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.

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

Marissa

I completely agree with your post regarding the challenges and strategies to help involve nurses in the policy evaluation processes. Many educational opportunities, learning tools, and advocacy strategies exist for nurses through professional nursing organizations undergraduate and graduate nursing programs. Yet, a significant number of nurses remain disengaged from the process of public policy advocacy (Reutter & Duncan, 2002). Nursing’s involvement with public policy is crucial to promote social justice and health for individuals, communities, and populations (ANA, 2010).

Although policy advocacy at work is a role expectation from the administration, one of the challenges faced in the workplace is that many clinical and administrative work environments may not fully support nurses’ engagement in public policy advocacy work, creating role conflict (Deschaine  & Schaffer, 2003). Many times, nurses attempt to become involved. Still, it is a futile attempt on behalf of the nurse due to the inability to attend meetings, participate in activities, or devote the needed time for nursing research because of short staffing and lack of experience and education. Many times, the suggestions of the nursing staff fall on deaf ears, and little to no result ever surfaces, thus creating frustration amongst the nursing community.

Nurses with master’s or higher levels of education were more politically active than those with lower levels of education. Kung and Lugo (2014) examined factors aligned with advocacy among advanced practice registered nurses (APRNs). They found that APRNs more likely to be politically active were those who perceived barriers to their practice authority and belonged to a professional nursing organization. Continuing education for the staff regarding policy review is vital to secure continued participation in the political arena. With the commitment and diligence of our community leaders, nursing instructors, and organizational leaders, we must keep our nurses involved in the policy review process. Tasking nurses with public service, running for local office, joining nursing organizations, interest groups, and lobbying for nursing agendas are all strategies and efforts to promote policy review.

 

 

Reference

American Nurses Association. (2010). Nursing’s social policy statement: The essence of the profession. Nursesbooks. Org.

 

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.

 

Kung, Y. M., & Rudner Lugo, N. (2015). Political advocacy and practice barriers: A survey of Florida APRNs. Journal of the American Association of Nurse Practitioners, 27(3), 145-151.

 

 

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

Response

Hi Marissa, thank you for your post. You are right about nurses, especially nurse managers supporting and encouraging one another to participate in policy review. One thing that nurses lack is supporting each other, even at the workplace. Nurses are not united at all, and it is the profession that is said to “eat their young”, this expression, according to an article means nurses being bullied at their workplace. This problem exists between physicians, supervisors and other nurses and new nurses (Gillespie et al., 2017). Looking at this, it is obvious nurses do not support themselves even at the workplace, how much more encouraging and supporting each other to participate in the political world. Some nurses are even envious and the simple fact that other nurses are involved in the political world and it is not them, they will not support or even encourage others to support. In the nutshell, nurses need to learn to work together, and support each other in every aspect. We all know that, nurses’ involvement in the political world will get our voices heard. It will also help get policies that benefit the profession and even patients implemented. As per another article, nurses working together can improve the quality of work and even reduce nurse turnover rate (Ylitormanen et al., 2019).

References

Gillespie, G. L., Grubb, P. L., Brown, K., Boesch, M. C., & Ulrich, D. (2017). “Nurses eat their young”: A novel bullying educational program for student nurses. HHS public access. J Nurs educ pract. 2017; 7(7): 11-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544026/

Ylitormanen, T., Turunen, H., Mikkonen, S., & Kvist, T. (2019). Good nurse-nurse collaboration implies high job satisfaction: A structural equation modelling approach. Nursing open. Nurs open. 2019 Jul; 6(3): 998-1005.

Hello Marissa,

Most certainly having to deal with others/conflicting beliefs or viewpoints can be a great challenge. I think this is why we have so many organizations catered to specific things, and why so many organizations do so many different things instead of focusing or catering to one thing only. Humans are very diverse and we all bring something to the table, and I am a firm believer in hearing others out, letting them express themselves. For that reason, I would say one way to deal with this would be to communication. According to Ian Henderson (2020), “good communication eases tension, builds trust, strengthens relationships and makes people feel at ease, because they are mutually understood” but also “remains firm on important points.”

I think you mentioned a great method for communicating your two strategies for getting involved in policy review that I didn’t even consider. Networking is something that’s so vital in all aspects of life, and yet sometimes people think it’s something to be used in a specific context (like getting a job). One way networking is so ideal is that it allows for the “exchanging information on challenges, experiences and goals [which] is a key benefit of networking because it allows you to gain new insights that you may not have otherwise thought of.” (Michael Page, 2021).

References

Michael Page. (2021, May 1). Top 12 benefits of professional networking and how to get started. https://www.michaelpage.com.au/advice/career-advice/career-progression/benefits-networking

Henderson, I. (2020, Feb. 20). Communication in conflict situations. https://www.accord.org.za/lessons/communication-in-conflict-situations/

Marissa,

Conflict resolution skills can improve teamwork, productivity, and patient and employee satisfaction (Lowry, A. & Overton, A., 2013). I have never even thought about people having a fear of “dealing with other peoples beliefs when they are different from their own.” Dealing with confrontation in itself is a scary thing when you are not accustom to it, though I’m not certain these skills can be obtained from nursing school solely.  I do however, agree that knowledge and confidence is essential for participation in healthcare politics.

