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Toallnurseswhohavemadepolicyanintegralpartoftheirlives

Tofuturenurseswhoreadthisbookandtakeaction

Tofamilies,friends,andcolleagues

Toallwhobelieveinnursingandthepowerofnurseadvocacy

Totheindividualswhoappreciateandvaluetheneedfora WashingtonFellowsProgramforNurses

Contributors

ForewordbyJoyceJ Fitzpatrick,PhD,MBA,RN,FAAN,FNAPandKateJudge,BA

Preface

Acknowledgments

SpecialAcknowledgments

Abbreviations

ShareNursesMakingPolicy:FromBedsidetoBoardroom

UNITI:MAKINGTHECASE

1. LeadingtheWayinPolicy

RebeccaM Patton,MargareteL Zalon,andRuthLudwick

2. AdvocatingforNursesandforHealth

DebbieDawsonHatmakerandKarenTomajan

3. NavigatingthePoliticalSystem

EileenM Sullivan-Marx

UNITII:ANALYZINGPOLICY

4 IdentifyingaPolicyIssue

RoseIrisGonzalezandSheilaA.Abood

5. HarnessingEvidenceinthePolicyProcess KathleenM White

6. SettingtheAgenda LindaK GroahandAmyL Hader

UNITIII:STRATEGIZINGANDCREATINGCHANGE

7 BuildingCapital:Intellectual,Social,Political,andFinancial SuzanneMiyamoto

8. ChangingOrganizations,Institutions,andGovernment TimPorter-O’GradyandKathyMalloch

9. ActivatingtheAdvocacyPlan

JeanetteIvesErickson,DeborahColton,andMarianneDitomassi

10. WorkingWiththeMedia:ShapingtheHealthPolicyProcess PamelaF Cipriano

11 ApplyingaNursingLenstoShapePolicy

JoanneDisch,MathewKeller,andEileenWeber

UNITIV:JUDGINGWORTHANDADVANCINGTHECAUSE

12. ServingthePublicThroughPolicyandLeadership VirginiaTrotterBetts,SusanTullai-McGuinness,andLorettaAlexiaWilliams

13. EvaluatingPolicyStructures,Processes,andOutcomes SeanP Clarke

14. EliminatingHealthInequitiesThroughPolicy,NationallyandGlobally ShanitaD Williams,JaniceM Phillips,andJosephaE Burnley

15 TakingActions,ExpandingHorizons

RebeccaM Patton,MargareteL Zalon,andRuthLudwick

Contributors

SheilaA.Abood,PhD,RN AdjunctFaculty,GrandValleyStateUniversity,KirkhofCollegeofNursing, GrandRapids,Michigan

VirginiaTrotterBetts,MSN,JD,RN,FAAN President,HealthFutures,Inc,Nashville,Tennessee

JosephaE.Burnley,DNP,RN,FNP-C NurseConsultant/ProjectOfficer,NursingPracticeandWorkforce Development,DivisionofNursing,HealthResourcesandServicesAdministration,US Departmentof HealthandHumanServices,Rockville,Maryland

PamelaF Cipriano,PhD,RN,NEA-BC,FAAN President,AmericanNursesAssociation,SilverSpring, Maryland;ResearchAssociateProfessor,UniversityofVirginiaSchoolofNursing,Charlottesville,Virginia

SeanP.Clarke,PhD,RN,FAAN AssociateDeanforUndergraduatePrograms;Professor,WilliamF. ConnellSchoolofNursing,BostonCollege,Boston,Massachusetts

DeborahColton,MSW SeniorVicePresidentforStrategicCommunication,MassachusettsGeneral PhysiciansOrganization,Boston,Massachusetts

JoanneDisch,PhD,RN,FAAN ProfessoradHonorem,UniversityofMinnesotaSchoolofNursing, Minneapolis,Minnesota

MarianneDitomassi,MSN,MBA,RN ExecutiveDirectorforPatientCareServicesOperationsand MagnetRecognition,MassachusettsGeneralHospital,Boston,Massachusetts

