Public health policy conversations rarely include nurses. They should.

The COVID-19 pandemic has highlighted the critical role nurses play in health care: millions of nurses around the world have been essential care managers on the front lines of the global health crisis. Yet in the public health policy debate, advocates say, nurses have historically been left out of the conversation, unrepresented in media coverage, health care leadership, government and academic publications. .

In a recent article published in the American Journal of Public HealthJennifer Morone, a nurse and researcher with the National Clinical Fellows Program at Yale School of Medicine, and her colleagues explore this historic and frustrating phenomenon and what can be done about it.

Morone sat down with Yale News to discuss possible strategies to increase nurses’ visibility, including focusing more on policy work during training and promoting the expertise of these vital healthcare providers in the media.

This interview has been edited and condensed.

How big is the nursing workforce?

Jennifer Morone: There are 5.8 million nurses in the United States, representing one of the largest job sectors in the country. That’s a pretty sizable portion of the US population that could have an incredible impact.

Her article describes how nurses have been systematically excluded from public health policy debates. Where is this underrepresentation most evident?

Morone: This has been a systemic and historical problem. It has been perpetuated by the media and media outlets not turning to nurses for expert opinions. But we also find that universities and health schools are not promoting nurses when they are asked for health-related experts.

Compounding this is the perpetuation of perceptions of what nurses do and who nurses are in the media, including magazines, newspapers, television shows and movies. This misrepresentation then feeds into a false narrative about nurses as predominantly secondary helpers, lacking authority, agency, and content expertise. In contrast, nurses are incredibly skilled and independently trained in a variety of settings. And yet, they are not derived from these expert opinions or perspectives.

Nursing is and has been predominantly a female-driven profession. And as we see with many other female-driven professions, there have historically been fewer opportunities in leadership positions or influential positions that can inform policy.

When you look at the public health and healthcare sectors, there is a discrepancy with the number of nurses who are in leadership positions. The number of nurses in congressional and representative leadership positions within government and within the health care industry is also significantly small given the number of nurses in this country. Nursing is not only one of the largest workforce sectors, it is also the largest healthcare and support profession within healthcare and public health. It seems a bit odd that we are not asking the majority cross-section of the population to weigh in on decisions and hold leadership positions, which suggests there are more systemic drivers.

How does it feel, as a nurse, to be ignored like this?

Morone: From a personal level, I would say that it is really hard to see yourself and your colleagues, who are incredibly capable, skilled and amazing doctors and thought leaders, being overlooked or not even considered for leadership positions that are really influential. to achieve changes within health facilities, community health and public health.

What is the public missing when nurses are not included in these conversations?

Morone: We bring a unique perspective that is different from medicine. We work alongside doctors, side by side, and it is an interdisciplinary effort to carry out health care. And all the components that our medical colleagues learn—the physiology of the disease, the treatment plans, the medications, the procedures, how to carry out care—the nurses have to learn as well. In addition, nurses play a critical role in creatively and resourcefully adapting prevention and care to a person’s life. Therefore, we are capable not only of evaluation, but also of diagnosis and treatment. And I think that is lost.

Our roots have always been in holistic care and rooted in community advocacy, and we have strong ties to social work. Therefore, the inherently integrated medical and social perspective that nurses bring to a problem is different from the medical mindset. It’s not that one is better than the other. They are just different and equally valuable. And in recent years, greater emphasis has been placed on the need to improve health care and social integration by addressing the social and structural determinants of health. Nurses must be central to this national dialogue and decision making.

What are some potential strategies to address this problem?

Morone: One would be the integration of skills related to policy, awareness and advocacy in the classroom and practical training in educational settings for nurses. And I think nurses, from earlier in their careers, could be exposed to more role models in policy making and leadership.

Second, health care schools, whether nursing, medicine, or public health, could do a better job of promoting nurses as experts when the media seeks expert opinions. And the media should deliberately seek out nurses as health care and public health content experts and thought leaders.

Is there anything that people outside of these organizations and institutions can do?

Morone: People are already helping in one way, and that is by trusting us. Nursing has consistently been ranked as one of the most trusted professions in the United States. Trust is critical to achieving public health goals, as we have seen in the COVID vaccine efforts.

I think there are opportunities for people to promote the importance of having nurses on leadership panels, within schools, and on their community boards. If you don’t see a nurse involved in anything related to changing or preventing health care in your community, you might suggest that they seek representation from nurses.

And if you have nurses in your life, maybe give them a little more love and support and recognize the value of their training, knowledge and skill.

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