I liked that you pointed out how building relationships can be beneficial to communicating opportunities for policy review. This could be done simply by your manager inviting you to attend a meeting. When it comes to social media, the United States congress member are encouraged to use social platforms for transparency and communication, such as Twitter (Charalambus, A., 2019). Social media is a great way to network among small and large groups. An example would be, our department at work has a facebook page that sends messages about meetings and or opportunities related to upcoming events. Some hospitals also have a web page that shares information about policy meetings for staff to attend.

References

Chalarambus, A., (2019).  Social media and health policy.  Social Media and Health Policy (nih.gov)

Lowry, A., & Overton, A., (2013). Conflict management: difficult conversations with difficult people.  Conflict Management: Difficult

Conversations with Difficult People (nih.gov)

Great post, I completely agree! I did not think about the fact that during the policy review there might be backlash from colleagues whose opinions differ. Networking is a great way to combat this. Establishing strong relationships with fellow nurses could encourage others to participate in the policy review process as well as bring you to like-minded people that share similar views. Do you think that fear of negative feedback is a hindrance from higher-ups to the participation of nurses in policy review?

References:

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.

Excellent discussion Marissa!

Policy review is so vital. Health care is a specialty of it’s own. Policies and standards change rapidly (RLDATIX Marketing, 2020). One can’t simply put an expiration date on health care procedures.

You mentioned that there is a major lack of participation from health care professionals. One way to maximize participation is to spread the word. I think is great and essential. I believe that this should be addressed in nursing school as well. Facility orientation is another great place. Nurses should be educated on the power they have to make changes, even if they are still learning the ropes themselves (Brokaw, 2016).

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

professions-potential-impact-policy-politics/

RLDATIX Marketing. (2020). When to review healthcare policies and procedures.

https://resources.rldatix.com/en-us-blog/when-to-review-healthcare-policies-and-procedures

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

Jamie,

I appreciated your post and shared some similar thoughts. There are lots of concerns with who continues to make choices for nurses and patients, especially when it is not the nurses or patients. A Nursing Reform article mentioned how the cost of supplies, nurses’ wages, feedback from nurses’, adverse events, end of shift overtime, and other variable to go into discussion when mentioning policy changes (Bartmess, 2021). It is important for the policy makers to look at the challenges in nursing with all of the factors that affect it prior to making policies. I do believe that prior to implementing policies into place, the nurses’ voice should be heard. We are there for it all and have the necessary knowledge to add our feedback in towards to the topics at hand.

References:

Bartmess, M., Myers, C. R., & Thomas, S. P. (2021, July 1). Nurse staffing legislation: Empirical evidence and policy analysis. Nursing Forum, 56(3), 660.

 

A Journal of the American Association of Nurse Practitioners article shared similar experiences in which nurses shared adverse events while advocating for patients in a space to change laws (Hahn, 2019).

Hahn, J. A. (2019). The perceptions and experiences of national regulatory nurse leaders in advancing the advanced practice registered nurse compact policy agenda. Journal of the American Association of Nurse Practitioners, 31(4), 255–262. https://doi.org/10.1097/JXX.0000000000000135

Jamie

Your post is fascinating to me. Politicians making decisions for nursing is insane; however, if we don’t keep representation teach our nurses to advocate for policy, we will have politicians making healthcare policies that affect us as nurses. For this purpose, nurses need to influence the formulation of the health policies rather than just implementation. They need to be active in developing health policies to be better able to control their practices.  In 1991, the American Association of College of Nursing (AACN) announced that it is necessary to add health policy education to nursing at the Master’s level. We also found nursing courses with the content of policies in baccalaureate degree programs after 2000 (Arabi et al., 2014).

Although, you don’t have to be a nurse in Ghana to be overlooked as a nurse. We suffer from this in the United States every day in every community. This is why nurses must join professional affiliations and be adequately represented. Professional nursing organizations represent the members’ interests and form support for political participation locally and nationally. Nurses’ expertise and knowledge obligate them to assume a leadership role in the political domain to enhance their effectiveness as patient advocates (DeLeskey, 2003). It is well understood that nurses shy away from policy advocacy due to a lack of experience and knowledge. It is not within our comfort zone. Maybe with the mandate of a political advocacy class incorporated in the baccalaureate program and the masters’ program, we will see more involvement from younger nurses.

 

Reference

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian journal of nursing and midwifery research, 19(3), 315.

 

DeLeskey, K. (2003). Factors affecting nurses’ decisions to join and maintain membership in professional associations. Journal of PeriAnesthesia Nursing, 18(1), 8-17.

Jamie,

I completely agree with you! It is often older male politicians of a particular group with little to no background knowledge of the areas that policies affect that make the big decisions. It is crazy to think that this is the case, that is why including nurses in this process is so imperative. Knowledge is power, so if more nurses are informed about roles they could take to have a bigger impact then many more would be encouraged to speak up and speak out. Time management is definitely an impediment to engaging in outside work that extends outside your facility. Being involved in a nurse association could be a lower commitment way of still being involved though. This is a great point that you brought up! Do you think there should be easier ways for nurses to be heard by policymakers?