RoseIrisGonzalez,PhD,MPS,RN IndependentConsultant;PastDirector,GovernmentAffairs,American NursesAssociation,SilverSpring,Maryland

LindaK.Groah,MSN,RN,CNOR,NEA-BC,FAAN CEO/ExecutiveDirector,Associationof periOperativeRegisteredNurses,Denver,Colorado

AmyL.Hader,JD Director,LegalandGovernmentAffairs,AssociationofperiOperativeRegisteredNurses, Denver,Colorado

DebbieDawsonHatmaker,PhD,RN,FAAN ExecutiveDirector,AmericanNursesAssociation,Silver Spring,Maryland

JeanetteIvesErickson,DNP,RN,FAAN SeniorVicePresidentforPatientCareandChiefNurse, MassachusettsGeneralHospital,Boston,Massachusetts

MathewKeller,BSN,JD,RN RegulatoryandPolicyNursingSpecialist,MinnesotaNursesAssociation,St. Paul,Minnesota

RuthLudwick,PhD,RN-BC,CNS,FAAN IndependentConsultant;DirectorofNursingResearch, RobinsonMemorialHospital,Ravenna,Ohio;ProfessorEmeritus,KentStateUniversity,Collegeof Nursing,Kent,Ohio

KathyMalloch,PhD,MBA,RN,FAAN President,KMLS,LLC;AssociateProfessorofPractice,Arizona StateUniversityCollegeofNursingandHealthInnovation,Phoenix,Arizona;ClinicalProfessor,TheOhio StateUniversityCollegeofNursing,Columbus,Ohio;ClinicalConsultant,APIHealthcare,Hartford, Wisconsin

SuzanneMiyamoto,PhD,RN DirectorofGovernmentAffairsandHealthPolicy,AmericanAssociationof CollegesofNursing,Washington,DC

RebeccaM Patton,MSN,RN,CNOR,FAAN PastPresident,AmericanNursesAssociation;LucyJo AtkinsonScholarinPerioperativeNursing,FrancesPayneBoltonSchoolofNursing,CaseWesternReserve University,Cleveland,Ohio

JaniceM.Phillips,PhD,RN,FAAN DirectorofGovernmentandRegulatoryAffairs,CGFNS International,Inc,Philadelphia,Pennsylvania

TimPorter-O’Grady,DM,EdD,ScD(h),APRN,FAAN,FACCWS SeniorPartner,TimPorter-O’Grady Associates,Inc.;AssociateProfessor,LeadershipScholar,CollegeofNursingandHealthInnovation,Arizona StateUniversity,Phoenix,Arizona;ClinicalProfessor,LeadershipScholar,TheOhioStateUniversity CollegeofNursing,Columbus,Ohio;AdjunctProfessor,Dean’sAdvisor,EmoryUniversity,Atlanta, Georgia

EileenM Sullivan-Marx,PhD,RN,FAAN DeanandErlinePerkinsMcGriffProfessor,NewYork UniversityCollegeofNursing,NewYork,NewYork

KarenTomajan,MS,RN,NEA-BC Director,ProfessionalPractice,JohnMuirMedicalCenter,Concord, California

SusanTullai-McGuinness,PhD,MPA,RN AdjunctAssociateProfessor,CaseWesternReserveUniversity, FrancesPayneBoltonSchoolofNursing,Cleveland,Ohio

EileenWeber,DNP,RN,PHN,JD ClinicalAssistantProfessor,UniversityofMinnesotaSchoolof Nursing,Minneapolis,Minnesota

LorettaAlexiaWilliams,BSN,RN GraduateResearchAssistantandInstructor,JonasNursingLeadership Scholar(2012–2014),UniversityofTennesseeHealthScienceCenterCollegeofNursing,Memphis, Tennessee

ShanitaD.Williams,PhD,MPH,APRN BranchChief,NursingPracticeandWorkforceDevelopment, DivisionofNursing,HealthResourcesandServicesAdministration,US DepartmentofHealthandHuman Services,Rockville,Maryland

KathleenM White,PhD,RN,NEA-BC,FAAN Director,Master’sEntryIntoPracticeProgram; AssociateProfessor,JohnsHopkinsUniversitySchoolofNursing,Baltimore,Maryland

