In rapidly changing and developing health systems, nurses comprise the major group of health care personnel who are mainly responsible for providing people with qualitative care . The political, environmental, technological and financial pressures in healthcare systems affect all practical settings. These changes can make opportunities for all personnel, especially nursing staff to enhance their position and role in healthcare policies and management [2,3,4].
According to the definition by World Health Organization (WHO), health policies refers to decisions, plans, and actions undertaken to achieve specific health care goals within a society . Also WHO emphasized that health policy and practice require actions form multi-sectors, and decisions that are made in these sectors must be responsive and sensitive to the concern of health . The ultimate goal of health policies is to promote public welfare. It consists of three stages: formulation, policy implementation and policy reformation [7, 8]. Health policy is a tool which nurses must utilize to improve the safety and quality of healthcare .
When elaborating on health policies, there must be a motivation for nurses to participate in health policy-making processes. For example, nurses can have influence through their experiences on policies, laws, and regulations that govern the healthcare system [10, 11]. Nursing Staff are encouraged to participate in health policy for three reasons. First, nurses closely deal with patients and their families in a variety of settings; therefore, their comments can be considered as valuable sources for policy development. Second, different health policies have direct effects on nurses. Thus, policies should ensure a supportive work setting. Third, nurses play key role in professional development and can highly contributed to the formation of appropriate and efficient health policies [12, 13].
The International Council of Nurses (ICN) strongly emphasizes and supports those efforts in improving nurses’ readiness in developing policies . Previously, the ICN has tried to address topics such how health policy is made, different approaches to making policy and how nurses and professional organization can influence policy . Also, in issues of nursing such as health policy, the global Nursing Now campaign is working with the ICN, and the WHO, to create and strengthen strategic nursing leadership, as modelled by the International Council of Nurses’ Global Nursing Leadership Institute . Different factors affect nurses’ ability to be active in health policy development including gaining experience in policy development process, gaining knowledge on health systems, policy research and developing leadership skills [1, 16]. In recent decades, despite the fact that nurses have become increasingly knowledgeable, skilled, and well-educated, they have had limited involvement in policy making processes and political decisions,affecting the delivery of health services [13, 15]. Also, nurses’ ongoing work in the COVID-19 pandemic is making nursing history and there are significant opportunities to learn from this pandemic, to find better ways of doing things in practice, and contributing to policy-making through evidence-based research and empowerment strategies .
A study conducted in Thailand showed that most nurses are involved only in the implementation of health policies while it is essential issue that they must gain perception over the issue and actively participate in it . Abu-Al-Rub & Foudeh conducted a study to evaluate the level of involvement of Jordanian nurses in the development of health policy and perceived benefits, barriers, and impacts on health outcomes of involvement in health policy process. Their results indicated that the low level of Jordanian nurses’ involvement in health policy can be attributed to the fact that most participants, beside their roles in workplace, had family roles making them to allocate little time for health policies activities. Lack of mentoring by nursing leaders could also negatively affect their involvement in health policies development . In study by Shariff & Potgiete it was demonstrated that facilitators of health policy development comprise having knowledge and skills, enhancing the image of nursing and enabling structures and processes. Also, barriers to the participation of nursing leaders include the lack of involvement, insufficient knowledge and skills, negative image about nursing, lack of dynamic structures and insufficient resources .
Nurses’ participation in national policy making processes is significantly important in Low- and Middle-Income Countries (LMICs) where nurses comprise larger proportion of the health sector workforce. Thus, there is a need to enhance their ability in understanding, generating, and utilizing research knowledge that is beneficial for making changes in policy [16, 19, 20]. Several studies have emphasized that contemporary nurses influence health policies. The purpose of this systematic review was to designing a framework for nursing participation in health policy making. So, the research question were developed by authors was as follows: