Nursing Leadership

Nursing Leadership 20(4) December 2007 : 30-32.doi:10.12927/cjnl.2007.19464
ACEN Update

Lessons from a Policy Master

Mike Villeneuve


On a warm, dark evening in early October, I had the privilege of finding myself in Pretoria, South Africa with a group of nurse colleagues from many southern African nations, listening as various leaders brought messages of greetings before we were to share dinner. The minister of health had fallen ill that day and was replaced at the last minute by her director general. The minister's illness turned out to be an interesting turn of fate for us, because the comments of the director general amounted to a master class in policy - and he was able to say things that she surely never could have said.
Two of his comments really stayed with me, as I have been thinking about ACEN's efforts this fall to turn our attention to becoming more fully engaged in the world of influencing public policy. The first comment was his suggestion that while he was pleased to see efforts underway to increase the policy knowledge and skills of African nurses, we had to understand that the more powerful and knowledgeable we become, the more his power and leadership are threatened - or at least are brushed up against.

Of course, he was being humorous, but the underlying message nevertheless is exactly on point. It brings to mind the famous observation of John Maynard Keynes in 1937, that "there is nothing a government hates more than to be well informed." Being well informed can make decision-making more difficult and inaction tougher to defend.

The game of policy is not an easy one, and the pushback against change and reform can be harsh even from within our own ranks. We should not be fooled into thinking that being armed with the best evidence will make the game easy - nor should we assume that others want us to be involved in influencing public policy!

Phil Davies, former deputy director in the Social Policy Unit of Prime Minister Tony Blair's cabinet, warned as well about the danger of being drawn into the "long grass" approach to policy making, in which "kicking the issue into the long grass" can make it disappear for a while. He warned that the "let's do a pilot study" response can sometimes really be about "kicking it into the long grass" - allowing the kicker to effectively bury an issue, buy time and appear to be doing something while there is really no intent to respond at all. This does not mean that pilot studies are unimportant, but rather that we must all be wary of the strategy and not be drawn into the cycle.

Our evening in Pretoria brought forth an even more important lesson from the director general, when he said: "You say you want to influence policy. Okay: What policy? What is it you are talking about? What do you want to influence, and what do you expect me to do?"

His question may seem simple, but I think it is central to how we will think about our work at ACEN. His challenge, again deliberately provocative, was that nurses need to be very clear about the issue, the evidence, the costs, the potential (viable) solutions and the complex impact of all these things on the constellation of health determinants and competing priorities confronting any government. "Influencing policy" has become such a trendy phrase that I worry, sometimes, whether we are clear ourselves about what we actually expect to do or expect to happen.

That evening, speaking to many nurses involved in HIV/AIDS care, for example, the director general made a poignant point: "You want to know my policy priorities? Not HIV/AIDS, no, not always first. But rather tuberculosis, and malaria, and diabetes, and more importantly, poverty, clean water and safe food. So when you say you want to influence policy about HIV, what policy? What exactly are you asking for, and how will it relate to these priorities?"

The agenda for the 25th annual general meeting of ACEN has been constructed to give us opportunities to explore these and other policy questions among ourselves and with our partners. We are lucky to have a policy master of our own with us in the form of Abby Hoffman, one of the most decorated Canadian athletes in history and now assistant deputy minister (Acting) for Health Canada's Health Policy Branch. Our opening keynote speaker, Abby will push our thinking with those sorts of questions, and force us to think about the federated model in which ACEN conducts its business.

Siobhan Nelson, dean of the Lawrence Bloomberg Faculty of Nursing at the University of Toronto and an international policy leader, will help us connect those challenges to the nursing issues on our plates - and on our doorsteps. Do we care or cure? Both? What is the future of nursing, and how will we link the discipline to broad public policy priorities? We will spend much of the afternoon discussing and debating these points as we try to determine the priorities that should guide our operational work over the coming one to three years.

One thing is certain in all this: we are wading into a very crowded field that demands our full attention, energy and stamina. Some have described the work of policy making as a marathon versus a sprint. Judith Shamian once said that it is more like boxing because it entails a willingness to risk walking into the ring, giving your best effort, getting knocked out now and then and most importantly, wiping your face off and getting back up to go back for Round Two, Three, Four … and more. Those are some of the realities that ACEN faces as the organization matures and moves more forcefully into this arena.

Some 25 years ago, ACEN was founded by a group of like-minded executive nurses who recognized the need for, and value of, mutual support and sharing of ideas and innovations. Twenty-five years later, while there are more women and nurses at many of those executive tables, they are working in environments that are more complex than ever. ACEN helps to link them around issues of common concern, and that function must continue. Our big challenge over the coming one to three years is to create a meaningful foray into the world of healthy public policy without diminishing the affiliation and support benefits valued so much by members.

Keeping master policy lessons clearly on our radar screens will help us navigate that uncertain journey forward. As we make those steps, please join me in thanking our outgoing president, Leslie Vincent, for her vision and wise council. I want to thank Leslie personally for her support in helping me navigate the learning curve during my first year as executive director of ACEN. Let me also ask you to join me in congratulating and welcoming the new Executive Committee of ACEN under the enthusiastic leadership of our new president, Noreen Linton, and president-elect, Joy Richards. We are in smart, caring and visionary company as we move towards the future.

About the Author(s)

Mike Villeneuve, Executive Director
Academy of Canadian Executive Nurses


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