MargareteL Zalon,PhD,RN,ACNS-BC,FAAN Professor,DepartmentofNursing,Universityof Scranton,Scranton,Pennsylvania

Foreword

TheAmericanNursesFoundation(ANF)wasfoundedin1955asthephilanthropicarmoftheAmerican Nurses Association (ANA) for the purpose of improving health care and supporting registered nurses throughout the United States As of 2012, the strategic direction of the ANF has been to invest in key initiativestoadvanceitsmission:“Transformingthenation’shealththroughthepowerofnursing.”

Thisbook,NursesMakingPolicy:FromBedsidetoBoardroom,editedbyRebeccaM.Patton,MargareteL. Zalon,andRuthLudwick,willbeakeymarkerinthetransformationofnursing Patton,Zalon,andLudwick designed this book with a clear goal in sight: the creation of a Washington Fellows Program for Nurses, administered through the ANA and supported through the book royalties. The legacy of this commitment is far-reaching, as each new fellow will build on the successes of his or her predecessors This nursing influence, at the executive and legislative branches of our government, is viewed as a complement to existing policy programs Atthesametime,italsotakesthenursingagendatoanewlevelofinfluence

Patton, Zalon, and Ludwick have gathered the experts in nursing policy development and implementation as chapter contributors the best of the best in nursing These contributors have provided keyinsightstomovethenursingprofessionforwardandpositionnursesinleadershiprolesinthehealthpolicy arena,locally,nationally,andglobally

The editors’ generosity in supporting the ANF reflects their professional and personal commitments to thepowerofnurses’philanthropy EachhasplayedakeyroleinensuringtheFoundation’sgrowthandsuccess toensurethatnursesmaximizetheirpower

CurrentFoundationinitiativesdesignedtoempowernursesinclude:

1 Leadership programs: Supporting ANA’s Leadership Institute and increasing the number of nurses on key influential boards of directors in the following health care sectors: for profit, philanthropic, andhealthsystems

2 Educational scholarships: Provided to undergraduate and graduate students focused on leadership andunderrepresentedgroups

3. Promotion and advocacy: Promoting the contributions to health care by nurses through multiple mediaoutlets

ANFinitiativesthatarefocusedontransforminghealthinclude:

1 Nursing research grants: Annual awards to nurses to provide seed money to beginning and experienced researchers to conduct studies that advance health science and the enhancement of patientcare

2 Specific health programs: Development of a tool kit to assist nurses in recognizing posttraumatic stress disorders in the nation’s veterans and military service members, and a sleep disorders program focusedonhelpingnursesunderstandthedeleteriouseffectsofshiftwork

3. Health Nurse Project: Development of a mindfulness tool kit for nurses and sponsorship of other initiativestohighlighttheneedforimprovingnurses’health

The ANA’s board is committed to transforming the nation’s health by helping nurses solve key health issues We will accomplish this mission by generating and providing the funds for nurses to influence and lead in these key areas central to health care We applaud the work of our colleagues, the editors and contributors to this book, for taking the lead in telling nursing’s story in health policy and advancing the skills of future generationsofnurseswhoaspiretolead

JoyceJ Fitzpatrick,PhD,MBA,RN,FAAN,FNAP ElizabethBrooksFordProfessorinNursing FrancesPayneBoltonSchoolofNursing CaseWesternReserveUniversity Cleveland,Ohio Chair,AmericanNursesFoundationBoardofTrustees KateJudge,BA

Preface

This book uses a hands-on approach designed to help graduate students and nurses across a variety of settings develop health policy skills in order to advocate for patients and work empowerment at the bedside, boardroom, or in state and national politics The textbook is divided into four units: Making the Case, Analyzing Policy, Strategizing and Creating Change, and Judging Worth and Advancing the Cause. The chapters of the book take the reader on a journey though the policy-making process, from identifying a policyissue,toinitiatingaplan,to,finally,evaluatingit

