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Nurse state legislators: The journey to state capitols

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Debbie W Herman
Abstract:
Nurses represent the nation's largest health care worker with over 3.1 million registered nurses in the United States and have the potential to make significant contributions to public policy on behalf of the patients they serve. Although nurses have been politically active since the 19th century, few nurses have pursued elected office at the state or national level. In 2000, approximately 100 nurses held political office, representing 0.005% of the total two million registered nurses (Feldman & Lewenson, 2000). Eleven years later, less than 100 nurses are serving in state legislatures (ANA, 2010). The journey of nurses to elected state legislative positions or the characteristics that might motivate nurses to seek public office have not previously been studied. The purpose of the study was to explore and describe the personal attributes, motivators, and life experiences of an elected nurse state legislator. A naturalistic design and grounded theory techniques were used to guide a qualitative study with the existing population of approximately 87 elected nurse state legislators in the United States. A demographic and electronic interview format was the primary instrument with open ended questions using Survey Monkey for collecting and analyzing demographic data. The response rate was 23% with 21 nurse legislators completing or partially completing the survey. Demographically, the nurse legislators were predominately female, Caucasian, married/partnered, democratic, and older with a moderate to higher income level. The majority of the nurses were highly educated with master's degrees, which demonstrated significant diversity n their field of study. The vast majority of nurses had been practicing nursing over 30 years and just over 50% were continuing the nursing career with many of the remaining participants in retirement. In contrast, the nurses were in elected office close to 12 years on average, but the range was diverse from 2 to 30 years. Nursing experiences were predominately as clinical staff nurses, nurse managers, and academia. The majority of nurses were members of professional nursing organizations in the past, but the memberships declined for the current year; while, the political, philanthropic, and civic organizational memberships significantly increased from past to present. A thematic narrative analysis of political activism in nursing evolved from three major themes to include early imprints, evolutionary journey, and illuminating actions. Within the theme of early imprints, the categories are political family heritage; diverse life experiences; valued traits; and knowledge and skills. The categories for evolutionary journey are political exposures, passionate altruism, supportive connectedness; defining moments; and openness to discovery. Illuminating action was characterized by the categories of voice of the voiceless; making a difference; caring on a grand scale; and a moral imperative to the common good. The study of currently elected nurse legislators added significant insight and knowledge into a population of nurses who are contributing to state and national public policy issues. The knowledge gained from the study may enable nurse educators to foster political activism in young nurses and facilitate more nurses who are interested in public office to pursue their dreams through the identified journey of political activism.

viii TABLE OF CONTENTS DEDICATION……………………………………………………………………………iii ACKNOWLEDGEMENTS……………………………………………………………....iv ABSTRACT……………………………………………………………………………….v LIST of TABLES..…………………………………………………………………….…xi LIST OF FIGURES…………………..……………………………………………… …xii CHAPTER I: INTRODUCTION…………………………………………………………1 Problem……………………………………………………………………………1 Rationale and Significance………………………………………………………..2 Purpose.……………………………………………………………………………4

Research Approach………………………………………………………………..4 Anticipated Outcome……………………………………………………………...5 CHAPTER II: REVIEW OF LITERATURE………………...…………………………..6 Theoretical Framework………………………………………………..………......6 Political Activism……………………………………………...………………….9 Support for Political Activism ………………………………………………..…10 Motivators for Political Activism. ………………………………………………12 Women and Politics……………………………………………………………...14 Women in the State Legislature………………………………………………….18 Nurses and Politics…………………………………………………………….…19 Political Participation of Nurses…………………………………………………20

ix Professional Nursing Traits………………………………………………………21 CHAPTER III: METHODOLOGY……………………………………………………..23 Grounded Theory Methodology and Methods……………………….…………..25 Sampling Frame…….……………………………………………………………26 Data Collection Method: Electronic Survey………………………………….….28 Participant Recruitment………………………………………………………….30 Data Collection Instruments……………………………………………………..33 Data Collection Processes…………………………………………………….….34 Qualitative Data Analysis………………………………………………………..35 Human Subjects and Ethical Considerations………………………………….…38 CHAPTER IV: FINDINGS………………………………………………………..……40 Sample Characteristics…………………………………………………………..40 A Political Activism Journey for Nurses…………………….…………………..48 CHAPTER V: CONCLUSIONS AND INTERPRETATIONS, LIMITATIONS AND METHODOLOGICAL CONSIDERATIONS, THEORETICAL IMPLICATIONS, RECOMMENDATIONS, AND SUMMARY…………………………………………118 Conclusions and Interpretations.…….………………………………………….118 Methodological Considerations…………………………..…………….………127 Theoretical Implications………………………………………………..………128 Recommendations………………………………………………………………129 Summary………………………………………………………………………..131 REFERENCES…………………………………………………………………………133 APPENDICES………………………………………………………………………….148 APPENDIX A: Letter of Invitation to Participate…………………………...…149

x APPENDIX B: Survey Monkey Study Overview and Survey…………………152 APPENDIX C: Contact Information Form……………………………………..168 APPENDIX D: Codes and Categories by Question………………….………..171

xi L IST OF T ABLES Table 1. List of States and Nurse Legislators in 2010……………………….…………..27 Table 2. Summary of Participant Demographics…………………………..….…………42 Table 3. Summary of Participant Nursing Experience………………………..…………43 Table 4. Summary of Participant Nursing Positions………………………….………….44 Table 5. Summary of Participant Political Experience ......................................................45 Table 6. Summary of Reported Participant Association Memberships. ............................46 Table 7. Professional and Non-Professional Memberships ...............................................47 Table 8. Valued Traits, Knowledge, and Skills of Nurse State Legislators .......................77

xii L IST OF F IGURES Figure 1. The Grounded Theory Process………………………………………………...37 Figure 2. Thematic Narrative: A Journey of Political Activism in Nursing……………..50

1 CHAPTER I INTRODUCTION Political activism in nursing is a potentially powerful force, which could substantially transform health policy at the state and national level through a variety of arenas to include elected legislative positions. Nurses have the elite skill and knowledge to enhance the quality of health care through public policy avenues with their compassion, communication skills, people-focused approach, and passionate agendas. Health care consumes greater than 17% of the Gross Domestic Product (GDP) with over 70% of expenditures on 10% of individuals with chronic illness (Mongan, Ferris, & Lee, 2008); thus, nurses have the potential to significantly impact health policy. The value of nurses participating in public policy making is unprecedented on varied issues such as public health, environmental threats, chronic illness, health disparities, uninsured citizens, Medicare/Medicaid, health research, housing, education, unemployment, economy, and numerous additional subjects that are passionately embraced by nurses. Transforming leadership in nursing, including involvement in the policy making process is an Institute of Medicine (2011) recommendation, which challenges and motivates nurses to engage in leadership roles in political activism. A noted nurse legislator and political activist, Dr. Bethany Hall-Long (2009), believes that nurses are educated for a political journey, if only they will accept the challenge. Historically, nurse leaders have played an active role in health policy and legislative initiatives. The earliest nurse leader, Florence Nightingale, significantly

2 impacted public policy in military health care as well as British and Indian health care systems (Mason, Leavitt, & Chaffee, 2002). She is known as the profession’s original reformer and the “consummate politician” (Meyer, 1992, p. 56). Countless other nurse activists have significantly influenced health care, including Lillian Wald’s promotion of public health, Margaret Sanger’s advocacy for birth control (Lewenson, 2002) and Wilma Scott Heide’s political activism in the National Organization of Women (Haney, 1985). The nursing profession has a legacy of political activism, but has been hampered to some degree due the fact that nursing is viewed as a women’s profession. Although nurses have been politically active for over 100 years, few nurses have pursued elected office. In the United States, registered nurses constitute the largest segment of the nation’s health care workforce, with over 3.1 million registered nurses (American Nurses Association, 2011); yet, only 100 nurses held political office in 2000, representing 0.005% of the total professional population (Feldman & Lewenson, 2000). In 2002, the number of nurse legislators remained at 100 with only three nurses as elected members of congress (Leavitt, Chaffee, & Vance, 2002). The current number of state nurse legislators has declined to less than 100 members (American Nurses Association, 2011). The American Nurses Association Political Action Committee is the fourth largest health care political action committee in the United States; thus, there is a significant population of potential nurse politicians (Betts, 1996). Elected nurse legislators provide a forum for the nursing profession to influence the lawmaking process (Canavan, 1996). Mary Wakefield, currently President Obama’s appointee for Administrator of the Health Resources and Services Administration (HRSA, 2009) and previous director of the Center for Health Policy and Ethics at George Mason University in Virginia, stated, “the

