We have discussed nurses’ opportunities to get involved in the political process throughout the entire course. This week we move on to policy evaluation or review.

To recap, the stages of policy development follow a process very similar to the nursing process. If we are caring for a patient, we would assess the patient to identify issues that need to be addressed. We would formulate a nursing diagnosis that helps us to assign meaning to all the information we just gathered. Next we would formulate a plan and set a goal. To achieve our goal, we implement nursing actions that will be beneficial to our patient. And finally, we evaluate to ensure that our goal was met, or to determine what new information is available and what changes should be made to our plan of care.

We follow a similar process for policy development. First we set an agenda, assessing the situation and identifying areas/issues that need to be addressed or fixed. Next, we formulate a policy that we thing will address the problem, or that sums up the issue. We follow this up by adopting the policy, and then implementing it. After implementation, just like with our patient and the nursing process, we must evaluate or review the policy to determine if it is having the desired effect. Is it working? Have things changed? Has it improved patient care or created a larger problem?

This week, consider ways nurses can be involved in the policy review process. How can we help to determine whether or not new policies and new legislation has actually been effective? What are some challenges to nurses being a part of this review process?

For a brief review of policy development process, CLICK HERE to watch a short YouTube video from Kahn Academy. If the link doesn’t work, copy and paste the followng url into you browser window.

https://www.youtube.com/watch?v=ipm5Bk10Fio

Here’s to another great week of discussion!

Happy Studying!!

Dr. Mooring

Although participation in policy-making is an important responsibility and obligation for nurses, involvement in policy review is just as critical. One opportunity for nurses to actively participate in policy review is to join the policy committee at one’s workplace to conduct health policy research. Health policy research studies the impact of a policy after it has been implemented. Nurses can evaluate a policy to determine its effectiveness in improving the quality of care and its effect on healthcare disparities (Ellenbecker & Edward, 2017). Another opportunity for involvement in policy review is to join a professional nursing organization. Professional nursing organizations can provide nurses with various resources to participate in policy review as they are often asked to collect data for policy evaluation. Nursing organizations can also get nurses other resources they may need to contact legislators to share evidence-based data they have collected.

One challenge that participation in policy review may present is the fear of dealing with others’ beliefs and opinions that differ from one’s own views. Overcoming this challenge can be done through education during nursing school. Nurses need to be aware that they may come across resistance and opposition while being politically active. Nurses must have the confidence and knowledge necessary to participate in healthcare politics instilled in them to be capable of responding to different opinions. Another challenge that may present is the lack of external support. This challenge can be overcome by educating nurse managers and leaders on the importance of organizational structure in policy reform (Hajizadeh et al., 2021). Nurse managers and leaders should be educated on the resources available to back their employees’ policy review and research efforts.

One strategy to communicate the existence of opportunities for nurse participation in policy review is to reach out to other nurses in one’s workplace. This can be done by networking with other healthcare professionals to build relationships. Nurse managers are great people to build relationships with as they can assist in the encouragement and spread of ways to participate in policy review (Olson, 2020). Another strategy to advocate for nurse involvement in policy review is to use social media as a means to promote involvement. Social media is becoming a much more prevalent way to communicate in today’s society, especially in the younger generation. By using social media to promote nursing involvement in politics, a much broader audience can be reached.

References

Ellenbecker, C. H., & Edward, J. (2017). Conducting nursing research to advance and inform health policy. Policy, Politics, & Nursing Practice, 17(4), 208–217. https://doi.org/10.1177/1527154417700634

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00648-6

Olson, K. (2020, November 4). Influence through policy: Four steps YOU can take. Sigma Nursing.

It comes as such a shock when you read that politicians are making healthcare decisions. If you were going to enforce a policy that affects healthcare professionals, you would want their input. Why have we strayed from this? A study in Ghana revealed that healthcare professionals are overlooked. Nurses do not understand the importance of getting their voices heard. Of the nurses who participated in policy review, the majority were higher leadership. It also proved that educating and exciting nursing students urged more nurses to participate (Acheampong et al., 2021). Policy review is an important opportunity for nurses to enforce change. Barriers at this time include confidence and knowledge.

