The Warner reference is the only required reference for this question.
References
Warner, J. R. (2003).
A phenomenological approach to political competence: stories of nurse activists (Links to an external site.)
. Policy, Politics & Nursing Practice, 4(2), 135-143. https://doi.org/10.1177/1527154403251855
This week our focus is developing advocacy skills and political competencies. The Warner article in your Week 5 readings provides six areas where nurses must develop political competency and you will consider and write about these for the Week 5 Assignment.
For this discussion, share your plans for just one of the six areas. Just like in the assignment, make sure you include two very personal and specific action steps you plan to will take to become more competent in that area. You may include any pertinent webinars, workshops, joining professional organizations, or practical experience in your development plan.
Use an APA 7 style and a minimum of 250 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.
• Textbooks are not considered scholarly sources.
• Wikipedia, Wikis, .com website or blogs should not be used
ARTICLEPOLICY, POLITICS, & NURSING PRACTICE / May 2003
A Phenomenological
Approach to Political
Competence: Stories
of Nurse Activists
Joanne Rains Warner, PhD, RN, DNS
F
rom its historic foundation to its essential
core, nursing is political. Inclusion of
political participation in the professional
role has been evident throughout the
development of the profession, the evolution of
the health care system, and the changes in the
sociopolitical context over the years (Milstead,
1999). This fact, however, has not always been
understood or emphasized to the extent needed
for the public’s health or to maximize the
profession’s capability.
Politics refers to a process of “influencing the
allocation of scarce resources” (Leavitt & Mason,
1998, p. 9). It is a value-laden process intended to
be a means to an end, specifically, the preferred
decision or use of resources. Throughout history,
nursing has advocated for particular choices,
sought to influence decisions, and promoted val-
ues consistent with health and healing. Historic
examples of Florence Nightingale’s influence or
Lillian Wald’s activism were followed by more
contemporary examples of Nancy Milio’s advo-
cacy in Detroit and Sheila Burke’s decades in fed-
eral government (Leavitt, 1998; Leavitt & Mason,
1998; Milio, 1970). These individuals are joined by
a cadre of nurse activists who daily use persua-
sion and influence toward specific ends at work
and in their communities.
Nursing’s collective political development in
recent years indicates growth from an early “buy-
in” stage that emphasized political awareness and
a “call to arms,” to self-interest related to nursing
135
Political competence is the skills, perspectives,
and values needed for effective political
involvement within nursing’s professional role.
Political competence is requisite within nursing
to (a) intervene in the broad socioeconomic and
environmental determinants of health, (b)
intervene effectively in a culturally diverse
society, (c) partner in development of a humane
health care system, and (d) bring nursing’s
values to policy discussions. This pheno-
menological study used narratives of 6 politically
expert nurse activists to enhance our
understanding of political competence. Six
themes emerged from an analysis of the lived
experience of their political involvement. They
include nursing expertise as valued currency,
opportunities created through networking,
powerful persuasion, commitment to collective
strength, strategic perspectives, and perseverance.
These themes can inform development toward
greater political efficacy for individual nurses
and for the profession collectively.
Keywords: political activism; political compe-
tence; phenomenology
Policy, Politics, & Nursing Practice
Vol. 4 No. 2, May 2003, 135-143
DOI: 10.1177/1527154403251855
© 2003 Sage Publications
issues, to political sophistication and active work
on health issues beyond nursing. The final stage in
this model has involved proactive leadership of
interdisciplinary coalitions focusing on broad
health concerns (Cohen et al., 1996). This progres-
sion has not been strictly linear, nor have the
stages been mutually exclusive, but the stage of
interdisciplinary leadership positions nursing in a
more prominent and influential role. How can the
profession continue to advance in political devel-
opment? Cohen et al. (1996) suggest it “requires
an examination of preconceived notions about
‘appropriate’ political behavior bringing new
vision to political action” (p. 265). One step
involves clearly understanding the behaviors
involved in effective political action. What is polit-
ical competence for professional nursing? What
are its components or elements? How would
political competence manifest itself when demon-
strated by faculty members, practicing nurses, or
students?