3 profession has fielded a strong class of individuals who are influencing public policy through an array of positions and activities” (Wakefield, 1999, p. 205); yet, very few nurses have seized the opportunities to influence public policy. Wakefield (2002) emphasized the need for nurses’ voice in public policy discussions to address the vast array of problems confronting access, financial and quality issues in health care. Ms. Lois Capps (2002), U.S. Congresswoman from California, indicated that nurses have credibility, respect, and trust with the public. Recent nurse legislators have attributed their successful elections and terms in office to the public’s trust in the nursing profession (Trossman, 2005). Nurses were added to the Gallup’s Annual Honesty and Ethics Survey in 1999 and have been ranked first every year with the exception of 2001 when firefighters were rated first following 9/11 terror attacks in New York City (Jones, 2011). Professional nurses are highly regarded by the American public, which can only potentiate the role of public servant to enhance positive change for health care to all citizens. Nurses have the expertise to lead successful change at the state, national and international level for healthcare and social goodwill. Nurses have been active in politics since the early 19 th century; however, it is only in recent history that nurses have sought and acquired positions as legislators. Political participation and activism of nurses (Dollinger, 2006; Eskesen, 1991; Gebbie, Wakefield, & Kerfoot, 2000; Gesse, 1989; Hanley, 1983; Hanley, 1987; Hayes & Fritsch, 1988; Hewlett, 2008; Krassa, 1994, 1998; Maraldo, 1986; McDaniels, 1991; Raines & Barton- Kriese, 2001; Small, 1989; Warner, 2003; Wilson, 2002; Winter & Lockhart, 1997) and a significant number of women politicians (Andersen, 1996; Baer, 1993; Dodson, 2006; Dolan & Ford, 1998; Flammang, 1997; Kathlene, 1994; Mattei, 1998; Palmer & Simon,

4 2006; Rule, 1990) have been investigated; however, nurse state legislators have not been studied. Political activism among nurses has been associated with the desire to “make a difference,” which was highlighted in the qualitative research of Gebbie, Wakefield and Kerfoot (2000) as well as the study conducted by Wilson (2002). The participants indicated an enthusiastic commitment to the philosophy of serving others- a “passion for care.” Other disciplines also acknowledged the motivating force of “making a difference” with political activism (Carter, 1989; Denker, 1994; Wise, 1999; Woodbury, 1988). Nurses have a moral and ethical obligation to participate in the public policy process (Milstead, 1999). State legislatures with a nursing presence provide the profession direct influence on policies and laws (Canavan, 1996). O’Malley, Cummings, and King (1996) conclude that political activism is a worthy passionate goal for nurses to make a difference in our own lives and the life of our society. Nurses in elected office have an opportunity to dramatically impact positive change for health care and beyond at the state and national level in America. Purpose The purpose of the study was to explore and describe elected nurse legislators’ experiences in becoming and being actively engaged in elected politics, specifically as an elected state legislator. Current nurse state legislators completed an on-line open-ended survey in which they were asked to describe their journey of political activism and journey to an elected state office.By examining the nurses’ descriptions of how they came to be elected to public office, the broader goal of the research was to assist and

5 inspire other nurses to pursue elected positions at the local, state, and national level; thus, increase nurses’ direct influence in public policy. In summary, this descriptive study of currently elected nurse legislators contributes insight and knowledge into a population of nurses and women politicians who are contributing to state and national public policy issues. Further research may build on these initial findings, contributing evidence that can be used to encourage and facilitate the path for nurse professionals who aspire to become active in public policy in elected state positions. Nurses in elected state positions will have the opportunity to make a difference for the nursing profession and their communities through political activism.

