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

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

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

Nurses make a difference in the lives of their patients by providing the most needed care to optimize health outcomes. However, other than the bedside services, there is a shift in a pattern in the roles of these professionals as they are visibly conspicuous in the boardrooms of the hospitals to formulate policies that influence the fate of healthcare delivery systems (Williams & Anderson, 2018). Nurses have the requisite education and clinical expertise that can help them to present health care issues of special concern to a country. Since health policies go beyond formation and implementation, nurses have additional opportunities to evaluate the whole process. Specifically, Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) are frontline care providers who take part in decision making and advocate for change in patient care through evaluating a vision of a change. However, the roles of nurses in evaluating policy formulation remain unclear due to a lack of clear guidelines on operations. As such, the present article analyzes opportunities for the involvement of nurses in policy evaluation, associated challenges, solutions, and recommendations for improvement.

Opportunities for Policy-Evaluation Involvement

Nurses exhibit advocacy skills and can write to a state regarding implementation of a health policy bill and how it affects the patients. For a time in history, nurses have been considered advocates for patients and therefore they live at the edge of policy regulations that influence the quality outcomes to these clients. RNs and APRNs lobby on behalf of patients on the implementation of a policy by analyzing the cost implications of the proposed intervention (Glasgow, Lichtenstein & Marcus, 2003). They also assess the policy to ascertain its relevance in addressing the current health challenges faced by patients and therefore recommend or refute the adoption of the specific intervention. Nurses as well use their advocacy skills to propose amendments to operational framework of health policy to ensure it conforms to the needs of patient care. Additionally, nurses assess the implementation of old policies and might suggest the removal of such practices if they do not offer evidence of improved patient care.

Registered nurses have excellent communication skills which they can use to review the present health policy. As frontline care providers, nurses use their expertise to interact with patients so as to get insights about their present illnesses. The same skill is translated into policy evaluation in which nurses communicate with the stakeholders about the framework of the policy and potential challenges. Besides, through communication, nurse addresses the standards of delivery of care outlined in the policy to assess its effectiveness in assuring the quality of care (Williams & Anderson, 2018). The premise is supported by comparing existing policy framework with those developed by the regulatory bodies in a state. With communication skills, nurses have an opportunity to attract the interest of stakeholders to meet the needs or goals of patient care in an institution.

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Challenges

The opportunities outlined may also work to the disadvantage of the nurses. For instance, implementation of policy allows nurses to use their advocacy skills but they may use this opportunity to review the implementation matrix based on their biased opinion. In other words, nurses may use the opportunity to address issues of personal or institutional needs as opposed to presenting the voice of their patients (Milstead & Short, 2019). Based on this premise, the policy in question may be amended or important clauses removed while adding unnecessary policies that might not address the present healthcare needs. Notably, nurses need to use their advocacy skills wisely to provide positive amendments that improve the quality outcomes to patients.

With regard to communication skills, nurses may take the opportunity to criticize the policy especially if there are clauses that are not defined appropriately. The approach may comprise the collaborative framework needed to achieve successful implementation of the program as there will be a team of supporters and opposition. Nurses can also use their views to communicate with other healthcare providers on the reason to oppose the policy especially by addressing its negative impact on their professional practice (Glasgow, Lichtenstein & Marcus, 2003). The outcome may lead to frustration and disillusionment among the care providers and the bitterness may affect the delivery of care to the given facility. As a remedy to this, nurses are encouraged to use their communication skills to channel their genuine dissatisfaction to improve a positive impact in their profession.

Recommendations

First I would recommend that the policy evaluation based on the advocacy skills of nurses be passed through a panel of senior nurse practitioners and medical officers to ascertain that the opinions present represent the ideas and needs of patients. According to Milstead and Short (2019), senior members must be included in the policy evaluation as their input will guide the formulations of the regulations to govern such amendments.

Second, I recommend standards to be set to guide nurses on how they use their communication skills. In essence, procedures for communication must be clearly outlined and nurses should be advised accordingly against mobilizing other cadres of health to resist the provisions of a given policy (Williams & Anderson, 2018).

Conclusion

As illustrated, health policies in care facilities do not end at the implementation process. Nurses are still mandated to oversee their implementation by assessing the performance metrics of the policy. However, caution must be taken to ensure that nurses use their skills to improve the implementation rather than compromise the performance of a policy.

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.

