Discussion 2: The Role of the RN/APRN in Policy-Making

 

 One of the most significant steps nurses and APRNs can take to become more active participants in lobbying/policy-making is joining a professional nursing organization. Many of the bills that affect healthcare and nursing have been brought to congressional attention by professional nursing organizations and lobbying groups that represent the interests of nurses. Nurses and APRNs also have the opportunity to write to their legislators, using their professional knowledge and expertise to either support or refute currently legislation on the table. Many professional organizations include fact sheets about certain legislation on their website that can be printed and included with letters to congressmen (NACPM, n.d.). 

 One great example of a law resulting from a ground-up effort by advanced practice nurses is S. 1697, the Midwives for MOMS (Maximizing optimal maternity services) Act of 2021 (Congressional Research Service, 2021). The bill was proposed in 2021 and is currently in committee in the Senate. If passed, the act would expand federal funding for the training and diversification of the midwifery workforce (Congressional Research Service, 2021). The bill is supported by the National Association of Certified Professional Midwives and they even have links on their website of how to write or call your congressmen about the bill (NACPM, n.d.). 

 While advanced practice nurses have many opportunities to become involved in policy-making, there are also challenges involved. Milstead & Short (2019) point out two potential barriers for success when implementing or evaluating policy, which include lack of resources (either human, financial, technological), and a potential lack of stakeholder buy-in. When nurses decide to take action in the world of public policy, it can be beneficial to use our skills of collaboration and communication to include members of other health professions in our efforts (Milstead & Short, 2019). Interprofessional collaboration not only helps build a larger grassroots platform, but also increases the knowledge base of the involved parties. Nurses can also use social media as a platform to increase public awareness and participation in their campaign (Milstead & Short, 2019). 

 

References:

Congressional Research Service. (2021). Summary: S.1697. Congress.gov. https://www.congress.gov/bill/117th-congress/senate-bill/1697?q=%7B%22search%22%3A%5B%22nursing%22%2C%22nursing%22%5D%7D&s=2&r=48 

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. Jones & Bartlett Learning. 

NACPM. (n.d.). Support H.R. 3829, The Midwives for Moms Act! Call Your Legislators today. National Association of Certified Professional Midwives (NACPM). https://nacpm.org/support-h-r-3829-the-midwives-for-moms-act-call-your-legislators-today/ 

In teaching undergraduate, pre-licensure nursing, one of the distinct differences I have found between teaching BSN and ADN level nursing courses is the fact that outcomes for the BSN, led by the BSN essentials, includes such topics as political advocacy, leadership and management, and nursing research. However, I think these topics are important for nurses at all levels. Do you think there is time in an ADN curriculum to teach political advocacy? How can we ensure that nurses at all levels are properly prepared to become active in the political process?

Dr. Mooring

 

 

Dr. Mooring,

I agree that ADN nurses deserve a voice in the political arena as much as their bachelor’s-educated colleagues. Having worked with many ADN nurses over the years, most of them have expressed how rigorous their programs were, especially when it came time to prepare for the NCLEX. Because ADNs have the same level of patient care responsibilities as RNs after graduation, I believe that the vast majority of their curriculum should be devoted to the hands-on nursing process, for the safety of their future patients. One possible answer to this conundrum is that more hospitals should be paying for continuing education for ADNs. According to a post from Nurse.org (Brusie, 2020), many ADNs are eligible for tuition reimbursement from their hospitals and aren’t even aware of it. If we make it possible for ADN-prepared nurses to work while obtaining a BSN, that would level the playing field in terms of potential political involvement.

Reference:

Brusie, C. (2021). How to get your RN to BSN paid for by your employing hospital. Nurse.org. https://nurse.org/education/employer-paid-rn-bsn/ 

Andrea,

Amazing post! I had no idea about that proposed bill that expands available maternity services. I think it is a great utilization of alternative care for those who are pregnant. There are many who choose not to do a “traditional” birth at the hospital and find it much more comfortable to do it at home or another facility in the care of midwives. If this law passes do you think there should also be regulation to go along with it because there are certain risks associated with giving birth in facilities outside of a hospital? On another note, I agree that a lack of resources whether it be financial or in regards to available professionals and collaboration can definitely combat this. Networking can lead to economical or professional opportunities that can aid in advancing policy.

References:

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. Jones & Bartlett Learning.

NACPM. (n.d.). Support H.R. 3829, The Midwives for Moms Act! Call Your Legislators today. National Association of Certified Professional Midwives (NACPM). https://nacpm.org/support-h-r-3829-the-midwives-for-moms-act-call-your-legislators-today/

Thank you for your reply, Chris. As far as I understand the Midwives for Moms Act, it is aimed at expanding the workforce of CNM (certified nurse midwives) but does not touch on the practice of at-home or out-of-hospital birthing centers. Many hospitals are adding midwives to their in-hospital birthing teams, who collaborate with physicians in the hospital setting much the same as acute care NPs do. Many midwives have the potential to practice in outpatient OB/GYN offices as ease the physician caseload and address the backlog of patients seeking prenatal care (Dawson et. al., 2015). I do agree with your point that in the case of home births, regulations are necessary to protect mothers, babies, and the professional licenses of the midwives who perform home births.

Reference:

Dawson, A.J., Nkowane, A.M. & Whelan, A. (2015). Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review. Hum Resour Health 13, 97. https://doi.org/10.1186/s12960-015-0096-1

Response

Hi Andrea thanks for your post, I enjoyed it.  Facing opposition at work or while working on something you know could be beneficial to others could be very frustrating, but as you mentioned, working together with others can help reduce the barriers while providing quality care; However, not everyone knows how or is comfortable in working together with others, but as nurses, it is important that we collaborate with other health care professionals to provide care to our patients. “Interprofessional collaboration is considered by many in governments and health care organizations and professions to be critical to the provision of safe, effective, and efficient care” (Prentice, et al., 2015). Interprofessional collaboration can begin from school. Health care students, like nursing and medical students can be trained on how to work collaboratively with others while in school and by the time they get out in the real world they will be ready (Prentice, et al., 2015). Interprofessional collaboration increases patient safety and also improve healthy work environment.

