There is an increasing number of countries that are gradually engaging in the privatization of healthcare and the United States of America is at the forefront. This is despite the controversy surrounding the whole process. Primarily, the desire to reduce government spending on healthcare is what motivates this. Additionally, this is motivated by the idea that healthcare should be seen mainly through an economic lens rather than a social one. This is an idea that is shared by a significant portion of influential players in governmental and commercial arenas. This paper, therefore, looks at how these influential people use their position of influence and power to exercise control over privatized health institutions. Furthermore, it also looks at how nursing issues within the whole privatization spectrum are affected when these influential entities exercise their power of control.
Power is, therefore, defined as having influence, dominance, or control over someone or something else. The Marxist view of power focuses on its relation to class domination in a capitalist society (Palermo, 2019). This view addresses the linkage of power to class relations in economics, politics, and ideologies. The most important question that the Marxist is interested in answering is why the dominated class seems to accept or fail to recognize their oppression. He or she is therefore interested in establishing the impact of resistance and strategies in bringing about radical change (Jessop, 2022). Concerning the Nursing issues discussed below, the challenge is therefore to describe the oppression of nursing officials in the privatized healthcare system, the reason why the nursing professionals seem to accept their oppression, and how the nursing professionals are using resistance and strategies to push for radical change in their place of work.
According to triumphIAS (2020), Weber defines power as “the chance that an individual in a social relationship can achieve his or her own will even against the resistance of others”. For nursing issues in the wake of privatization, Weber would be concerned with showing how private investors and the government exercise their will over the nurses despite any form of resistance by the nursing professionals. Therefore, the government’s power over the resisting private investors and that of the private investors over the resisting nurses will also be addressed.
In a privatized healthcare system, the investor exercises power that has been granted to him or her by the investment. On the other hand, the nurse exercises power that has been granted to her or him by their expertise (Akagi et al., 2017). The investor exercises this power through hospital management while the nurse exercises this power through interactions with patients. The breadth of both of their abilities frequently depends on the restrictions imposed by law or custom. As a result, there are several power dynamics involving the nurse-patient, nurse-investor, and nurse-nurse relationships in a privatized healthcare system. These dynamics will be covered in more detail below.
The idea that nursing is a woman’s career has its roots in the socio-cultural context from which the profession of nursing has developed. Additionally, nursing tasks are carried out behind closed doors in hospital wards, away from public view. As a result, this contributes to a decreased perception of the profession’s worth and standing, which makes nurses seem more powerless. The notion that nursing is a woman’s job is a notion that is currently losing ground given the new trend of placing gender equality and parity at the forefront. Nonetheless, there still exist some elements of gender discrimination in the wake of privatization. In a show of their power and to cut costs, private investors are avoiding employing female workers within institutions for several reasons (Khalfalla, 2011). However, the main reason is the need to cut costs incurred during maternity leave and childcare service provision within such institutions.
Privatization of healthcare has little to no impact when it comes to matters to do with enhancing power in the nursing profession. If anything, privatization can be said to have taken more power away from the nurses in favor of private investors. This is because, in a private setting, nurses are hardly ever involved in hospital management issues (Jasemi et al., 2017). Typically, the investors use their influence over the nurses for their benefit. This is done through the hospital management piling pressure on the nurse too, for example, work more hours. Furthermore, private institutions tend to squeeze more work hours per nurse for many reasons. Chief among such reasons is that maintaining as few workers as possible is essential to maximizing profits.
Control over the content of nursing practice refers to a nurse’s capacity to act by his or her knowledge and judgment. In nursing practice, autonomy and independent judgment are crucial (Pursio et al., 2021). This is because the nurse is the one who is closest to the patient in a hospital setting. This makes him or her the only one who can recognize the patient’s patterns and subtle indications and react properly. Nurses frequently are, however, unable to fully utilize their professional knowledge in the privatized healthcare sector. For example, a nurse that is fully aware of their hospital’s policy of minimizing costs may feel pressured to take the most cost-effective alternative to patient care. This would ordinarily not be the case had he or she not felt that pressure or in other words if she or he had been operating independently.
