History and Healthcare Policy in Nursing

History and Healthcare Policy in Nursing

Meg Fitzgerald

The policies in nursing have been largely influenced by history and politics within the larger healthcare ecosystem. Today there are close to 4 mm nurses in the U.S representing a formidable voting block but on issues close to home the profession doesn’t yield the same power and influence. Despite the history, obstacles and politics nurses are revered and valued members of the healthcare system. They own a strong position that should be leveraged for practice and pay gains.

Data shows that in healthcare policy creation nurses face many barriers to entry. These barriers include being involved in policy development, having the right knowledge and skills, the negative image of nursing structures and processes which enhance seclusion. (Sharif, 2014). And these barriers have followed the practice of nursing since its inception.

The genesis of the nursing profession dates back to 300 AD when the Roman Empire built hospitals which required doctors. Those doctors needed assistance requiring a new role; the nurse. This is likely when the politics and branding around a nurse as a deputy or subordinate took hold. This structure and dynamic continues to challenge and hinder policies in the field today.

Over the last century, the nursing profession has evolved into a more important and visible practice due some help from the Catholic Church which built hospitals to care for any sick individual. This mission aligned well with values of nursing and remains dominant theme in many of the policies supported by the profession. Many of these mission driven hospitals provided nurses the autonomy to provide a range of medical care services. Many feel these early models served as the policy jump off point for nursing policy and likely plays a role for the broad services the nurse performs today.

And in New York City, Lillian Wald followed this playbook harnessing the support of those in power to establish the field of public health nursing which went on to establish the National Organization of Public Health Nursing in 1912 (Mason 2016). What is remarkable about Lillian aside from her clinical leadership was her policy and business skills. Her public health efforts were cemented with the creation of powerful alliances like the American Red Cross, coupled with her fundraising and wooing of wealthy donors and foundations.

The intersection of clinical value and policy making that Lillian pioneered is an important lesson for nurses looking to affect policy today. When the ACA was established, public health advocates and nurses used this bill to increase access to care, contain costs and push the promotion of alternative sites of care and expand the scope of nurse practitioners. Whenever there is a major policy change or upgrade from Health and Human Service, the practice of nursing needs to be close shaping the debate.

And at every turn in the history of healthcare policy, the most important factor was research and evidence. Data is the currency of healthcare policy. And it’s an area all in nursing must embrace and advance.

Nursing research has changed dramatically in the past 150 years starting with Florence Nightingale but it was not until the 1950s that nursing research began the advancement that has been seen in the past three decades (Stolley, 2000). When nursing decided to put a premium on the advanced degree the foundation for research began. And as a result of this research, funding and political support was attracted to the cause.

The profession of nursing has evolved throughout history and today nurses own the most important position in politics; trust. However, there is a growing recognition from peers, policy makers and payors that nurses need to publish and promote their value more. Every time we move forward in our practice, we must back it up with data to advance policies that lift us. If we continue to prove that our industry drives cost savings, quality and access then money and political capital will flow our way .


Mason, Diana J. Policy and Politics. In Nursing and Health Care. 7th edition 2016.

Shariff N. (2014). Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. BMC nursing, 13, 20. https://doi.org/10.1186/1472-6955-13-20

Stolley, J. M., Buckwalter, K. C., & Garand, L. (2000). The Evolution of Nursing Research. Journal of the neuromusculoskeletal system : JNMS : a journal of the American Chiropractic Association, Inc, 8(1), 10–15.

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