Unique features of this 15-chapter book are the steps to changing policy, which are presented in detail, and actual exemplars (Policy Challenge and Policy on the Scene) that are offered in every chapter as told by nurses working locally and nationally These stories are written by direct-care nurses as well as high-profile nationallyknownleaders Throughouteachchapter,policydevelopmentisexemplifiedatboththebig“P”and little“p”levels,fromthegrandscaleofstateornationalwork,tothelocalworkenvironment Webelieveboth are essential and often the interplay between the two levels is not always recognized or acknowledged. Thus, health policy is every nurse ’ s responsibility Although the creation of the American Nurses Foundation Washington Fellows Program for Nurses endowed fund is designed to ensure nurses ’ placement at the highest policy tables, our commitment is to engage and foster nurses ’ policy activism at all levels This will enable nurses taking one step at a time to realize the full power generated by more than 3 million nurses takingstepstogethertoadvancehealth

Thebook’sintendedaudienceincludes:

• Graduatenursingstudents;inparticularstudentsindoctoralprograms

• Registerednursesenrolledinbaccalaureatedegreecompletionprograms

• Registerednursesworkingtoimprovetheirpracticeenvironments

• Leadersofstatenursesandspecialtynursesassociations

To enhance understanding of the policy process, each chapter introduces a real-life situation in a Policy Challenge, which is directly related to a specific aspect of the policy process, as well a number of Policies on theScenethatillustratekeypoints.ConcludingeachchapteristheOptionforPolicyChallengethatdescribes outcomesofthePolicyChallenge EachchapterincludesKeyConceptstoaidinlearning LearningActivities takereadersthroughthestepsofthepolicyprocessinordertoenhancetheirpolicyexpertise Alsoincludedin each chapter are E-Resources. These consist of websites, social media links, important policy documents, policy tool kits from various organizations, and additional resources to expand understanding of the policy process APowerPointpresentationofthematerial,providedinalecture/discussionformatforeachchapter, isavailableforinstructorsthroughSpringerPublishingCompany,bye-mailingtextbook@springerpubcom

RebeccaM.Patton MargareteL Zalon RuthLudwick

Acknowledgments

This book is a testament to collaboration among friends and colleagues and reflects the support of numerous family members Support from family and collaboration and encouragement from friends and colleaguesareessentialingredientstoacommitmenttopolicy,whetherworkinglatetowriteoverduepolicies, runningforelectedoffice,orwritingabookonpolicy.Asyoureadouracknowledgmentsweencourageyouto thankthosewhoaresupportivetoyou.

We thank, in the Patton family, mother Mary Ellen, sister Betty Jane both registered nurses and brothers Bob and John In the Zalon family, we thank husband John; and in the Ludwick family, we thank husbandJohn,sonTom,andmotherBernicePotisuk.

We are grateful for the assistance of Lynn Barabach, MSN, RN, who initially assisted as part of her DNPcourseworkandcontinuedbecauseofhercommitmenttoadvocacy

Withoutadoubtweoweendlessthankstothecontributors theesteemedauthorsofeachchapter and thosewhosharedtheirreal-lifestoriesinthePolicyChallengesandthePoliciesontheScene.

We thank the colleagues who embraced the need for this book, the creation of the American Nurses Foundation (ANF) Washington Fellows Program for Nurses, and the establishment of the ANF endowedfund(wwwanfonlineorg) Thisbook,NursesMakingPolicy:FromBedsidetoBoardroom,launchesthe creationofthisfundtoensurenurses’voicesareheardatthehighestlevel.

