Influencing Policies at Your Workplace – Nurses as Leaders
workplace and patients.

As nurses, we have a responsibility to our patients and to advocate for their safety and quality of care. We are on the front line and spend more time with our patients than many other healthcare professionals. Because of this, we often recognize subtle changes in a patient’s condition and can identify concerns before they become more serious. We gather the patient’s health history, assess their condition, communicate with the healthcare team, and often have a more complete picture of what is happening with the patient.

Part of our responsibility is also holding ourselves, physicians, and other healthcare professionals accountable. This should not be viewed as confrontation, but rather as professional collaboration and patient advocacy. Nurses need to feel comfortable speaking up when they have concerns because our primary responsibility is to the patient.

I believe nurses have more power to influence healthcare policies than we sometimes realize. The experience we gain working directly with patients gives us valuable knowledge that can be carried into leadership and management roles. We understand what happens at the bedside, but we also begin to understand how policies are developed and how those policies affect the delivery of care.

Nurses also see the challenges healthcare organizations face, including government regulations, limited resources, and decisions about how funding is allocated. We see firsthand how these decisions can affect staffing, patient care, and the resources available to healthcare professionals. This gives nurses an important perspective when advocating for changes in workplace policies.

By using our clinical experience, knowledge, communication skills, and understanding of the healthcare system, nurses can have a meaningful influence on workplace policies. Leadership does not always require a management position. Nurses can be leaders simply by speaking up for their patients, advocating for safe and effective care, and participating in decisions that improve both patient outcomes and the healthcare environment.

WeRPN is a great example of a nursing organization that influences change in health policy.
I am both a member of weRPN and a member of the board of directors.
Through participation in the organization I have taken part in Queens Park Day which is an important day to advocate for the nursing profession and RPNs in particular.
WeRPN participates in provincial discussions related to RPNs and the workforce, scope or practice, education and healthcare policy.

I think it’s important to “pick our battles” when advocating because attempting to advocate for everything can dilute credibility and reduce the impact.
For example, at Queens Park day we focused on advocating for;
– Fair Compensation: Urging fair and harmonized compensation for RPNs.
– Staffing Ratios: Pushing for safe nurse-to-patient ratios.
– Workplace Safety: Demanding immediate action to curb workplace violence.
– Mental Health: Advocating for universal access to mental health supports for health workers

Pros for being known as an advocate:
– promotes positive change and improves patient outcomes
– promotes leadership
– encourages collaboration

Cons for being known as an advocate:
– Potential conflict
– Time consuming
– Challenges if people disagree

Some key nursing organizations that influence health policy include the Registered Practical Nurses Association of Ontario (WeRPN), the Registered Nurses’ Association of Ontario (RNAO), and the Canadian Nurses Association (CNA). While I am not heavily involved in these organizations from a formal advocacy perspective, I do follow their work and have attended events such as the WeRPN conference. I think these organizations are important because they provide nurses with a collective voice on issues that can be difficult to influence individually. The readings reinforced that nursing leadership includes advocacy and that nurses at all levels can contribute to influencing practice and policy. Nurses can also have considerable influence without holding formal leadership positions by using their knowledge, professional relationships, communication skills, and firsthand understanding of patient needs.

Choosing your battles is important because advocacy is more effective when it is focused on issues where we have relevant knowledge, experience, and a realistic opportunity to influence change. I would prioritize issues that directly affect patient safety, quality of care, scope of practice, staff competency, or the ability of nurses to provide appropriate care. This is particularly important because the readings point out that nurses providing direct care are often absent from the policy-making processes that affect their own practice. Being known as an advocate can be a strength because others may see you as someone willing to speak up, question decisions, and represent concerns that might otherwise be overlooked. However, there is also a risk of being viewed as difficult or confrontational if every issue becomes a battle. To me, effective advocacy is not about speaking the loudest or speaking on everything. It is about recognizing when an issue matters enough to speak up and being able to support your position with evidence, experience, and a clear rationale.

One of my meaningful experiences as a unit nurse in long-term care is guiding PSWs to provide safe, respectful, and resident-centred care. As a nurse, I work closely with PSWs because they acted as one of the frontliners too, who spend a lot of time with residents and understand residents daily needs and routines.
For example, when I notice that a resident’s care needs have changed, I communicate with the PSWs and explain the appropriate way to provide care, such as transfers, repositioning, feeding, toileting, and personal hygiene. I also remind staff to follow the resident’s care plan and to report any changes in the resident’s condition. If I notice that a certain approach is not working well, I discuss it with the team and suggest a safer or more appropriate way to provide care.
I believe this is one way I influence policies and practice as a nurse leader. Leadership is not only about making decisions; it is also about teaching, guiding, listening, and supporting other staff. By working together with PSWs and encouraging them to follow best practices, I can help improve the quality and safety of care for residents.
I also share concerns and suggestions with the nurse in charge and management when I notice repeated issues, such as staffing challenges, falls, missed care, or difficulties meeting residents’ needs. Speaking up and providing practical suggestions can help management review current practices and make improvements.
This experience has taught me that nurses have an important leadership role especially in the long-term care facility that I have working with. By communicating clearly, supporting PSWs, advocating for residents, and leading by example, I can help influence workplace practices and make sure residents receive the care they deserve.

