing profession by emerging as one of  the best among other professions.

"What one ‘need’ and one ‘want’ will you strive to achieve in the next twelve months?"

My need now is having assess to more policy making resources and positions ,and will want to be faced with more policy related challenges.

"Will the next generation face the best or the worst in nursing? Why?"

They will face the best, because we believe our advocacy for the nursing profession would had yielded fruits by then.

"What role are you playing in shaping the future of nursing?"

Developing policies and advocating for better reforms.

"How do you describe the future of nursing in one word?"

Light.

Ndasi Noubissi Maxel, MMS, BNS, SRN, HND

Connect with and follow on: LinkedIn

Read: Ndasi Noubissi Maxel - African chairman of Nurses in Charge

October 2024

Uncharted Waters

Reflections & Navigational Reckoning a Nurse Leader’s Journey

As I reflect over my journey through nursing, I have been drawn to the concept of wayfinding and homecoming. The need to feel safe, located, stable, seen and occasionally - found. My deep thinking brought me to an unexpected memory: not one of nursing school or a patient, but rather surprisingly of my father. My dad was a sailor (among many other things), and when I was a child possibly no more than 5 years old he thought it was profoundly important to teach me the principles of “dead reckoning.” He said one day, you will find that the light you counted on can’t be seen, and the navigation you have isn’t quite working, and I will need you to know what to do. It is these many years later that I understand that my father in his wisdom was not speaking exclusively about getting to shore from the turquoise waters of my homeland Jamaica, he was speaking and guiding at a much greater density. 

Merriam Webster defines dead reckoning “as the determination without the aid of celestial observations of the position of a ship or aircraft from the record of the courses

sailed or flown, the distance made, and the known or estimated drift”. My dad said it much more simply to a 5 year old me. He said “When everything fails, remember you

can find your way if you can remember where you first came from and retrace as many of the position changes you have made to get to where you are”. Little did I know that years later - with a doctoral degree, 19 years of licensed nursing practice and numerous position changes - I’d find myself steering my own ship through uncharted waters, relying on my expertise in nursing quality and professional development to chart a course. It dawned on me that, like those sailors, I was responsible for navigating the uncertainties of modern healthcare, while never losing sight of the ultimate goal: making a global impact. A dream I held firmly and quietly but hesitated upon actualizing. 

I’ve always believed that the heart of nursing leadership lies in issue expertise, understanding the nuances of our field and recognizing where points of most impact will intersect. I realized that equipping nurses with the skills and knowledge they need isn’t a one-time effort. The work of nursing leadership must be continuous, adaptive, and aligned with the evolving healthcare landscape. Like a captain in the storm, my leadership relied on my ability to adapt and navigate each shift in healthcare policy or practice without losing direction. Above all, it also relied on relationships and human connection. 

In retrospect, I have realized that dead reckoning is more than just a navigation tool - it is a metaphor for the way I have had to lead recently. Whether working to elevate nursing quality within my own organization or reminding peers of their own capacity and expertise to step into spaces, my leadership has been rooted in using past experience to anticipate future needs while trying to account for drift and the unforeseen - such a global pandemic. Issue expertise gave me the confidence to lead, but it was the unknown - new regulations, patient demands, and emerging global health crises - that kept me pushing for innovation. It also kept me pushing myself to step into spaces and opportunities such as joining professional organizations and networks that would support the directions I most wanted to grow in. My last uncharted venture led me to SONSIEL. This collaborative professional association supported my desire to lean globally and the opportunity to speak at a United Nations parallel event in conjunction with the Commission on the Status of Women. The support there and my passion led me to pursue further a UN immersion opportunity to learn about the policies and operations I can most support and impact. If someone had told me even a year ago, this is what my October 2024 would be like, I would not have believed it.

Had I singularly relied on my “GPS” plan, perhaps I would not have had these experiences. It was my ability to recognize that our issue expertise is the compass that guides us, while our vision for the future keeps us moving forward. I am driven by a deep belief that nurses, with the right development and quality frameworks, can influence global health. Dead reckoning has taught me that while we may not always see the entire path ahead, we can trust in our training, our experience, and our passion for the nursing profession to lead us toward the future we want to create - a future where nurses stand at the helm of global healthcare transformation, making an impact that echoes across the world.

I wanted to share a few of my favorite “compass” resources:

• SONSIEL Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders - https://www.sonsiel.org

•  Human Centered Leadership in Healthcare - https://www.uleadership.com

•  Caring Science International Collaborative - https://caring.science/leadership.html

References

Merriam-Webster. (n.d.). Dead reckoning. In Merriam-Webster.com dictionary. Retrieved October 10, 2024, from https://www.merriamwebster.com/dictionary/dead%20reckoning

Dayna Dixon PhD, RN, NPD-BC, CPHQ

Connect with and follow Dayna on: LinkedIn

October 2024

Engaging Nursing Students in Policy Discussion

It is essential for nursing professionals to have a good understanding of policy, its various components and layers, and how to actively participate in it. This understanding has a significant impact on the scope of nursing practice, workforce, and educational requirements at all levels, workplace conditions, and quality and safety standards. However, nurses’ involvement in policy has been historically limited. As the largest healthcare workforce globally, nurses possess valuable insights into how policy decisions can affect nursing practices and patient outcomes. Furthermore, the participation of nurses in healthcare policy has far-reaching benefits for the entire system, including improvements in overall performance, more efficient workflows, increased reimbursement, and reduced healthcare costs.