We are pleased to be part of a ground breaking publishing arrangement between Springer Publishing Company and the American Nurses Association In particular, we thank Margaret Zuccarini, Publisher, Nursing,forhersupportandencouragementinthedevelopmentofthisproject

AACN

AmericanAssociationofCritical-CareNurses

AAFP AmericanAcademyofFamilyPhysicians

AAMI AssociationfortheAdvancementofMedicalInstrumentation

AAN AmericanAcademyofNursing

AANA AmericanAssociationofNurseAnesthetists

AANP AmericanAcademyofNursePractitioners

AARP AmericanAssociationofRetiredPersons

ACA AffordableCareAct

ACNM AmericanCollegeofNurse-Midwives

ACNP AmericanCollegeofNursePractitioners

ACO AccountableCareOrganization

ACOG AmericanCollegeofObstetriciansandGynecologists

ADHD attentiondeficithyperactivitydisorder

ADM automaticdispensingmachine

AHA AmericanHospitalAssociation

AHCPR AgencyforHealthCarePolicyandResearch

AHRQ AgencyforHealthcareResearchandQuality

AIM AdamsInfluenceModel

AIR assessment,intervention,reassessment

AMA AmericanMedicalAssociation

AMIA AmericanMedicalInformaticsAssociation

ANA AmericanNursesAssociation

ANAI AmericanNursesAdvocacyInstitute

ANC ArmyNurseCorps

ANCC AmericanNursesCredentialingCenter

AORN AssociationofperiOperativeRegisteredNurses

APN advancedpracticenurse

APRN advancedpracticeregisterednurse

ASA AmericanSocietyofAnesthesiologists

ASC ambulatorysurgerycenter

ASPAN AmericanSocietyofPeriAnesthesiaNurses

ASPEN AmericanSocietyforParenteralandEnteralNutrition

ATSDR AgencyforToxicSubstancesandDiseaseRegistry

AzNA ArizonaNursesAssociation

BCIS BureauofCitizenshipandImmigrationServices

BHB B’moreforHealthyBabies

BLS BureauofLaborStatistics

BON boardofnursing

BORN BoardofRegistrationinNursing

CABSI catheter-associatedbloodstreaminfection

CAS ComplexAdaptiveSystems

CAUTI catheter-associatedurinarytractinfections

CCNA CentertoChampionNursinginAmerica

CCTP Community-BasedCareTransitionsProgram

CDC CentersforDiseaseControlandPrevention

CEO chiefexecutiveofficer

CEPR CenterforEconomicandPolicyResearch

CFAR CenterforAppliedResearch

CGFNS CommissiononGraduatesofForeignNursingSchools

CHAPS CoalitionforHealthcareWorkerandPatientSafety

CLABSI centralline-associatedbloodstreaminfection

CMMI CenterforMedicareandMedicaidInnovation

CMS CentersforMedicareandMedicaidServices

CNM certifiednursemidwife

Abbreviations

CNN CableNewsNetwork

CNO chiefnurseofficer

CNS clinicalnursespecialist

CPG clinicalpracticeguideline

CPR CoalitionforPatients’Rights

CRBSI catheter-relatedbloodstreaminfection

CRNA certifiedregisterednurseanesthetist

CSDH CommissionontheSocialDeterminantsofHealth

CSH CenterforSpiritualityandHealing

CTSA ClinicalandTranslationalScienceAward

CVD cardiovasculardisease

DHHS DepartmentofHealthandHumanServices

DME durablemedicalequipment

DNP doctorofnursingpractice

DOJ DepartmentofJustice

DOL DepartmentofLabor

DRA DeficitReductionAct

EBP evidence-basedpractice

ED emergencydepartment

EHR electronichealthrecord

ENA EmergencyNursesAssociation

EPC evidence-basedpracticecenter

EVIPNet Evidence-InformedPolicyNetwork

FDA FoodandDrugAdministration

FHBC familyhealthandbirthcenter

FHSSA FoundationforHospicesinSub-SaharanAfrica

FQHC federallyqualifiedhealthcenter

GNA GeorgiaNursesAssociation

GSA GerontologicalSocietyofAmerica

HAI hospital-acquiredinfection

HANYS HealthcareAssociationofNewYorkState

HCH healthcarehomes

HCUP HealthcareCostandUtilizationProject

HHS HealthandHumanServices

HIA healthimpactassessment

HIE healthinformationexchanges

HIMSS HealthInformationandManagementSystemsSociety

HIPAA HealthInsurancePortabilityandAccountabilityAct

HIT healthinformationtechnology

HP HealthyPeople