References

Prentice, D., Engel, J., Taplay, K., & Stobbe K. (2015). Interprofessional collaboration, the experience of nursing and medical students’ Interprofessional education. Global qualitative nursing research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287322/

Sigmon, L. (2020). Interprofessional collaboration made easy. American Nurse. https://www.myamericannurse.com/interprofessional-collaboration-made-easy/

HI Andrea, great post, very insightful. If this proposed bill is passed, it will be a great way to expand maternity servies to expecting moms. This would allow nurses and APRN to use their professional knowledge, experience and expertise to implement these services to expecting mothers. As much as this bill being passed will benefit the targeted population we can not overlook the barriers at hand, the lack of resources financially and technologically, one way to potentially overcome these barriers is through professional collaboration and networking.

                                                                                                                              References

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. Jones & Bartlett Learning.

NACPM. (n.d.). Support H.R. 3829, The Midwives for Moms Act! Call Your Legislators today. National Association of Certified Professional Midwives (NACPM). https://nacpm.org/support-h-r-3829-the-midwives-for-moms-act-call-your-legislators-today/

Andrea,

Before reading your post I had not heard of the MOMS act. I think that this ACT is critical for improving quality care for pregnant mothers. Congresswoman Alma Adams announced that the MOMS act along with the maternal CARE act, were both crucial for decreasing morbidity and mortality in maternal care in April of last year (Adams, 2021). This came at the end of black maternal health week which targeted an audience of diversity. I think that when trying to convince legislature of policy changes, we should first identify our audience and what is important to them. Another important factor for influencing policy changes is the act by which it is written.  Merely sending a letter to your congressman may not be enough but, witting them in a fashion that is appealing as well as using language that they can understand may be more beneficial. Understand how to identify your audience and learn to craft your writing to meet their needs (University of Maryland Global Campus, n.d.).

References

Adams, A. (2021). Adams announces MOMS Act and maternal CARE Act to conclude black maternal health week.  Adams Announces MOMS Act and Maternal CARE Act to Conclude Black Maternal Health Week | Congresswoman Alma Adams (house.gov)

University of Maryland Global Campus. (n.d.) Writing for an audience.  Writing for an Audience | UMGC

     Nurses are the largest profession in the industry. RN’s and APRNs have a significant role in policymaking. Nurses have specific knowledge, skills, and first-hand perspectives to offer and contribute to health care policy design and implementation. RN’s and APRNs have a great influence on the transformation of the health care model (Sundean et al., 2018). Health policy directly affects RN’s and APRNs because it affects how they provide care to their patients.  Since RNs spend a lot of time working directly with patients, they know the specific needs of the communities they serve. In turn, RNs are excellent advocates for public policy development. Nurses have the duty to advocate for change for policy by reviewing, modifying, implementing, and evaluating policy through various organizations (Milstead & Short, 2019).

There are 2 popular and simple approaches that RN’s and APRNs can use to participate in policymaking. The first method is to join professional organizations and nursing boards. Boards of Nursing and Professional Organizations present opportunities to influence health policy and the opportunity to role model governance leadership and decision-making. As members, you can influence and provide unique and specific information to educate legislators and interest groups. Increasing nurse board appointments will also leverage the knowledge, skills, and perspectives of nurses critical for governance decision-making and health care transformation (Sundean et al., 2018).  Any bill that is introduced to the house concerning health must pass through committees where expert opinion is recruited to change policy; health practitioners from the board of nursing are part of this process. If nurses and nurse practitioners sit on those boards, they can influence and provide informed opinions on the proposed policy. They can support and oppose the bill, then the committee can present their suggestions or perspectives regarding the bill (Milstead & Short, 2019).  Professional organizations can be used by nurses to review a certain policy and make sure that the policies that are implemented are effective.

The second method RN’s and APRNs can use to promote policymaking is through the workplace. They can advocate for high quality and service for their patients as well as improve the working environment.  Through this advocacy, nurses can influence health care policy. By gaining a comprehensive understanding of and specialization in particular areas of health care, nurse practitioners are uniquely situated to support positions that will benefit our communities. NPs can conduct quality improvement projects in their working environments and can use their findings to help implement new policies at the facilities where they work (Chilton, 2015). Nurses on the front line are knowledgeable about what policies are effective and produce quality results in the workplace. Nurses can join quality assurance programs, participate in programs to increase improved outcomes thereby challenging the current ineffective and outdated policy. RN’s and APRNs can use evidence-based research to support policy change in the workplace through active involvement on facility boards and committees.   Capitalizing on this can influence nurses  become involved as well as become a catalyst for change when opportunities present themselves would result in substantial advancement in the profession in addition to the populations they care for (Romain-Lapeine, 2016). These methods do not come without issue. Consideration of the professional organization to introduce, advance, or promote policy, ultimately, the decision still resides with the legislator. This method can take many sessions, unrelenting lobbying efforts to educate and persuade legislators and special interest groups to remain interested and focused on the policy. The second obstacle with the workplace is a lack of knowledge by nurses’ regarding updated policies or new policies. Many nurses’ involvements are insufficient regarding policy reform. Many contributors regarding policy in the workplace are introduced by quality management, senior-level administrators, or adjunct staff that does not have the hands-on perspective and knowledge that the nurse could toward the policy. Key strategies to incorporate better involvement in policymaking would be to better educate nurses on how to join professional organizations, how to lobby or encourage written letters to legislators, voting, and introducing health policy as courses required in course programs and encourage robust and involved leadership in our facilities. Increase communication amongst nurses by using spotlights in your facilities’ communication paper, Quizlet, monthly updates in nursing meetings, and provide incentives to participate and become involved in the development of new proposals, implementation, reform, and evaluation processes for policy. Provide the nurse educators with robust and innovative techniques in the training of nurses. Provide computer-based modules to employees to better understand why a policy is important and how policy becomes laws.