I was not very involved in policy due to my limited understanding of its scope beyond the political arena. I suspect that this is the case for many nurses as well. Unfortunately, nurses are often more involved in implementing policies rather than making them. There are several reasons for nurses' limited participation in policymaking, including insufficient knowledge of how health systems function, lack of experience in policy development, poor communication networks, difficulty conducting thorough policy research, and limited leadership skills and opportunities. Additionally, power dynamics within and between professions and the marginalized role of nurses further contribute to this issue. Even nurse leaders involved in policymaking often feel unprepared and inadequately equipped to engage in policy discussions beyond their profession (Inayat et al., 2023). 

I agree with the points mentioned above. However, there seems to be a lack of understanding of the term "policy" as an umbrella term and the various approaches that can be taken towards it. It is important for this understanding to begin in nursing education. Being a regular member of the Nurse Policy Entrepreneur Café group discussions, I have gained more insight into how to engage my students and ignite their enthusiasm for policy engagement. Thomas et al. (2020) made some grim statements about the historical absence of nursing from policy dialogues and the lack of nurses as policy decision-makers. They suggested that nursing students could be more involved in policymaking through experiential learning activities. As a result, I have recently created an assignment to help my graduate students better understand policy and encourage their involvement in policymaking. The class was divided into groups, and they had to present based on the following questions:

• What is healthcare policy?

• How does it influence healthcare?

• Describe the different ways Health Care Policies are Identified; give examples.

• What are some examples of policy issues at your clinical sites?

• Which AACN Essential Domain(s) and sub-competencies can you apply to your clinical sites to address policy? What specific interventions can you implement to address policy issues at your sites? This should be a collective discussion of issues at each clinical site of the group members. 

The students gave excellent presentations. We talked about how policies are created at different levels of governance, including local, state, and federal governments, and globally. Additionally, policies can also be developed by healthcare organizations, professional bodies, and regulatory agencies. They were able to identify issues at their practice sites that required policy changes to improve practice and patient outcomes. They also found ways to influence these changes through policy engagement. We discussed how to assess the identified gaps requiring policy changes, and how to develop new policies when necessary. We also talked about the evidence needed to gain stakeholder support, including audits, data collection, research evidence, and patient outcomes. I was very encouraged by my students' enthusiasm and how one experiential assignment improved their understanding of policy and the role of nurses in it.

References

Inayat, S., Younas, A., Andleeb, S., Subia, P. R., & Parveen, A. (2023). Enhancing nurses’ involvement in policy making: A qualitative study of nurse leaders. International Nursing Review, 70(3), 297-306. https://doi.org/10.1111/inr.12828

Thomas, T., Martsolf, G., & Puskar, K. (2020). How to engage nursing students in health policy: Results of a survey assessing students’ competencies, experiences, interests, and values. Policy, Politics & Nursing Practice, 21(1), 12-20. https://doi.org/10.1177/1527154419891129

Sandra Ojurongbe PhD, APRN, PMHNP-BC

September 2024

From the Director's Desk: Advocacy in Action

Ask any nurse about their clinical experience, and you'll likely hear a familiar refrain: unsafe patient assignments, burnout, and relentless staffing shortages. As a nurse with nearly 30 years of experience, I know these challenges all too well. I began my career full of hope, only to realize that bedside care wasn't sustainable. This was especially disheartening, as nursing had been a lifelong dream. Witnessing the healthcare system's failure to adequately support its nurses left me disillusioned.

But just as I was contemplating leaving the profession entirely, a spark reignited my passion. I stumbled upon a call for volunteers at the Commission for Nurse Reimbursement (CNR). This seemed like the perfect opportunity to channel my frustration into positive action. I joined CNR as a volunteer in June 2023, and my dedication quickly led to my appointment as Executive Director in early 2024.

CNR has not only given me a renewed sense of purpose, but it has also connected me with countless other nurses who share my passion for change. Through this network, I've found mentorship and support, which continue to fuel my commitment to educating others about CNR's mission and the critical need for sustainable reimbursement structures in nursing.

The Root of the Problem: Outdated Reimbursement Models The current nursing crisis is fueled by a nearly century-old policy – nursing services are bundled into the overall room rate. This means that nursing care, no matter how skilled or complex, is considered a pure cost to healthcare systems, with no mechanism for direct reimbursement. When budget cuts loom, hospitals are left with no option but to reduce nursing staff, often leading to unsafe nurse-to-patient ratios.

A Catalyst for Change The CNR was founded in early 2023 to address this critical issue. Its mission is to modernize outdated reimbursement models and advocate for policies that recognize the true value of nursing care. By bringing together nurses, healthcare administrators, policymakers, and patient advocates, the CNR aims to create a sustainable future for the nursing profession.

A History of Advocacy and Progress Since its inception, the CNR has been driven by a commitment to research, policy development, and education. The Commission conducts extensive research to identify the shortcomings of existing reimbursement models and develop innovative solutions. It actively advocates for policy changes that reflect the complexity and value of nursing care. And, crucially, it empowers nurses to become advocates for their own profession through education and outreach initiatives. The CNR's impact is already evident. Thousands of nurses and healthcare professionals have joined the movement, and hundreds volunteer their time and expertise to further the Commission's mission.