6 CHAPTER II R EVIEW OF L ITERATURE The review of literature is reflective of the purpose to explore journey of nurses to elected state legislative positions. Relevant theoretical frameworks from political science and nursing related to political activism are introduced followed by literature related to the attributes, motivators and life experiences in the political arena are presented. Theoretical Framework Other disciplines have identified potential theories that have successfully demonstrated the link of human values to political activist behaviors (Mayton & Furnham, 1994). Krampen’s (1991) action-theory model of personality has used variables of collective control, efficacy and competing threats, expectancies, etc. to demonstrate political activism. Schwartz and Bilsky (1987) associated universal motivational types of values to predicting political activism with power, achievement, hedonism, stimulation, self-direction, universalism, benevolence, tradition, security and conformity. Political scientists have noted three primary motivators for political activism to include personal gains, intangible rewards or purposive, universalistic gains (Jones, 1996). Hinkle, Fox-Cardamone, Haseleu, Brown, and Irwin (1996) developed a theoretical model of grassroots activism within the context of intergroup conflict. Verba & Nie (1972) developed a socioeconomic model of political participation, which indicated that participation was determined by social circumstances and an individual’s attitudes. Christy (1985) acknowledged that substantial literature exists to explore the

7 causal correlates of political participation and the various associated theories, but indicates the social-psychological concepts are outdated and the attitude-behavior relationship as a better model. These theories support the motivational aspects, individual attributes, and social circumstances associated with political activism. The political process theory has been associated with the development and political impact of the women’s movement in the 1960-70s and consists of three components: 1) mobilization of resources; 2) consciousness-raising through empowerment of potential supporters; and 3) facilitation of the movement through governmental sources (Costain, 1992). Within the nursing literature, few models of political development have been proposed. Chalich and Smith (1992) developed a Model for Individual Political Development which is described as a ladder with four rungs: Rung 1- Civic Involvements, Children’s sports, School Organizations, Neighborhood Groups, Rung 2 - Advocacy (i.e. Writing letters to public officials), Rung 3 - Organizing (i.e. citizen groups), Rung 4 - Long-Term Power Wielding (i.e. campaigning, agenda setting/planning). The model identifies political staging for a nurse, with potential to become an elected legislator; however, is insufficient to address the supportive and motivational factors as well as the individual skills and knowledge. In 1996, a landmark document delineating four stages of the nursing profession’s political development (Cohen, Mason, Kovner, Leavitt, Pulcini, & Sochalski) was published and has since been discussed by many prominent nurse scholars. The four stages include “buy-in” (recognition of the importance of political activism), “self interest” (development of political expertise with relation to self-interest), “political

8 sophistication” (activism beyond self-interest to public interest), and “leading the way” (nurses assuming leadership for broad health care issues (Cohen et al, 1996, p.259). Actions, language, coalition building and nurses as policy shapers characterize each stage of political activism. Wilson (2002) tested the framework by comparing the political action of nurses and non-nurses, which substantiated the first three stages of the model for nurses and the first two stages for non-nurses. The study demonstrated that nurses were motivated by the public good as opposed to the self-interest of the non-nurses, which supports the components of the motivators in the Model for Political Activism in Nursing. Hewlett (2008) tested the model by evaluating a sample of nurses’ level of political development and concluded the participants were in the early stage of political development. Nurses with advanced degrees were more politically active in campaigning activities. Organizational membership, age, family background and political attitudes were significantly associated with political activities. More recently, Dollinger (2006) conducted a grounded theory study of nurse advocacy in health policy, which demonstrated the core category of giving voice with six strategies including learning the culture, selective self-disclosure, translating, creating access, invoking others, and careful truth. Based upon the data, nurses were influential in nursing issues, but less with health care in general due to significant barriers related to dominance of the medical model and lack insufficient recognition of expertise. The investigator recommended that nurses seek opportunities to change the culture to increase the power of the profession.