 

Chilton, L. (2015). Nurse practitioners have an essential role in health policy. The Journal for Nurse Practitioners, 11(2), A19.

 

Milstead, & Short, N. M. (2019). Health Policy and Politics (6th ed.). Burlington, MA: Jones & Bartlett Learning.

 

Romain-Lapeine, F. (2016). Starting Early: Influencing Change Through Nurse Engagement in Health Policy.

 

Sundean, L. J., Polifroni, E. C., Libal, K., & McGrath, J. M. (2018). The rationale for nurses on boards in the voices of nurses who serve. Nursing outlook, 66(3), 222-232.

Nurses are taught to advocate for their patients during the earliest days of nursing school. However, many are not comfortable discussing politics or have not been taught to truly evaluate bills and other political writings. What can we do to ensure all nurses are prepared, not only to advocate for patient needs during their health care stay, but also to advocate for policies that will improve patient outcomes?

Dr. Mooring

Dr. Mooring

The most effective method to prepare nurses to be advocates for policies that will improve patient outcomes is to introduce students to the political arena early in their degree programs. Most nurses do not feel comfortable in the political arena or policymaking because it is unfamiliar and rarely addressed or introduced early on in the education program.  Mund (2012) states that the foundations for understanding policymaking should be grounded in formal nursing education and synthesized with practice and work environments.  Nursing students must be educated to view politics and policymaking as a standard step in the professional development of their career rather than an obstacle.

The other obvious choice is to educate nurses’ or institute a proposed requirement from the BON that all licensed nurses must obtain membership in a professional nursing organization, a condition of licensure.  Nursing organizations are designed to educate, engage, promote nursing leadership, and strengthen nurses’ impact in our profession to yield positive results and advancement in their professional roles.  Despite this role expectation as part of nursing practice, many clinical and administrative work environments may not fully support nurses’ engagement in public policy advocacy work, creating role conflict (Deschaine and Schaffer, 2003).  It is imperative to reach out and educate and inform our nurses of our professional obligation to establish and promote our role as practitioners and advocate for our patients with practical and applicable policies.

References

 

Deschaine, J. E., & Schaffer, M. A. (2003). Strengthening the role of public health nurse leaders in policy development. Policy, Politics, & Nursing Practice, 4(4), 266-274.

 

Mund, A. (2012). Policy, practice, and education. American Association of Nurse Anesthetists Journal, 80 (2012), pp. 423-426

Shelly,

I liked that you pointed out how nurses understand the “specific needs of the communities that they serve.” I think that one of the benefits of being a nurse is that you have the perspective that others may not have. You actually know the issues that patients and their families are dealing with. This insight gives nurses an advantage for policymaking. Incorporating a nurse’ input can help protect patient safety, increase quality of care, and facilitates patient’s access to required resources (Arabi, 2014). It is usually easier for most people to determine the problems that exist in our health care system rather than providing solutions for those issues. Encouraging nurses to join professional organizations can help them get motivated and work together to solve these issues. The ANA is a great example of this and offers resources, support, networking opportunities, and webinars that you can let your thoughts be heard (ANA, n.d.). As you well know, communication and knowledge are two key factors for social growth and change.

 

References

American Nurses Association. (n.d.). ANA membership.  American Nurses Association (nursingworld.org)

Arabi, A., Cheraghi, M., Ghiyasvandian, S., Rafii, F. (2014). Nurse’ polciy influence: A concept analysis. Nurses’ policy influence: A

concept analysis (nih.gov)

Charity

Thank you for the words of encouragement. I have been a nurse for over three decades and getting involved in the policy-making segment is uncomfortable yet of great importance to our profession. As a young nurse, thirty-five years ago, there was fear of the unknown for me. I thought that the job of lobbying and policy advocacy was for the most senior nurses who held doctorate degrees. This could not be farther from the truth. Our young generation of professionals needs to stand up and let their voices be heard so that the profession can advance and create a better work environment than we had three decades ago.  Nurses are the largest workforce organization. The advancements that we could make if every nurse took a professional stance and participated in the political arena are obscene. I am excited to see what the future has in store for us as advanced practice nurses.  Milstead (1999) contends that whereas nurses in advanced practice have taken on multiple roles, most of this expansion has been direct patient care, and “the role of political activist has been given short shrift by many advanced practice nurses who do not see the role as central to their practice.” This points to the need for advanced practice nurses to understand the policy process and ways to influence this process to foster population health.

The other key factor to all nursing careers is participation in professional organizations.   I am an American Psychiatric Nurses Association (APNA), American Nurses Association (ANA), and Emergency Nurses Association (ENA) member. All have been so beneficial to me once I realized their value for me. Joining a professional organization is of great significance and benefit.  The American Nurses Association Social Policy Statement (Cohen & Milone-Nuzzo, 2001) asserts that social policies and their effects on the health of individuals, families, and communities fall under the purview of nursing care and research.

 

References

 

Cohen, S., & Milone-Nuzzo, P. (2001). Advancing health policy in nursing education through service-learning. Advances in Nursing Science, 23(3), 28-40.

 

Milstead, J. (Ed.) (1999). Health policy and politics: A nurse’s guide. Gaithersburg, MD: Aspen.

Shelley,

Thank you for the reminder of some ways nurses can make a difference daily. Nurses are advocates and have the knowledge set to truly verbalize what some of the needs are for our patients and for better patient outcomes. There are some barriers that can include lack of knowledge on certain policies or protocols. There are lots of obstacles that present themselves while one aims to be a leader including losing sight on the patient, sometimes, just to get a point across. (Prestia, 2020). A NASN School nurse article highlighted a significant and necessary fact. This pandemic that we are currently in has encouraged everyone, including nurses to speak up for ourselves and our patients with our feet on a solid foundation, regardless of our background. (Largent, 2021).