The Road Ahead: Building a Sustainable Future The path to equitable reimbursement is a challenging one, but the CNR is making significant strides. Current initiatives include:

• Developing a value-based reimbursement model that directly ties nursing care to positive patient outcomes.

• Advocating for greater transparency in reimbursement practices.

• Educating nurses on how to advocate for fair reimbursement effectively.

• Educating legislators on the need for reimbursement reform.

• Partnering with government agencies on research.

The CNR believes that every nurse has a role to play in shaping the future of their profession. Your voice matters, and your advocacy can make a tangible difference. By working together, we can build a healthcare system that truly values and rewards the essential contributions of nurses. Become a CNR volunteer today and be part of the solution.

Melissa Mills, RN, BSN, MHA

Executive Director, Commission for Nurse Reimbursement

August 2024

Are We on Board, Yet?

Advancing Nursing Leadership in the Boardroom

Due to our rapidly evolving healthcare landscape, it is essential that clinicians and health professionals are represented in healthcare governance and shared decision-making at all levels, including boardrooms. In 2022, however, the American Hospital Association (AHA) found that only 5% of the 993 health systems and hospitals surveyed had a nurse serving on their board (compared to 17% for physicians) (AHA, 2022). This is particularly concerning since nurses comprise the largest proportion of both the U.S. and global healthcare workforce, and are often the closest to patients, families, and other key stakeholders (AACN, 2024; WHO, 2020). Hospital boards frequently make decisions that directly impact nursing practice, such as staffing cuts, the types and numbers of patients nurses care for, and their salaries (Curran, 2016). Therefore, in order to better advocate for themselves, their patients, and their communities, nurses must have seats at the board table where policy decisions are made. 

Unfortunately, many nurses are unaware that board service is a possible avenue for them to influence change beyond the bedside. It wasn’t until I connected with nurses actively serving on boards and joined the Nurse Policy Entrepreneur (NPE) Café meetings that I began to connect the dots and visualize myself in this role. We may also think we don’t have the appropriate skillset for this work — this couldn’t be further from the truth. Nurses are well-positioned to be effective and valuable board members. In fact, research has shown that having boards with higher percentages of nurses as voting members is associated with a higher quality of care (Szekendi et al., 2015). Nurses’ foundational education and clinical experience hone expert knowledge and competencies that are easily adaptable to the boardroom (Curran, 2016). We are critical thinkers who understand complex healthcare delivery problems and offer innovative solutions (Sundean et al., 2018). Our strong communication skills allow us to collaborate well in multidisciplinary teams, resolve human resource issues, and build meaningful relationships with stakeholders. Nurses already apply these skills in leadership roles in their organizations through shared governance structures and committee work, as well as in local chapters of nursing organizations such as Sigma Theta Tau (Curran, 2016). 

My own journey to the board room began several weeks ago when I was scrolling LinkedIn and came across a notification that Timmy Global Health* was recruiting for board members. Even though I have worked with Timmy over the past 10 years, volunteering on medical service trips in Ecuador and Guatemala as a nursing student, student trip leader, and registered nurse, I never imagined becoming a board member. But, seeing other nurses step up and do this work inspired me to reflect on my own career and consider the difference I might make with the unique skills and perspective I could bring to the boardroom. So, with fingers crossed, I took a leap of faith and replied. While it wasn’t on my bingo card for 2024, I am very excited to share that later this month I will officially be joining Timmy’s Board of Directors. My experiences with Timmy ignited a passion for global health that has profoundly shaped the course of my nursing career, so the opportunity to contribute to Timmy’s mission in this new way is particularly meaningful. 

Resources offered by the Nurses on Boards Coalition (NOBC) have been very helpful in this process, with the board readiness assessment tool providing valuable insights into my strengths and areas for improvement in leadership development (e.g. governance, relationship building and collaboration, adaptability, communication, etc.). Additionally, “Nurse on Board: Planning Your Path to the Boardroom” by Connie Curran contains a wealth of knowledge on this topic. I highly recommend it to nurses considering board service. 

As I begin this new adventure, I’m reminded of how much growth comes from leaving your comfort zone. As Laurie Benson, Executive Director of NOBC, said, “[b]ump out your boundaries. Get out of your comfort zone. This is where the magic happens. This is where the boardroom appears” (Curran, 2016, p. 130). 

*Timmy Global Health is a non-profit organization that increases access to primary healthcare in eight sites across Ecuador, Guatemala, the Dominican Republic, and Nigeria. They do this by coordinating medical service trips in which teams of medical professionals and student volunteers support the work of in-country partner organizations in local clinics. Timmy uses a community-oriented primary care model centered on close collaboration with these partners, local health workers, and community leaders to build local healthcare capacity and empower communities to sustainably address health disparities. 

References

American Association of Colleges of Nursing (AACN) (2024) Nursing workforce fact sheet. Available at: https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet

American Hospital Association (AHA) (2022). AHA National health care governance survey report. 2022. Available at: https://trustees.aha.org/aha-2022-national-health-care-governance-survey-report

American Nurses Credentialing Center (ACCN) (2024) Magnet Model - creating a magnet culture. Available at: https://www.nursingworld.org/organizational-programs/magnet/magnet-model/

Curran, C. (2016) Nurse on board: planning your path to the boardroom. Sigma Theta Tau International.