Another barrier includes time management. It takes a great deal of time to hold a full-time job and advocate for healthcare in significant ways. Two great opportunities to uphold policy review include a nurses’ association or simply working with local politicians via an internship or as a board member (American Nurses Association, n.d.).

Quality care is evolving and at our fingertips! An Iranian study stated that the participation of nurses in policy review is relatively new and can be intimidating. However, it is an exciting and vital change in politics and healthcare (Arabi et al., 2014).

References

Acheampong, A., Ohene, L., Asante, I., Kyei, J., Dzansi, G., Adjei, C., Adjorlolo, S., Boateng, F.,   Woolley, P., Nyante, F., Aziato, L. (2021). Nurses’ and midwives’ perspectives on participation in national policy development, review and reforms in Ghana, a qualitative study. BMC Nursing 20. 26. https://doi.org/10.1186/s12912-021-00545-y

 

American Nurses Assciation. (n.d.). Expert policy analysis. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/expert-policy-analysis/

 

Arabi, A., Rafii, F., Cheraghi, M., Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iran J Nurs Midwifery Res. 19(3): 315-322. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/

As nurses, we have the opportunity to evaluate policies every day as we implement them. There just has to be a system in place for us to report areas of needed improvement when we see them. Some nurses feel that administration is not always open to feedback. How can we bridge that gap between staff and administration and keep the lines of communication open?

Dr. Mooring

Response

Hello Jamie, thanks for your post.  I am from Ghana and you are right, confidence and knowledge play a very vital role when it comes to nurses involving themselves in the political world and in policy review. After living there and also living here in America, I see a big difference. Things might be changing a bit in some part of the country but I feel like we are raised to be too timid. Our confidence level is low which can all affect nurses’ involvement in political issues. There is also a problem with the whole health care and political systems. Even patients do not have much say about their own health issues; and when it comes to trusting our politicians too, it’s a whole new story all together.  Like you mentioned, lack of knowledge also play a major part in this problem. I believe most nurses do not even know they can engage in health policies to get their voices heard on issues concerning their profession and patients. There isn’t also much support from their leaders and their organizations as a whole (Shariff, 2014). According to another article, other barriers to nurses’ political involvement include lack of trust in politicians, fear of confrontation and lack of right connections (Alhassan et al., 2020).  This problem could be minimized or eliminated if right from school up to the career level nurses are educated on health policy and the importance of their involvement.

References

Alhassan, A., Siakwa, Mate., Kumi-Kyereme, A. & Wombeogo, M. (2020). Barriers to and facilitators of nurses’ political participation in Ghana. Sage Journals. https://journals.sagepub.com/doi/full/10.1177/1527154419899602

Shariff, N. (2014). Factors that act as facilitators and barriers to nurse leaders’participation in health policy development. BMC Nursing. BMC nurs. 2014; 13: 20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105513/#:~:text=Other%20major%20factors%20acting%20as,lack%20of%20supportive%20organizational%20structures.

There is no doubt that nurses have an advantage in developing health care policy. We are at the frontlines every day and we are the ones who develop that special relationship with our patients. We know what they want, what they need , and what would benefit them all from spending 12-hours a day with our patients. Policy-making from the perspective of a nurse is developed through the experience of working in the health care field. Better ways to take care of the patients and ourselves can be implemented by what we face day to day. Nurses are well trained in the nursing process, and we can use this same process to develop health care policy (Milstead & Short, 2019, p. 117). The process of evaluation can be applied to policy programs by analyzing the outcomes of the change at hand (Milstead & Short, 2019, p. 117).

Nurses have the opportunity to be trained, educated, and mentored in health care policies (Acheampong et al., 2021). One problem that female nurses face is patriarchy-which is the presence of male dominance, especially in politics (Acheampong et al., 2021). In some cultures, women are taught to be submissive to men and therefore have no voice in congress. In many countries, men are the only leaders in matters that affect the nation and women are insubordinate (Acheampong et al., 2021). In Ghana, women leaders are only allowed to bring up matters dealing with healthcare to fellow nurses (Acheampong et al., 2021). They are not allowed to discuss such matters in front of men. In reality, this is not a problem we face in the United States, but other countries can see the benefit of having nurses participate in leadership roles. I would like to point out that even though this is not typically seen in the U.S, it does not mean that it does not exist.