References:

Largent, P. (2021). Advocacy for School Nurses and Student Health and Safety: Highlighting National and State Efforts. NASN School Nurse (Print), 36(4), 188–190.

https://doi.org/10.1177/1942602X211019136

Prestia, A. S., & Dyess, S. M. (2020). Losing Sight: The Importance of Nurse Leaders’ Maintaining Patient and Staff Advocacy. Nurse Leader, 18(4), 329–332. https://doi.org/10.1016/j.mnl.2020.04.005

Nurses are one of the largest groups of health care providers, so who better to advocate for policy change than nurses? Nurses provide a different point of view on health care policies. Because nurses have direct patient contact, they can efficiently identify current problems within the healthcare industry and advocate for change to improve the quality of care. One of the many opportunities for nurses to participate in policy-making is becoming a member of a professional nursing organization. Professional nursing organizations such as the American Nurses Association (ANA) or the American Psychiatric Nurses Association (APNA) give nurses access to multiple resources regarding policy change (Abood, 2007). Through nursing organizations, nurses can learn more about healthcare policies, how to propose changes, and how to support current proposals.

Another opportunity for nurses to be active in policy-making is to further their education by obtaining a Master of Science in Nursing (MSN) degree. Advancing one’s education allows one to expand on their current knowledge and skillset while also placing one in a better position to advocate for change (Walden, 2020). APRNs are much better equipped to influence policy change because they have a greater awareness and insight for what changes should be implemented and how to go about implementing new policies.

Stepping out of one’s comfort zone and becoming overwhelmed by participating in policy change are challenges these opportunities present. Despite the ease of joining a nursing organization, nurses may become discouraged when presented with the various resources that they provide. Nurses may feel as though they don’t know what they’re doing or wonder if they’ll make a difference. One way to address this challenge is by educating nurses on the power of advocacy and that no change is too small. Educating nurses about the importance of policy change throughout nursing school is imperative in ensuring the confidence nurses need to advocate. Another challenge is the inadequacy of nursing school education regarding policy reform. Nursing schools should effectively prepare nurses for participation in policy-making (Rasheed et al., 2020). Nurses cannot be expected to advocate for policy change if they are not instructed on its importance and relevance to their careers.

One strategy to communicate the existence of these opportunities in policy-making is to ensure that nursing students’ curriculum contains a healthcare policy course. I remember briefly discussing policy during my RN program, but I wasn’t fully introduced until my BSN program. Prior to obtaining my BSN, I did not know much about my role in policy reform and how I could potentially influence positive change. More thoroughly implementing this material in the curriculums of LPN and RN programs is necessary for laying the foundation for nurse activism.

Another strategy to create awareness of these opportunities in policy-making is to do so through the workplace. Most hospitals already have some form of a policy committee in place as a resource for nurses interested in policy-making. These committees should be expanded and advertised more often as most people may not even know that they exist or how to get in touch. Policy committees can provide nurses with resources and connections with other people who share common goals.

References

Abood, S. (2007). Influencing Health Care in the Legislative Arena. OJIN: The Online Journal of Issues in Nursing, 12(1). https://doi.org/10.3912/OJIN.Vol12No01Man02

Rasheed, S. P., Younas, A., & Mehdi, F. (2020). Challenges, extent of involvement, and the impact of nurses’ involvement in politics and policy making in in last two decades: An integrative review. Journal of Nursing Scholarship, 52(4), 446–455. https://doi.org/10.1111/jnu.12567

Walden University. (2021, March 25). Why Nurses Are Such Good Advocates for Policy Change. Walden University. Retrieved December 14, 2021, from https://www.waldenu.edu/online-masters-programs/master-of-science-in-nursing/resource/why-nurses-are-such-good-advocates-for-policy-change

There may be push back from administration as nurses organize and become more politically active. In reading articles and watching news reports about the Senator from Washington who made the remark about nurses “playing cards” most of the day”, I couldn’t help but wonder who’s best interest she had in mind and who was relaying this information to her.

Dr. Mooring

Great post, Marissa. You make a great point about how nurses are underrepresented politically despite making up the vast majority of the health care workforce. In my reading this week, I came across an article that highlights some of the reasons that nurses finally overcome professional and personal barriers and push into the political arena. The Yoder-Wise framework of planned policy change states that nurses collectively respond to a precipitating event (such as the COVID-19 pandemic) that causes stress, after which nurses hit a ‘critical point’ and feel forced to take political action (Anders, 2021). Sometimes it takes external factors and stressors to force us to overcome the traditional barriers to political action such as time constraints or being intimated to step into the political area (Milstead & Short, 2019). Do you think that as a result of the COVID pandemic, many more nurses will begin to find their political voice?

References:

Anders R. L. (2021). Engaging nurses in health policy in the era of COVID-19. Nursing forum, 56(1), 89–94. https://doi.org/10.1111/nuf.12514

Milstead, & Short, N. M. (2019). Health Policy and Politics (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Response

Hi Marissa, thanks for your post, you made an important and interesting point about including health care policy in RN and LPN `curriculum. Nurses are well respected and trusted in most part of the world among other health care professionals and their involvement in health policies would make greater impact on health care, yet they continue to be missed in action (Anders, 2020). Why is this so? As you mentioned, it could be due to lack of knowledge on nurses’ involvement in policy making.  I have been a nurse for a while now and I feel I am learning a lot more about policy making and the role of the nurse in policy making now than ever. Before this class, I wasn’t aware of the extent nurses could be involved in policy making and I am sure like myself; there are other nurses out there who do not know much about the power they hold as nurses. According to an article, even though nurses make up the largest part of the health care population, their involvement in health policy is low (Lewinski & Simmons, 2018). As I have mentioned above, am sure this is due to the fact that most nurses are not that knowledgeable on health policy, so I believe getting exposed in the earlier stages or while preparing to become a nurse like you mentioned, will be very beneficial and will get nurses more involved once they begin to practice.