As a nurse who supervises unregulated personal support workers, I feel that the one area that
I can exert some influence is listening to their concerns and advocating for better patient care. I do this by developing good relationships with those who have influence in the community and by
explaining to them how I feel more care will help a certain patient. Of this is a negotiation as increased care hours is not something that will be continued in a long term basis except in some instances. I do find that being able to advocate for patients is a form of leadership and influence in my small corner of the world.
The reading this week on Leadership by the CNA stated that no matter what the area, a nurse is able to provide some form of leadership. I believe that even in small ways all nurses can and do provide leadership each day, despite having many obstacles. If nurses just keep going despite the obstacles, there is at least a chance of improving things like patient care, wages, working conditions.

Given our discussions to date, reflect on the ways to best “choose your battles” in order to have the most influence in decision-making. Is it important for RPNs to have a say on everything? If not, how would you decide which issues to take a stand on?

I think “choosing your battles” is important because the healthcare system has many major issues and everyone knows this. RPNs cannot realistically address everything at once, so change needs to happen through a building-block approach. I would focus on issues that directly affect patient safety, quality of care, and our ability to practice effectively. This would include ratios, fair pay, and better resource allocation. By addressing smaller, realistic problems and advocating for meaningful changes, RPNs can build credibility and gradually influence larger organizational and system-wide issues. We may not have a say in everything, but we should use our voice strategically where it can create the greatest impact.

Assignment : Influencing Policies at Your Workplace – Nurses as Leaders
The Payton article titled “The Informal Power of Nurses for Promoting Patient Care” provides insight into how subtle changes in approaches to the interprofessional communication paradigm can positively impact patient care. I am also guided by the words written by my fellow students, Jamie and Mary Ann, specifically, because their words and experiences have an immediate impact on my role as a nurse and as the shift leader.
Supervising the UCP and PSW as well as assessing the needs of 40 residents in a retirement home is providing ample opportunity to observe how my leadership is currently manifesting and how, as a new nurse, my nursing leadership role could be improved. One key factor is listening. Although dedicated time is given to any individual resident, I have noticed that my expectation of the team’s ability to efficiently communicate with me is at a higher level than where we currently are. As the team lead, I am accepting responsibility for the disconnection and perhaps unrealistic expectations I have of myself and the team.
I doubt if my revelation will change any particular policy, but I trust that with a considered plan of action, and consistency in its application, we, as a team may improve our level of communication and consequently behave in a more comprehensive and professional environment thus promoting the professionalism of the RPN team leader.

Identify some key nursing organizations that are attempting to influence health policy either at a provincial or local level. How involved are you in those organizations?

Some key nursing organizations attempting to influence health policy at provincial and local levels are WeRPN, the RNAO, and the CNO . I am involved as a member of both WeRPN and the CNO. I feel my CNO membership is more passive, and I am honestly not heavily involved. However, they do advocate for nurses scope of practice, and they have played a major role in expanding the scope of practice for RPNs over the last several years. I am much more involved with WeRPN. I attend in-person workshops to learn and network, and I also engage online through continuing education and the supportive community they provide. Although I am still relatively new to being involved with WeRPN, it has personally made me feel empowered which I believe is the first building block for making change and feeling seen/heard.

Given our discussions to date, reflect on the ways to best “choose your battles” in order to have the most influence in decision making. Is it important for RPNs to have a say on everything? If not, how would you decide which issues to take a stand on?

It is neither realistic nor effective for RPNs to have a say on everything. Trying to weigh in on every single decision dilutes our impact, leads to burnout, and can diminish the strength of our advocacy.
To decide which issues to take a stand on, I prioritize passion, relevance, and depth of knowledge. I feel strongly about choosing one key issue or topic and putting my all into it. This approach allows me to dedicate the necessary time, care, consideration, and education required to make a meaningful difference. Being genuinely passionate about what I advocate for is one of the strongest drivers of success,it brings authenticity, persistence, and clarity to my voice when influencing decision-makers.

What are the pros and cons of being known as an advocate?

PRO- Become a leader, encouraging others to step up as well.
PRO-Feeling fulfilled
PRO-Make a difference, and have your voice heard
PRO-Give voices to the people that don’t have one.

CONS- Burnout, everyone coming to you with ‘problems’ with no ways of being able to solve them all.
CON- Having to absorb any negative feedback from others.
CON- Being ‘labelled’ as difficult