Discussion: The Role of the RN/APRN in Policy Evaluation NURS 6050

                 Nurses are at the forefront of reviewing health policies that policymakers have developed and put into law. Nurses are more equipped with the knowledge to help drive policymaking to be functional, sustainable, and successful due to the care they provide they can see how policy works for patients. Evaluating nursing policies is invaluable to the sustainability and success of the program. The importance of policy review helps congress and the executive branch to know what impact the program is having and is it achieving the goals that it was designed to do (Laureate Education, 2018). Being able to measure the outcome through effectiveness and efficiency is key to see if the program is successful (Laureate Education, 2018).

One strategy for nurses to engage in health and nursing policy review is through accessing a nation professional nursing organization-often through the first point of entry- the organization’s website (Catallo et al, 2014). Nurses have also joined forces with other professional organizations to create a movement that allows them to express their knowledge and feed it to policy makers through internships and working with the very people that develop health care policy. The American Nurses Association (ANA) has an entire section dedicated to advocating for health care policy making and review. One of ANA’s primary ways to achieve improved health care reform is by advocating on behalf of registered nurses at the top levels of the government as policies are conceived, debated, and implemented (ANA, n.d.). ANA is also responsible for monitoring federal agencies as they issue regulations and implementation of federal laws (ANA, n.d.).

Health care and public health systems around the world operate within frameworks of health policies. These health policies vitally and directly affect the delivery and availability of care for populations, health outcomes, health disparities, health equity, and the environmental, socio-cultural and industrial contexts of health workers (Turale & Kunaviktikul, 2019). Nurses can no longer afford to be blind to health care reform and policymaking. For so long nurses were content with doing their job and not becoming an active participant in health care policy design, implementation, and review and to prosper for the greater good nurses can no longer stay quiet.

While nurses are key in policy review, they have also encountered many barriers along the way. Barriers to nursing involvement in health policy have included a lack of political awareness and understanding of the importance of being involved in nursing organizations, time to engage in policy development outside of nursing work, and resources to develop skills in policy participation (Catallo et al, 2014). Nurses are the largest group of health care providers but in some countries they are not encouraged to engage in health policy, participation and reform, thankfully the United States encourages nurses to get involved through their profession nursing organization. Another challenge nurses encounter are bureaucratic walls which act as barriers to nurses being denied opportunities to openly voice their policy concerns (Turale & Kunaviktikul, 2019). Education is key to getting nurses to have the knowledge and comprehension to become actively involved in policy review. According to Turale and Kunaviktikul (2019) at the heart of nurses not being involved enough in policy, politics and advocacy is the gap in their education about these important matters. Nurses need access to well-thought-out policy training programs to effectively advocate for policy review and reform.

Nurses and APRNs can overcome these barriers by taking additional educational courses on policy making and review and getting involved. Nurses will never know how to impact change if they are not willing to learn. Education courses on health policy and politics is such as this one is a great way to get a foundation to improve knowledge and be able to actively participate in policy review and reform. Becoming an advanced educated nurse such as a APRN in education or leadership are great ways to strengthen knowledge and speak in a clear and professional means when advocating policymaking. When nurse leaders do not make it into the settings where decisions are made that have profound effects on health and health care-for example in parliament, in government, and in boardrooms of major organizations- they are often neither heard nor headed (Salvage & White, 2019). Nurses can impact change in policy review and reform if they get involved. Become a member of your local, state, and federal professional nursing organization. They offer support and offer toolkits to members on how to advance nursing and advocate for positive and effective change.

Resources

American Nurses Association. (n.d.). Practice and Advocacy. Retrieved from Federal Issues | Advocacy | American Nurses Association (nursingworld.org)

Catallo, C., Spalding. K., & Haghiri-Vijeh, R. (2014). Nursing Professional Organizations: What Are They Doing to Engage Nurses in Health Policy? Sage journals. https://doi.org/10.1177%2F2158244014560534

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

Salvage, J., & White, J. (2019). Nursing leadership and health policy: everybody’s business. International Nursing Review. https://doi.org/10.1111/inr.12523

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

            Just like in policy development, RN’s and APRN’s have the opportunity to participate in policy review. When programs and policies are implemented it is not a given that they will be effective, will work out as intended, or not have unforeseen impact (Laureate Education, 2018). Policy review is just as important, if not more so, than policy development. The evaluation component is something that needs to be considered from the beginning because it is important to see if a bill needs to be reshaped and written in a way to reach the legislators or public in a better way (Laureate Education, 2018).

