Advocacy Teaching

Nursing Is Social Justice Advocacy

As part of society, nursing has a social contract to provide care and nurturing to the well and to the sick as individuals, families, communities, and populations. Society allows nursing the authority and autonomy to manage the functions vital to nursing and in return nursing takes on the public trust to act responsibly on behalf of those being served (Donadedian, 1972). Components of autonomy have been identified as: control of the education of the practitioners of nursing, legal recognition of the practice, and development of standards of practice and a code of ethics (Kelley, 1985). This commitment to the care of individuals was shown in 1859 by Florence Nightingale in her Notes on Nursing: What It Is and What It Is Not: "What nursing has to do is to put the patient in the best condition for nature to act upon him." Nursing's long history of commitment to social issues and to the public it serves is exemplified not only by Nightingale but many other nurses as well through decades of war, epidemics, social upheaval, civil unrest, and victories for human rights (Dossey, 2000; Schorr & Kennedy, 1999).

This concept of social justice is not new. In many regards it has been around since the inception of civilization. It is often mentioned briefly after a discussion regarding ethics, often equated with what is fair or what is deserved or giving others what is their due. Many articles and books fail to define the concept beyond this notion of ethical fairness.

Social justice is often defined as the "equitable distribution of benefits and burdens in society" (Redman & Clark, 2002). Some references also define it as changing social relationships and institutions to promote equitable relationships. Social justice is concerned with equitable balance between societal benefits and burdens, implies that there are social rights and collateral responsibilities with those rights, and is essentially concerned with the fair distribution of the benefits and burdens of living together as a society.

In nursing education, the majority of sources regarding justice focus on the clinical preparation of undergraduate students to meet the needs of culturally diverse populations (Herman & Sassatelli, 2002; Leuning, 2001; Redman & Clar, 2002; Scanlan, Care, & Gessler, 2001) or global consciousness (Leuning, 2001, Messias, 2001). Nurses need to explore how they see others - as vulnerable or privileged. An awareness of social justice is an ongoing process. Nurses need to see the conditions around them and what is available to their patients.

Knowledge regarding social justice verifies that social groups are not treated equally in society. Social justice gives privilege to the most vulnerable group in an effort to promote justice within the society as a whole. A just health care system assumes a sound theory that places reasonable parameters on the rights claimed by individuals. It considers individual freedom versus communal well-being, and relevant and irrelevant differences when it comes to providing goods to society.

Nursing care involves social justice: who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it.

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Ten Reasons to Lobby for Your Cause »

The Current Political Environment for Nursing. The Cultures of Nursing and Policy-Making

Never before in the NLN's history has the organization, a leader in fostering critical thinking and participatory dialogue, been better poised to lead nurse educators into the complicated and justifiably necessary arena of politics. In 2010, Congress passed and the president signed into law comprehensive health care legislation that set the stage for nursing to take its rightful place in the strategic development and support of health care systems that improve the health and health care of the nation. These laws, the Patient Protection and Affordable Care Act (PPACA) (Public Law 111-148) and the Health Care and Education Affordability Reconciliation Act (Public Law 111-152), create the political context where nurses and nurse educators will find they can transform their former culture of nursing care into a potent force of policymaking through political advocacy and influence.

Underwritten by the Robert Wood Johnson Foundation (RWJF), the Institute of Medicine's (IOM) report, The Future of Nursing: Leading Change, Advancing Health, accepts that PPACA is basic social justice reform, representing "the broadest changes to the health care system since the 1965 creation of the Medicare and Medicaid programs." The IOM report explains that the study was undertaken to explore how the nursing profession can be transformed to help exploit the PPACA opportunities and contribute to building a health care system meeting the health needs of the US population in the 21st century:

What nursing brings to the future is a steadfast commitment to patient care, improved safety and quality, and better outcomes. Most of the near-term challenges identified in the health care reform legislation speak to traditional and current strengths of the nursing profession in such areas as care coordination, health promotion, and quality improvement. How well nurses are trained and do their jobs is inextricably tied to every health care quality measure that has been targeted for improvement over the past few years. Thus for nursing, health care reform provides an opportunity for the profession to meet the demand for safe, high-quality, patient-centered, and equitable health care services. We believe nurses have key roles to play as team members and leaders for a reformed and better-integrated, patient-centered health care system. (IOM, 2011)
The IOM report begins with the assumption that nursing can fill such new and expanded roles in a redesigned health care system. To take advantage of these opportunities, however, nurses must be allowed to:
practice in accordance with their professional training, and the education they receive must better prepare them to deliver patient-centered, equitable, safe, high-quality health care services; engage with physicians and other health care professionals to deliver efficient and effective care; and assume leadership roles in the redesign of the health care system. In particular, we believe the search for an expanded workforce to serve the millions who will now have access to health insurance for the first time will require changes in nursing scopes of practice, advances in the education of nurses across all levels, improvements in the practice of nursing across the continuum of care, transformation in the utilization of nurses across settings, and leadership at all levels so nurses can be deployed effectively and appropriately as partners in the health care team.(IOM, 2011)

Nurse leadership knowledge, skills, and abilities in civic engagement are a necessity for today's nursing. As an example, even as this section of the toolkit is being written, a just-released report published evidence that access to health care for adults is declining (Kenney et al, May 8, 2012). Funded by the RWJF, the study shows that the gap in care is more pronounced in states where political leaders oppose implementation of PPACA. States with higher un-insurance rates have worse access to care. The report states that "it appears that the health care safety net that is designed, in part, to serve those without coverage is not acting as an effective substitute for health insurance..." suggesting that "the potential benefits of the coverage expansion in [PP]ACA are large and exist in every state. The analysis also suggests that states that intentionally delay [PP]ACA implementation or are less aggressive in seeking to enroll people on Medicaid or subsidized exchange plans will not see the potential benefits of [PP]ACA as soon as states that move more aggressively to expand coverage." The research authors concluded "the repeal of the [PP]ACA, or a Supreme Court decision that blocks its key provisions, would likely result in continued deterioration in access for adults in almost all states."

Clearly it is through the development of public policy advocacy skills that nurses will discover their greatest potential for success. In comments from Dr. Eleanor Sullivan's book, Becoming Influential: A Guide for Nurses (2013), she states, "Although nurses might achieve success for themselves as they become influential, they have a larger goal — one beyond themselves — which is to be more effective in what they do and to influence health care" (p. 7). Likewise in accord with the IOM report (2011), it will be through this new role as health care policymaker, partner, and career professional, that nursing will have the potential to leave its most positive marks on society over the next 20 to 50 years.

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