Competence is necessary to attract and keep power. Knowledge development comprises education and experience. The maintenance of power in hospital administration hence depends on the competence of clinical professionals within the hospitals. Compared to other health professionals, nurses acquire what is perceived to be a lower degree of schooling. As a result, they are seen as being less worthy of their better educate- medical professionals. Consequently, nurses are manifestly at a disadvantage in the privatized healthcare system – a system that primarily rewards educational skills. Since consideration is more likely to be given to their better-educated colleagues, they are unlikely to advance through the ranks into more significant positions of power (Sepasi et al., 2017). They also are likely to receive less in remuneration. Going by the logic that power and money go hand in hand, then the nurse with less money is one with less power.
Currently, even not-for-profit healthcare providers are making profits. Privatization is the greatest attribute of this emerging trend. In this increasing capitalist ecosystem, people are willing to pay the highest amount of money for treatment as long as they get value for their money. For investors in healthcare, this means running healthcare as an economic good where the goal is customer (patient) retention (Sawyer, 2018). This is done by increasing the customer perception of care offered in hospitals. To remain relevant, not-for-profit healthcare institutions are slowly morphing into the likeness of privatized institutions. Essentially, what this does is add elements of competition among all players in healthcare. In as much as competition has its own added advantages, there lie some downsides that come with it.
One of the downsides that come with competition is the exertion of added pressure on nurses. Since private investors are more interested in increasing value perception, there is a need to ensure that operations in the hospital run optimally. Through hospital administration, investors have introduced productivity tests that focus on cost calculation and output per hour for nurses (Lockhart., 2019). Slowly, the mark of a nurse’s success is based on the ability to work for longer hours incurring as minimal costs as possible, and not based on patient outcomes. Being in a lower position of power, the nurses can do nothing to change the standards set by private investors. The nurses, therefore, have to endure the burden that may come with poor patient outcomes as a result of the overall reduced quality of care.
Putting nursing professionals in a position of power is an issue that cannot be therefore ignored. Having a nurse at the helm of a hospital administrative position means more power for the nurses. Bad policies that directly affect the productivity of nurses within hospitals become easier to shoot down when one of them is at the top. Nurses are at the forefront of public health promotion given they are involved in direct interactions with patients and hospital resources (Threw, 2020). This means that the nurses themselves are better suited to come up with policies on issues that directly affect their operations.
Further delving into power dynamics among the nurses in the wake of privatization. It is imperative to talk about collective bargaining in the private sector and compare it to that of the public sector. Essentially, public employment is constitutionally protected in many states. As a result, public collective bargaining unions have more freedom regarding what they can or cannot do. For instance, in the case, Pickering v Board of Education, public criticism of your employer was held to be a constitutional right. From the holding, criticizing was seen to be an exercise of free speech. With the privatization of health institutions, such freedoms and rights are not protected by the constitution (Summers, 2015). Other than public criticism of the employer, public collective bargaining unions added with lobbying are better placed to demand incentives such as better pay for their employees and improved working conditions. This power is greatly diminished when it comes to private collective bargaining.
Private collective bargaining is only a contract. It is only concerned with the costs and benefits of private parties to the agreement. Fundamentally, nurses that find themselves in private health systems must adapt to focusing on maximizing their interests rather than the nursing profession as a whole (Summers, 2015, p. 443). Such nurses are also limited in what they can say as free speech is not protected within private collective bargaining agreements. This adds more pressure on the nurses since they must check on what they say before doing so or risk dismissal from employment.
Ideally, the private sector cannot be relied upon to always protect the common good of the public. This is because private and public interests do not always align. With that, reforms through various government channels are needed to ensure that the public is well represented by the private stakeholders (Staff, 2021). In this case, the government is in a position of power to dictate how private institutions run the healthcare system. Being in a position of influence over the private healthcare sector, therefore, means that the government has some form of influence over the nursing profession.