This article describes a qualitative research
study aimed at exploring the set of skills called
political competence as reflected in the stories of 6
politically expert nurse activists. A summary of
the literature that provides the rationale for nurs-
ing’s political competence precedes a description
of the six common themes that emerged in this
study. Implications for the profession are drawn
from the data.
WHY POLITICAL
COMPETENCE
The call for nursing activism within policy and
political work is suggested by several factors. The
most compelling rationale for nursing involve-
ment in policy is derived from a broad under-
standing of the nature of health. Increasingly, evi-
dence links health status to psychosocial factors,
environmental conditions, gender stratification,
and cultural-economic issues—factors outside of
the health care arena per se (Amick, Lovine,
Tarlov, & Walsh, 1995; Reutter & Williamson,
2000). The Pew Health Professions Commission
(1991, 1995) envisions practitioners by the year
2005 incorporating this broad perspective of
health into their care and addressing root causes
of physical and social environmental hazards that
threaten health. Strategies to accomplish these
goals often involve political action and policy
development. Reutter and Duncan (2002) describe
a shift in perspective on policy advocacy that
places greater emphasis on nursing’s involvement
in reform of the social and economic factors that
influence health. Nurses need to engage in politi-
cal work if they are to influence the determinants
of and the environments for health.
Another perspective on the linkage among
nursing, health, and politics is seen in the cultural
context (Leininger, 1995). The power and politics
embedded in each culture strongly influence
many factors that are importantly related to
health, such as family social structure, religious
traditions, and accepted norms/behaviors.
Nursing professionals need to understand the
sources of power and patterns in politics to effec-
tively promote health and prevent disease in a cul-
turally effective way. This is true within the prac-
titioner’s native culture and even more important
within a culturally diverse global society.
This cultural dimension of power and politics
also strongly affects the nature of nursing practice
and caring, which expands the rationale for nurs-
ing’s political involvement to shaping the profes-
sion and delivery of care. The Pew Health Profes-
sions Commission (1991, 1995) charges health
practitioners with the improvement of the health
care system. To continually improve the quality
and accountability of the health care system, prac-
titioners need to understand the political, socio-
economic, and legal determinants of the system
and have the requisite political skills to intervene
appropriately. Nurses collaborate in three ways in
the creation of new and improved delivery sys-
tems: “with individuals in the process of care;
with communities in the creation of health; and
with their health care colleagues in the develop-
ment and implementation of service” (Sigma
Theta Tau International, 1996, p. 18). These part-
nerships and responsibilities require political
competence.
Another important benefit of political activism
is to bring nurses’ values to the political discus-
sions and decisions. Backer, Costello-Nickitas,
Mason, McBride, and Vance (1998) note that nurs-
ing brings an emphasis on the values of caring,
equality, multiculturalism, connectedness, and
power sharing to policy and political discussions.
Gebbie, Wakefield, and Kerfoot (2000) note that
136 POLICY, POLITICS, & NURSING PRACTICE / May 2003
nurses bring knowledge of how policy decisions
affect real lives and have a grounding in clinical
practice.
Nurses’ strong beliefs in the capacity and
importance of people to care for themselves
distinguish nurses from other health professions
that share many of the same skills. This belief
becomes an orientation toward policy action to
enable people to help themselves. (p. 311)
Without the voice of nurses, this perspective may
be missing. Nursing values can expand and enrich
the decision-making process.
As the contemporary health care context
becomes increasingly politicized, nurses’ political
competence will be vital to improving the health
of the public at individual and collective levels.
Political skills will also be crucial in improving the
health care system, maintaining a strong profes-
sion, and bringing nursing values convincingly
into policy formation.
METHOD
This phenomenological research study used
narrative and “rich descriptions” of the activities
of politically seasoned professional nurses to
enhance understanding of the concept of political
competence. This approach involved an in-depth
analysis of the “conscious lived experience” of
everyday policy work and political involvement.
From this analysis emerged the elements that
people can consider the common understanding
of political activity (Fain, 1999). Benner (1994)
describes interpretive phenomenology as a partic-
ularly rich method for understanding “nursing
science, nursing practice, the lived experience of
health and illness, and health care ethics and pol-
icy“ (pp. xiii-xiv).