9 The Cohen et al (1996) model stages the political development of the nursing profession, which can be used at the individual level; however, the model does not incorporate the professional nurse’s knowledge, skills, motivators and supportive aspects for an individual nurse’s journey to elected positions. Despite a rich history of political activism in nursing, minimal theoretical models have addressed political activism in the nursing profession and there is no existing model to depict the journey of an individual professional nurse to an elected position in government. Political Activism A large body of literature on political activism exists in political science and to a lesser degree in nursing; however, there is relatively little in-depth review of either the terminology or a concept analysis to clarify the meaning of the concept. Politics is a process to influence the allocation of scarce resources (Mason, Leavitt, & Chaffee, 2007). The defining attributes of political activism are summarized as an affiliation with a government or authority, direct, vigorous action, controversial issue, and motivated by a cause or goal (Herman, 2004). Political Activism “provides a framework for connecting policy and politics to nursing practice (Fullam, Lando, Johansen, Reyes, & Szaloczy, 1998, p.2). O’Malley, Cummings, and King (1996) stated that “politics focuses on the acquisition of power, resources, or influence that results in attaining desired outcomes in a situation where there is little consensus about options” (p. 68). Several references indicated the actions that were associated with political activism such as join a political party, attend political meetings, volunteer for candidates and campaigns, write letters to

10 legislators, making speeches, organizing meetings/marches, attend public forums, etc (Brown & Brown, 2003; Franko & Beu, 2003). Brown and Brown (2003) studied political activism among African Americans in churches using a measure of nonvoting political activism, which included involvement in campaigns, contacts with public offices, petitioning, protest politics, and campaign activism involving attending fundraisers, making financial contributions, and distributing candidate materials. Denker (1994) indicated that political activism was a time- consuming activity and reiterated the various political activities to become involved in the political process. Support for Political Activism Among Nurses Researchers recognize the importance of support for the professional nurse especially political heritage with family members who have been political activists as well a mentors/role models. Heritage refers to generational status and traditions attributed to a person’s family. Socialization in politics was found to be associated with political activism (Bennett, 1996; Gebbie, Wakefield, & Kerfoot, 2000; Haslip, 1983; Hayes & Fritsch, 1988; Hewlett, 2008; Scalzi & Wilson, 1990; Sullivan, Walsh, Shamir, Barnum, & Gibson, 1993; Williams, 1983; Winter & Lockhart, 1997). Conversely, Archer (1983) reported that low political participation was due to inadequate socialization. In addition to family support, a professional nurse may have a mentoring relationship with a mentor who is generally a senior individual in terms of age or experience that provides advice, information, and emotional support (Bowen, 1985). The relationship may continue over an extended period with the mentor providing both

11 informal and formal influence to advance the career of the protégé’ (Bowen). Yoder (1990) identified the defining attributes of mentoring as a structural role, career development relationship and an organizational phenomenon. A more recent concept analysis of mentoring describes mentoring as a learning one on one process through personal reciprocal career development relationship between two individuals with diverse characteristics (Stewart & Krueger, 1996). Role models are also influential for the professional nurse and can be described as an identification process where an individual internalizes or emulates another individual’s behaviors or social roles such as behaviors, mannerisms, values, and appearance (Stewart & Krueger, 1996). Political mentorship/modeling have been found to increase political participation among nurses (Farley, 2004; Feldman & Lewenson, 2000; Gebbie, Wakefield, & Kerfoot, 2000; Palmer and Simon, 2006; Spencer, 2004; Winter and Lockhart, 1997). Hindrances to political involvement included a lack of resources, role issues, poor social support, and negative experiences (Winter & Lockhart). Professional memberships have demonstrated a strong influence on political activism among a variety of specialists to include nurse-midwives and nurse administrators (Farley, 2004; Gesse, 1989; Hayes & Fritsch, 1988; Krassa, 1994; Winter & Lockhart, 1997). Other disciplines have also recognized the positive association between professional memberships, and political activism (Hamilton, 1998; Hewlett, 2008; Phillips, 1984). Political scientists have noted that organizational involvement repeatedly increases political participation (Andersen, 1996). The membership provides a collegial support and offers opportunities to build coalitions and network with other influential individuals.

