Advocating for the Nursing Role in Program Design and Implementation
As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.To Prepare:Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.Select a healthcare program within your practice and consider the design and implementation of this program.Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.BELOW IS THE QUESTIONThe Assignment: (3 pages)In a 3-page paper, create an interview transcript of your responses to the following interview questions:Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?Who is your target population?What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?BELOW IS THE REQUIRED READINGLearning ResourcesRequired ReadingsMilstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.Chapter 5, “Public Policy Design” (pp. 87-95 only)Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137-146)Chapter 9, “Interprofessional Practice” (pp. 152-160 only)Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183-191 only)American Nurses Association (ANA). (n.d.). Advocacy. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementation. Retrieved from https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdfCongress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055-1080. doi:10.5465/AMR.1996.9704071863Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice, 21(6), 1014-1017.Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretion. Public Management Review, 16(4), 527-547. doi:10.1080/14719037.2013.841978:PLEASE DONT FORGET TO ADD 4 REFERENCES NOT MORE THAN 5 YEARS OLD:PLEASE REFER TO THE RUBIC FOR THE MAIN POINTS CORE SKILL: articulating what NURSES specifically bring to program design and implementation that other stakeholders cannot — which is the actual question behind the honeyguide/honey-badger metaphor in the prompt (each party has something the other lacks; the collaboration is what unlocks the value).
THE ARGUMENT TO MAKE: nurses possess FRONTLINE OPERATIONAL KNOWLEDGE that program designers and administrators structurally lack. They know what actually happens at 3 a.m., which steps in a protocol get skipped and why, what patients actually understand versus what they nod along to, and which “efficiency” will collapse under real conditions. Excluding nurses from design is why programs that look excellent on paper fail on implementation. This is the thesis, and everything else supports it.
THE ROLES TO NAME AND DISTINGUISH:
— In DESIGN: needs assessment, defining measurable and clinically meaningful outcomes, workflow analysis, identifying unintended consequences BEFORE they occur, ensuring health-literacy-appropriate patient materials, and advocating for the populations who are not in the room.
— In IMPLEMENTATION: champion and opinion leader, superuser and trainer, feedback conduit, workflow troubleshooter, and the person who identifies the workaround before it becomes standard.
— In EVALUATION: data collection, interpretation in clinical context (a statistician can tell you the rate changed; a nurse can tell you why), and identifying BALANCING harms.
THE DISTINCTION THE RUBRIC OFTEN PROBES: the nurse’s role in DESIGN versus IMPLEMENTATION versus ADVOCACY is not the same role. Design is about what gets built; implementation is about whether it survives contact with the floor; advocacy is about whose interests get represented at all. Say so.
ADVOCACY: for the PATIENT (access, equity, safety, informed consent), for the PROFESSION (scope of practice, staffing, reimbursement), and for the PROGRAM itself (securing resources, sustaining leadership attention).
STAKEHOLDER ANALYSIS: identify who is affected, who has power, and who has neither (patients frequently have the largest stake and the least power — naming that asymmetry is a strong move, and it is what “advocacy” actually means).
NAME THE BARRIERS honestly: nurses are often invited to implement decisions they had no part in making; “engagement” that consists of being told the plan is not participation; time and workload; hierarchy and the historical devaluing of nursing expertise; and lack of formal seats on governing bodies (which is why board representation and shared governance matter structurally, not symbolically).
FOR THE INTERVIEW/EXPERIENCE COMPONENT (many versions require you to speak with someone who has participated in program design): prepare questions that elicit CONCRETE examples of influence and of exclusion — “tell me about a time your input changed the design” and “tell me about a time it didn’t.” The contrast is the finding.
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