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/

Nurses play pertinent roles in the entire policy-making process, including problem identification, agenda setting, policy formation, policy legitimation, policy implementation, and policy evaluation (Ellenbecker & Edward, 2016). The latter entails the application of “evaluation principles and methods to examine the content, implementation or impact of a policy, or the activity through which we develop an understanding of the merit, worth, and utility of a policy” (Centers for Disease Control and Prevention (CDC), 2016 p.1). The purpose of evaluation research in health policy is to determine a law’s effectiveness in improving some aspect of a targeted population’s health (Ellenbecker & Edward, 2016). Thus, an opportunity for nurses in policy evaluation is performing research to examine the efficacy of the implemented policy by focusing on such outcomes as quality of care, the efficiency of care delivery, availability of access, and the effect on health disparities. In addition, nurses can also evaluate health policies by participating in policy forums, where they can use empirical evidence to support or ask queries regarding the effectiveness of the policy. In the above view, the nurse’s information or contribution will be regarded professionally credible since nurses have adequate experience and knowledge of the potential effects of certain policies (Centers for Disease Control and Prevention (CDC), 2016).

Participation in research to evaluate health policies require nurses to use such research methods as experimental designs to evaluate the outcome of a law; with the enacted law serving as the independent variable and the impacts on health outcomes serve as the dependent variables (Ellenbecker & Edward, 2016). The above task may be impeded by the nurse’s lack of knowledge of experimental research, and the strategy to resolve it is through consultation with experts and continuous professional development opportunities (Steven et al., 2018).  The nurses’ participation in health policy forums can be obstructed by the lack of time, which can be addressed by proper time management and prioritization of health policy evaluation as a core nursing obligation same as patient care.

References

Centers for Disease Control and Prevention (CDC). (2016). Brief 1: Overview of Policy Evaluation. https://www.cdc.gov/injury/pdfs/policy/brief 1-a.pdf

Ellenbecker, C. H., & Edward, J. (2016). Conducting nursing research to advance and inform health policy. Policy, Politics, and Nursing Practice, 17(4), 208–217. https://doi.org/10.1177/1527154417700634

Steven, A., Larkin, V., Stewart, J., & Bateman, B. (2018). The value of continuing professional development: A realistic evaluation of a multi-disciplinary workshop for health visitors dealing with children with complex needs. Nurse Education Today, 67, 56–63. https://doi.org/10.1016/j.nedt.2018.04.021

 

 

 

Nurses are often the ones most impacted by new health care policies and legislation. Yet, they often feel that administration does not listen to their input until the policy has already been implemented. What is the best way for nurses to communicate their impression of new policies with the powers that be? What should the nurses’ response be if administration or legislators do not respond positively to their feedback?

Dr. Mooring

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

 

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

Dr. Mooring,

I think that it would be very beneficial to start a new nursing role such as a nurse policy advocate. Just like nursing informatics, a nurse policy advocate would specialize in this field only. This would eliminate a lot of the problems we are facing today in regards to nurse participation. A nurse policy advocate is a name that I just made up. Universities can offer courses just for this specific role, just like going to school to be nurse practitioner is a specialty, then this new role can be too.

That is a great, innovative idea!

Claudia, I enjoyed reading your comprehensive post on our role in policy evaluation. I concur with you that the lack of adequate knowledge of the policy making process is a key impediment for nurses to engage in it as it contributes to what you mention as the unpreparedness and lack of confidence (Makarem et al., 2019). I believe the above obstacle can be addressed by individual nurses by seeking knowledge and information by attending seminars, checking the numerous resources online via websites of nursing association organizations, like ANA. Besides, there are numerous empirical studies and articles published by Centers for Disease Control and Prevention (CDC) (n.d.) highlighting the step-by-step actions that one can take to succeed in healthcare policy evaluation. Do you think information from empirical studies can inculcate confidence among nurses and inspire them to partake in policy assessment?

References

Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating violence and injury prevention policies: Brief 4 : Evaluating Policy Implementation. http://www.cdc.gov/injury/pdfs/policy/Brief 4-a.pdf

Makarem, A., Heshmati-Nabavi, F., Afshar, L., Yazdani, S., Pouresmail, Z., & Hoseinpour, Z. (2019). The comparison of professional confidence in nursing students and clinical nurses: A cross-sectional study. Iranian Journal of Nursing and Midwifery Research, 24(4), 261–267. https://doi.org/10.4103/ijnmr.IJNMR_102_17

 

Claudia,

 

I truly appreciate your insight on your post this week. As frontline workers, there are many opportunities to see and assess patient and staff needs. There are multiple opportunities for RNs and APRNs to be a part of the policy-making process and hold local seats to help implement strategies. APRNS and RNs have options in school, jobs, communities, etc., and many more places. Our insight into the field comes from many occurrences, including frontline experiences. An Advancing in Nursing Science article discussed how nurses provide valuable detailed insight and solutions to healthcare (Chiu, 2021). It also mentions how our role in advocacy continues to evolve, and so does the needs of our patients (Chiu, 2021). Each of us needs to use our voices and actions to be a part of our patients and solutions.