12 Motivators for Political Activism Several concepts are associated with motivating political activism among politicians and individuals who participate in political activities. Scholars in the political science field cite ambition (Jones, 1990; Leeper, 1995; Palmer & Simon, 2006), desire for social change (Arceneaux, 2001; Malilwe, 1989), power and personal control as motivating factors for politicians (Al-Jibouri, 1985; Barth & Ferguson, 2002; Sullivan, et al., 1993). Several researchers have identified sources of motivation among political activists to include a desire to impact others/social power drive (Small, 1989), party affiliations (Farley, 2004; Krassa, 1994; Small), political efficacy (Eskesen, 1991; Farley; Gesse, 1989; Krassa; McDaniels, 1991), “to make a difference” (Feldman & Lewenson, 2000; Gebbie, Wakefield & Kerfoot, 2000; Warner, 2003), and passion (Feldman & Lewenson; Gebbie, Wakefield & Kerfoot). A study conducted by Wilson (2002) found that nurses were the only health care professional group in the investigation that engaged in political action to advocate for the public rather than self-interest. Ambition has been cited in political science literature as a motivator for seeking political office. A landmark study by Schlesinger (1966) investigated elections from 1914 to 1958, leading to Schlesinger’s theoretical framework of political ambition with three categories. Discrete ambition refers to an officeholder who serves briefly. Static ambition represents an elected official who strives to retain the position for as long as possible. Finally, progressive ambition is a politician who advances in the hierarchy for more prestigious positions. The Citizen Political Ambition Study (Lawless & Fox, 2005) was conducted with 3,000 participants, which revealed that men were twice as likely to consider running for office as compared to women. Palmer and Simon (2006) studied

13 widows who served in their spouse’s seat and were more likely to run again demonstrating they were politically ambitious. Leeper (1995) studied political ambition of women and found that they were more likely than men to remain in state legislative positions, which represents the static ambition type. Political ambition was found to influence home styles and district characteristics in state legislative roles; however, gender differences were not evident (Jones, 1990). A desire for social change as a motivation for political activism was demonstrated by Malilwe (1989) with female candidates in Michigan. The investigation found political participation was influenced by a personal desire for social change. Arceneaux (2001) found more women in the state legislature in states with a stronger moralistic culture. Social power or the desire to have an impact on others motivated nurses to participate in political activities (Small, 1989). Other related concepts have been found to have a positive relationship with political activism including a desire to make a difference and a strong sense of passion among nurses (Feldman & Lewenson, 2000; Gebbie, Wakefield & Kerfoot, 2000; Warner, 2003) Power and personal control are linked to political motivation. Gender and power were investigated by Barth and Ferguson (2002) with female governors demonstrating more feminine orientation in public life; however, the women were more likely than their male colleagues to express a traditional, hierarchical power motive. Politicians have been found to have a greater sense of personal control and self-esteem that promote political activism (Sullivan, et al., 1993). Al-Jibouri (1985) found personal control is positively related to political participation and activism.

14 Party affiliation and the related ideology foster motivation for political activism as demonstrated by Small (1989) among a sample of nurses. Krassa (1994) and Farley (2004) also found partisan identifiers positively correlated with members of the Illinois Nurses Association and nurses in Washington State, respectively. Political efficacy refers to a subject belief that one can influence political decisions (Campbell, Gurin, & Miller, 1954). Eskesen (1991) found a significant relationship between political efficacy and nurse’s political participation. Political efficacy was positively related to political participation among members and non- members of a nursing association (Krassa, 1994). McDaniels (1991) and Farley (2004) found a significant positive relationship with political efficacy and political participation among a sample of registered nurses. Political efficacy was found to be a positive predictor of political participation among a sample of nurse midwives (Gesse, 1989). Women and Politics A political glass ceiling continues to impede women in the world of politics by a political glass ceiling with barriers such as cultural norms and gender stereotypes (Palmer & Simon, 2006). A major turning point for women’s political participation was during women’s suffrage with the ratification of the nineteenth amendment for voting rights of women in 1920 (Anderson, 1996). Prior to the mid-twentieth century, women were socialized to view politics as a “man’s game,” with roles associated with nurturing, homemaking, family, community, teaching, care giving, and serving (Palmer & Simon). Political activism expanded from 1970s through 1990s with the women’s movement including male dominated institutions such as the military and church (Katzenstein, 1998). Revolutionary gender differences were highlighted by Gilligan (1982) with a