Nurses on Boards Coalition (NOBC) (2024) Resources for nurses. Available at: https://www.nursesonboardscoalition.org/resources/for-nurses/

Sundean, L., Polifroni, E., Libal, K., and McGrath, J. (2018) ‘The rationale for nurses on boards in the voices of nurses who serve’, Nursing Outlook, 66(3), pp. 222–232. Available at: https://doi.org/10.1016/j.outlook.2017.11.005

Szekendi, M., Prybil, L., Cohen, D., Godsey, B., Fardo, D., and Cerese, J. (2015) 'Governance practices and performance in US academic medical centers', American Journal of Medical Quality, 30(6), pp. 520-525. Available at: https://doi.org/10.1177/1062860614547260

Timmy Global Health (2024) About us. Available at: https://www.timmyglobalhealth.org/aboutus

World Health Organization (WHO) (2020) State of the world's nursing 2020: investing in education, jobs and leadership. Available at: https://www.who.int/publications/i/item/9789240003279

Ongelique Conflenti, MSc, RN, PCCN

LinkedIn: www.linkedin.com/in/ongelique-conflenti

Twitter / X: @OConflentiRN

July 2024

Symbiosis: Advancing Your 'Why' with Meaningful Relationships

Nurses buzz around in multiple ecosystems. We bring keen insights to conversations where there isn't a healthcare lens, at tables in rooms nowhere near hospitals. Just as we translate care from patient to doctor and doctor to patient, we facilitate conversations between sectors and industries. Educated to be case managers, our wholistic approach identifies the Social Determinants of Health and how they impact individuals, health systems, and entire populations. Contrary to fitting a square peg into a round hole, we think differently and have a wealth of transferrable skills.

But we aren't known for our stellar mentorships nor for being recognized as professionals in roles other than at the bedside. Physicians have encultured into their discipline years long cohorts of residency, followed by prosperous individualized fellowships. Unfortunately, nurses often groan at the sight of students that they "have to" precept for twelve hours or less. I get it - as a line item on the hospital room bill (rather than a highly skilled revenue stream) nurses' relationships inside the hospital are transactional, and when we are already overworked and underpaid sometimes it's all we can do to mitigate moral injury and burnout for that extra $2.15 hourly differential. So, we simply verbalize our rationale to the student watching from the corner the room as we carefully glide from one calculated step to the next in our bundles of patient care. For me, rather than perpetuating the disgruntled and trite "way we've always done things", I welcome preceptorship roles (uncompensated when I was a traveling nurse) because I see the value in showing the next generation how we're supposed to do things, along with my critical thinking - not just in evidence based rationale - but critically analyzing if it is still the best, the only, or a yet-to-be improved process.

While I was still working at the bedside, and continuing with my career growth through new roles, I have this same mentality as I strive to be a good mentor as well as a mentee. I expand this outside of nursing into cross-sector professional relationships. I engage authentically in-person and online platforms alike, which open up opportunities that none of us would otherwise have at the click of a button without the global interconnectedness of the modern world. It has facilitated my ability to identify audiences who's shared passions and projects align with mine, and target them for meaningful conversations. Some of my "cold-calls" have ended with just the one conversation, but the alternative is the 'what if?' of a missed opportunity and in the process I get better at practicing my 'why'. Other calls have led to a new connection advancing my cause, and sometimes my name which is then mentioned in rooms where I have get to physically be. Sometimes, even when we want to, we can't say "yes" to every opportunity. We must cultivate our own identities, and set healthy boundaries with a "Do-Not-Do" list. A good mentor will support and uplift you, singing your praises and facilitate your growth by referring you for that opportunity to shine. A good mentee will continue to pay it forward, and not think transactionally. 

When we all lead, we all win.

• Like, Comment & Subscribe: How to use LinkedIn and other platforms to make meaningful connections

• The cold call / email: "You miss every shot you don't take"

• Square Peg, Round Hole: Bringing your expertise to a different table

• The "Yes" man / woman / person & the "Do-Not-Do" list

• "How can I support you?": Facilitating introductions & surrounding yourself with those who say your name when you're not in the room

Grace Kistner, RN, DTN, MMHA, BSBA, BSN, CCRN, CSSLHPM

June 2024

What's 'Op' Doc?

My Op-Ed (Opinion-Editorial) journey started with a LinkedIn post about the dangers of Physician Assisted Suicide laws that may disproportionately affect the vulnerable and marginalized. I had researched many of the unforeseen consequences of such a public policy and its effects around the world and so I responded to the post by the New York non-profit called Patient Rights Action Fund. They were concerned about contradictions between the Americans with Disabilities Act and a public policy that may make it easier to request Physician Assisted Suicide than to receive social services and disability accommodations, which was reported by a Canadian newspaper last year (Smith, 2023). They responded to my comments on their concerns with a request to testify for the upcoming Senate hearing on the topic, and later asked me to write an Op-Ed based on that testimony that they could publish before the bill was heard again in Connecticut. The bill has been heard fifteen times by the Connecticut General Assembly (Srinivasan, 2023). 