A purposive sample of 6 nurses was chosen to
tell their stories of political activity. Each activist
had published in national peer-reviewed journals
or books on the topic of political or policy involve-
ment. This group had had extensive experience,
variously including appointed and elected office,
organizational leadership, electoral campaigns,
congressional internships and staff positions, and
federal health care reform activities. Purposive
sampling assured that the data would reflect the
lived experience of political competence.
Consent was obtained according to the Institu-
tional Review Board guidelines. Each nurse was
interviewed in person or over the telephone; inter-
views were audiotaped and transcribed verbatim
to increase reliability. Each nurse was interviewed
at least once; three were interviewed twice for fur-
ther clarification and elaboration. The resulting
data came from over 500 minutes of conversation
and narrative.
The interviews involved open-ended state-
ments such as “Tell me a story about a time you
were in a situation where you were able to make
something happen because you had political
skills” and “Tell me about a time when something
happened wrong in your political work.” They
were prompted to “Tell me a story about being
political as a nurse as you tried to promote health
and well-being.” What resulted were stories or nar-
ratives about being politically competent. “Narra-
tive accounts of everyday skills comportment
allow participants to describe their everyday con-
cerns and practical knowledge, thereby giving
access to practical worlds” (Benner, 1994, p. 112).
Analysis of the transcribed interviews involved
a search for reoccurring themes and meaningful
patterns. Six themes emerged from the data as
dimensions of political competence. These themes
respectively emphasize the importance of nursing
expertise, networking, persuasion, collective
action, a broad perspective, and perseverance. To
enhance validity, a nurse researcher skilled in nar-
rative pedagogy and phenomenological research
independently reviewed the data and validated
the themes identified by the author.
SIX THEMES EMERGING
FROM THE NARRATIVE
Six themes drawn from the narratives were rep-
resented in almost all of the interviews. These
themes richly describe nursing involvement in
politics and policy formation and present ways to
demonstrate political competence. Each is dis-
cussed below along with supportive quotes from
the interviewees.
Nursing Expertise
as Valued Currency
In political interactions, participants must have
something to “bring to the table” and use in the
Warner / STORIES OF NURSE ACTIVISTS 137
process. For all interviewees, the most important
currency they brought was their nursing exper-
tise, which included clinical experiences with pol-
icy implications and connections, as well as the
unique values and skills acquired in nursing
socialization.
Being a professional nurse, I’ve found that
political leaders and government officials were
immediately interested in what I had to say. I
could speak from personal experience and that
put me a notch up in the discussion. It gave me
clout on the issue. (Nurse A)
Based on her experience organizing a national
network of nurses, one interviewee noted that
“nurses are incredibly good at interpreting policy,
talking to their members about it, and making the
connections” (Nurse A). She further explained
that these interactions between nurses and elected
officials included clinical stories and data.
Another interviewee noted that she knew how to
get information and use it effectively (Nurse B),
and another said, “You can change people’s
minds with facts” (Nurse C). Each expressed a
sense of valuing this nursing voice and using it to
further political causes.
Besides the knowledge and clinical examples,
nursing education and experience had given these
individuals certain very useful skills. “Nursing
gives you observational skills, lots of information,
and experience making quick decisions. . . .
Nursing is balancing competing priorities and
looking for ways for everyone to win” (Nurse D).
Another discussed nursing as excellent prepara-
tion for the legislator role: “We are very versatile.
We are able to grasp complex issues and keep
many things on the plate at one time” (Nurse C).
During a federal internship, one participant real-
ized that her professional skills, related to leader-
ship, communication, and “the ability to tackle
problems and make things happen in a wide vari-
ety of settings,” equipped her for participation in
health policy making (Nurse F). Another recog-
nized the importance of “clarity about your val-
ues, vision, and yourself—which comes from
nursing” (Nurse D).
Nursing’s credibility with legislators was
viewed as similar to that with the general public—
very high (Nurse C). One story about being hired
for a political campaign demonstrates that
confidence:
She said, “You are hired,” and I said, “You don’t
even know me.” She said, “It doesn’t matter; ANA
was the first group to endorse me. I know that if
you are a nurse you can do this job.” (Nurse B)
All of the participants believed that being visi-
ble as a nurse was an advantage. One credited her
reelections to a partisan committee to the one-
word descriptor by her name on the ballot: nurse.