APRN’s have a direct line into program evaluation in their line of work. Programs funded by governments, nonprofit organizations, and most private foundations require that these programs be evaluated regularly to meet a variety of criteria, including ensuring that the program is being conducted as developed, that there is fiscal responsibility, that goals and objectives are being met, and increasingly, that the outcomes are examined (Milstead & Short, 2019). Most APRN’s are directly involved in these types of programs. Especially in small, community-based programs, an APRN could be selected to study the needs of different social groups, plan program interventions, help to write proposals, as well as work to develop the evaluation process (Milstead & Short, 2019). This is one example of how a professional nurse can actively participate in policy review.

Another way a professional nurse can directly participate in policy review would be for the RN or APRN to develop a relationship with local legislators who are the ones supporting whatever legislation you are trying to get passed. You can be the one to provide the evaluation data to them to demonstrate that the program you are suggesting is or will work. They can then provide you with questions or feedback of things that need to be revised in the program, and you can take that information back to recraft the program if needed (Laureate Education, 2018).

Nurses policy influence is the nurse’s ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurse’s job environment and increases patient outcomes (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). We can see the importance of nurse’s influence of policy development and evaluation, but there are struggles to accomplish these tasks. If an APRN works in a place where government funded program design isn’t happening, it may be hard for them to become involved in policy review and evaluation. They may have to look at how their policies are developed and figure out how they can use where they are at to become an active participant in this area. Another foreseen barrier would be the struggle to develop relationships with legislators. This may take many years. You may have to work your way up the ladder by researching their view on topics, who works beneath them and start to develop those relationships lower down the ladder until you can work your way up.

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014, May). Nurses’ policy

influence: A concept analysis. Retrieved April 20, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/

Laureate Education (Producer). (2018). Program Policy and Evaluation[Video file]. Baltimore,

MD: Author.

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.).

Burlington, MA: Jones & Bartlett Learning.

Hi K..,

I enjoyed reading your post. You listed some great ideas on how nurses can get involved in policy evaluation. Here are a few suggestions to consider as well. Many nurses think they must get involved in a major nursing association or contact their congress members to be involved in this evaluation step of health policy. However, we are involved daily with evaluation. The patient evaluation we document daily is compiled to be used in reports that are forwarded on to people who use this information at the state and federal levels to make policy changes and improvements. This information becomes evidence-based to justify or improve efficiency (Laureate Education (Producer), 2018). As nurses, we must be mindful of this every time we chart patient outcomes. Everyone involved in the policy procedure of design, implementation, and evaluation can view documentation provided by nurses to see the effect their policies and programs have and whether they are efficient and productive or not (Milstead, J. A., & Short, N. M.,2019). It takes all of us to design, implement, and evaluate health policies and programs for the best patient outcomes possible.

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.). Burlington, MA: Jones & Bartlett Learning.

Response 2

Week 9

Kayla, I enjoyed reading your post as you made good points regarding policy review. In one of your challenges you posted you said that it may be hard to develop a relationship with legislators. I have also wandered how a nurse or anyone for that matter can start to develop a relationship with a legislator to be able to get there voice out there. I feel that without having a means of a relationship will greatly increase the difficulty of trying to participate in political matters. I am sure that representatives are also overwhelmed at times by lobbyist, and without proper planning, time, and research in whatever you are trying to change your actions may just be thrown to the side. This is why I feel it necessary to develop relationships and spend time with your local representatives and lobbyist. An introduction from the American College of Clinical Pharmacy states “An effective and sustained relationship with a Member of Congress and staff members in the Congressional office is built upon a foundation of personal communications and face-to-face exchanges. These  must  occur  consistently  over  time  so  that  the  other communications that you will invariably need to use – letters, e-mails, phone calls, — will have  the  kind  of  personal  impact  and  value  that  can  result  in  real  action  from  the office in support of the issues of importance to you” (Webb, E. n.d.).

There are also some ways you can start building these relationships. These tips I found from the American Academy of Ambulatory Care Nursing seem to be a good starting point for nurses to take to get to the initial development of knowing and having your representatives know you. “face-to-face meetings, telephone calls, letters, or e-mails. Generally, the more personal the contact, the more effective. If you cannot meet with a legislator, a meeting with his/her legislative assistant is almost as good” (Phillips. R. 2003). Generally, this is what lobbyist do. So, you can technically call yourself a nursing lobbyist by performing these tasks.

References

Phillips, R. (2003). The ABC’s of Lobbying. American Academy of Ambulatory Care Nursing.

Retrieved from: https://www.aaacn.org/volunteer/teams/legislative/abcs-lobbying

Webb, E. (n.d.). Building Relationships with Elected Officials. American College of Clinical

Pharmacy. Retrieved from: https://www.accp.com/docs/govt/advocacy/ga_build.pdf