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

Williams, J. K., & Anderson, C. M. (2018). Omics research ethics considerations. Nursing Outlook, 66(4), 386–393. doi:10.1016/j.outlook.2018.05.003

I enjoyed your post. Unfortunately, every situation may have its shortcomings. A few challenges to health policy evaluation include: lack of resources to complete assessment, lack of comparative results, and social media (Milstead & Short, 2019). Although a lack of resources may be a problem, joining a professional association can give you with a wealth of information for a policy review. Social networking is a fantastic tool to communicate and learn about other people’s perspectives. Professional nursing organizations can use social media to disseminate policy information to their members and followers (Waddell, 2019). Nurses must take an active role in policy development by joining a professional association, using social media, and conducting evidence-based research to better themselves and the communities they serve.
Nurses must use techniques to advocate for and explain policy issues during the review process. It is the “moral and professional obligation of nurses to be engaged in legislation that affects their patients,” according to Brokaw. Researching evidence-based data using reputable and credible databases is one technique for effectively communicating with legislators about policy review. Using current and credible resources will assist you in developing a strong proposal to offer to the legislature. Another way to lobby for policy change is to join a professional organization and network with other RNs/APRNs in your area. Nurses can join professional groups to advocate for themselves and their patients’ well-being, allowing them to better serve their communities (ANA, 2021).

References

American Nurses Association. (Jan 2021). ANA Enterprise. Retrieved July 25, 2021, from https://www.nursingworld.org Brokaw, J. (2016, September 26). The nursing profession’s potential impact on policy and politics. American Nurse. Retrieved July 19, 2021, from https://www.myamericannurse.com/nursing-professions-potential-impact-policy-politics/.

Thank you for your post. I like how you talked about policies and the association with quality care, as it is important that the policies out in place are directly correlated with quality care. The Institute of Medicine (IOM) has defined quality as “the degree to which health care services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge.” (Seelbach CL, 2021) Nurses and APRN are an important aspect of ensuring the policies are a direct reflection of what the patients need as they are in the frontlines of patient care. As an advocate for patients, it is the responsibility of the nurses to review the policies being brought forth to ensure they reflect an answer to the issues the patients voiced a concern with.

Reference:

Seelbach CL, B. G. (2021, March 16). Quality Management. Retrieved from StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK557505/#_NBK557505_pubdet_

Nurses are the backbones of the medical system.  The nursing profession is the largest in the U.S. healthcare industry.  For seventeen consecutive years, nursing ranked the most trusted job in Gallop’s ethic survey (For the 17th Year in a Row, Nurses Top Gallup’s Poll of Most Trusted Profession | AHA News, 2019). With so many responsibilities in nursing, it is an obligation that nurses actively participate in the policy review. By involving in policy review, nurses draft and analyze policies to be in a better position to advocate for their patients. This post will discuss the opportunities that currently exist for RNs and APRNs to actively participate in policymaking. 

One opportunity for RNs and APRNs to actively participate in policymaking is policy draft.  Through policy drafts, nurses will be able to identify topics that will be critical for the next few years in healthcare. For example, Covid-19 pandemic really took a toll in U.S. healthcare industry.  As of date, over 700,000 people have died from Covid-19 infection in America (CDC, 2020).  Nurses played a significant role in the fight against Covid-19 and continue in the path to defeat this deadly virus.  Professional experiences of the nurses who worked with Covid-19 infected patients speak volumes about how exhausted the healthcare system is.  During the rollout of the Covid-19 vaccines, professional nurses were argued to engage in the vaccine advocacy campaign. Advocacy is a skill that nurses often use in their career; therefore, pairing that skill with a policy draft will enable nurses to organize the policy document with operational benefits properly. A well-drafted document will be easier to administer, maintain and enforce.  Likewise, Rasheed et al. (2020, P 447, Para 2) stress the importance that “due to their close interactions with individuals and communities across the healthcare system, nurses can offer greater direct insights concerning the effect of healthcare policies on individuals and communities.”   So, nurses need to be the drafters of the policies because it will reduce the overall amount of time an organization needs to spend on those activities, for example, vaccine advocacy programs. Appropriate content and specific knowledge and skills are essential in the policy document to avoid valuable time being wasted editing, discussing, and rewording statements that do not belong in the policy in the first place.