15 psychological theory on women’s development that demonstrated the different voice of women with an ethic of care and the importance of relationships, which influences their motives for public office and political process. Historical accounts since suffrage document that women demonstrate a distinct political style based upon cooperation, consensus building, caring, and information gathering (Andersen). Despite significant progress in women’s political participation and serving in elected positions, Mattei (1998) found as late as 1990 that women are treated differently within legislative institutions during nomination hearings, which perpetuates an outsider status. Kathlene (1994) found that women state legislators were seriously disadvantaged with unequal participation in committee hearings. Although more than half of the United States population is female, women candidates continue to face many obstacles to electoral success (Han, 2010). Early women trailblazers who pursued politics were subjected to unpleasant consequences both socially and psychologically. Another barrier has been the pipeline theory; whereby, the hierarchy of public office serves as a career ladder for positions from local to national offices, which typically included male candidates from the law profession (Palmer & Simon, 2006). Due to male dominance in elected positions, women pursued politics through other avenues such as roles of “expression” as volunteers for hosting socials and menial tasks or through the lateral entry as widows of elected spouses (Palmer & Simon). As career paths have evolved in recent decades, women’s careers are becoming more like the male counterparts. Women from various career paths continue to enter politics from fields other than law to include education and health including nursing. Representative Carolyn McCarthy (2002), a nurse from New York, started her

Full document contains 213 pages
Abstract: Nurses represent the nation's largest health care worker with over 3.1 million registered nurses in the United States and have the potential to make significant contributions to public policy on behalf of the patients they serve. Although nurses have been politically active since the 19th century, few nurses have pursued elected office at the state or national level. In 2000, approximately 100 nurses held political office, representing 0.005% of the total two million registered nurses (Feldman & Lewenson, 2000). Eleven years later, less than 100 nurses are serving in state legislatures (ANA, 2010). The journey of nurses to elected state legislative positions or the characteristics that might motivate nurses to seek public office have not previously been studied. The purpose of the study was to explore and describe the personal attributes, motivators, and life experiences of an elected nurse state legislator. A naturalistic design and grounded theory techniques were used to guide a qualitative study with the existing population of approximately 87 elected nurse state legislators in the United States. A demographic and electronic interview format was the primary instrument with open ended questions using Survey Monkey for collecting and analyzing demographic data. The response rate was 23% with 21 nurse legislators completing or partially completing the survey. Demographically, the nurse legislators were predominately female, Caucasian, married/partnered, democratic, and older with a moderate to higher income level. The majority of the nurses were highly educated with master's degrees, which demonstrated significant diversity n their field of study. The vast majority of nurses had been practicing nursing over 30 years and just over 50% were continuing the nursing career with many of the remaining participants in retirement. In contrast, the nurses were in elected office close to 12 years on average, but the range was diverse from 2 to 30 years. Nursing experiences were predominately as clinical staff nurses, nurse managers, and academia. The majority of nurses were members of professional nursing organizations in the past, but the memberships declined for the current year; while, the political, philanthropic, and civic organizational memberships significantly increased from past to present. A thematic narrative analysis of political activism in nursing evolved from three major themes to include early imprints, evolutionary journey, and illuminating actions. Within the theme of early imprints, the categories are political family heritage; diverse life experiences; valued traits; and knowledge and skills. The categories for evolutionary journey are political exposures, passionate altruism, supportive connectedness; defining moments; and openness to discovery. Illuminating action was characterized by the categories of voice of the voiceless; making a difference; caring on a grand scale; and a moral imperative to the common good. The study of currently elected nurse legislators added significant insight and knowledge into a population of nurses who are contributing to state and national public policy issues. The knowledge gained from the study may enable nurse educators to foster political activism in young nurses and facilitate more nurses who are interested in public office to pursue their dreams through the identified journey of political activism.