References

Anders, R. L. (2020). Engaging nurses in health policy in the era of covid-19. Wiley public health emergency collection. Nurs forum. 2020 Oct 6: 10. 1111/nuf. 12514.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675349/

Lewinski, A. A. & Simmons, L. A. (2018). Nurse knowledge and engagement in health policy making: Findings from a pilot study. Pubmed.gov. https://pubmed.ncbi.nlm.nih.gov/30148538/

Hi Marissa,

I enjoyed reading your post, very informative. You made an interested point about colleges including health care policy classes within the nursing curriculum. Nursing is the most sought out career in the nation, we are the most well respected healthcare professionals and we are capable of making a greater impact on healthcare and implementing new ways to deliver  care and increase patient satisfaction. As nurses we have to get more involved and expand our knowledge and make changes, and remember that small changes can lead to great outcomes.

References

Lewinski, A. A. & Simmons, L. A. (2018). Nurse knowledge and engagement in health policy making: Findings from a pilot study. Pubmed.gov. https://pubmed.ncbi.nlm.nih.gov/30148538/

Milstead, & Short, N. M. (2019). Health Policy and Politics (6th ed.). Burlington, MA: Jones & Bartlett Learning.

The Role of the RN/APRN in Policy-Making

 

 

Precious Dixon

Walden University

NURS 6050

Dr. Mooring
1/19/2022

 

The Role of the RN/APRN in Policy-Making

Nurse professionals are obligated professionally and morally to engage in healthcare policy-making. Nurses can influence policy-making at any level of governance by taking part in leadership. It is unfair for nurse professionals to feel the adverse impacts of policies developed and implemented by less knowledgeable and incompetent individuals. The frustration causes increasing burnout and job dissatisfaction, affecting health care quality and patient safety.

Nurse professionals can impact healthcare policy and change the state of affairs in the healthcare system. One opportunity for nurses to influence policies is to work as consultants with primary care groups (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). Consulting local nurses regarding key fields in care services effectively ensures involvement and collaboration. Locally, nurses can participate in politics by embracing leadership positions in the healthcare system. Nurses can receive formal political training within these positions, enhancing their involvement as consultants. Nurses can participate in policy implementation evaluation which involves understanding the stakeholders, facilitators and barriers, and the critical components of the logic model, such as inputs, activities, and outputs (Centers for Disease Control and Prevention, n.d ). When nurses have political training, they can understand the bureaucracies involved in policy-making and policy implementation. The knowledge allows nurses to be competitive players in the policy-making arena. Similarly, nurses can join professional organizations and interest groups (Milstead & Short, 2019). Professional organizations provide a platform for lobbying the government to address nursing issues. Care providers can inform their state representatives about policy challenges in the healthcare system. The benefits attached to being nurses enable the individuals to engage in committees and city councils and run for available government offices. Nurses often have a heavy workload, and these opportunities are not easy to embrace; however, they yield significant results when taken.

The role of nurses in policy implementation is critical in ensuring patient safety and overall quality of care. Opportunities for nurses to participate in policy-making are available at the local, state, and national levels depending on how far the nurse is willing to go. If more nurses could participate in legislation-making activities, they would improve the condition of healthcare nationally.

 

References

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iran Journal of Nursing Midwifery Research, 19(3), 315–322 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/

Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementation, (n.d.). Centers for Disease Control and Prevention. https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdf

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. Burlington, MA: Jones & Bartlett Learning.

Precious

Approximately 3.1 million registered nurses in the United States compose the largest group of health care providers (American Nurses Association (ANA), 2014). This figure alone allows nurses to yield enormous positive political influence in the healthcare system and nearly dominate the healthcare arena. The numbers purely recognize the political power. If all nurses participated and engaged in the political arena, the results would be outrageous.  There are numerous educational opportunities, learning tools, and advocacy strategies for nurses through undergraduate and graduate nursing programs and professional nursing organizations. Yet, a significant number of nurses remain disengaged from the process of public policy advocacy (Reutter & Duncan, 2002).  We must engage with all licensed nurses and educate them on making their voices heard, their opinions are valued, and intellectual input be supported. Encourage engagement in the workplace for policy implementation and reform, quality assurance committees, unit boards, nurse counsel, and other professional boards in the workplace. As you opened your discussion with the obligation and moral duty of nurses to engage and participate in the policy advocacy, the nursing’s code of ethics (ANA, 2011) and professional social contract with society as set forth by the ANA’s Nursing’s Social Policy Statement highlight the importance of political advocacy by nurses.

APRNs can operate most effectively as Role models that promote political confidence and participation in nurses and strengthen the profession’s political influence. The advanced nurse is deemed competent, formally educated, knowledgeable regarding policy advocacy, and most likely to influence peers. Who better to guide policy that affects patients and nurses than nurses themselves? We are the most informed and educated on how the policies affect patient care and outcomes; hence we are on the clinical front line and can offer the most valuable and accurate information and feedback.  Another approach is encouraging our educators and trainers to provide an innovative and robust program.

It is essential to provide mentoring professionals to support nurses in the political setting, utilize technology, embrace communication, navigate the system effectively and efficiently, endorse professional participation in workplace projects, and ignite momentum and unveil the power that nursing can yield over the healthcare system (Abood, 2007).

References

Abood, S. (2007). Influencing health care in the legislative arena. OJIN: The Online Journal of Issues in Nursing, 12(1), 2.

American Nurses Association (ANA). (2014). About ANA

http://www.nursingworld.org/FunctionalMenuCategories/AboutANA.

