In this systematic review we have tried to identify factors affecting nursing participation in health policy making. The effective factors are developing and changing over time. The total of 11 included studies published from 2000 to 2019 indicates these common factors. Most of the studies were homogenous in terms of purpose and data collection methods. It is not precisely clear why nurses do not become involved in health policy making, according to our there is consensus over several factors. These factors include sources limitations, insufficient time, political knowledge, heavy workloads, and gender issues, negative images about nurses, management supports, and fear to encounter with others’ beliefs that negatively affect nurses’ involvement in policy making.
The extracted factors were divided into three themes and fifteen sub-themes. Themes on nursing-related factors referred to subjects such as viewpoint, skill and experience, and reaction and education. Management and organizational factors included: information, communication, resourcing, leadership, organizational structure, participation in committees and policy factors. Creating a positive work environment is related to rules and supportive and environmental factors.
The findings of present review revealed that insufficient knowledge on the health policy making is one of the important reasons of nurses' non-involvement in health policy making. The findings also indicated that insufficient knowledge and skills on evaluation of policy and insufficient knowledge on the health policy formulation guidelines are barriers to the nurses’ participation in health policy making (12, 15).
Lack of resources was most frequently mentioned factor in studies. Lack of available resources was identified as a factor for the participation of nursing leaders in health policy making (5, 15). According to our findings, gaining external support was mentioned as one of the sub-themes for creating a positive work environment. Lack of support on behalf of different sectors such as the political sector, government officials, or professional organizations were obstacles in low involvement of nurses in policy making (1).
Based on the results of our review, education and research system, as a nursing-related sub-theme could affect nurses’ participation. Researches in, PhD curriculum in nursing and training were regarded as the facilitators of nurses’ involvement in policy making processes in LMICs (26, 30). Also, Parallel to our study, the study of O'connor (29) showed that education and research are necessary to develop nursing workforces’ participation.
Most of the factors that affect nurses' participation are related to management and organizational factors, to which the included studies point to their importance (12, 13). Supportive organizational structure is a prerequisite for the establishment of policy making activities.
Establishing communication networks was identified as one of the factors affecting nurses' participation in the policy making processes (13). This network largely focuses on interacting with internal organizational members and interested external publics. Leadership styles are categorized as one of the sub-themes of management and organizational factors (1). This factor is dependent on the organizational structure according to the framework presented. Based on the findings, health policy outcomes and impacts are considered as a supportive system for establishing organizational structure. Many studies have mentioned the importance of this factor in increasing the nurses’ participation (28).
The results of this study provide a framework for decision makers and policymakers to engage nurses in their affaires. Understandings factors that affect nurses’ participation in health policy making can offer insight about strategies to strengthen nurses’ role in health policy.
Nurses’ inadequate participation in policy-making processes is going to continue in the future and in many countries. Nurses need to understand the importance of empowerment and participation in the policy-making process. This review identified key factors that will help nurses to have an active and productive participation. Also, it leads to long-term benefits in workplaces. Despite progressions in in nurses’ skills and knowledge, there is a gap in the active involvement of nurses in health policy-making processes. Identifying the barriers and facilitators can help nurses to play an effective role in formulation, implementation and reformation of health policies. These include creating a context for nurses to communicate with policymakers, reducing the burden of their workload and using appropriate leadership approaches which all can help nurses in this regard. Also, the extracted factors can be applied in the development of educational programs on improving nurses' knowledge and skills.
Based on our findings, the researchers recommend that nursing managers and professors should focus on the empowerment and reinforcement of nurses in all fields such as clinical, educational, and skill and communication. Future studies need to examine the relation between effective factors and nurses' participation in policy making which can identify the needs and the fields of improvement. In order to enhance nurses' participation in health policy-making processes, leadership and political competence are suggested. Also the future studies should investigate the impact of the factors extracted from the studies on nursing roles.
Limitations
Lack of fluency in other languages to use the results of non-English language studies was one of the most important limitations. Another limitation was inaccessibility to some other databases such as CINAH and Web of Science. Also, we had no access to unpublished dissertations and full-text of some articles.