Nurses are often the ones expected to carry out healthcare policies, implement organizational changes, and manage the consequences of decisions made by others, but how often are we actually included in making those decisions?
Throughout my career, I have worked at the bedside, in disaster response, public health, education, and federal service. These experiences have given me the opportunity to see healthcare from very different perspectives.
I have cared for patients affected by policies I had no role in developing. I have also sat in meetings where decisions were being made that would eventually affect thousands of healthcare workers and the communities they serve, and one thing has become increasingly clear to me:
Nurses should not simply be expected to implement healthcare decisions. We should be helping make them.
As we continue DNP Week, I want to discuss why nursing leadership must extend beyond traditional clinical roles and why DNP-prepared nurses have an important responsibility to participate in healthcare policy, governance, and systems-level decision-making.
We Understand Healthcare From a Different Perspective
Nurses have a unique understanding of how healthcare systems function because we see what happens when those systems succeed and when they fail.
We understand the consequences of staffing shortages, delayed care, inadequate resources, communication failures, and policies that do not reflect clinical realities.
We see how social circumstances influence health outcomes and how barriers to accessing care affect patients long before they reach a hospital.
We also recognize that what works in one healthcare setting may not be practical in another.
A policy developed for a large academic medical center may be difficult to implement in a rural hospital.
A public health recommendation may overlook the needs of individuals who lack transportation, reliable internet access, or the ability to take time away from work.
And a disaster preparedness strategy may look comprehensive until the healthcare workers expected to implement it discover that critical resources are unavailable.
These are not minor details.
They are the realities that determine whether healthcare policies and programs actually work.
If nurses are not part of the conversation, an important perspective is missing.
Leadership Does Not Require Permission
One of the lessons I have learned is that leadership is not limited to individuals with executive titles.
Some of the most effective leaders I have encountered were nurses working directly with patients who recognized problems and took action to improve care.
They questioned unsafe practices, developed better processes, mentored colleagues, and spoke up when something needed to change.
That is leadership, but we also need nurses willing to take those experiences into spaces where broader decisions are made.
This includes hospital boards, professional organizations, government agencies, legislative discussions, public health committees, and international healthcare initiatives.
I have had opportunities to participate in policy discussions and work alongside individuals responsible for decisions affecting healthcare delivery and emergency preparedness.
Those experiences reinforced something important: clinical expertise is valuable, but we must also understand how decisions are developed, funded, implemented, and evaluated.
It is not enough to identify a problem.
We need to understand how to influence the systems responsible for addressing it.
The DNP and Healthcare Policy
The Doctor of Nursing Practice prepares nurses to examine healthcare challenges beyond individual patient encounters.
Through advanced education in systems leadership, evidence-based practice, organizational improvement, and healthcare policy, DNP-prepared nurses can contribute to decisions affecting entire populations and healthcare systems, but earning the degree is only the beginning.
We have to be willing to use that preparation.
That might mean serving on a hospital committee, contributing to legislative discussions, evaluating organizational policies, or participating in professional governance.
It might mean addressing barriers to healthcare access, improving workforce safety, strengthening disaster preparedness, or ensuring that underserved populations are considered when healthcare decisions are made.
Not every DNP-prepared nurse needs to pursue a political or executive position.
However, we should understand that healthcare policy is not something that happens separately from nursing practice.
Policy determines what resources are available, who can access care, how services are delivered, and what nurses are permitted or expected to do.
Whether we recognize it or not, policy influences our work every day.
Representation Must Go Beyond Having a Seat at the Table
We often hear discussions about the importance of nurses having a seat at the table.
I agree that representation matters, but simply being present is not enough.
We must be prepared to contribute, ask difficult questions, challenge assumptions, and offer practical solutions.
We also have a responsibility to recognize whose perspectives may be missing.
Healthcare is not experienced equally across populations or geographic locations.
Rural communities, displaced populations, individuals with disabilities, older adults, and people living in resource-limited settings often face challenges that are overlooked in broader policy discussions.
My experiences working domestically and internationally have shown me how differently healthcare systems operate and how important it is to avoid assuming that one approach will work everywhere.
Nursing leadership must account for those differences.
And when we participate in decision-making, we should remember that we are not there simply to represent ourselves or our credentials.
We have a responsibility to consider the patients, healthcare workers, and communities who will be affected by those decisions.
Disaster Preparedness Is Also a Policy Issue
My work in disaster nursing has reinforced the importance of nursing involvement in policy and governance.
Disaster preparedness is shaped by decisions about funding, infrastructure, workforce capacity, emergency authorities, resource allocation, and coordination between organizations.
These decisions often occur long before an emergency.
Yet when a disaster happens, nurses are among those expected to manage the consequences.
We cannot continue to separate disaster response from the policies and systems that determine whether healthcare organizations are prepared.
Nurses need to be involved in discussions about emergency planning, healthcare continuity, workforce protection, and recovery, and we need leaders who understand that preparedness is not simply about having a plan.
It is about ensuring that plans can actually be implemented when conditions are difficult and resources are limited.
We Need More Nurses Willing to Step Forward
I also believe we need to do a better job of encouraging nurses to pursue leadership opportunities outside traditional clinical settings.
Too often, nurses underestimate the value of their experience or assume they need additional credentials before contributing to broader discussions.
Education is valuable, but so is experience.
A nurse who has spent years caring for patients in an understaffed emergency department has important insights into healthcare workforce challenges.
A community health nurse understands barriers to care that may never appear in hospital quality reports.
A nurse working in a rural facility may identify resource limitations that are overlooked when policies are developed in larger healthcare systems.
These perspectives matter.
We should be creating opportunities for nurses at every educational level to contribute to organizational decisions, professional leadership, and healthcare policy.
For DNP-prepared nurses, part of our responsibility should be helping create those opportunities for others.
Leadership should not be about collecting titles or being the only nurse in the room.
It should be about ensuring nursing knowledge and experience influence the decisions being made.
What Will We Do With Our Voice?
As I reflect on my own career, I am grateful for the opportunities I have had to work in different healthcare environments and participate in conversations that extend beyond direct patient care, but those experiences have also reminded me how much work remains.
We continue to face challenges involving healthcare access, workforce safety, preparedness, health inequities, and the sustainability of healthcare systems.
Nurses have valuable perspectives on all of these issues.
The question is whether we are willing to bring those perspectives forward.
As we recognize DNP Week, I encourage DNP-prepared nurses to think about where their knowledge and experience could contribute beyond their current roles.
Join a committee. Participate in professional governance. Contribute to policy discussions. Mentor nurses interested in leadership. Ask questions when decisions do not reflect clinical realities.
And when you have an opportunity to influence a decision, remember the people who will be affected by it.
Nursing leadership is not about being the most educated person in the room. It is about using our knowledge, experience, and judgment to help make better decisions.
We should not have to wait until a policy fails to explain why nursing perspectives were needed.
We belong in those conversations from the beginning.
My question for today: What is one healthcare policy or organizational decision you believe would benefit from greater nursing involvement?
I would love to hear your thoughts.
Happy DNP Week!
Dr. Jamla Rizek, DNP, MBA, RN, FAAN, FAEN
Founder, Adventures with Nurse Jamla®
www.adventureswithnursejamla.com