American Nurses Association (ANA). (2011). Code of ethics

http://www.nursingworld.org/Mobile/Code-of-EthicsClose

 

Reutter, L., & Duncan, S. (2002). Preparing nurses to promote health-enhancing public policies. Policy, Politics, & Nursing Practice, 3(4), 294-305.

Hi Precious.

I agree with your post. Nurses have crucial rules in health care decision of policy making and there are many opportunities that exist for nursing professionals to participate in policy making. According to  (Arabi et al.,  2014) , “Nurses influence in health policies protects patient safety,  increases qualityof care, and facilitates their access to the  required  resources  and  promotes quality health care”. Nurses can become active in policy making through advance education by becoming APRN which can give them the opportunity to serve as health care advocates. Nurses must bond together to fight for patient’s rights.

Also, becoming an active member of  a nursing organization can help nurses support new policies which assist in creating EBP. Strength comes in numbers who share the same ideas in other to decrease push back. I think this opportunity helps nurses to be involved in a nursing association and provide opportunities such as advanced education that offer courses like this which helps drive home the importance of our voices.

According to (Brokaw, 2016), professional organizations “often have lobbyists that bring nursing issues to Capitol Hill” and this can serve as another way nurses can bring their voice to federal policies that may affect them or the health of their patients. According to (Brokaw, 2016), professional organizations “often have lobbyists that bring nursing issues to Capitol Hill” and this can serve as another way nurses can bring their voice to federal policies that may affect them or the health of their patients.

Arabi, A., Rafii, F., Cheraghi, M. A., Ghiyasvandian, S. (2014 May). Nurses’ policy influence: A concept analysis. Iranian journal of nursing and midwifery research, 19(3), 315–322. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/

Brokaw, J. (2016, Sept. 22). The nursing profession’s potential impact on policy and politics. https://www.myamericannurse.com/nursing-professions-potential-impact-policy-politics/

Hi Precious!

I didn’t know exactly what nursing consultants were. A nursing consultant is able to pinpoint issues and concerns and design care plans to address the topics (National Nurses in Business Association, 2022). It’s wonderful that there is an outlet for these issues to be settled and brought to political eye. However, what about bedside nurses? If were in such a nursing shortage, do we have enough nurses to also fill in consultant jobs?

Professional organizations need to be talked about more within health care facilities. There is an abundance of groups focusing on nursing specialties fostering the attitude and culture for various nursing individuals and style. The groups can then discuss needed changes, sending their comments and concerns to the political agenda (Halstead, n.d.).

Halstead, J. (n.d.). Professional nursing organizations. Jones and Bartlett Learning,

            LLC. https://samples.jbpub.com/9781284104899/9781284104981_CH05_Pass03.pdf

National Nurses in Business Association. (2022). Nurse consultant: What is a nurse

consultant? https://nursesbusiness.com/faq/nurse-consultant/

Precious,

Your post highlighted many truths, including frustrations that lead to burnout and job dissatisfaction. As Nurses, we advocate and encourage others to advocate all of the time. It can be very frustrating when you advocate and there is an adverse outcome. A Nurse Leader article described one nurse’s story while attempting to advocate for her patients and how it made her feel even though she was doing the right thing Downs, 2022). Each and every one of us take courageous actions daily. Doing the right thing and advocating for the patients is always the right this to do. A Florida Nurse article magnified the actions taken by a nurse as she made a difference in her patient’s life and those who she precepts. (Mead, 2021). This particular article discussed how important she believes that paying attention to current events contributed to her impact to everyone.

References:

Downs, S., & Fiore-Lopez, N. (2022). Getting Comfortable With the Uncomfortable: Nurse Leader as Advocate—One Leader’s Story. Nurse Leader, 20(1), 37–42. https://doi.org/10.1016/j.mnl.2021.10.004

Mead, M. (2021). Lessons of a Nurse Advocate. Florida Nurse, 69(1), 2.

Socially and economically disadvantaged groups are less likely to be in good health, less likely to have access to quality healthcare services, and more likely to die prematurely when compared with socially and economically advantaged (National Center for Health Statistics, 2016; Singh et al., 2017). In the United States, those who live in poverty, the uninsured, the disabled, and people of color endure most of the health inequities burden (Singh et al., 2017). Registered nurses (RNs) can advocate on behalf of social determinants of health (SSDOH) and health equity, particularly on behalf of poor and disadvantaged persons (Singh et al., 2017). They can find out why patients, families, and entire communities end up in poverty, and every time an RN administers a prescription medication for diabetes to patients unable to afford to eat nutritious food or participate in physical activity in a safe, walkable neighborhood, that nurse is engaging in downstream rescues, and subsequently, use the gathered information to push for SDOH policies at state and federal levels. The second opportunity is to join professional associations, like the American Nurses Association, through which they can lend their voice to advocate for health policies.

The two impediments that may obstruct RNs from actively engaging in policy advocacy practices include the lack of adequate knowledge in their role in policy advocacy and workplace burnout (Barzegar Safari et al., 2020). Often, after graduation, RNs are swamped with patient care responsibilities limiting their time to engage in active policy advocacy. Thus, the potential strategies overcome the above challenges is to prioritize advocacy in nursing training and clinical practice. The two strategies I would embrace to best advocate for my patients are joining the American Association of Nurse Practitioners (AANP) and the ANA, where I would visit their learning resources to acquire knowledge and skills of advocating for my patients (AANP, n.d.) Similarly, I would also investigate the causes of poor health outcomes of my patient and write to my state legislature using empirical evidence to request them to sponsor or promote a specific health bill.