The “Opinion-Editorial” that runs opposite the editorial page, bridges gaps in public understanding of important topics that affect communities, written by an author who is not a regular member of an editorial board of the publication. The Op-Ed should be no more than 750 words, written for the lay person, and cannot include references, but can include hyperlinks to verify accuracy (Dean, 2009; Eliason, 2021; Patient Rights Action Fund, n.d.). The steps for writing an Op-Ed include:

1. Get to know the publication, its audience, and the types of articles and Op-Eds they have previously published (Dean, 2009). In my case, the non-profit took care of this, saving my Op-Ed for the next legislative session that included a bill for Medical Aid in Dying. They plan to send it to the largest newspaper in the state.

2. When a topic in the news inspires you and aligns with your expertise as a health care professional, move quickly. Timeliness is crucial to ensure publication while the topic is still being discussed in news reports (Dean, 2009). 

3. A successful letter is terse, avoids technical jargon, and is roughly the same length as other letters that the publication has published. It will include references to the event or article you are discussing (Dean, 2009). I am anything but terse, which caused numerous rewrites and an editing spree by the non-profit and my mother-in-law, an English Literature major with a knack for cutting my sentences in half, while removing all the forms of verbosity for which I am famous. Paragraphs cannot look like they came from the Department of Redundancy Department. 

4. State your objection, clarification, amplification, related ideas, and whatever else you might want to communicate (Dean, 2009). You are telling a story and why this is important to the community. I discussed worldwide unintended consequences of the pending legislation and why this legislation would be difficult to implement. Personal stories are encouraged (Patient Rights Action Fund, n.d.). 

5. Provide information on how to contact you, reasons that you are an authority on the topic, such as that you authored a book on the topic or are the head of an organization that encounters the issue, etc. If you are a published author, this can be helpful for dissemination, but editors are wary of letters for this sole purpose (Dean, 2009). I included that I am a geriatric palliative care nurse practitioner, caring for suffering patients at the end-of-life, and a content reviewer for many worldwide textbook publishers of palliative care and hospice. 

6. Expect criticism, but also the rewards of teaching others to look at an issue in a new way, while explaining previously unheard viewpoints that the health care provider may have. Sketches or artwork are also welcome in many publications (Dean, 2009). My favorite, a Los Angeles Times Op-Ed about palliative care and end-of-life, included sketches and artwork by the author depicting the struggles of caregivers with dying loved ones. The artwork told the story as much as the words that were written and was the most compelling feature of the Op-Ed (Gray, 2020). Always know, that as nurses, we are educators, and the Op-Ed is an opportunity to teach a new audience about a compelling topic that affects health care and future health policies, in the traditions of the Nurse Policy Entrepreneur (Polacek, 2023). 

References

Dean, C. (2009). Am I making myself clear: A scientist's guide to talking to the public. Harvard University Press.

Eliason, S. (2021, January 15). How I learned to write an Op-Ed. Canadian Family Physician. https://www.cfp.ca/news/2021/01/15/01-15

Gray, N. (2020, February 16). Op-Ed: Think you want to die at home? You might want to think twice about that. Los Angeles Times. https://www.latimes.com/opinion/story/2020-02-16/doctor-patients-send-home-to-die

Patient Rights Action Fund. (n.d.). Instructions to advocates in drafting opinion editorials, letters to the editor, and public testimony. https://patientsrightsaction.org/contact/

Polacek, M. (2023, June 6). The nurse policy entrepreneur as a full partner in healthcare policy reform. Sigma Theta Tau International. http://hdl.handle.net/10755/23185

Smith, W. J. (2023, June 23). Canadian disabled woman opts for euthanasia because she can’t get timely assistance. National Review. https://www.nationalreview.com/corner/canadian-disabled-woman-opts-for-euthanasia-because-she-cant-get-timely-assistance/

Srinivasan, S. (2023, January 19). Grieving family members plead for CT legislators to pass aid in dying bill. CT Mirror. https://ctmirror.org/2023/01/19/ct-aid-in-dying-bill-advocates-general-assembly/

Leah D Ward, MSN, MA, AGNP-C, ACHPN

Leah is a DNP student at Western Connecticut State University with plans to graduate at the end of 2024, content reviewer for worldwide publishers, geriatric palliative care NP in Northwest Connecticut long term care, and serves the Connecticut Organization to Advance Palliative Care Board of Directors

May 2024

What’s on the Café Menu?

The Foundation for Developing into a Policy Entrepreneur

Before heading off on the journey policy making, one will benefit from creating a personal professional development. This plan will never be complete and continuously be revised as pertinent skills and strategies will emerge because of experiences along the journey. 

One of the problems with becoming a Nurse Policy Entrepreneur (NPE) is that we often do not have a good sense for how the healthcare policy making and implementation system works and what we need to learn to become effective in that system. Readiness to become an agent of change starts with being internally driven to act—your why must inspire you to act. Next comes a spirit of curiosity about how to go about it, being prepared to be that agent. Presuming that you are already prepared can be as disappointing as feeling like you are not good enough to act. Others will recognize the hubris.

Assess yourself to determine what skills you have and what skills you should develop. These categories and concepts are certainly not exhaustive and there is room for improvement—but it’s a starting point. 

Before heading off on the journey policy making, one will benefit from creating a personal professional development. This plan will never be complete and continuously be revised as pertinent skills and strategies will emerge because of experiences along the journey. 

