Nurses' Engagement in Healthcare Policy Development: An Umbrella Review

Lindsay Smith, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, NSW, Australia.
Karyn J. Roberts, School of Nursing, University of North Carolina-Greensboro, Greensboro, North Carolina, USA.
Barbara Giambra, Pulmonary Medicine and James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Michele Polfuss, University of Wisconsin-Milwaukee School of Nursing College of Health Professions and Sciences Milwaukee, Milwaukee, Wisconsin, USA.
Cynthia Danford, Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, Ohio, USA.
Debbie Sheppard-Lemoine, University of Windsor, Windsor, Canada.
Theresa Ryan Schultz, Emergency Medicine and Trauma, Children's National Hospital Division of Nursing, Washington, District of Columbia, USA.
Natalie Winter, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
Adam Mulcaster, Information Services Librarian, Leddy Library, University of Windsor, Windsor, Ontario, Canada.
Intima Alrimawi, School of Nursing, Georgetown University, Washington, District of Columbia, USA.
Junko Honda, Research Institute of Nursing Care for People and Community, University of Hyogo, Hyogo, Japan.
Petra Brysiewicz, School of Nursing and Public Health, University of KwaZulu-Natal, Glenwood, Durban, South Africa.
Susan Carr, Professor Emeritus, Faculty of Health and Life Sciences, Northumbria University, Newcastle, England.
Suzanne Feetham, Nursing Research Consultant Children's National Hospital, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

12-1-2025

Journal

International nursing review

Volume

72

Issue

4

DOI

10.1111/inr.70109

Keywords

engagement; healthcare; nurses; policy development; umbrella review

Abstract

BACKGROUND AND INTRODUCTION: Healthcare policy establishes guidelines for delivering safe and effective healthcare, achieving and improving health-related outcomes, and mitigating public health risks. Nurses are uniquely positioned to lead healthcare policy development; however, evidence of nurses' engagement in policymaking is limited. This umbrella review aims to examine and summarize nurses' involvement in healthcare policy development aimed at transforming health. METHODS: Following the Joanna Briggs Institute umbrella review methodology, a systematic search was conducted across seven databases for peer-reviewed literature. Quality and risk of bias were assessed using the ROBIS tool. Data were analyzed using qualitative content analysis and meta-synthesis. This review is registered in PROSPERO (ID: CRD42023458475). RESULTS: The search yielded 591 records, which were evaluated using PRISMA guidelines. Articles (N = 7) were included if they were written in English, Japanese, or Arabic, reported a literature review study, and participants were registered or licensed nurses. Four master themes were identified: (1) diminished support and preconceived expectations of nurses' roles in policy development contributed to individual, organizational, and system-level barriers; (2) hierarchical marginalization of nurses' voices, interprofessional and gender dynamics, and limited leadership roles of nurses impact meaningful participation; (3) nurses' internal perceptions, knowledge, and beliefs regarding power, role expectations, and interest, limit involvement in policy development; and (4) the development of skills and understanding of policy through education, training, modeling, and mentorship is foundational for informed and authentic engagement. CONCLUSIONS: None of the included reviews identified nurses' engagement in healthcare policy development. Lack of engagement was due to multilevel barriers, hierarchical marginalization, and limited skills. IMPLICATIONS FOR NURSING AND HEALTHCARE POLICY: Nurses are the voice of patient, family, and community health and well-being. This responsibility requires our engagement in healthcare policy development at all levels. Including nurses in healthcare policy development is crucial in creating healthcare that is fit for purpose and in the sustainability of the nursing workforce.

Department

Pediatrics

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