 

References:

 

Chiu, P. (2021). Advancing Nursing Policy Advocacy Knowledge: A Theoretical Exploration. Advances in Nursing Science, 44(1), 3. https://doi.org/10.1097/ANS.0000000000000339

 

 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

 

 

 

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

Thank you for your reply, Dr. Mooring. As a staff nurse, I have personally experienced the frustration that comes from not feeling heard or facing opposition from hospital administration when problems are brought to light. It is a very common occurrence that administration dismisses the concerns and ideas of nurses.  I found an article that points out some of the factors that negatively affect the feedback process. One of these is a lack of respect for the source of the feedback (Hardavella et. al., 2017). Nurses have made great strides in becoming respected members of the health care team, but there is still room for improvement. This barrier can be overcome by maintaining professionalism when voicing issues or concerns, and by using approved feedback methods, such as staff satisfaction surveys (Hardavella et. al., 2017). For nurses, participating in the evaluation process is crucial to successful employee engagement. Making sure our voices are heard helps keep nurses satisfied at work and even reduces employee burnout and turnover (Geisbers et. al., 2021).

References:

Giesbers, A. P. M., Schouteten, R. L. J., Poutsma, E., van der Heijden, B. I. J. M., & van Achterberg, T. (2021). Towards a better understanding of the relationship between feedback and nurses’ work engagement and burnout: A convergent mixed-methods study on nurses’ attributions about the ‘why’ of feedback. International Journal of Nursing Studies, 117, 103889. https://doi.org/10.1016/j.ijnurstu.2021.103889

Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I., & Sreter, K. B. (2017). How to give and receive 
feedback effectively. Breathe (Sheffield, England), 13(4), 327–333. https://doi.org/10.1183/20734735.009917

I agree! We often blow off those surveys as busy work or unnecessary, but if administrators truly use the data collected to prompt meaningful change, we should make time to respond.

Hi Andrea,

I like how you talked about the expectations of a policy change versus the reality. Nurses can effectively participate in this area as they are the ones who see the policy in action day to day. Nurses are also great at identifying problems, formulating strategies, and communicating (Olson, 2020.) Through policy review, nurses can impact the health of individuals, populations, and staff. Nurses are also in the best position for advocating for both patients and other nurses and healthcare workers (UNCW, 2021). Contrary to popular belief, participating in policy isn’t as intimidating as it appears, and we as nurses should encourage other nurses to get involved.

References

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

University of North Carolina Wilmington. (2021, March 15). How nurses can shape health policy. University of North Carolina Wilmington.

Andrea, thanks for a comprehensive post. Unfortunately, nurses’ involvement in health policy studies is still quite small when one reviews the research literature, but research that informs health policy has enormous potential (Turale & Kunaviktikul, 2019). At graduate and post-doctoral levels, undertaking evaluation of health policy, laws and regulations is central to understanding how to develop health policy to benefit the health of the public and will expand the knowledge of nurses regarding the complex workings of health systems. Studies that are targeted at helping understand how populations can get better access to health and health equity will provide valuable information to policymakers, health leaders, and the profession of nursing (Arabi et al., 2016). Which problem(s) have you identified in your practice that may be an issue for policy advocacy?

References

Arabi, A., Cheraghi, M. A., & Ghiyasvandian, S. (2016). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research, 19(3), 11–16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/pdf/IJNMR-19-315.pdf

Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. International Nursing Review, 66(3), 302–304. https://doi.org/10.1111/inr.12550

 

 

 

Week 9 Discussion Reply 1

Andrea, I enjoyed reading your post. I really didn’t think of joining in on research projects until I read your post. That would be a great way to help gather information and statistics on a certain subject or population that’s needed for policy evaluation. Also, you are correct in the fact that more education brings more knowledge of subjects and confidence to be able to speak up. I think healthcare policies need more nurses to participate on the input or our healthcare system would be worse than it already is today.

References

Sikma, S., & Young, H. (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

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

 

“It is critical that professional nurses are familiar with evaluation principles and can apply aspects of evaluation throughout all phases of healthcare program planning, implementation, and outcome assessment” (Milstead & Short, 2019, p. 116). Nurses can actively participate in policy review through evidence-based research. “The purpose of evaluation research in health policy is to determine a law’s effectiveness in improving some aspect of a targeted population’s health” (Ellenbecker & Edward, 2016). Evaluation processes may be considered either formative or summative in nature (Milstead & Short, 2019). Formative evaluations assist program developers with addressing concerns and the ability to make improvements in the policy; summative evaluation is at the end of the program where data is summarized, and goal achievements are determined. “Both types of evaluation are critical in assessing healthcare policies and invaluable for nurses to utilize and understand the policies’ implications” (Milstead & Short, 2019, p. 118). Nurses can be instrumental in collecting pertinent data that can assist with shaping and improving healthcare practices and policies. Another way nurses can be involved in policy review is through membership in a nursing organization. Nursing organizations, such as the American Nurses Association (ANA), allow nurses to participate in the policy-making process including education, advocacy, and research. The ANCC Institute for Credentialing Research, part of the ANA, supports research-related processes and activities for ANCC organizational and individual credentialing programs (American Nurses Association, n.d.). One research program the ANCC is recruiting for is a study for magnet organizations to participate in a 3-year multisite research study on evaluating discharge readiness (ANCC, n.d.).

