Nurses’ Participation in Health Policy Making: Factors, Benefits, and Barriers Assessment

Introduction

Historically, healthcare systems have heavily invested in illness-related care, which prioritizes treatment over overall health promotion, often resulting in substandard economic and health outcomes (Peters, 2002). The mission of healthcare is to ensure societal health, which can only be achieved through effective service delivery.

Nurses are pivotal in this context. As the largest group of healthcare workers worldwide—over 35 million globally they play a key role in both delivering care and influencing public health policies (Shariff, 2014; Lewinski & Simmons, 2018). Their involvement in policymaking ensures that healthcare services remain safe, effective, accessible, and cost-efficient (Jivraj Shariff, 2015).

Despite encouragement for participation, nurses often remain underrepresented in health policy reform processes. Their close interaction with patients uniquely positions them to provide insights for effective health policies (Etowa et al., 2016; AbuAlRub & Foudeh, 2017).

Purpose of the Study

This study aimed to examine:

1. The factors associated with nurses’ participation in health policy activities.

2. The perceived benefits of involvement in policy-making.

3. The barriers preventing effective nurse participation in health policy development.

Methods

Design:
A descriptive cross-sectional study was conducted in hospitals affiliated with Iran University of Medical Sciences in 2018.

Participants:
Out of 530 nurses in six hospitals, 220 were selected via cluster and stratified sampling. Inclusion criteria included:

• Minimum of a bachelor’s degree in nursing.

• At least 2 years of work experience.

Data Collection:
A standardized self-management questionnaire was used, covering:

• Demographic information

• Participation in health policies (17-item checklist, 5-point Likert scale)

• Perceived barriers (19-item checklist, nominal scale yes/no)

• Perceived benefits (17-item checklist, nominal scale yes/no)

Translation and Validation:

• Forward translation, expert panel review, back translation, pretesting with cognitive interviews.

• Cronbach’s alpha = .85; content validity ratio = .83.

Ethical Considerations:

• Voluntary participation and confidentiality maintained.

• Ethical approval obtained from the Islamic Azad University Ethics Committee (code: IR.IAU.TMU.REC.1396.05).

Results

Demographics:

• 76.1% women, 23.9% men.

• Mean age: 33.54 ± 4.60 years; Mean experience: 8.93 ± 3.53 years.

• 52.7% married, 92.2% held a bachelor’s degree.

• 83.2% worked rotating shifts.

Participation in Health Policy Making:

• Moderate involvement overall (mean = 2.75/5).

• Highest participation: Providing written reports of problems or receiving consultation from a related official.

• Lowest participation: Verifying or studying legal affairs related to health policies.

Perceived Barriers:

• Most common: Disappointment in work procedures (50.45%), Lack of external support (48.64%), Lack of time (46.82%).

• Least common: Lack of any barriers (5.91%).

Perceived Benefits:

• Most cited: Resolution of nursing challenges by nurses (56.36%), Nursing independence (52.27%), Personal satisfaction/building self-confidence (49.55%).

• Least cited: Helping those incapable of creating changes (10.45%).

Demographic Associations:

• No significant association between age, gender, marital status, education, work shift, or experience and participation, perceived barriers, or benefits.

Discussion

The findings suggest that Iranian nurses are only moderately involved in health policy making, aligning with studies from other countries showing limited nurse participation (Shariff, 2015; Ditlopo et al., 2014). Barriers include lack of support, limited time, insufficient understanding of policy-making processes, and professional constraints.

Despite these challenges, nurses recognize the benefits of involvement, including professional growth, increased autonomy, and enhanced ability to resolve challenges within the profession. Education, leadership training, and organizational support have been suggested to increase nurse participation in policy-making (Shariff, 2014; Gimbel et al., 2017).

International recommendations include:

• Incorporating health policy education in nursing programs.

• Promoting nursing leadership and participation at higher management levels.

• Supporting professional nursing organizations.

Conclusions

Nurses have the potential to significantly impact health policy development, yet their participation remains moderate. Strategies to enhance involvement include:

1. Establishing career pathways as health policy experts.

2. Providing more information and education regarding health policies.

3. Enhancing perceptions of the importance of nursing in policy-making.

4. Appointing nurses to high-level healthcare management roles.

5. Supporting professional nursing organizations to foster engagement.

Increasing the involvement of nurses in health policy not only empowers the nursing workforce but also strengthens healthcare systems to better meet the needs of society.

Assessment Requirements 

The assessment required the student to critically analyse nurses’ involvement in health policy-making. Key pointers to be covered included:

• Historical context: Understanding how healthcare systems have historically focused on treatment rather than health promotion.

• Role of nurses: Highlighting nurses as a major healthcare workforce and their potential influence on policy.

• Purpose of the study: Examining factors affecting nurses’ participation, perceived benefits, and barriers in policy-making.

• Methods: Detailing study design, participant selection, data collection tools, translation, validation, and ethical considerations.

• Results: Reporting demographics, participation levels, perceived barriers, benefits, and associations with demographic variables.

• Discussion: Interpreting findings, comparing with global studies, identifying challenges and benefits, and providing international recommendations.

• Conclusions: Summarizing strategies to improve nurse participation and the broader impact on healthcare systems.

The assessment required a clear, logical presentation, incorporating evidence from literature and study findings, and demonstrating critical analysis of nurse engagement in health policy.

Outcome and Learning Objectives Covered

• Outcome Achieved:

  • A well-structured, evidence-based assignment demonstrating moderate nurse involvement in health policy, highlighting barriers and benefits, and suggesting practical recommendations for improvement.

• Learning Objectives Covered:

  • Critical analysis of the role of nurses in policy-making.

  • Interpretation of quantitative and qualitative data.

  • Application of ethical principles in research.

  • Linking research findings to professional practice and international recommendations.

  • Development of evidence-based recommendations to improve nursing engagement in policy.

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