CHAPTER 5 PHASE TWO INTERVENTION: CAPACITY-BUILDING WORKSHOP
5.4 SECOND SESSION OF THE WORKSHOP
5.4.3 Reflections and exploration
After the facilitator had presented the role of nurses and how they could influence policy, the floor was open for comments. The discussions that followed were about where the
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nurses are and the lessons taken on their role moving forward. The facilitator’s comment was that nurses are not vocal enough about policy issues. An example cited was that of the National Health Insurance (NHI). None of the participants had made input to the policy and yet it will affect nurses. The facilitator suggested:
“It is not too late to start engaging with the current policy reforms. It boils down to confidence and leadership.” (Fac)
The participants felt that it could be said that nurses are the backbone, but policy-makers do not see it that way. Instead, nurses always come second to doctors. Other participants expressed that:
“Most of these policies are shoved down on our throats.” (Mng)
“Everything is about the doctors. It is like somebody has muted us with a big plaster so that we can keep quiet.” (Mng)
The issue of the policy-makers undermining the power of nurses came out. Others felt that no one cared about nursing issues.
“When a nurse is vocal about something, they are labelled as rude.” (Mng)
“The question is what are nurses doing about all these issues? No one wants to listen to the issues of nurses.” (Mng)
Participants themselves also deliberated on the challenge of dealing with nursing issues as a united voice. They agreed that they work in silos as institutions. They even look down upon each other instead of sharing best practices. A comment from one participant was:
“If we can be sorted as nurse leaders it would be better. We do not even share best practices. It must be unity first. We need to destroy all the barriers” (Mng)
5.4.3.1 Potential solutions i. Establishment of a forum
After discussing the challenges related to participation in health policy development, the group discussed potential solutions that would help to mitigate the key difficulties.
Participants recognised that it was important to identify and share policies with colleagues at the workplaces and even at different forums where they meet. They acknowledged that to be involved in policy development, it is necessary to identify existing policies that affect one’s work as a health professional. The argument made by participants was that for effective participation in policy development, it was necessary to have knowledge of
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existing policies to make effective change. To increase their level of involvement, participants mentioned that they required more knowledge and skills in policy issues.
The participants thought about the potential establishment of the nurse leaders’ forum.
Excerpt from participant:
“We need to get into action, push and have a voice.” (Mng)
The assistant nurse managers (ANMs) reported that they do not have any forums where they meet and discuss issues affecting nursing. The nurse managers do have meetings at district level. The participants had different suggestions as to who should be in the forum.
Some believed that the existing discussion groups for nurse managers should be expanded to include ANMs. Others believed that a new forum needed to be established.
One participant pointed out that the existing district meetings were mainly for nurse managers to share challenges from their facilities. No issues pertaining to policy or moving the profession forward were discussed. A suggestion was that a restructuring was needed.
The issue of action and having one voice recurred in all the discussions. The feeling was that a forum would bring a solution to the challenges that nurses face. It would unify nurses and fill existing gaps. Some comments were:
“We have been quiet for a long time and relied a lot on unions (COSATU). People need to unfold in this profession.” (Mng)
“If we action this, eventually we will have one union.” (Mng)
Other participants suggested that unity among nurse managers is required first, since they have a lot of differences. It is also important to bring in the younger generation of nurses.
They must be invited to participate in all aspects of issues. Another view was that before a forum is established, they need to decide who the nurse leaders are, and the structure of the forum and issues that would be discussed there. The forum would need to have clear terms of reference. The Senior Nursing Officer was identified as the person who should drive the process. One of the nurse managers who was present was also identified as the person who could assist in influencing nurse managers in the eThekwini district about the issue of the forum.
ii. Training
Participants expressed the view that another workshop or training session would be beneficial. They also felt strongly that providing this training to students should be a priority (potentially as part of their graduate curriculum), as it would help the next generation to develop their policy development skills. The academics reported that they would start
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discussing the issue of incorporating policy development into the curriculum in their structures.
ii. Writing a policy brief
The researcher had already agreed with the research team members that a policy brief was one of the immediate solutions to empower nurse leaders to exercise their role in policy participation.