Another proudly began one interview by saying,
“I am a registered nurse,” as if that was the way
she began all of her stories (Nurse D). Their nurs-
ing expertise and experience was the valued cur-
rency they spent in their political interactions.
Opportunities Created
Through Networking
Networking was a second theme mentioned by
all study participants. Networking involves estab-
lishing and maintaining relationships and was
described by one interviewee as the “backbone of
success in policy and politics” (Nurse F). Time and
again, networking was cited as integral to the suc-
cesses of these political activists. It was not net-
working for its own sake but to enable change, to
assemble the crucial assortment of policy players,
or to link ideas and people. Opportunities were
created and seized.
“Relationship is primary; all else is derivative,”
summarized one participant, noting that “the abil-
ity to establish relationships can lead to support
for you or for what you are trying to accomplish.
People support you . . . because they have a rela-
tionship with you, they trust you, and they believe
you” (Nurse D).
Networking was seen as including casual and
formal interactions: “the right conversations at the
right time” (Nurse C).
Going to a reception, walking around, eating
shrimp, and making small talk is a political
activity, and it is vital networking. You don’t do
anything or get a movement along until you meet
the right people in the right places. To get
business done you have to get out there getting
138 POLICY, POLITICS, & NURSING PRACTICE / May 2003
your name known, meeting people, swapping
business cards, getting an e-mail, and nurturing
relationships. (Nurse F)
This interviewee described publishing as essen-
tial networking for her, one that has created
excellent opportunities for new employment and
connections.
These nurses understood the essential and uni-
versal nature of networking.
Most of the work doesn’t take place in the State
Dining Room of the White House or on Capital
Hill; it takes place day to day by our network of
nurses. [It is] the importance of making a
relationship and keeping a relationship with an
elected leader and getting nurses involved early
in campaigns. Getting us visible in campaigns,
get-out-the-vote work, and really integrating
nursing into legislative work. I see it as having
high profiles, but even the lower profile work is
just so critically important for nursing. (Nurse C)
These nurses had made policy gains or reaped
professional benefits from networking. One said
her involvement in the women’s movement led to
a leadership role on a committee, which led to
another volunteer role and then a job offer
through the network (Nurse A). Through net-
works, opportunities opened up: “What hap-
pened was a typical serendipitous situation which
I am certainly convinced has a lot to do with the
opportunities we take” (Nurse B). Another noted
that “When you are paying attention, making con-
nections, and making an effort to network, the
path is huge” (Nurse F). The interdisciplinary
nature of networking was emphasized by several,
one noting that it has given her a sense of nurs-
ing’s worth and contributions beyond the disci-
pline (Nurse B).
Maintaining relationships while dealing with
contentious and varied political issues was seen as
challenging. One story began with the moral
“Friends come and go, but enemies accumulate.”
She spoke of testifying against one individual
month after month on a particular issue and later
finding herself working with him on another
committee.
If I had alienated him and made an enemy of him
based on some issue, I would have lost the
opportunity to work with him. You never know
who is going to be your friend and it is just not
worth making enemies, ever, ever, ever. (Nurse E)
Networking was not described as second
nature to nurses.
It is a skill that so few nurses have, but I would
have never had the experiences I have [without
it]. Most nurses are not comfortable with
networking and don’t understand how people
want to be able to help you. It is not an
imposition, they really want to do it for the most
part. Because they expect that if they need
something, you are going to do it for them.
She continued by noting that “the ability to ask for
help sometimes is perceived as weakness rather
than strength,” a misperception that limits nurs-
ing (Nurse B).
Networking created personal opportunities,
positioned these activists for action and change,
and produced beneficial outcomes. It was seen as
a crucial factor in political competence.
Powerful Persuasion
The importance of persuasive abilities was a
third theme in the stories of these political activ-
ists. The explicit purpose of communication in the
political arena was viewed as persuasion and
influence. The 6 participants variously told stories
involving the need to garner enough votes to pass
a resolution in a professional organization, win an
election, and support a congressional bill. They
spoke of persuading people to collaborate on a
task force, to agree to a funding arrangement, or to
include a book chapter within a limited number of
total pages. Persuasion was the required
approach.