References

AANP. (n.d.). Advocacy. https://www.aanp.org/

Barzegar Safari, M., Bahadori, M., & Alimohammadzadeh, K. (2020). The related factors of nurses’ participation and perceived benefits and barriers in health policy making. Journal of Nursing Research, 28(4), 1–8. https://doi.org/10.1097/jnr.0000000000000385

 National Center for Health Statistics. (2016). Health, United States, 2015 with special feature on racial and ethnic health disparities. Department of Health and Human Services

Singh, G.K., Daus, G. P., Allender, M., Ramey, C. T., Martin, E. K., Perry, C., & Vedamuthu, I. P. (2017). Social determinants of health in the United States: Addressing major health inequality trends for the nation, 1935-2016. International Journal of MCH and AIDS, 6(2), 139–164. doi:10.21106/ijma.236

Nurses are definitely pressed for time, especially when they are required to work overtime, or even have to work extra shifts or multiple jobs. That makes it almost impossible for them to attend meetings and rallies. With all the barriers to being politically active, how can nurses still become involved? How and why should their facilities support their efforts?

Dr. Mooring

Hello Dr., irrespective of our busy schedules, we still need to prioritize patient advocacy as part of our responsibilities. We can still advocate at the hospital level by promoting evidence-based programs to ensure patient safety.

Janelle

I enjoyed your post this week. Discuss the two impediments to nursing involvement in actively engaging in policy advocacy and burnout. Another factor is the lack of knowledge regarding policy advocacy in health care.  All nursing curricula should mandate a course in policy advocacy and the nurse’s role. According to Reutter and Duncan (2002), a requirement for preparation in advanced nursing practice in community and public health nursing is the standard.  The beginning understanding of the policy process and approaches to policy advocacy. This preparation should enable nurses in advanced practice roles to collaborate more effectively with others to determine the impact of policies on health, understand the factors influencing the policy process, and apply strategies to influence policy change. Most importantly, it is crucial to legitimize their roles in policy reform and turn the tide toward more focused activism among advanced practice and leadership roles. In this way, graduate nursing education can ultimately best contribute to the health of populations.  The perfect bridge to involve our nurses is providing them with knowledge and a bucket of tools that can fix problems.  The correct tools and knowledge would lessen the burden on our nurses and help prevent burnout of our nurses.  Basic knowledge of the policy process is the first step in planning how to initiate your potential political power and influence fundamental changes in your patients’ lives, your work environment, or social policy change in your community and beyond (Patton et al., 2015).

Nurses can be activists in different participation models, such as government activities, institutional decisions, organizational positions, or professional standards. They can become involved by joining committees, unit boards, nurse counsel, and quality management teams. Nurses can lobby their legislature with letters or in-person visits, join professional organizations, participate in community projects and schools. You can attend seminars, open forum discussions, or even run for office in your local community or state. Nurses “… practice at the intersection of public policy and personal lives; they are, therefore, ideally situated and morally obligated to include sociopolitical advocacy in their practice” (Falk-Rafael, 2005, p. 222). Nurses engage in advocacy every day to bring about change to address their patient’s needs (Patton et al., 2015).

Reference

 

Falk-Rafael, A. (2005). Speaking truth to power: Nursing’s legacy and moral imperative. ANS. Advances in Nursing Science, 28(3), 212–233

Patton, Zalon, M. L., Ludwick, R., & Abood, S. A. (2015). Nurses are making policy: from bedside to boardroom / Rebecca M. Patton, Margarete L. Zalon, Ruth Ludwick, editors ; contributors, Sheila A. Abood [and twenty-seven others]. Springer Publishing Company

 

Reutter, L., & Duncan, S. (2002). Preparing Nurses to Promote Health-Enhancing Public Policies. Policy, Politics, & Nursing Practice, 3(4), 294–305. https://doi.org/10.1177/152715402237441

Shelley, thank you for your candid response to my discussion. Nurses’ involvement in health policy development ensures that health care is safe, of a high quality, accessible and affordable (Jurns, 2019). I agree with you that numerous factors influence nurse leaders’ ability to be politically active in influencing health policy development, with the lack of adequate knowledge of the policy-making process being a key obstacle. Over the years, I have learned how political issues affect health care by reading the works of such nurse advocates as Florence Nightingale (Shariff, 2016). What are your plans regarding upgrading your advocacy knowledge and skills pre and post-graduation?

References

Jurns, C. (2019). Policy advocacy motivators and barriers: Research results and applications. OJIN: The Online Journal of Issues in Nursing, 24(3). https://doi.org/10.3912/OJIN.VOL24NO03PPT63

Shariff, N. (2016). Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. BMC Nursing, 13(1), 20. https://doi.org/10.1186/1472-6955-13-20

 

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Janelle,

You bring up an important percentage of the population who need nurse advocates who fight to improve social conditions that impact health. The socially and economically disadvantaged population is the most affected by public policy because the right policies and programs can interrupt the cycle of poverty, disadvantage, and poor health by addressing inadequate social and material resources (Williams, Phillips, & Koyama, 2018). Nurses should advocate for policies to improve social conditions that shape the well-being of poor and disadvantaged populations because a core nursing value is a concern for the social, emotional, physical needs of all patients.

The nursing profession has adopted social determinants of health (SDOH) as one of the central issues affecting health disparities. The American Nurses Association recognized the importance of SDOH, supporting recommendations for the nursing professional to include SDOH in all nursing courses, to practice interprofessionally, to prioritize research to connect SDOH to health outcomes, and to collaborate with agencies to address the effects of the SDOH (Schneiderman, & Olshansky, 2021). Gaining expert knowledge on SDOH and advocating for those who are poor, disadvantaged, and vulnerable is how nurses begin to address the healthcare inequities of this population.

References

Schneiderman, J. U., & Olshansky, E. F. (2021). Nurses’ perceptions: Addressing social determinants of health to improve patient outcomes. Nursing Forum, 56(2), 313–321. https://doi.org/10.1111/nuf.12549

Williams, S. D., Phillips, J. M., & Koyama, K. (2018). Nurse advocacy: Adopting a health in all policies approach. Online Journal of Issues in Nursing, 23(3), 5. https://doi.org/10.3912/OJIN.Vol23No03Man01

Nurses are patient advocates who spend the majority of the time getting to know the patient physically, emotionally, and mentally. We have the privilege of forming a special bond with our patients and their families. Many nurses have taken their bedside experience to congress and have implanted change within the health care field.