Nurses and nurse practitioners have the ability to be empowered through their schools, jobs, communities, and organizations to lead change in health care policy.  “Empowerment of nurses and nurse leaders makes them proactive and advocates in the health sector which are great attributes for contribution to policy development and review” (Acheampong et al., 2021).

Nurses may feel that they are not well prepared to deal with health care policy and do not have enough confidence in themselves (Turale & Kunaviktikul, 2019). If a nurse wants to participate in policy-making and policy-review, he/she needs to become involved with local and state agencies, nurse organizations, and have ability to join policy training programs (Turale & Kunaviktikul, 2019).

Pairing up with a mentor is an excellent way to obtain experience in policy-making, review, and implementation.

Reference:

Acheampong, A.K., Ohene, L.A., Asante, I.S.A., Kyei, J., Dzansi, G., Adjei, C.A.,  Adjorlolo, S., Boateng, F., Woolley,P., Nyante, F., & Aziato. L. (2021). Nurses’ and midwives’ perspectives on participation in national policy development, review and reforms in Ghana: a qualitative study. BMC Nursing, 20(1), 1–10. https://doi.org/10.1186/s12912-021-00545-y

Milstead, J.A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6^th ed.). Burlington, MA: Jones & Bartlett Learning

Turale, S., & Kunaviktikul, W. (2019, August 20). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. Wiley Online Library. Retrieved January 26, 2022, from https://onlinelibrary.wiley.com/doi/full/10.1111/inr.12550

 

 

 Just as advanced practice nurses have the capability and expertise to engage in policy-making, nurses should also play a key role in policy evaluation. There is a well-known phenomenon within the field of research which also affects policy: despite the fact that best-practice guidelines exist does not mean that they are always followed in the clinical setting (Glasgow, Lichtenstein & Marcus, 2003). This means there is often a disconnect between the intentions of creating a certain policy change, and the actual outcomes of the policy change. Who better to help bridge this gap than nurses, who routinely re-assess and reevaluate as part of the basic nursing process (Milstead & Short, 2019)?

 There are several opportunities for nurses to become more involved in the process of policy evaluation. One of these ways can mean participating in research projects that aim to measure outcomes of policy change. In Oregon, 2003, a new law was passed which allowed nurses to delegate certain tasks, such as oral medication administration and wound care, to LPNs or nursing assistants under certain circumstances (Sikma & Young, 2003). A nursing research team designed a qualitative research project to assess nurses’ sense of how the policy was affecting patient care. In this way, the research team was able to provide data about the effects of the new policy on nurses within the state, which legislators could then use to make amendments to the new law, if necessary (Sikma & Young, 2003). Joining a professional organization that lobbies and has a policy analysis team, such as the ANA, is another great way for nurses to get their foot in the door with regards to policy evaluation. The ANA’s policy analysis team writes political action briefs and works to support legislation that is likely to impact nurses and patients in positive ways (ANA, n.d.). 

 Many nurses shy away from the field of research in the same way they do from politics, due to doubts about balancing research or advocacy with leading busy lives or a fear of being unable to achieve measurable results (Nkrumah et. al, 2018). Some of these barriers can be overcome by including comprehensive education for advanced practice nurses during their schooling that includes topics such as policy, research, and advocacy. When nurses feel adequately prepared to participate in policy evaluation, they are better equipped to evaluate policy in a way that is ethical, research-based, and data-driven (Milstead & Short, 2019). Another barrier that can prevent nurses from successfully evaluating health policy is a lack of resources, whether that means financial, human, or technological. Careful planning of potential impacts of policy change during the implementation process can help overcome these barriers and ensure that nurses have the necessary tools to implement, evaluate, and make changes in the policy arena (Desveaux et. al., 2019). 

