The Role of the RN/APRN in Policy-Making
Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation.To Prepare:Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.BELOW IS THE QUESTIONPost an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.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/ CORE SKILL: identifying the STRUCTURAL barriers that keep nurses out of policy-making, and proposing strategies that address the structure rather than exhorting individuals to be braver.
THE OPPORTUNITIES — where nurses can actually enter policy: serving on hospital boards and committees (shared governance); state boards of nursing; professional organization policy committees; legislative testimony; serving as a congressional or state-legislative HEALTH POLICY FELLOW; running for office (there have been nurses in Congress, and naming them is a nice concrete touch); working for regulatory agencies; the RULEMAKING COMMENT PROCESS (an enormously underused avenue — when an agency issues a proposed rule, ANY member of the public may submit a comment, and agencies are legally obligated to respond to substantive comments; this is a real, accessible lever and almost no clinicians use it); coalition-building; media and public commentary; and grassroots advocacy.
THE CHALLENGES — and be honest and structural rather than moralizing:
— TIME AND SHIFT WORK. Policy happens during business hours; nurses work nights, weekends, and twelve-hour shifts. This is not a motivation problem; it is a scheduling problem, and it has a structural fix.
— LACK OF POLICY EDUCATION. Nursing curricula have historically been clinically focused; many nurses have never been taught how a bill becomes law, what rulemaking is, or how to read a fiscal note.
— PERCEIVED LACK OF EFFICACY — the belief that one nurse cannot matter.
— WORKPLACE CULTURE that treats policy engagement as extracurricular rather than professional, and offers no protected time.
— HISTORICAL HIERARCHY and the gendered devaluation of nursing expertise.
— FEAR OF EMPLOYER RETALIATION for public advocacy, particularly on staffing — which is a real and underdiscussed constraint, and naming it is honest.
THE STRATEGIES TO ADDRESS THEM — and they must map onto the barriers you named, or the paper is incoherent: employer-provided PROTECTED TIME and support for policy engagement; policy content embedded in nursing curricula and in continuing education; mentorship and fellowship programs (the ANA and RWJF policy fellowships); professional organization membership, which aggregates individual voices into institutional weight; coalition-building with other professions and with patient advocacy groups; and starting SMALL and LOCAL, where the barrier to entry is lowest and the feedback fastest (a unit practice council, a hospital committee, a state association) — competence and confidence are built there, not in Congress.
THE ARGUMENT FOR WHY IT MATTERS: nurses are the LARGEST healthcare profession and are consistently ranked the MOST TRUSTED profession in public polling (Gallup, for over two decades). That combination — numbers plus credibility — is an enormous latent political asset that the profession systematically underuses. Meanwhile, policy determines staffing ratios, scope of practice, reimbursement, and patient access: THE CONDITIONS UNDER WHICH ALL NURSING CARE OCCURS ARE SET BY PEOPLE IN ROOMS THAT NURSES ARE MOSTLY NOT IN. If nurses are absent from those rooms, the decisions get made anyway — just without the people who know what happens at 3 a.m. That is the thesis, and it is worth stating plainly.
CITE: the Future of Nursing report (IOM/NAM) and its explicit recommendation that nurses be FULL PARTNERS with physicians and other professionals in redesigning healthcare — including its call for nurses on boards. The Nurses on Boards Coalition is the concrete follow-through.
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