One of the problems with becoming a Nurse Policy Entrepreneur (NPE) is that we often do not have a good sense for how the healthcare policy making and implementation system works and what we need to learn to become effective in that system. Readiness to become an agent of change starts with being internally driven to act—your why must inspire you to act. Next comes a spirit of curiosity about how to go about it, being prepared to be that agent. Presuming that you are already prepared can be as disappointing as feeling like you are not good enough to act. Others will recognize the hubris.

Assess yourself to determine what skills you have and what skills you should develop. These categories and concepts are certainly not exhaustive and there is room for improvement—but it’s a starting point. 

Becoming a Nurse Policy Entrepreneur shares basic qualities of a business entrepreneur who is internally driven to figure out how to transform their vision into a reality. A very wealthy man once told me this, “Where you are at in five years from now depends directly upon what you read and who you associate with.” Make it a point to start reading how to become an agent of change as well as devoting time to reading and writing to expand your understanding of the healthcare issue that drives you to act. 

Do not fall to the temptation of skipping the exercise of reading relevant textbooks and articles! I knew an Olympic sprinter from Trinidad who had a body that looked like it was sculpted from marble. I watched one of his four-hour work outs and realized that there was some congenital talent, but success is impossible without the insane level of hard work. Thomas Edison said this about genius, “Two per cent is genius and ninety-eight per cent is hard work.” One can certainly be successful without hard work, but that gap is unavoidably obvious during a deep conversation. Start by developing a personal professional development plan and set goals for yourself.

There are several texts (there may be newer editions) that can help you become ready to enter the playing field of healthcare. There are many books available. Here are four that that I have used:

There is so much richness in these books that it might seem overwhelming. That may be especially true if you are currently in school, or can are triggered by the memory of overwhelming reading assignments when you were in school. Create a reading plan of your own development that might focus on a particular aspect of policy making such as how a bill becomes or does not become a law. Or perhaps how to analyze a current policy so you understand the capacity to intervene, history, current efficacy, and potential future interventions.

Nothing comes from nothing and now is always the best time to start something of importance!

References

Boykin, A., Schoenhofer, S., & Valentine, K. (2013). Health care system transformation for nursing and health care leaders: Implementing a culture of caring. Springer Publishing Company.

Curran, C. R. (2016). Nurse on board: Planning your path to the boardroom. Sigma Theta Tau International 

Patton, R. M., Zalon, M. L., & Ludwick, R. (Eds.). (2022). Nurses making policy: From bedside to boardroom. (3rd ed.) Springer Publishing Company.

Short, N. M. (2021). Milstead's health policy & politics. (7th ed.) Jones & Bartlett Learning

Michael J. Polacek, DNP, RN, PMH-BC, NPD-BC

Apr 2024

Political and Personal Lessons of Policy

Summer of 2023 I joined a campaign to unseat our local State Senator. A neighbor identified a candidate to run because our recent, now past State senator, had not supported any sensible gun legislation. While my part was small, I wrote postcards that went out to individuals in our jurisdiction. I paid for the stamps as well. I attended events in support of his candidacy. 

My local area developed a Homeless Task Force Summer of 2023. I applied, but was not accepted to serve. The public is permitted to attend meetings, but without a voice. Video versions of the meetings are available online. After attending several meetings, without a voice, I sent a letter of suggestions to the Mayor and a member who was developing a questionnaire for the homeless. Surprisingly my comments were well received. Suggestions for additional questions to be added to the questionnaire were based on my experience on Assertive Community Treatment (ACT). 

At a house party for a candidate, I had a conversation with a woman that previously I had never spoken with, but knew she had served on our school committee. I didn't know at the time she was an MSW/Attorney and on our local Continuum of Care Committee (CCC). We talked about homelessness, the task force, the responsibilities of our local mental health department. I referenced that Boston had a Homeless Court system. Homeless Court was a new concept for her and she was interested. When I got home I sent her a video from YouTube of interviews with the Judge of the Boston Homeless court. The judge had been my daughter's soccer coach before we moved. A google search revealed that a number states in the U.S. have homeless court systems. 

So all this has led to me, the mayor and the MSW/attorney emailing back and forth, recommending books to each other. The mayor has found it of interest that many of the homeless grew up in the foster care system, so this led me to a recently published book on the topic of dismantling the foster care system in favor of supporting healthy families. 

In her book DOPESICK, author Beth Macy highlights the local program of intensive case management and substance abuse treatment in our local detention center. Peer Support case managers are essential team members. As of today (March 26, 2024), our Homeless Task Force will recommend that a Homeless Court Docket for individuals with repeated misdemeanor charges be implemented..Case managers typically work with these individuals to assist in accessing resources including housing. 

Lessons learned here, policy is political, and policy is personal.

Susan Jacobson MS, APRN, PMHNP

Mar 2024

Don't Stop Believing You Matter: Be an Agent of Change

Sir Winston Churchill once said, "continuous effort—not strength or intelligence—is the key to unlocking our potential." I found out the hard way that the hospital I worked at did not have a policy for how to handle a situation after a staff member was assaulted. Because I had such a bad experience, as a healthcare worker that was assaulted at an organization without a policy in place to support me, I decided to write one. 