HRSA HealthResourcesandServicesAdministration

HSA HealthSecurityAct

IBCLC internationalboard-certifiedlactationconsultant

ICN InternationalCouncilofNurses

IHIA IndianHealthImprovementAct

IHI InstituteforHealthcareImprovement

IMR infantmortalityrate

IOM InstituteofMedicine

IRB institutionalreviewboard

ISMP InstituteforSafeMedicationPractices

IV intravenous

IWPR InstituteforWomen’sPolicyResearch

LACE

licensure,accreditation,credentialing,andeducation

LANO LouisianaAllianceofNursingOrganizations

LBW lowbirthweight

LDA LobbyingDisclosureAct

LHHS Labor,HealthandHumanServices

LOS lengthofstay

LPN licensedpracticalnurse

LPN/LVN licensedpractical/vocationalnurses

LSNA LouisianaStateNursesAssociation

LWBS leavingwithoutbeingseen

MAP MeasureApplicationsPartnership

MARN MassachusettsAssociationofRegisteredNurses

MMA MedicarePrescriptionDrug,Improvement,andModernizationAct

MNA MinnesotaNursesAssociation

NACNS

NationalAssociationofClinicalNurseSpecialists

NAHN NationalAssociationofHispanicNurses

NAPNAP NationalAssociationofPediatricNursePractitioners

NAS NationalAcademyofSciences

NASN NationalAssociationofSchoolNurses

NCATS NationalCenterforAdvancingTranslationalSciences

NCMHD NationalCenteronMinorityHealthandHealthDisparities

NCNR NationalCenterforNursingResearch

NCSBN NationalCouncilofStateBoardsofNursing

NDNQI NationalDatabaseofNursingQualityIndicators

ND nursingdoctorate

NFP nursefamilypartnership

NGO nongovernmentalorganization

NHL non-Hodgkin’slymphoma

NHTSA NationalHighwayTrafficSafetyAdministration

NIH NationalInstitutesofHealth

NINR NationalInstituteofNursingResearch

NIWI NursesinWashingtonInternship

NLC nurselicensurecompact

NMHCs nurse-managedhealthcenters

NNCC NationalNursingCenterConsortium

NOLF NursingOrganizationLiaisonForum

NOVA NursesOrganizationforVeteransAffairs

N-PAL nursepoliticalactionleaders

NP nursepractitioner

NPN nursepoliticiansnetwork

NPS NationalPreventionStrategy

NPSF NationalPatientSafetyFoundation

NPUAP NationalPressureUlcerAdvisoryPanel

NQF NationalQualityForum

NSNA NationalStudentNursesAssociation

NSSRN NationalSampleSurveyofRegisteredNurses

N-STAT NursesStrategicActionTeam

NYONE NewYorkOrganizationofNurseExecutives

NYSNA NewYorkStateNursesAssociation

OAC ObesityActionCoalition

OADPG OfficeoftheAssociateDirectorforProgram

OASIS OutcomeandAssessmentInformationSet

OCHE OregonCoalitionforHealthCareErgonomics

OECD OrganizationforEconomicCooperationandDevelopment

OHRP OfficeforHumanResearchProtections

ONA OhioNursesAssociation

ONL OrganizationofNurseLeaders

ONS OncologyNursesSociety

OPCSA OfficeofPolicy,CommunicationsandStrategicAlliances

OR operatingroom

OSHA OccupationalSafetyandHealthAdministration

PA physicianassistant

PAC politicalactioncommittee

PACE ProgramofAll-InclusiveCarefortheElderly

PACU postanesthesiacareunit

PCMH patient-centeredmedicalhome

PCORI Patient-CenteredOutcomesResearchInstitute

PES PracticeEnvironmentScale

PEST political,economic,sociocultural,technological

PEST(LE) political,economic,sociocultural,technological,legal,environmental

PHI protectedhealthinformation

PICC peripherallyinsertedcentralcatheter

PPACA PatientProtectionandAffordableCareAct

PR publicrelations

PSNA PennsylvaniaStateNursesAssociation

QR quickresponse

QSEN QualityandSafetyEducationforNurses

RAC regionalactioncoalition

RCT randomizedcontrolledtrial

RN registerednurse

RNFA registerednursefirstassistant

RWJ RobertWoodJohnson

RWJF RobertWoodJohnsonFoundation

SANE sexualassaultnurseexaminer

SBAR situation,background,assessment,andrecommendation

SBHC school-basedhealthcenter

SBHP school-basedhealthprogram

SDOH socialdeterminantsofhealth

SES socioeconomicstatus

SNA statenursesassociation(s)