 

References:

ANA. (n.d.). Expert policy analysis. ANA. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/expert-policy-analysis/

Desveaux, L., Soobiah, C., Bhatia, R. S., & Shaw, J. (2019). Identifying and overcoming policy-level barriers to the implementation of Digital Health Innovation: Qualitative Study. Journal of Medical Internet Research, 21(12). https://doi.org/10.2196/14994

 

Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why Don’t We See More 

 Translation of Health Promotion Research to Practice? Rethinking the Efficacy-    to-Effectiveness Transition. American             Journal of Public Health, 93(8), 1261–    1267.https://doi.org/10.2105/AJPH.93.8.1261

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

 

Nkrumah, I., Atuhaire, C., Priebe, G., & Cumber, S. N. (2018). Barriers for nurses’ 

 participation in and utilisation of clinical research in three hospitals within the         Kumasi Metropolis, Ghana. The Pan             African medical journal, 30, 24.     https://doi.org/10.11604/pamj.2018.30.24.15230

 

Sikma, S. K., & Young, H. M. (2003). Nurse Delegation in Washington State: A Case 

 Study of Concurrent Policy Implementation and Evaluation. Policy, Politics &         Nursing Practice, 4(1), 53.             https://doi.org/10.1177/1527154402239456

 

 

 

Dr. Mooring:

In my experience as both a floor nurse and supervisor, upper management does tend to be out of touch at times with the concerns of staff. Getting buy in as a manager from staff on new policies or organizational changes is key to its success. One of the best ways for nurses to communicate their impression of new policies is by being involved in key practice workplace committees or employee forums. These involvements often influence decisions, policies or practices that affect nursing responsibilities (Indeed Editorial Team, 2021). If nurse(s) do not get favorable feedback from administration, it is vital to be persistent and have key, precise facts to present to administration or legislators. It is important to have a strong argument on a specific issue or concern and know all information. “By knowing all the components and issues that must be addressed in each phase, the nurse in advanced practice will find many opportunities for providing expert advice” (Milstead and Short, 2019).

References

Indeed Editorial Team. (2021, May 27). Advocacy strategies in nursing: Definition, benefits and how-to. Indeed. https://www.indeed.com/career-advice/career-development/advocacy-strategies-in-nursing

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett learning.

 

HI Gabriel, Great post very informative. You made great points, who better to make and evaluate policies than nurses. We are the eyes and ears for everyone, we spend the most time with the patients, and that plays a part in data collection.  Because we are the primary caregivers, we should definitely get involved with development and implementation of policies which will help improve patient care and patient satisfaction. Nurses can use their expert skills of communication to advocate for the patient and express the effectiveness of a particular policy to lawmakers (Laureate Education, 2018).

 

References

Laureate Education (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.)

Oestberg F. Policy and politics: why nurses should get involved. Nursing. 2012;42(12): 46-49.

Policy review is a process in which a specific policy is assessed. If a certain policy is not efficiently functioning after implementation it is put under review and sometimes changed to further improve. Seeing as how policy does, directly and indirectly, affect how we, as nurses, carry out our duties in a healthcare setting, it is our duty to play our part in ensuring proper implementation and usage of policies passed as well as advocating for improvement if there is an issue. This advocacy is built upon “meeting the needs of individuals and families, and upstream advocacy efforts intended to influence change in the structures and relationships” (Spenceley, 2006, p. 182).

To carry out this duty of advocacy nurses must participate in the policy review process. Two paths to doing this include research for data collection and reaching out to legislative bodies. In America, and around the world, there are large disparities in care based on race, class, sexuality, and more. Many nurses witness this firsthand and feel as if their own personal ideals do not align with the healthcare system and “describe the context of health care as hostile and marginalizing to nurses and clients” (Spenceley, 2006, p. 182). The first step to decreasing the magnitude of this gap is collecting data that represent that trends in care. By utilizing “the mechanism of successful clinical and translational research infrastructure programs” nurses can aid in creating systematic change through evidence and statistical data (​​Shiramizu, 2016, p. 8). State policymakers have offices, emails, social media, public phone numbers, and social media, each of which is an easily accessible method of getting in contact with them. Although it may seem like your voice could be insignificant, contacting politicians and bridging their attention to certain issues with a policy can garner attention and lead to change. Providing feedback from personal and professional experience allows more information to reach leaders in policymaking and is part of the policy review process.