I collaborated with one of my colleagues that had significant experience working in high violence areas in hospitals in Oregon. Together, we authored a policy that we submitted to the hospital for what to do after staff have been assaulted. It was easier than I thought to do this: and then the next time (and hopefully the last time) that I was assaulted, the charge nurse in the emergency department responded to the post-assault holding a copy of the policy that I had helped author. It was good to see that I was able to make something good come out of a traumatic situation; so that hopefully the policy makes the organization handle similar unfortunate events better: so people feel supported and know they aren't alone during such a difficult time.

The fact that there was no policy in place was a barrier to my recovery initially, because it meant I had to figure things out on my own. I needed to go to get a follow up for a head injury, and I did not know that I was supposed to make an appointment with a specific department at the hospital. I had thought the follow up would be with employee health, in fact, it was a different side of the same building where staff saw workers compensation cases. Due to not knowing where to make the right appointment, I was suffering from a concussion that wasn't diagnosed in a timely manner due to a lack of communication and direction on where to follow up after the assault at work. In this case, the lack of adequate post-assault support and supportive policy led to my medical and mental health deteriorating after the assault.

Now that the organization has implemented the policy, my hope is that after future assaults on staff, that the policy I helped write for what to do to help staff post-assaults will help others have a safer, more supported experience than I did. The steps that led to this policy creation and implementation were not difficult to do, but it did require persistence. With the input and some feedback from one of my nursing professors, colleagues and mentors, and a final review and approval from the organization: the new post-assault policy is now implemented and is (hopefully) being utilized in the unfortunate cases where healthcare workers are assaulted on the job.

Currently, I am working with legislators to advocate to implement policies at a statewide level that will create safer, trauma-informed care environments for healthcare workers that have been assaulted. I've learned more about the session lengths here in Oregon. On the even years, the legislative session is only 35 days, on the odd years, the legislative session is 165 days. This is helpful because I know I will be able to get more work done with my legislators during the odd years when we have more time. I agree with Sir Winston Churchill: it is indeed the repeated efforts, not intelligence or strength, that is key to unlocking our potential for change and creating a better world. 

Ruthy Lindvall, BSN, RN, PMH-BC

Feb 2024

Think Outside of the Box

en·tre·pre·neur / äntrəprəˌno͝or

Origin: mid 18th century (denoting a person who undertakes a project): from French, from entreprendre ‘undertake‘

The term "entrepreneur" has been synonymous in modern history with starting a business. However, a business is not limited to a storefront selling goods. Consider the businesses of healthcare: hospitals, care facilities, insurance companies, provider groups, medical equipment and supplies, wellness products, pharmacies, etc. There are two sides to the health industry coin: business operations requiring management and care delivery that requires leadership. It's important to make the distinction between the two. Entrepreneurs can undertake projects on both sides, and nurses are well-positioned to lead effective care delivery with efficient business operations management.

Nurses think outside of the box. We are masters of the work-arounds, rejecting the status-quo of "this is how it's always been done" and artistically embracing the notion that there is more than one way to effect change. We have keen insight to what our patients and populations need, the scientific evidence for best practice interventions, and the compassion to provide person-centered care. Utilizing these wholistic lenses, we act as interdisciplinary diplomats navigating bio-socio-eco-politico- (every-o) determinants of health. Policy doesn't always mean politics.

So why is the "Nurse Policy Entrepreneur" identity underdeveloped? Since Florence Nightingale's time, the perceived image and professional role that nurses take-on have morphed behind the scenes. Despite our high levels of training and engagement, the face of healthcare tends to illuminate nurses as angels that follow doctors orders and pass medications. Only after being a first witness to the frontlines does one see the commitment, critical thinking, and choreography that nurses provide day-in and day-out as the backbone of health systems strengthening. We know our capabilities, we have maintained trust, and at almost 30 million worldwide we can inform health-in-all-policies at every level and in every setting. First, we must educate and advocate for our own development and in our own styles.

I was finishing my last semester of my business degree when I realized that I wanted to be in healthcare, and quickly determined that nursing was the discipline that aligned with my vales best. Looking back, I can't recall a single moment that called me into the profession. As I've learned more about it, myself, my family history, it's almost as if I was born a nurse and it slowly came into realization in my twenties and continues to become more and more clear every day. The ethos of nursing, everything that it encompasses, runs through me. My soul is nourished and positively charged by it like the nutrients carried through my blood and the electricity innervating my body. This passion is what I bring to every capacity in which I have practiced. Right out of school I was thrilled with the intensity of critical care units. I gained expertise of life support for every organ system and was quickly certified in multi-specialty care. Just as quickly, I wanted to improve nurse-driven policies at the unit level - I created a new-to-specialty orientation for new-grads like me and experienced nurses entering the ICU for the first time. It helped them hone their passion and follow a development track for cardiothoracic and neuro-intensive surgery care. I also represented my ICU in an interdisciplinary, multi-department Rapid Breakthrough Improvement process for decreasing "door-to-needle" time for patients suffering acute stroke that, after showing success in a Plan-Do-See-Act test period, was rolled out system-wide in the second largest healthcare system in the state. Taking my first nursing role beyond borders, I represented the Midwest region in the 2015 Surviving Sepsis Campaign. This kicked off a bigger expansion of my practice over the better part of the following decade when I traveled around the country working for over ten hospital systems with various populations, and grew into leadership roles volunteering in clinical trips across eight countries.