One opportunity that exists for a nurse to actively participate in policy-making is through continued education such as obtaining a bachelor’s degree, master’s degree, or doctoral degree (Milstead & Short, 2019, p.203). These health care programs include classes on health care policies and nursing leadership that offers a nurse the opportunity to advance in the clinical ladder. Many challenges to pursuing higher education include, time, money, family dynamics, and even the desire to continue studying. One way to overcome these obstacles would be to work for a hospital that provides tuition reimbursement or tuition discounts. Often, nurse managers are willing to work with flexible schedules in order for a nurse to continue to pursue higher education.

Another opportunity that nurses and nurse practitioners have to actively participate in policy-making would be to join a professional nursing association (Brokaw, 2016). Joining such organizations allows a nurse to actively participate in healthcare decision making. Nursing organizations work together with lobbyists and are able to provide significant work experience that would bring a better understand to the proposed change (Brokaw, 2016). One challenge that may represent in becoming a board member of such organizations, would be the amount of working experience they require. In Florida, the board of nursing requires four years of work experience to apply to become a member (The board, n.d.). One way to overcome this would be by becoming the representative of your unit and join the nursing professional practice council of your hospital. This would allow you nursing advocacy experience while also obtaining work experience.

Nurse practitioners can be part of community meetings, local school meetings, and district school meetings where student health care issues are a priority, and a change needs to be addressed regarding certain matters (Chilton, 2015). NPs are also able to write to their legislators regarding a health care topic that is of concern to the community where they practice (Chilton, 2015). A challenge noted in this matter would be the lack of expertise in health care policy. Even though a majority of nurses and nurse practitioners should be involved in health care policies, the truth is that not every nurse is interested in policy-making. We want change but we are not willing to pay the price for that change. Higher education programs already include health care policies in their curriculum in order to prepare nurses and make them aware. I must admit that hospitals do not emphasize the need for health care policy awareness as much as they should. Nursing administrators can develop programs where nurses can get involved and bring change to their unit. Nursing schools also should incorporate health care policy right from the beginning because it can open up many opportunities for nurses.

 

References

Brokaw, J. J. (2016, September 22). The nursing profession’s potential impact on policy and politics. American Nurse. Retrieved January 19, 2022, from https://www.myamericannurse.com/nursing-professions-potential-impact-policy-politics/#:~:text=At%20the%20state%20and%20federal,joining%20a%20professional%20nursing%20organization.&text=Nurses%20can%20also%20write%20their,work%20on%20matters%20affecting%20healthcare.

Chilton, L. (2015). Nurse Practitioners Have an Essential Role in Health Policy. Retrieved January 19, 2022, from https://www.npjournal.org/article/S1555-4155(14)00687-4/pdf

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. Burlington, MA: Jones & Bartlett Learning.

The Board. Florida Board of Nursing. (n.d.). Retrieved January 19, 2022, from https://floridasnursing.gov/the-board/

Nurses are taught to advocate for their patients during the earliest days of nursing school. However, many are not comfortable discussing politics or have not been taught to truly evaluate bills and other political writings. What can we do to ensure all nurses are prepared, not only to advocate for patient needs during their health care stay, but also to advocate for policies that will improve patient outcomes?

Dr. Mooring

Claudia, I enjoyed reading your post, and I concur that joining professional bodies offers an important chance for policy advocacy among RNs. Professional organizations and associations in nursing are critical for generating the energy, flow of ideas, and proactive work needed to maintain a healthy profession that advocates for the needs of its clients and nurses, and the trust of society (Matthews, 2018). ANA for example has outlined the Code of Ethics for Nurses with Interpretive Statements, which provides a framework for nurses to use in ethical analysis and decision-making (ANA, n.d.). The Code of Ethics establishes the ethical standard for the profession. It is not negotiable in any setting nor is it subject to revision or amendment except by formal process of the House of Delegates of the ANA. What is your opinion of the use of the Code of Ethics for Nurses with Interpretive Statements to guide advocacy actions?

References

ANA. (n.d.). Advocacy. https://www.nursingworld.org/practice-policy/advocacy/

Matthews, J. H. (2018). Role of professional organizations in advocating for the nursing profession. Online Journal of Issues in Nursing, 17(1), 3. https://doi.org/10.3912/OJIN.VOL17NO01MAN03

 

            Any nurse has the given potential to influence policy changes. The government allows nurses to make the following actions: propose changes for policies, create policy messages, write forums educating public and lawmakers about medical needs, partner with stakeholders, participate in development meetings, serve in decision-making groups, make appointments with the health department boards and local government to bring topics to attention, and attend health policy agendas (Duquesne University School of Nursing, 2020).

A small study revealed that only one-third of nurses participate in a policymaking, yet they fulfill the largest division of healthcare careers (Lewiniski & Simmons, 2018). The vast profession of nurses can make a change, but how does one motivate nurses to act?Feedback from front-line nurses is quite crucial at this time during a pandemic. There are barriers to acquiring time and place to meet with government policymakers to discuss proposed changes. A powerful platform of today is social media. A post can influence the local community, but messages can spread worldwide (Anders, 2020).

Anders, R. (2020). Engaging nurses in healthcare policy in the era of COVID-19. Nurs Forum. doi:

10.111/nuf.12514

Duquesne University School of Nursing. (2020). How nurse managers play a role in policy

decision-making. https://onlinenursing.duq.edu/blog/nurse-managers-play-role-policy-

decision-making/

Lewinski, A., Simmons, L. (2018). Nurse knowledge and engagement in health policy making:

Findings from a pilot study. J Contin Educ Nurs. 49(9):407-415. doi: 10.3928/00220124-

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