Again, as I mentioned in previous posts, the main concern for things like research is the resources available. It takes personnel and funding to effectively carry out credible research. There also might be pushback from those in the majority as they do not see nor concern themselves with how those in the minority are affected by disparities in care. Also often times emails and other forms of contact are brushed to the side because legislative bodies are busy or overwhelmed with other responsibilities.

It may be hard to bypass these challenges but there is a way. Often workplaces will provide certain programs or advertise others that will financially support research. If not through your own facility, there are outside organizations willing to donate as well. When reaching out to policymakers it is best to continuously reach out over a period of time. Networking also helps in this sense. Getting colleagues to support the cause you want to bring attention to can increase the chances of it reaching higher-ups. Especially if that support comes from leaders in your own facility.

 

References:

Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93(8), 1261–1267.

 

​​Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by success: Impact of a clinical and translational research infrastructure program to address health inequities. Journal of Racial and Ethnic Health Disparities, 4(5), 983–991.

 

Andrea,

In 2012 CMS began using HCAHPS to determine reimbursement amounts for hospitals (Davidson, K. et. al, 2016). HCAHPS stands for “Hospital Consumer of Healthcare Providers and Systems,” this is the first nationally standardized survey of patient perspectives that is publicly reported (CMS.gov, 2021). I can relate to your story about short staffing numbers last year and high patient to nurse ratios. This is definitely a huge contribution to patient satisfaction.  When these patient surveys come out, staff are not usually involved in processes to fix them. Many times, the people who make decisions for improvements see that there is a problem but, are unable to see all of the factors that contribute to it. This is why it is so important for nurses to be involved in the review of policies.

One night while I was supervising a man passed away while waiting in our waiting room. We were very short staffed with two nurses caring for 40 patients.  The patient was a young guy and one that I wouldn’t have suspected. I couldn’t help but, wonder what a difference it would have made, if his wife could have been allowed to wait with him. These situations make me  understand how truly important it is for nurses to be involved in policy making.

References

CMS.gov. (2021). HCAHPS: patients’ perspectives of care survey.  HCAHPS: Patients’ Perspectives of Care Survey | CM

Davidson, K., Emeruwa, Falzon, L., I., Inneh, I., Manzano, W., Mascielli, S., Shaffer, J., Sundquist, K., Ting, H., Yawdrey, D., Ye, S.,

(2016). Interventions to improve hospital satisfaction with healthcare providers and systems: a systematic review.

INTERVENTIONS TO IMPROVE HOSPITAL PATIENT SATISFACTION WITH HEALTHCARE PROVIDERS AND SYSTEMS: A 

SYSTEMATIC REVIEW (nih.gov)

Charity,

One important reason nurses do not participate in policy-making/review is because a lot of nurses have families and do not have time to be part of this leadership role. Taking family into consideration, how can a nurse become involved in health care policy when the workload is so much leaving nurses exhausted and unwilling to dedicate more time away from their families. “Understandings factors that affect nurses’ participation in health policy making can offer insight about strategies to strengthen nurses’ role in health policy” (Hajizadeh et al., 2021). The truth is, the more the nurse takes on a charge on the unit the more responsibility is also given to that nurse. Managers must realize that one nurse can not do everything for the unit. It would be beneficial to offer a position in health care policy as soon as that nurse is hired. Mangers have to start thinking outside the box and offer positions that include such matters that can make a difference on the unit, hospital, and ultimately the nursing profession. Managers and nursing educators need to concentrate on empowering and strengthening nurses to actively participate in health care policy.

 

Reference

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021, July 12). Factors influencing nurses participation in the health policy-making process: A systematic review – BMC Nursing. BioMed Central. Retrieved January 30, 2022, from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00648-6

 

 

We have to educate ourselves on the policies, in order to evaluate or review them. Many nurses report that implementing new policies is difficult because there are so many changes that happen so quickly. I remember rolling out new policies as a clinical educator, and having nurses groan and complain, especially when the information was communicated in an email. How do we get buy-in from staff when they are already overworked and understaffed?