Challenges to nurse participation in the evaluation of research data and policy outcomes include lack of resources for evaluation completion and/or lack of stakeholder collaboration/buy in (Milstead & Short, 2019). Adequate funding can be through nursing associations with research funding programs; also getting buy-in from stakeholders. Nurses should adopt strategies in the implementation of policies by utilizing resources available to guide effective evaluation and offer solutions to common challenges (Milstead & Short, 2019). According to Milstead & Short (2019), one question to ask when reading evaluations and reports is whether the program or policy is achieving the objectives and goals for which it was designed. One strategy to better communicate the opportunities for funding through nursing associations is by media. Grassroots initiatives with the use of social media can bring awareness to social issues or policy improvements. Nurses can utilize networking with other nurses to collaborate and gain further insight on issues from their peers. Nursing organizations are also an invaluable resource to advocate through lobbying, funding, and research. Another communication strategy is utilizing nursing knowledge and vast experience to lobby legislators for important nursing agendas.

 

References

American Nurses Credentialing Center (n.d.). Credentialing research. https://www.nursingworld.org/ancc/programs/credentialing-research/

Ellenbecker, C. H., & Edward, J. (2016). Conducting Nursing Research to Advance and Inform Health Policy. Policy, Politics, & Nursing Practice, 17(4), 208–217. https://doi.org/10.1177/1527154417700634

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

Nurses are often the ones most impacted by new health care policies and legislation. Yet, they often feel that administration does not listen to their input until the policy has already been implemented. What is the best way for nurses to communicate their impression of new policies with the powers that be? What should the nurses’ response be if administration or legislators do not respond positively to their feedback?

Dr. Mooring

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.

 

Absolutely! Being involved in committees and taskforces is a great way to have input and to advocate for real, meaningful change that meets nurses’ needs.

     Nurses have been and continue to be pivotal in developing and delivering innovative care coordination practice models. The rapid changes transforming health care today and the increased demand for care coordination require immediate action to enable nurses and other qualified health professionals to deliver outstanding care coordination to achieve the nation’s quality agenda (Lamb et al., 2015). Policy advocacy and review is an obligation that RN’s and APRNs are obligated to participate in and help protect the public’s interest in quality health care. Professional nurses are “responsible for . . . shaping and reshaping health care in our nation, specifically in areas of health care policy and legislation that affect accessibility, quality, and the cost of health care” (Fowler, 2010). RNs in the workplace on the front line providing the care are the most valuable asset that the public and legislators have to design, implement and evaluate current policies. After having spent 35 years in the acute care setting in a kaleidoscope of roles, I can personally attest that nurses are the obvious choice at the forefront of policy review and provide the most knowledge concerning what policies work to provide efficacy the most effective. Professional nurses, regardless of their practice setting, expertise, and level of education, are typically well versed in evaluating and analyzing the effectiveness of their assessment, planning, and implementation efforts; the foundational theory of the nursing process includes the critical step of evaluation. The same principles that nurses use to assess the impact and effectiveness of clinical interventions, procedures, or clinical practices can be applied to program/outcome evaluation or policy evaluation (Milstead & Short, 2019).

Nurses can face challenges and strategize on overcoming these obstacles by the following: Nurses and Advanced Practice Nurses can provide leadership in policy review in several ways. First and foremost, nurses must align with one another and learn to collaborate and support each other as a profession, hence joining an organization such as American Nurses Association (ANA). Joining these organizations supports the nurse’s role. It teaches and mentors the nurse how to participate, guide the nurse their value and worth in the community, and the accountability and responsibility of our positions as health care professionals. This is a formidable strategy to communicate or advocate for the profession.  The second and most popular is through the workplace. Nurses can join policy committees, health wellness groups, care coordination, and nurse counsel positions within their organizations. Participation in these groups allows nurses to network and influence other nurses, take an interest, and participate in the policy advocacy role. Nurses collaborate with many other professionals in the health care arena, such as pharmacists, therapists, counselors, managers, physicians, CNOs, CFOs, and many others. The nurse’s influence to voice the concerns, address the problems, and deliver positive outcomes is monumental. APRNs are unique in advocating for the legislation since they are at the forefront of policy review. Current care coordination payment models include provisions for APRN payment. APRNs are better positioned to lead and influence policy and evaluate the high-value care coordination models (Lamb et al., 2015).

The RN and the APRN face similar challenges to policy advocacy and change. The inadequate resources available and the inability to obtain accurate data coupled with the RN and APRN’s lack of education or experience in research or policy advocacy. The professional organization can prepare and assist with guidance and expertise, so the Nurse or APRN is successful.  Also, external factors may be critical components of influencing evaluation results, including economic conditions of the affected communities or systems, public awareness of the policy or program, social media, and political campaigns (Milstead & Short, 2019). This is a prime example of why nurses need to be out in the community and involved in their local government to know the issues and involvement are not such a hurdle.  It provides the nurse with the awareness of other legislative bills, stakeholders, and the objectives/goals on the agenda. This allows the nurse to plan and introduce material at the right time to the right person, better noted as diplomacy.  This was a critical method that we learned earlier in this course.

Professional nurses are urged to use their power to elicit positive change. Nurses must be empowered to take the initiative to participate in the evolution of the health care system and the providers. This is the era to push for nursing advancement in independent roles as Bachelor pre-pared nurses and full scope authority for APRNs.