For instance, the Affordable Care Act in the United States is one classic example of how the state exerts its power on the entire healthcare environment. In a general sense, this act has both direct and indirect impacts on the nursing profession. Since the introduction of the affordable healthcare Act, there has been an increase in access to healthcare as more people can afford to go to hospitals (Staff, 2021). Consequently, this has increased the demand for healthcare. The increased demand for healthcare means that more nurses are needed to cater to the increased number of patients. In privatized institutions where the employment of more nurses is not welcomed, imposing an excessive workload on the existing nurses is inevitable. The overall effect is burnout and ineffective care.
Furthermore, the Affordable Care Act calls for greater focus on outcomes. Resultantly, there is increased pressure on nurses to give effective care as per the stipulations of the act (Staff, 2021). In a privatized healthcare system, this is an added pressure on nurses who must now focus on both good outcomes for the patient. Additionally, in their provision of effective care, these nurses must have cost-cutting in mind to abide by the needs of their private investors. This is because despite the act being revolutionary, it does not cover everything. This is a difficult balance to maintain as often, effective care does not come cheap.
In general, the demand for healthcare caused by laws meant to improve the overall healthcare system such as the Affordable Healthcare Act is a bonus for job-seeking nurses. Nonetheless, there exist some downsides that come with increased demand (Rafferty, 2018). The main challenge within the nursing profession in the United States is a shortage of nurses in hospitals. To maximize profits, privatized healthcare institutions welcome the increased demand for care but neglect on employment of more nurses to reflect the increased demand. With the position of influence and power that the government has, there have been little to no efforts done to mitigate this problem. There is a need for the state, therefore, to come up with reforms to tackle the threat of a lack of nurses. Such reforms in tackling nurse shortages can be borrowed from what the UK is doing.
The UK government, through a program termed the 50000 nurse program, went on a quest to employ nurses from overseas jurisdictions. This was done to maintain safe staffing levels for the nurses (Gov, 2022). It could be argued that the employed nurses would only benefit the NHS. Additionally, concerns that such steps would do nothing to change the situation in private institutions were also raised. To counter these concerns, it is imperative to note that nurses in the NHS meant that the limited nurses in privatized healthcare settings do not go to the public healthcare setting as part-time contracted workers. This is because, with enough nursing staff in public hospitals, this gap is filled. The resultant effect is improved full-time care for patients in privatized hospitals.
There are several recommendations for the privatization of healthcare that ought to be looked at to ensure that this sector flourishes. Essentially, private investors must be willing to put their trust in medical practitioners to run the internal affairs of their hospitals. There has been a great improvement in this when it comes to medical doctors. However, nursing professionals have largely been left out in this regard. This is despite a recent trend that has been seen where patients prefer to be treated, for preventive care, by advanced practice nurses over physicians (Staff, 2021). Given this trend, private investors must therefore act in their power and empower nurses in their hospitals through financing and facilitation of further education and promotions to positions of power to capitalize on this trend.
Under international human rights law, governments can be held liable for abuses committed in the private sector. This presents a power dynamic in which even the states can be influenced by the international community (Pamba, 2021). To avoid breaking international laws that come with their own set of consequences, the state is tasked with the duty of regulating and monitoring private health care facilities. It is therefore recommended that the state must come up with more policies and laws meant to regulate this sector. From a nursing perspective, this means policies such as those setting the nurse-patient ratios, mandatory nurse insurance covers, and periodical nurse training seminars.
In conclusion, there are several issues affecting the nursing profession. Privatization is a recent development in an increasingly capitalist world and forms one of the greatest nursing issues. From a reduction of the nurse’s powers through the diminished role of their collective bargaining unions to powerlessness that gets them exposed to unbearable pressure from private investors, the nursing profession in the wake of privatization is faced with tremendous impacts. These impacts are both negative and positive. However, privatization of healthcare is here to stay, despite all the challenges it faces, due to the positive attributes that it possesses. Therefore, there is a need to follow the aforementioned recommendations on how the nursing profession should be empowered for optimal achievement and maintenance of public health.
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