Dr. Mooring

Precious,

I enjoyed reading where you added the challenges that effect policy and program evaluation. Sometimes, those challenges never get acknowledge and the same vicious cycle continues.  In order too see change, we must be involved in the development and implementation of policy design. The impact on the implementation from planning to data collection and implementation and maintenance a nurse can have is enormous; it improves the outcome, patient care and productivity (Milstead & Short, 2019.)  Oestberg stated, “If nurses don’t stand up for issues that are important to us, those with competing interests in healthcare may be the only ones whose voices are heard.” By making our voices heard, we have the ability to affect healthcare on an exponential level. I’ve never understood why those affected the most by policy change aren’t the ones making these policies in the first place, rather it be the administration. What do you think we can do, other that being 100% involved (which is hard to do at times), to make our voices heard?

 

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.)

Oestberg F. Policy and politics: why nurses should get involved. Nursing. 2012;42(12): 46-49.

 

 

We have to educate ourselves on the policies, in order to evaluate or review them. Many nurses report that implementing new policies is difficult because there are so many changes that happen so quickly. I remember rolling out new policies as a clinical educator, and having nurses groan and complain, especially when the information was communicated in an email. How do we get buy-in from staff when they are already overworked and understaffed?

Dr. Mooring

Hello Tricia,

I really like how you started off with saying “who better to be involved in healthcare policy evaluation than professional nurses…”. This sentence is so true and yet nurses aren’t really the ones being confronted throughout the whole process of new healthcare policies being made. It’s important for nurses to be a part of the policy process because “A lack of or inadequate existing policy directly impacts the nurse’s ability to deliver safe and optimal patient outcomes” and as advocates for public health it’s vital that we do just that by getting involved in all stages of policy (Anders, 2020).

Specifically, one way nurses can get involved in policy review is by joining professional organizations (like ANA, AACN, NLN, AANP) which are asked by policymakers “to assist with data collection and eventual dissemination of summative evaluation data through their professional communication networks to patients, to interprofessional team members, and to other stakeholders” (Milstead and Short, 2017, p. 122). This method also allows for nurses with similar interest to gather together and amplify their voices when advocating for healthcare policy changes.

References

Anders R. L. (2020, Oct. 6). 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, J. A., & Short, N. M. (2017). Health policy and politics (6th ed.). Jones and Bartlett.

 

Monique,

I agree that being an advocate to our patients is a primary goal of nurses. To effectively lead change, the Institute of Medicine affirms that nurses must view health and public policy as being within their scope to shape, develop, and engage in the political process effectively (Taylor, 2016). Nurses have the ability to influence nursing practice and policy through legislation, position statements, collaboration with other professional organizations, or practice changes. This article, written by Milbratth and Snyder (2021), discusses the impact of three initiates: care for vulnerable populations, trauma and injury prevention, and patient quality and safety. These provisions were considered the most impactful policy initiatives in the first 50 years of the Emergency Nurses Association. In recent years, the role of the emergency care nurse has shifted from professionalizing to maintaining an adequate workforce and advocating for safe working conditions. Although hospital crowding during the recent COVID-19 pandemic continues to plaque hospitals, the issue will remain consistent, and patients will require additional support through the ENA process. During this past year, the ENA has helped showcase emergency nurses to the world, demonstrating extreme resiliency in a world of uncertainty, determining best practices, and maintaining the health care safety net for the most vulnerable populations (Milbrath & Snyder, 2021).

References

Milbrath, G., & Snyder, A. (2021). The Emergency Nurses Association: 50 Years of Advocacy and Advancement. Journal of Emergency Nursing, 47(2), 224–238. https://doi.org/10.1016/j.jen.2020.11.007

Taylor, M. R. S. (2016). Impact of advocacy initiatives on nurses’ motivation to sustain momentum in public policy advocacy. Journal ns. of Professional Nursing, 32(3), 235–245. https://doi.org/10.1016/j.profnurs.2015.10.010

Hi Monique!

You are correct when you say nurses wear many hats! It can be overwhelming, challenging, yet rewarding at the same time. As it may be scary to participate in policy review, I wanted to explain why it is so crucial. Politicians have very little knowledge regarding health care as it is. Health care is constantly changing and evolving. Policies regarding health care also must change. It is essential for safety that health care professionals are available to bring about the needed change and advocate for specialties (Robinson, n.d.). Health care all-around needs teamwork. Policy review is no exception. Not speaking up and advocating for patients at work or in public leads to a communication deficit (Okuyama et al., 2014). We took an oath that we would stand by our patients. We must not allow others to misconceive the practice.

