The recent Supreme Court decision in the Davis case, which allowed a federally-assisted college to exclude a severely hearing impaired woman from its registered nurse training program, has caused great concern among handicapped people and their advocates. Institutions of higher education also have reason for dissatisfaction with the decision since it fails to provide sufficient guidance for those recipients of federal funding to measure their compliance with section 504 of the Rehabilitation Act of 1973. A letter dated October 5, 1979, from Patricia Harris, Secretary of Health, Education and Welfare (HEW), to college presidents is the latest official statement concerning the decision.

Nurses and nurses' aides probably administer almost all the medications in most large mental institutions. Until recently it was generally assumed that whatever drug the physician ordered, the nurse had to administer and the patient had to accept. Two recent cases, however, have challenged these assumptions and may lead to major changes in the way mental patients are treated.

There are two basic justifications for confining the mentally ill: (1) to protect them or other members of society — the so-called “police power” justification; and (2) to care for those unable to care for themselves — the parens patriae justification. Both generally require use of the “least restrictive alternative.” Mentally ill patients may or may not be competent to make any number of decisions, including the decision to accept or reject medications; but when can they be forcibly treated?

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.”