 

Reference 

Fowler, M. (Ed). (2010). Guide to the Code of Ethics for Nurses. Silver Spring, MD: American Nurses Association.

Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., … & Peterson, C. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521-530.

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 (6^th ed.). Burlington, MA: Jones & Bartlett Learning

I really enjoyed reading your post, Shelley. You make a great point about how external factors can influence the way nurses are able to evaluate policy. That got me thinking about COVID, and how the pandemic impacted nurses’ ability to give feedback in the hospitals where they work. Early in the pandemic, a majority of nurses surveyed reported feeling unheard by their administration and forced into situations they perceived as dangerous (Cho, Sagherian & Steege, 2021). Factors such as lack of resources and under-staffing made it difficult for nurses to perform their basic job functions, much less participate in policy evaluation. But ultimately, many nurses stepped up and found their voice in advocating for positive changes in the workplace as a result of the frustrations that developed from feeling unheard early in the Pandemic. In many states with unions, nurses went on strike to obtain safer nurse-patient ratios and necessary PPE, which ultimately resulted in improvements for the nurses who have continued to remain at the bedside throughout the pandemic (Spolar, 2021). I think this story highlights how nurses’ feedback can result in significant improvements for both nurses and patients.

References:

Cho, H., Sagherian, K., & Steege, L. M. (2021). Hospital nursing staff perceptions of resources provided by their organizations during the COVID-19 pandemic. Workplace Health & Safety, 69(4), 174–181. https://doi.org/10.1177/2165079920987543 

Spolar, M. K. (2021, December 16). Nurses in crisis over Covid dig in for better work conditions. Kaiser Health News. Retrieved January 27, 2022, from https://khn.org/news/article/nurses-unions-organizing-campaigns-labor-relations/

 

Andrea,

Thank you for the words of encouragement. You are correct; the intrinsic or external factors influence the level of participation on the nurse’s behalf. The social awareness of the public knowing what the issue is and the financial concerns of how the funds are to be allocated, and how do we disburse the product to the facilities and supply chain failures…. etc.  All of these are unknown factors but can serve as an obstacle to evaluating policy for nurses (Milstead & Short, 2019).

 

As a nurse and a manager, I can completely identify with the staffing issue surrounding Covid-19. We all have a responsibility to sustain and encourage one another during the Covid-19. Nurses have been on the front line of tragedy during this entire 18 months of the pandemic, dealing with death, under severe duress at times, while being worried about being infected themselves and transmitting to their family at home. They are also providing our time and efforts taking care of people in the hospital while leaving our own families to take care of themselves being infected with Covid-19.  This also is an example of an external factor, staffing. So many nurses could not participate at the expected levels in policy review or any other activist’s role due to the poor staffing, high stress, and needs of their families during the covid 19.

The ethical problems being experienced by nurses and other health workers in the current pandemic are complex. They require multi-disciplinary thinking and policies and strategies to guide future practice and education. Ethical frameworks need to be revised or developed and adopted widely in nursing practice, with support and input from national nursing organizations, nurse educators, and nurse leaders. We also hope that nurses, governments, and health systems learn more about health care worker experiences and data arising from 21^st-century outbreaks of viral diseases.  Nurses need to argue for and be involved in policies to receive solid ethics education to assist in their work and risk management during emergencies and disasters. They also need strong leadership, clear direction, and continued support from each other, their employers, the public, and their nursing organizations to continue to protect communities, save lives and prevent suffering in this pandemic and for new and emerging diseases. With clear insight, there will be research studies analyzing these ethical issues and challenges, discussion in the profession and with other disciplines to be better prepared for public health emergencies. All of us must protect and sustain nurses’ well-being and competency so that they, in turn, can undertake their roles and responsibilities in caring for the world’s populations (Turale et al., 2020).

 

 

 

 

 

Reference

 

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., Meechamnan, C., & Kunaviktikul, W. (2020). Challenging times: ethics, nursing, and the COVID‐19 pandemic. International nursing review, 67(2), 164-167.

Hi Shelley,

 

I enjoyed reading your post, specifically regarding nurses being involved within their own workplace. As a supervisor, staff tend to complain but do not offer suggestions or solutions to specific issues. Being involved in workplace committees is an opportunity for nurses to work with peers, management, and other departments to be solution focused. Belonging to a workplace committee can be an opportunity for learning new skills, ensuring one’s understanding of the inside workings of healthcare organizations, and multidisciplinary or intradisciplinary collaboration (Carlson, 2022).

 

Nurses may be apprehensive to become part of committees for various reasons. From personal experience, lack of time or lack of motivation are a few factors. It is important for nursing leaders to encourage participation. According to one research article in the International Nursing Review, lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy growth (Richter et al., 2012). Strong support from the management team is necessary to facilitate nurses’ involvement in policy development. At my workplace, one committee where nurses have representation is the safety committee. This committee addresses various safety issue concerns from staff safety to COVID protocols. What committees at your workplace are nurses involved?