Okuyama, A., Wagner, C., Bijnen, B. (2014). Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC

            Health Serv Res. 14:61. doi: 10.1186/1472-6963-14-61

Robinson, L. (n.d.). How to approach the healthcare policy review process.

            PolicyMedical. https://www.policymedical.com/how-to-approach-the-healthcare-policy-review-process/

Hi Monique,

Great post! I agree with you that patient advocacy is the primary goal in nursing. As nurses we have the ability to implement changes in health care delivery to our patients, collaborate with other health care professionals and be active in policy review. A great example for nurses to participate in policy review is by joining a professional organization (Milstead and Short 2017).

References

Milstead, J. A., & Short, N. M. (2017). Health policy and politics (6th ed.). Jones and Bartlett.

Taylor, M. R. S. (2016). Impact of advocacy initiatives on nurses’ motivation to sustain momentum in public policy advocacy. Journal ns. of Professional Nursing, 32(3), 235–245. https://doi.org/10.1016/j.profnurs.2015.10.010

 When discussing the opportunities in which RNs and APRNs must participate in policy reviews, we must first now what the definition of a policy review is. According to IGI Global (2020), a policy review is known as a “process to evaluate the working [efficiency] of a particular policy.” This is mainly provided when the outcome of a policy is not working as intended, or to receive feedback on the efficiency of a policy. When nurses, who are actively involved with and create relationships with their patient, become present to help influence the politics of the workplace, they tend to take on the role of advocate, not only for themselves, but also for their fellow coworkers and patients.

A great example for nurses to participate in policy review is by joining a professional organization. According to Milstead and Short (2017), Nursing organizations such as the ANA, AACN, NLN and AANP “were asked to assist with data collection and eventual dissemination of summative evaluation data through their professional communication networks to patients, to interprofessional team members, and to other stakeholders” (p. 122). Another way would be by utilizing evidence-based practice to reach out to legislation and advocate for patients and/or other nurses if the policy is harmful and not beneficial. By constantly checking on your surroundings/the effects a policy has after its introduction, you ensure the safety and satisfaction of those around you, including yourself. If a problem with a new policy is not called to attention, it could lead to frustration, unnecessary negativity, and biased resentment at the workplace.

Misunderstanding of a policy is also a problem that is faced frequently and is on of the leading causes of termination in most workplaces. A nurse’s knowledge and involvement in policy making and review helps ensure the best care is received by the patient, and also ensures a structured and simple environment for the workers. One challenge could be getting consent from patients to collect their data, but this could be overcome by explaining and being transparent with the patient of how this data collection will affect them. Another challenge would be finding nurses who would be able to help you with evidence based research so your voice is amplified, but this is also easily fixed by joining a professional organization with people who share the same passion/will as you.

One way to communicate the existence of the things a professional organization does is to be vocal about it. Create posters, hold organization information fairs, mention some of the ways professional organizations are beneficial, such as the fact that they are necessary 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, 2012). Another method would be by encouraging nurses to get advanced education if possible, essentially advocating for nurses to pursue BSN and MSN (and further) degrees, where they will learn how to utilize and conduct evidence-based research.

References

IGI Global. (2020). What is policy review. https://www.igi-global.com/dictionary/history-policy-making-and-sustainability/81491

Milstead, J. A., & Short, N. M. (2017). Health policy and politics (6th ed.). Jones and Bartlett.

Matthews J. H. (2012). Role of professional organizations in advocating for the nursing profession. Online journal of issues in nursing, 17(1), 3.

Blessing,

You gave several great examples of how nurses can play an active role in the health care policy process, also discussed challenges that they may face along the way. When you mentioned the large number of health care workers who misunderstand and misinterpret policies and this being one of the leading causes for termination, I began to think of the risk that this lack of knowledge puts on not only the safety of the patient but of the health care worker. Many health care policies are created with the primary goal to protect the health care worker and reduce hazards in the workplace, such as prevention of sharps injuries, chemical or drug exposure, back injuries, latex allergies, violence, and stress. According to the CDC (n.d.), cases of nonfatal work injury and illness with health care workers is the highest of any industry sector. Most agree on the importance of health and safety of the health care workforce, especially during times of crisis like we’ve encountered during the COVID-19 pandemic. Fang and McDonald (2018) suggest that it is nurse managers’ responsibility to improve workforce quality, satisfaction and motivation, and to recommend operational strategies for avoiding known risk factors.