Nurses were viewed as particularly equipped
with experience in persuasion. “If you can con-
vince someone to drink Metamucil, you can con-
vince them to vote,” suggested one participant
(Nurse E). Another said,
Nurses have to go into the field and be
comfortable talking to some people about things
that nobody else talks to them about. My varied
clinical experiences gave me the power of
persuasion and salesmanship—the power to be
Warner / STORIES OF NURSE ACTIVISTS 139
able to persuade a group of people to do
something that is helpful. (Nurse A)
Each activist interviewed described the energy
and passion needed for persuasive communica-
tion. One spoke of a time she addressed a national
student meeting and really motivated the group;
she noted, “There is not enough passion in the
world and so people who are passionate about
things can manipulate people in a good way or
bad way. It is a skill—the power of persuasion”
(Nurse A). This communication was equally
important with individuals and groups, as dem-
onstrated by this experience in the context of orga-
nizational politics: “We did an awful lot of hall-
way meetings and education and made some
powerful speeches before the House of Delegates
explaining our side. We did a lot of one-on-one
influencing people” (Nurse F).
Beyond passion, there was an emphasis on
thoughtful analysis of the ideas: “What was
needed was the clarity of the idea, the ability to
communicate that persuasively, and why it would
be important to the audience” (Nurse F). Another
noted, “You can change people’s minds with facts.
You can influence people in a particular direc-
tion” (Nurse C). She also described the prepara-
tion that preceded the interview of a presidential
candidate, recalling the rehearsal of idea presenta-
tion so it was clear and convincing.
One referred to the idea in the Tipping Point
(Gladwell, 2002) that three types of people are
needed to create a social movement or prompt
change: connectors, helper persons, and sales peo-
ple. “Nurses are all three. I think we are so natu-
rally cut out for politics. So take those three essen-
tial things that we have naturally and you apply
the nursing process to politics or to managing
anything.” She also pointed out a limitation: “We
just fail to apply [the nursing process] outside of
our work life with some regularity” (Nurse E).
So, whereas these nurses recognized and val-
ued their nursing expertise, connecting with a
variety of individuals and networks, they were
made aware of the need for powerful persuasion.
One described the essential nature of persuasion:
“When it comes down to it, you can have great
data in your head, but if you can’t communicate
your position individually and in groups and
make them comfortable, it won’t work” (Nurse F).
Because “in politics it is who has the most mar-
bles” (Nurse E), powerful persuasion is an
essential component of political skill.
Commitment to Collective Strength
The fourth theme in the stories of these nurses
related to the value of collective action as a source
of strength. “Individually we make a difference.
Collectively we make a bigger difference,” sum-
marized one nurse (Nurse D). The collectives in
their stories included professional organizations,
interdisciplinary task forces, groups of nurse pol-
icy leaders at the state level, coalitions for particu-
lar policy issues, political parties, and a “set of
trusted political colleagues” assembled within a
work setting. Sometimes the groups assembled
through statute or interest in the same issue;
sometimes the nurses took the initiative to build
(through networking and persuasion) a contin-
gent of people committed to the same priorities
and agendas or a group of people who brought
expertise and knowledge that one nurse could not
have. Group consensus was seen as a powerful
collective strength.
The sample identified the benefits of the collec-
tive. “I have felt able to influence that political
world in part because of what I have learned
through the association—also because I have the
association behind me, supporting me, informing
me, advising me” (Nurse C). The collective was
viewed as refining the individual wisdom that
was brought to the policy table.
When these nurses were part of a collective
group, they knew their voice was louder and per-
suasion was greater. One expressed this best by
noting,
We need to be aware that we can defeat our own
purpose by having a lack of collectiveness. I really
value the collective greatly. I couldn’t do what
I’m doing without marshalling the support of the
collective. It is because I represent a collective
history and collective body that anybody should
bother listening to me. It comes from a collective
source. I see it, I value it, I understand it, I respect
it, and I promote it as a value; we should search
for collectiveness. (Nurse C)
These nurses acknowledged the paradoxical
role of the individual in collective action. “Policy
140 POLICY, POLITICS, & NURSING PRACTICE / May 2003
change is collective action. But we don’t get collec-
tive action unless individuals do something”
(Nurse D). Another noted the challenge of
prompting a collective action because it runs
counter to American individualism and the ethic
of the rugged individual. Her solution was
“exploring how to be strong and individual, and
then maximizing those individual strengths in the
collective“ (Nurse C). The collective was not
seen as negating the individual, but as depend-
ing on and, in the best cases, strengthening the
individual.
