Nursing’s Social Policy Statement
Catherine E. Neuman MSN, RN, NEA-BC
Overview
Nursing is a part of the society from which it grew and continues to evolve. As a profession, nursing is valued both within and outside that society. From the time of Florence Nightingale’s Notes on Nursing: What It Is and What It Is Not in 1859 and the work of Virginia Henderson in 1961, the nursing profession has been responsive to the needs of society. Continuing this tradition, in 1980 the American Nurses Association (ANA) published the first Nursing: A Social Policy Statement (ANA, 1980), which was updated in 1995 as Nursing’s Social Policy Statement. In 2003, ANA published the second edition ofNursing’s Social Policy Statement. Subsequently in 2010, ANA published Nursing’s Social Policy Statement: The Essence of the Profession (ANA, 2010a), which articulates the ways in which contemporary nursing as a profession is valued within U.S. society and is uniquely accountable to that society. As with its predecessors, the current edition provides helpful information to nurses, other health professionals, legislators, regulators, members of funding bodies, and the public. This new guide presents a summary of each section, followed by a discussion of how each social policy statement applies to nursing practice.
Social Context of Nursing
Nursing continues to evolve, but it has always been an essential part of the society from which it grew. Nursing is responsible to society because its professional interests must be perceived as serving the interests of society. Professions,
including nursing, are the property of society, not of the individual. What individuals acquire through training (education) is professional knowledge and skill, not a profession or even part ownership of one (Page, 1975, p. 7).
including nursing, are the property of society, not of the individual. What individuals acquire through training (education) is professional knowledge and skill, not a profession or even part ownership of one (Page, 1975, p. 7).
Nursing is dynamic rather than static and reflects the changing nature of society’s needs. As health care continues to be of utmost importance in the United States and throughout the world, nursing provides a leadership role in guiding the public and political leaders in the following areas:
Organization, delivery, and financing quality health care Quality health care is a human right for all (ANA, 2008). It is expected that healthcare professionals address the increasing costs of health care; the ongoing health disparities; and the continuing lack of safe, accessible, and available healthcare resources and services.
Provision for the public’s health
This provision promotes the responsibility of nursing to supply basic self-help measures for all, and it enhances the use of health promotion, disease prevention, and environmental measures.
Expansion of nursing and healthcare knowledge and appropriate application of technology
Evidence-based practice, including the incorporation of research and evidence into nursing practice, promotes the application of knowledge and technology into healthcare outcomes.
Expansion of healthcare resources and health policy Expanded facilities and workforce capacity for personal care and community services are required to accomplish this goal.
Definitive planning for health policy and regulation Collaborative planning must be responsive to the needs of healthcare consumers and must provide resources for the health care of all members of society.
Duties under extreme conditions
Healthcare professionals provide care under extreme conditions, thereby weighing their obligation to provide care with their own health and that of their families during emergencies.
Social and political priorities for nursing include addressing the cost and quantity of healthcare services, along with having regulatory bodies provide various types of guidance. For example, both The Joint Commission and the Centers for
Medicare and Medicaid Services (CMS) set standards for expected quality of care. Others, such as the Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI), provide guidelines and protocols to attain quality and better outcomes.
Medicare and Medicaid Services (CMS) set standards for expected quality of care. Others, such as the Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI), provide guidelines and protocols to attain quality and better outcomes.
Authority for nursing is based on a social responsibility, which derives from a complex social base and social contract. Nursing’s social contract reflects the long-standing core values and ethics of the profession, which provide grounding for health care in society.
There is a social contract between society and the profession. Under its terms, society grants the profession’s authority over functions vital to itself and permits them considerable autonomy in the conduct of their own affairs. In turn, the professions are expected to act responsibly, always mindful of the public trust. Self-regulation to assure quality and performance is at the heart of this relationship. It is the authentic hallmark of the mature profession. (Donabedian, 1976, p. 8)
Today’s contemporary society—as a result of apathy, depersonalization, disconnectedness, and growing globalization—sometimes encourages nursing to overlook this contract. Society validates the existence of the nursing profession through licensure, legal and legislative parameters, and public affirmation. This profession fulfills the need of society for qualified individuals who provide care according to a strong code of ethics to all in need, regardless of their social, cultural, or economic status.
The public has recognized nursing as one of the most-trusted professions. This trusted position imposes a responsibility to provide the very best health care, which requires well-educated, clinically astute nurses and a professional association composed of those nurses, which establishes a code of ethics, standards of care and practice, educational and practice requirements, and policies that govern the profession. The ANA, which is the professional organization for nurses, performs a critical function in articulating, maintaining, and strengthening the social contract that exists between nursing and society, thereby supporting the authority to practice nursing. Elements that undergird nursing’s social contract with society include the following (ANA, 2010a, pp. 6-7):
Humans manifest an essential unity of mind, body, and spirit.
Human experience is contextually and culturally defined.
Health and illness are human experiences. The presence of illness does not preclude health, nor does optimal health preclude illness.
The relationship between the nurse and patient occurs within the context of the values and beliefs of the patient and nurse.
Public policy and the healthcare delivery system influence the health and well-being of society and professional nursing.
Individual responsibility and interprofessional involvement are essential.
The nursing profession focuses on establishing effective working relationships and collaborative efforts, which are essential to accomplishing its health-oriented mission. Many factors contribute to intensifying the importance of direct human interactions, communication, and professional collaboration: the complexity, size, and culture of the healthcare system and its transitional, dynamic state; an increase in public interest and involvement in health policy; and a national focus on health. Collaboration means true partnerships—partnerships that value expertise, power, and respect for all and partnerships that recognize and accept separate and combined spheres of activity and responsibility. To be successful in this arena, nursing needs to respond to diversity by recognizing, assessing, and adapting the nature of working relationships. Such relationships may be with individuals, with populations, with other health professionals, and with health workers, both within and between nurses and public representatives in all areas where nursing is practiced.
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