According to Friese (2019), evidence is clear that despite the potential health risks, nurses routinely break protocol and do not wear personal protective equipment (PPE) as recommended when handling hazardous drugs. Several barriers to PPE adherence include facilities not making appropriate PPE readily available, or not providing ongoing training, colleagues not wearing PPE, and discomfort of wearing. The CDC and NIOSH have a concept called the hierarchy of controls, which includes engineering controls like devices and equipment; administrative controls including policies, procedures, and monitoring; and proper PPE enforcement—to curb hazardous drug exposure among nurses and other healthcare providers (Friese, 2019). Nursing leadership must get involved to reinforce the importance of understanding and following safety policies within their organization.

References

Centers for Disease Control and Prevention. (n.d.). The national institute for occupational safety and health: Healthcare workers. https://www.cdc.gov/niosh/topics/healthcare/default.html

Fang, Y., & McDonald, T. (2018). Management capacity to promote nurse workplace health and safety. Journal of Nursing Management (John Wiley & Sons, Inc.), 26(3), 288–294. https://doi.org/10.1111/jonm.12544

Friese, C. (2019). Evidence supports strategies for better safe handling practice. ONS Voice, 34(9), 20.

in order for nurses to identify and eliminate policy issues, we must elect officials who have knowledge of nursing philosophy. We are at a crossroads where simply demanding change will get the job done when it comes to reviewing policy and making changes. Policies are rarely perfected on the first try and because of this nurses need to work together to eliminate policy issues (Nurses, 2014). To do this nurses should become involved in policy review, achieving this can be done by joining nursing boards and nursing associations. 

Challenges that nurses face in policy review can be policymakers who do not have knowledge of nursing philosophy.  Our goal to help eliminate this barrier would be to get patients, family members, clinicians, and educators involved with policymakers and nurses to provide real change(Gottlieb & Gottlieb, 2017). 

 

                                                                              Reference

Gottlieb, L., & Gottlieb, B. (2017, July 23). Strengths-Based Nursing: A Process for Implementing a Philosophy Into Practice. Journal of Family Nursing, 23, 319-340. https://journals-sagepub-com.ezp.waldenulibrary.org/doi/full/10.1177/1074840717717731

Patton, R., Zalon, M., & Ludwick, R. (Eds.). (2014, November 13). Nurses Making Policy (1 ed.). Springer Publishing Company.

Week 9 Main discussion

I think two ways nurses can get involved in politics would be joining a professional nursing or healthcare organization. There, he or she has access to other like-minded individuals and lobbyists that help support and fight for changes. Another way is to get involved locally and maybe even run for politic office or higher position within the healthcare field. A big factor that nurses face today against them is the lack of knowledge held in those positions where no one knows anything about healthcare or has little knowledge of the issues faced. Being more educated on policy and politics will also help nurses become more aware and have more power in fighting for changes or policies that need to be brought up.

References

(n.d.). Congress.gov. Retrieved January 7, 2022, from https:/www.congress.gov

The nursing profession’s potential impact on policy and politics. (2016). American Nurse Official Journal. Retrieved January 14, 2022, from https://myamericannurse.com

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

Week 9 Main discussion

I think two ways nurses can get involved in policy evaluation would be joining a professional nursing or healthcare organization. Most of these organizations have the branch of reporting evaluation of the policies that have been approved or proposed. There are also policy committees inside most workplaces that gather together and discuss the issues of any policies set forth or any that need to be made. They are usually made up of different directors, nurses, higher administrative personnel or even physicians within the hospital. This allows a broad view of the different aspects associated with the facility and how each policy that is implemented can or does affect those different aspects.

References

(n.d.). Congress.gov. Retrieved January 7, 2022, from https:/www.congress.gov

The nursing profession’s potential impact on policy and politics. (2016). American Nurse Official Journal. Retrieved January 14, 2022, from https://myamericannurse.com

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