Strategic Perspective:
A View From Stepping Back
The fifth theme of all the nurses in the sample
was that they viewed nursing and health from a
broad perspective that incorporated strategic
analysis of players, action, agendas, and a multi-
tude of other factors within the larger context of
any situation. They looked beyond the individual,
the local, and the immediate. Being politically
competent as a nurse was described by one indi-
vidual as a matter of perspective: “If you are to
give competent care, is the standard ‘excellent
care given to that individual patient’ or is the stan-
dard ‘excellent care given to that individual
patient along with what the nurse can contribute
in altering the conditions that lead to that individ-
ual’s needing that particular type of care in the
first place’ ” (Nurse D). A perspective beyond the
immediate was seen as requisite to awareness of
the possibilities that could be accomplished
through policy and politics. Without this perspec-
tive, the right questions would not be asked.
Another understood this perspective as “ana-
lyzing your environment and knowing how to
influence it” (Nurse B). Included was the action
that results from this perspective. Another nurse
shared what was a new insight for her: the link
between economic opportunities and long-term
health outcomes.
That is what I want nurses to get—that if they
want to have an impact on the large health
outcome over time, they have to be concerned
about the economy—about the people at the
bottom of the food chain being able to sustain
themselves. (Nurse E)
This statement reflects a perspective that places
health in a broad context and thinks strategically
about how to effect change.
Several nurses used the term assessment to name
the foregoing process but added some other
descriptors. “Community assessment. It is not just
the patient; the patient is the community. It is
really a healthy community approach,” clarified
one nurse (Nurse A). While recounting some pro-
fessional successes, another noted, “I have had the
ability to stand back and assess situations. I think
[about] some things very differently from a lot of
my peers and fix problems largely because I can
step back” (Nurse F). Her perspective involved
seeing a large context.
A “chess board” analogy emerged in one inter-
view to describe a strategic understanding of
issues—seeing the whole chess board past, pres-
ent, and possible.
It means having a long-range vision. . . . What are
my next three moves, my next three sequences.
That is why nurses are so wonderfully suited to
play [chess, though] we forget to apply what we
do in the hospital and the public health clinic and
in the school. We forget to apply our innate ability
to look at the person in the context of their whole
environment. . . . We have to take that assessment
skill, which is the big picture assessment skill,
and say, OK, who is this person politically?
(Nurse E)
Not only was this perspective seen as equip-
ping one for political or policy success but as
allowing nurses to see more of their practice and
professional work as political activity. One nurse
quoted Leavitt and Mason’s (1998) definition of
political work as “influencing the allocation of
scarce resources” whether in the workplace, gov-
ernment, or associations. She mused about novice
nurses entering into political work:
Nurses graduating from a baccalaureate program
may not feel ready a year after practicing to come
to Washington and lobby a senator. But if they see
a problem in their community that [needs to be]
addressed by the Board of Health, they may be
very comfortable in doing something, like
offering to teach a class. Is that political? We don’t
have a lens that we look at a lot of things we do in
Warner / STORIES OF NURSE ACTIVISTS 141
our work places and communities and
professional associations as political activity
because we are used to thinking of politics as
“what a bunch of overweight cigar-smoking
white males are doing behind closed doors.”
There are so many things that we do that are
political activity—and not until you expand the
definition of politics do you see it that way.
(Nurse F)
Stepping back and using a broad perspective was
seen as allowing nurses to see the political nature
of their work, the significant context, the needed
details, and the possibilities for change and
progress.
Perseverance
A final theme in these stories of political compe-
tence related to perseverance. The stories were not
all of victory. There were stories of electoral loss, a
troubled relationship with the press, a coalition
stifled by racism, defeated legislation, and fund-
ing difficulties. The nurses did not define them-
selves by victorious outcomes only but demon-
strated an attitude of perseverance and
acknowledgement of competence beyond “win-
ning.” One organization president said, “You
don’t always win. We are rebounding” (Nurse C).
