The formal role that nurses play in an institution's policy-making varies widely depending upon the institution. But regardless of their formal role, and whether they realize it or not, nurses are influencing policy-making every day by carrying out their nursing responsibilities. A nurse's influence may be positive or negative, depending upon her awareness.

Hospitals, like other large institutions, have many policies (both written and unwritten) designed to facilitate the smooth running of “business.” Since the major part of hospital business is caring for patients, most hospital policies have at least some effect upon its patients. For the purpose of discussing the nurse's role in policy-making, hospital policies which have an impact upon patient care may be divided into four categories: 1) patient care policies; 2) administrative policies; 3) business policies; and 4) “rules.”