 

 

References

 

Carlson, K. (2022, January 28). Want to grow your nursing career? Join a workplace committee. NursesUSA.https://nursesusa.org/articles_grow_your_nursing_career_by_joining_workplace_committee.asp

 

Richter, M., Mill, J., Muller, C., Kahwa, E., Etowa, J., Dawkins, P. and Hepburn, C. (2013). Nurses’ engagement in AIDS policy development. International Nursing Review, 60: 52-58. https://doi.org/10.1111/j.1466-7657.2012.01010.x

 

Tamisha,

It is my experience that new nurses are intimidated by the overwhelming process of policy review. It is not within their “wheel house” per say. As management, we become accustom to the written processes that are involved with management, presentation, and communication venues. The formal education that is now required for baccalaureate and masters’ programs brings about a brighter forecast for the future for nurse involvement in policy review.   On the other hand, results of a survey about the health managers’ and authorities’ perceptions of the effect of various health professions on revision of health affairs reveal that nurses are in the sixth (the last) grade with a dominant point interval in comparison to other health professionals (Arabi, 2014).

There is never enough time in a nurses schedule with career, family, education, as well as the magnitude of other daily life . Time management and lack of resources will always be a factor that we must take into consideration and face these challenges. Joining a nurse organization will help delineate the lack of resources and assist in teaching time management skills ( DeLeskey, 2003).

Reference

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian journal of nursing and midwifery research, 19(3), 315

DeLeskey, K. (2003). Factors affecting nurses’ decisions to join and maintain membership in professional associations. Journal of PeriAnesthesia Nursing, 18(1), 8-17.

Week 9 Discussion Reply

Hi Tamisha, I enjoyed reading your post. I do agree that getting involved in your own workplace, if possible, is a great start to making a difference. It does require your administration to be supportive and let others be heard. I know I have sat in many committee meetings and never had an opportunity to say a word. I’ve also sat in a few that I was made to participate and voice any concerns in. Committees are put together to have varying and diverse voices to help make a difference, safer, more cost-effective or for better quality given to patients.

References

American Association of Nurse Practitioners. (2021). https://www.aanp.org/membership/member-benefits

Burns, M. K. (2018). Creating a Nursing Portfolio. Ohio Nurses Review, 93(3), 16–17.

Echevarria, I. (2018). Making connections by joining a professional nursing organization. Nursing, 48(12), 35–38.

Who better to make and evaluate policies than the ones implementing them, and the ones affected by them every day? As primary caregivers in healthcare, 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). As nurses, we should be used in the maintenance of the policy to help assist with accurate, and important feedback from implementing a new policy such as quality, safety, and efficiency assuring that the expected outcome is always up to date with current practice. (Polit & Beck 2012).

 

Nurses can have control over the care they provide by being actively involved in the construction of new policies. I have never understood the logic behind those such as political leaders that make policies and laws for healthcare professionals but have never once walked in our shoes. At the state and federal levels, nurses can get involved in policy and politics by joining a professional nursing organization. Nurses can also write to their state representatives regarding healthcare policy. Nurses can undertake internships with elected officials to personally work on matters affecting healthcare (Kovner, 2020.)

 

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.

 

References: 

Burlington, MA: Jones & Bartlett Learning. Polit, D., & Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing

Kovner, C. (2020). Policy, politics, nursing practice, and covid-19. Policy, Politics, & Nursing Practice, 21(2), 55–55. https://doi.org/10.1177/1527154420933016

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.

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.

Main post

The nursing profession involves the five main nursing processes which are assessment, diagnosis, planning, implementation and evaluation. All of these stages play an important role in caring for patients and providing effective and safe care to patients; however, evaluation which happens to be the last stage happens to be very important. Why do I say this? The whole purpose of these stages is to reach a better and quality outcome. It’s for the safety and betterment of our patients and the only way nurses will know they have achieved the expected outcome after implementation is through evaluation. The same applies to health care policy making. Once a policy has been implemented, it has to be reviewed or evaluated in order to know if it is effective or it needs to be revised (Milstead & Short, 2019).

There are several opportunities that currently exit for RNs and APRNs to actively participate in policy review, and these include one, joining professional organizations such as ANA, AANP, NLN among others. Through these organizations, nurses can involve themselves in policy review. Through these associations, we can have nurse legislator liaison who can work directly with the state’s representatives and senators, and here, they can participate in the review of health care policies, ensure the effectiveness and also see to it that those policies favor nurses. Some challenges associated with nurses becoming members of theses associations include lack of information or knowledge on the importance of becoming members, lack of time or busy schedules and other personal issues, the cost involved etc (Aspen University, 2021).

Secondly, RNs and APRNs can participate in policy review by signing up for internships with selected government officials or running for office positions in our local, state or federal offices.  Instances are Congresswoman Cori Bush (D-MO-1) from Missouri and Congresswoman Lauren Underwood (D-IL-14) from Illinois who are both nurses and are serving in congress (American Nurses Association, n.d.). Some of the challenges that can be associated with running office are that, it could be time consuming especially if the nurse is a family women and could also require relocation so as a family women, you will need a very supportive and understanding husband and/or children.

Some strategies to communicate the existence of these opportunities include holding meetings and seminars with local health care teams and in different healthcare organizations to educate them on the importance of involving themselves in policy reviews in order to advocate for their profession. Nurses could also be encouraged to join professional organizations and they can begin with their state nurses associations which could be a stepping stool for making their voices heard.