One quote summarizes this perspective well:
I think it is not about what doesn’t go right, it is
about what gains you can make because most of
the time, most of the gains are small in
comparison to what the obstacles are in policy. I
don’t really see it as obstacles or things that don’t
go well, because I think it is the norm in the
political arena; it doesn’t matter whether it is in
government or organizations. It is not a personal
issue. Once it becomes personal you just lose the
momentum and you can really get discouraged.
(Nurse B)
Together, these six patterns of behavior
reflected the political competence of these 6 nurse
activists. They used their nursing expertise and
experience as valued currency in political work,
they created opportunities through networking
and collaboration, and they purposefully pursued
powerful persuasion. They accomplished political
ends through collective strength, they stepped
back from situations to gain a strategic and
contextual perspective, and they maintained
optimism through perseverance and by defining
competence as more than winning.
DISCUSSION
The behaviors described in the narratives of
these politically seasoned nurses were intimately
embedded in their professional roles and identi-
ties. The behaviors were not radical but were
those often noted on clinical units or in traditional
nursing roles. Political competence in this sample
involved a classic set of nursing abilities including
assessment, strategic problem solving, and inter-
personal relations, all for the purpose of convinc-
ing powerful policy makers to decide in favor of
caring, health, equality, and other nursing values.
The implication here is that with only a slight
reframing of the lens/perspective, political com-
petence may be within every nurse’s skill set.
Each of the identified themes was apparent in
each interviewee’s stories. The implication is that
political competence is not about demonstrating
one or several of these behaviors. It appears to be a
wholistic enterprise requiring the whole package.
Each identified theme is a necessary but not suffi-
cient ability in political competence.
Sheila Burke provides a contemporary example
of nurse activism whose insights come from over
20 years’ involvement in politics and from power-
ful staff positions within the U.S. Senate (see
Leavitt, 1998). The five skills Burke describes as
essential to political effectiveness are compatible
with the themes from the sample of this study;
they include communication, active listening,
consensus building, team building, and strategic
planning. Her nursing background was integral to
her effectiveness: “Many of her skills as a nurse
were brought to bear in finding ways to maneuver
around competing demands [in the U.S. Senate]
and to find ways to resolve issues” (p. 460).
Findings from this phenomenological study,
although not generalizable to the total population,
can inform our individual and collective journeys
toward greater political efficacy. Nurses who
aspire to be more effective in political contexts
could consider the behaviors described in the nar-
ratives of these seasoned activists and explicitly
explore their use in their practice and professional
lives. Nurse educators committed to modeling the
142 POLICY, POLITICS, & NURSING PRACTICE / May 2003
full range of the professional role could also exam-
ine their strengths and deficiencies and more
deliberately frame their activities through a politi-
cal lens. All practitioners could look for the politi-
cal and policy underpinnings of their clinical
work; they should ask questions about what they
see, about the strategic context for the clinical situ-
ation, and about the preferred environments for
caring and promoting quality of life. All clinical
areas present policy opportunities; one of the
interviewees expressed the ease with which she
saw “the impact of policies on the ability to pro-
vide care in maternal child health” (Nurse B). Just
asking the question about government influence
on care, on populations, on health, and on the
environments that determine health is a place to
begin.
To continue advancing nursing’s collective
political development requires more and more
practitioners, educators, and leaders to hone and
express their political competence. Motivation for
this growth relates to our commitment to influ-
ence the determinants of health, advocate for cli-
ents, contribute substantively in the creation of
our health care system, and position nursing for
its optimal role in delivery of care. One inter-
viewee offered a compelling and succinct sum-
mary: “You have a professional responsibility to
participate in policy making such that you
improve the health of the population” (Nurse D).
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Joanne Rains Warner, PhD, RN, DNS, now serves as associate
dean for graduate programs at Indiana University School of
Nursing (Indianapolis); she previously served as dean of nursing at
Indiana University East. Her political competence is demonstrated
in a variety of political activities: electoral campaign management,
chair of a national peace and social justice lobby group, governor-
appointee to a state commission, Indiana Nurse-PAC Board and
member of a college board of trustees. She served as a U.S. Public
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Health Policy and Health of the Community (Indiana University).
Warner / STORIES OF NURSE ACTIVISTS 143