SOPP scopeofpracticepartnership

SPHM safepatienthandlingmobility

SPS studentpolicysummit

SRPP socialresearch,policy,andpractice

SWOT strengths,weaknesses,opportunities,andthreats

TBNE TexasBoardofNurseExaminers

TCM TransitionalCareModel

TNA TennesseeNursesAssociation

TNA TexasNursesAssociation

UAP unlicensedassistivepersonnel

UCLA UniversityofCalifornia,LosAngeles

UTI urinarytractinfection

VA DepartmentofVeteransAffairs

VAE ventilator-associatedevents

VAP ventilator-associatedpneumonia

VBP value-basedpurchasing

VHA VeteransHealthAdministration

VLBW verylowbirthweight

VRU voiceresponseunit

WHO WorldHealthOrganization

WWWorW3 WorldWideWeb

NursesMakingPolicy

I MakingtheCase

LeadingtheWayinPolicy

nursesmustseepolicyassomethingtheycanshaperatherthansomethingthathappenstothem InstituteofMedicine(2011)

OBJECTIVES

1. Explaintheroleofnursesinpolicyinavarietyofsettings.

2 Analyzethehistoricalunderpinningsfortheroleofnursesinpolicy

3 Examinenurse’sresponsibilitiestosocietyinformulatingpolicy

4. Appraisethepotentialofnursing’sinfluenceandimpactonhealth,quality,andsafety.

As a registered nurse (RN), you make a difference in the lives of your patients You have ideas to create change that will positively impact patient care or the nursing work environment. You picture yourself as an advocate improving quality, access, or value However, you do not know where to begin You have advocated for a change in patient care and made a case by searching and evaluating the evidence, or completing research, or teaching information that was prerequisite to carrying out your vision of change In spite of your diligence, have you found you did not see the results you expected? Maybe you became discouragedwithpolicieswithinyourorganizationorfeltpowerlesstomakeachange?Orperhapsyoudidnot see the results expected in the time frame you projected Did you persist? Maybe you achieved the expected change but found you could not account for the success of the plan. Key to the success in making your vision become reality is understanding the policy-making process and using it to help translate your change into the reality of everyday practice; in this way, you can become a policy advocate Nurses are vital to leading the way inpolicyfromthebedsidetotheboardroom

We make the case beginning with this chapter and throughout the book that once policy skills are understood and practiced, nurses can successfully engage in policy making. These skills are essential to nurses in the trenches, performing direct care across all settings, as well as for nurses in leadership, education, and research positions Thus, policy making permeates every aspect of nursing practice, whether or not we realize it.

Giventhatnursescomprisethelargestsectorofhealthcareproviders,spendthemosttimewithpatients, and share a unique intimacy with patients related to functional care activities, nurses bring critical understanding and potential solutions to many high-profile complex health care issues such as access, quality, cost, and value. 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) Every day, nurses see how health policy decisions such as access to care based on preexisting conditions impact patients and their families, and how organizational staffing policies may harm patients and adverselyaffectthemandtheirworkenvironment.

Creating and maintaining a health policy is everyone ’ s job. Some believe that one ’ s position defines policy involvement We argue that health policy is everyone ’ s responsibility Nurse managers, educators, and administrators are often viewed as having more obvious roles in the successful articulation of federal and state regulations and implementation of institutional policies. Direct-care nurses live at the edge of those policies and regulations every day. “Nursing skills are political skills” (Feldman & Lewenson, 2000, p. 58). Nurses are uniquely qualified to assume important roles in policy See the Policy Challenge, which illustrates one nurse ’ s policyjourneyastrusteeofacommunityhospitalboard

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