References

American Nurses Association. (n.d.). Nurses serving in congress. https://www.nursingworld.org/practice-policy/advocacy/federal/nurses-serving-in-congress/

Aspen University. (2021). Should I join a nursing organization? https://www.aspen.edu/altitude/join-nursing-organization/

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

Hi Yvonne,

I enjoyed reading your post. I agree internships are another good option for nurses to participate in policy review. The American Association of College of Nurses (AACN) offers a Government Affairs and Policy Internship in Washington, D.C. Activities of the internship include learning about academic nursing on the federal level; attending policy hearings, briefings, and other Capitol Hill events; drafting letters and newsletter articles; assisting with preparation of the Fall and Spring Annual Conferences (American Association of College of Nurses (n.d.). Nursing internships are very beneficial for both the intern and employer. “Nursing internships and practicums provide nursing students with real-world experience that can help their future careers” (Meering, 2022). In my opinion, the more real world experience and knowledge a new nurse can obtain, the better prepared they will be in their future nursing career field.

 

References

American Association of College of Nursing (n.d.). AACN Government Affairs and Policy Internship: AACN Internship Activities. https://www.aacnnursing.org/Policy-Advocacy/Student-Resources/Internships

Deering, M. (2022, January 20). Nursing Internships and Practicums. NurseJournal. https://nursejournal.org/resources/nursing-internships-and-practicums/

Yvonne,

Your post was very informative. I had not even thought about doing internships with government officials. Is it something that nurses can participate in? If so, that is awesome and would be a great way for nurses to get involved in policy review and construction! There are more and more ways for nurses to get involved these days. This is very important because as nurses we should be used in the maintenance of the policy to help assist with accurate, and important feedback from implementing a new policy such as quality, safety, and efficiency assuring that the expected outcome is always up to date with current practice (Polit & Beck 2012.)

From my post, one quote that stood out to be was by Oestberg. They 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.” This resonated with me because who better to help make the change than those directly affected the most!

Burlington, MA: Jones & Bartlett Learning. Polit, D., & Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing

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.

 

Nurses are often the ones most impacted by new health care policies and legislation. Yet, they often feel that administration does not listen to their input until the policy has already been implemented. What is the best way for nurses to communicate their impression of new policies with the powers that be? What should the nurses’ response be if administration or legislators do not respond positively to their feedback?

Dr. Mooring

The best way to communicate a need as a nurse would be to get together as a united front if there is a shared opinion about policy to create a bigger impact and impression on leadership. Many voices are more likely to be listened to. If the response they receive is not positive, depending on the severity of the case, they can try explaining further and providing evidence as to why there is a certain opinion about positively.

We are definitely stronger together! I am from NC, which is considered a “non-Union” state. Nurses there are discouraged from organizing for fear of retaliation and even legal action. HOw can we encourage those who are hesitant to participate in the “United Front”?

Charity,

You make some great points in your post. For nurses, understanding the ways to approach hospital administration with problems or ideas can pave the way to more nursing inclusion in policy development and analysis. Giving feedback that is precise, communicating professionally, and involving stakeholders from other medical specialties are some ways that nurses can improve the feedback process with their hospitals (Hardavella et. al., 2017). When the feedback or evaluation process fails, there can be consequences ranging from staff dissatisfaction all the way to a decrease in the quality of care delivery.

As you pointed out in your post, I know myself, and probably many of our colleagues have sat in meetings with disgruntled employees after an administrative change was made that was not discussed or planned with the nursing staff. My hospital, for example, did a 10-week project to improve patient satisfaction scores which had plummeted after the onset of COVID. Hospital administration brought in a coaching team to have weekly meetings with the ED staff on new projects we would roll out every week to make our patients feel heard and appreciated. The hospital spent almost $ 20,000 for this coaching program. The problem? Our staffing had taken a huge hit as many nurses and ancillary staff were out with COVID. Our ED was overcrowded and our nurse: patient ratios had gone from 4 patients to 7, many times with 2 or more of those patients being intubated and COVID positive. The move came across as tone-deaf on the administration’s part, and being asked to do things such as update white boards hourly and write thank-you notes to patients who were discharged was frankly insulting to a worn-out staff who was barely able to stay on their feet for their 12-hour shifts in full PPE with no breaks. In hindsight, had administration chosen to hear feedback from nurses, they could have used that money on other things, such as hiring travel nurses, which would have alleviated the pressure on the nursing staff and ultimately improved patient satisfaction scores anyway. This is just one example of a communication failure between nurses and hospital administration, and it ended up costing the hospital money without making any measurable improvements. If, as Milstead and Short (2019) recommend, the hospital had approached the ED nurses to ask for ideas about how to improve satisfaction scores during the planning phase of the project, a solution could have been found that would have worked best for nurses, patients, and the hospital.

References:

Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I., & Sreter, K. B. (2017). How to give and receive 
feedback effectively. Breathe (Sheffield, England), 13(4), 327–333. https://doi.org/10.1183/20734735.009917

Milstead, J & Short, N., (2019) Health policy and politics: a nurses guide (6^th ed). Jones and Bartlett Learning.