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The Four Spheres of Political Action in Nursing: NR 506 Week 1 Discussion

NR 506 Week 1 Discussion: The Four Spheres of Political Action in Nursing

The Four Spheres of Political Action in Nursing- Week 1

Please discuss the four spheres of political action in nursing. In addition, please develop a brief argument sharing how these spheres are interconnected and overlapping by applying an example from your practice.  What are some ethical considerations here?

The Four Spheres of Political Action in Nursing SAMPLE APPROACH

The original framework for Action had four spheres of influenced. The four spheres were: the workplace, the government, organizations, and the community (Chaffee, Leavitt, and Mason, 2014).  The term workplace has been broadened to include the workforce now as well.  Organization has been expanded upon as well to now include “associations and interest groups.”

Each of the four spheres are part of a broader and more complex system (Chaffee, Leavitt, and Mason, 2014). Nurses can be big influences within a community by identifying problems, forming strategies, and advocating for change (Chaffee, Leavitt, and Mason, 2014). Nurses can get involved in their community to have their voice be heard on issues involving nursing and healthcare.

As far as the workforce and workplace goes, there are several different settings a nurse can work in. Nurses can work in hospitals, clinics, schools, factories, etc. but they must all abide by certain laws and other factors that are set forth by their state or by their scope of practice.
As for the workplace and workforce, we as nurses must follow the same guidelines regardless of where we work. While our job descriptions can vary significantly depending on the type of nursing we practice,  we must still only practice what is outlined within our scope of practice.

I do all of the new RN orientation at our hospital. One thing we have began to incorporate in our orientation is to have nurses familiarize themselves with the Illinois Nurse Practice Act to look at what is in our scope of practice as a nurse.  I was very intrigued to find after years of nursing that I was not aware with certain things listed within.

Government- The government responds to and funds disasters. They also regulate much of healthcare, therefore how government views health policy is important because the government has a large influence over nursing practices.

With all of the regulations set forth by payers as well as CMS, it is necessary to follow the guidelines set forth by these agencies.  One example within my practice that comes to mind is documentation.  There are many different required fields of documentation that must be completed on each patient. VTE prophylaxis, immunization status, and sepsis screening  are a few areas that must be addressed on each patient at the time of admission. Another thing that comes to mind is documentation on swing bed patients.  Certain things that seem pretty small can actually be very important when it comes to receiving payment. For swing bed patients, it is necessary that the nurse or CNA charts the number of people required to assist the patient in getting out of bed.  If the correct documentation is not completed, the entire stay can be seen as unnecessary and payment can be refused. I teach all nursing students and new employees how important a simple step of documenting the number of people it takes to transfer or ambulate a patient. As mentioned, this is a very simple step, but can mean a huge difference.

Nurses can also become involved in lobbying for what they believe in or in changes they think need to happen.

Organizations – There are many organizations within nursing. They work together for the good of their cause.  Resources  can be shared which can promote networking and can limit the amount of resources used by each organization. When organizations work together, they can be much stronger and have more opportunities.  At our hospital, our CEO works with many local hospitals and organizations to build strong relationships so we can build off of one another. Working together can save time, money, and resources, and eliminate having multiple people researching the same information for potential changes.

Community-  It is important for nurses to become involved in their community to help to promote change when needed, or to stand up for what is current if they feel no change is needed. Nurses can both volunteer and have paid positions where they work to influence policy and changes within policy.

I currently do not have any involvement in my community other than speaking to prospective students about nursing, but many people throughout history have voiced their concerns to promote a change.

As with anything, there can be ethical concerns. Some ethical concerns that would involve government, community, and organizations would be having an ulterior motive or any conflict of interest in what the nurse is promoting or how they are choosing to speak on certain topics.  Like many things within politics, there is always a concern that someone is financially backing a person and that those people have a personal interest or have something to gain by their involvement. An example I can think of is I used to work with a physician who was the Medical Director of a local nursing home. He refused to send his patients to any nursing home other than the one he was the Medical director of. He worked with the community to promote this nursing home, but it all came back to the fact that he had personal involvement as well as financial gain from his involvement.

There can be a lot of ethical dilemmas within the workplace. Some can be as simple as the nurses and physicians not seeing eye to eye. Other ethical dilemmas could be the nurses feel like they have an inequitable workload (Bajwa, Hamid, Kanwal, Rhalid, and Mubarak, H. (2016).  This is something that is especially on my mind right now. Our hospital census has been almost double what it normally is for almost four months. Nurses are feeling overworked and as if their workload is more than they can handle. There is constant talk of this. Many good nurses have left recently due to this complaint.  One argument is that even with the increased census, the nurses still take much smaller patient loads than many of the neighboring hospitals are required to take.  But because our nurses have been a little “spoiled” the last several years with a lower census, they now are not satisfied with a normal full patient load. The major dilemma becomes 1) are our patients being taken care of and 2) can how do we focus on being profitable while satisfying the nurses.

The Four Spheres of Political Action in Nursing References:

Chaffee, M., Leavitt, J., & Mason, D. (2014). Policy & Politics in nursing and health care. (Sixth Edition.) St. Louis, Missouri. Elselvier.

Bajwa, M., Hamid, S., Kanwal, R., Rhalid, S., & Mubarak, H. (2016).  Ethical issues faced by nursing during nursing practice in District Layyah, Pakistan. Diversity & Equality in health care. Retrieved from:

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