My NPE journey started before I realized it, like a kindling fire slowly growing a burning flame of passion inside of me. The vast and diverse experiences that I have had have given me a unique understanding of the broader scope and intersectionality of determinants of health, and has driven me to match that level in my advocacy. I know I can affect change more than by just one patient at a time from the bedside. In October of 2022 I found this NPE Café in my search for formal, professional recognition and acumen in all of my combined experiences. I thought if I could just find a program to put at the top of my long résumé or more credentials behind my name, it would be enough to give me the credibility to work in this capacity and earn a seat at decision-making tables. I spent months in a deep search that only built up frustration: I couldn't get credentials without already being in management, I didn't work for a single organization to climb into that role or be sponsored for training, and - even if I could justify the mortgage of another student loan - the problem with a Masters or Doctorate degree is that it didn't exist for what I was seeking. I don't desire bureaucratic management for profit-driven institutions, I don't support contributing to pay-walled siloes of research, and I can't teach future generations without being able to further my own education to qualify to do so.

I felt stuck, restricted, frustrated. When I spoke out about it, I realized that I was not alone. So many other nurses have felt this way at some point in their career. We often know what needs to be done, and find that we are climbing an uphill battle to effect change. For me, it was a combination of passion, determination, and the curiosity to ask "why?" (or sometimes, "why not?"). Why wasn't I successful? I was failed. The pathway didn't exist, but I could see all of the parts needed to create it. Instead of trying to re-invent the wheel, I thought outside-of-the-box and reorganized them to innovatively design a program for all of the nurses like me. Today, I am continuing in that entrepreneurial spirit: presenting at international conferences, collecting surveys of market research, developing prototypes for testing, and pitching to potential partners for targeted roll-out. I also continue to self-curate my own education journey, utilizing the power of accessible and affordable on-line formats, which refines my lived experience and more truly encapsulates my translational skills. Moreover, I'm earning my "PhD in Volunteering" - inserting myself into networks of like-minded disrupters who want to see a healthier world and take action to build it. At first, I wanted to go fast - but I felt alone. Together in a network we can each go farther. When you speak your truth and live your passion, connections will grow organically and opportunities will arise. 

Before you know it, you're a Nurse Policy Entrepreneur.

Grace Kistner, RN, DTN, MMHA, BSBA, BSN, CCRN, CSSLHPM

Jan 2024

Nurse Policy Entrepreneur: Get Started

The best way to get started with any endeavor is to begin with a spirit of curiosity or inquiry. In this case, that means asking yourself many questions and self-reflection. I am barely a notch above novice, but I have had some experience working on community projects with other disciplines, participating in legislative processes, and have served on several boards of directors. So, I have had to trudge through some grim times adjusting to the playing field of policy making.  Because I had no previous preparation or mentorship, there were times when I was simply out of my league.

My why changed as I dove into policy making. Initially, my hot button was suicide prevention and advocating for the implementation of trauma-informed science. I began by reading and taking related courses as much as I could about both. In addition to completing the APNA suicide prevention training twice, mental health first aid, and became a certified instructor for QPR suicide prevention gatekeeper training. Then I conducted a personal survey for all the organizations in my home state that focused on trauma-informed science and suicide prevention.

Eventually, I decided that the American Foundation for Suicide Prevention was the best vehicle to contribute as a policy maker for suicide prevention. After volunteering at events, I was selected to serve on the state board of directors as president. Among other great activities, we collaborated with the State Department of Corrections to conduct several Out of Darkness Walks inside prisons with inmates and correctional officers. Both populations have high rates of suicide and until these walks, there was virtually no community support. This was great work that inspired me to do more.

At about the same time, I was introduced to PACEs Connections which had been affiliated with the Robert Woods Johnson Foundation. This NGO offers a powerful networking tool to connect communities seeking to advance trauma-informed science. With the help of my peer Ruthy Lindvall, we established a blog and information-sharing platform for a community. Nearly 500 communities are using this platform nationally and internationally. Networking with other policymakers can help you focus on tried interventions and avoid missteps.

As I continued with other local efforts, both public and private, including work on a study of nurses on boards in the state, my Why changed. There were no nurses involved and that was a clear problem.

Curious and somewhat self-conscious about my lack of skill set, I generated a personal/professional development plan. My ability to speak in a group was pathetic, driven by anxiety and a lack of experience. I had no idea how to perform on a board of directors or in group decision-making entities. I had gained a degree of expertise on my primary Why, but I had to revise my plan to raise awareness for nurses to become engaged in policy making. This resulted in writing and publishing papers. Writing helps you organize your thoughts so that when you speak, the words are there.

Here is my list of how to get started.

• ·         Clarify your Why and develop an expertise—READ and WRITE about it.

• ·         Create a personal/professional development plan—Write it down and expand upon it as you go.

• ·         Find out what organizations share your Why and join up—get on a board as soon as possible.

• ·         Learn everything you can about how to be a competent board member—learn Roberts Rules

• ·         Practice speaking whenever you can know it might be rough initially—join Toastmasters Int.

• ·         Present your Why in every venue possible—teach it and present it at conferences

• ·         Purposefully seek out people with the skills, knowledge, or networks that you need to learn and advance your Why.

Michael J. Polacek, DNP, RN, PMH-BC, NPD-BC

May 2023

The NPE as a Full Partner in Healthcare Reform