After completing a well-drafted policy document, nurses can participate in policy analysis and evaluate the current policy.  They can make a judgment about what went well and what did not, “whom to involve in future efforts, whom to trust, what the most effective timing is, how to create more powerful coalitions, and so forth” (Yoder‐Wise, 2019, p 52). The evaluation step is crucial because it allows the group to determine how to protect the current success and strategies needed to succeed.  However, there are challenges to these opportunities. 

Policy drafting and analysis opportunities may present challenges because of poor technical knowledge and clinical skills and a lack of exposure to federal and state government involvement (Scott and Scott, 2020).  These current opportunities present challenges that can be overcome by proper training regarding policy draft and analysis during undergraduate nursing level and, of course, at the graduate level, encouraging students and faculty to participate in politics for policymaking and visiting the state and federal policy places. Scott and Scott (2020) argue that establishing relationships with policymakers is one of the best methods to get your issue on their agenda; it is about who you know and how you can influence them to listen to you.  Therefore, nurses must visit their local representatives to understand their stand on specific issues.  For example, if the nurse advocates for Covid-19 vaccines, they need to know how their local representative feels about the mass vaccination because if the representative does not fully support the vaccines, then the nurses will lose the support for publicizing the importance of the vaccines.  The representative can lobby against it because it is not profitable for them, challenging the nurses to prove their support and decisions.  If that becomes the case, nurses can use irrefutable evidence and knowledge more clearly and justifiably to publicize their support for the policy. 

The strategies for better advocating are training and education programs for the nurses. Nurses already understand that they are the largest number of healthcare professionals in the healthcare industry, and therefore, their voices and suggestions are essential.  Advocating for patients at the bedside is as important as advocating for them at the state or federal government.  Nurses must understand that what they want for their patients, only they can deliver, and so, therefore, no one else can provide that on their behalf (Scott and Scott 2020). Suggestions from nurses will ensure safe and quality care through policymaking. 

References

CDC. (2020, March 28). COVID Data Tracker. Centers for Disease Control and Prevention. https://covid.cdc.gov/covid-data-tracker/#datatracker-home

For the 17th year in a row, nurses top Gallup’s poll of most trusted profession | AHA News. (2019, January 9). American Hospital Association | AHA News. https://www.aha.org/news/insights-and-analysis/2019-01-09-17th-year-row-nurses-top-gallups-poll-most-trusted-profession

Rasheed, S. P., Younas, A., & Mehdi, F. (2020). Challenges, Extent of Involvement, and the Impact of Nurses’ Involvement in Politics and Policy Making in in Last Two Decades: An Integrative Review. Journal of Nursing Scholarship, 52(4), 446–455. https://doi.org/10.1111/jnu.12567

Scott, S. M., & Scott, P. A. (2020). Nursing, advocacy and public policy. Nursing Ethics, 28(5), 723–733. https://doi.org/10.1177/0969733020961823

Yoder‐Wise, P. S. (2019). A framework for planned policy change. Nursing Forum, 55(1), 45–53. https://doi.org/10.1111/nuf.12381

            Tax-payer dollars are a conundrum of sorts but not to mention always a hot topic of debates at the capital, city halls, and local towns. After all, the publics’ voting is reflective of what each candidate will be doing with taxpayers’ dollars. Program and policy in nursing are no different. For example, money, in the form of tax-payer dollars, is being requested to be allocated to either reshape, support a bill, or research and not personal monies Laureate Education (2018b). A great majority of decisions and programs at the federal, state, and local levels, involve the health status of the population Milstead and Short (2019). One must be engaged in continuous evaluation at every level of program planning related to the economic impact as tax-payer dollars Milstead and Short (2019). Nurses impact policy through evaluation are poised to measure what the impact is likely to be and the effectiveness of the implemented program, outcomes, or policy Laureate Education (2018b). Furthermore, nurses can review current policy, like at their place of employment or within their practicing state, and engage in evaluation to see why a process did not work Milstead and Short (2019).  According to Milstead and Short (2019), nurses must be in the hierarchy of those in attendance having a pivotal voice at meetings for the redesign of healthcare systems. This includes being engaged from the beginning of policy planning with key participants, to program evaluation of healthcare policies within facilities Milstead and Short (2019). Also, the bill could also come from congress that a nurse may evaluate Laureate Education (2018b). Nurses should utilize the “five-step” framework from the Center for Disease Control and Prevention (CDC) for the evaluation in public health CDC (n.d.).  Nurses must promote cost clarity, patient education, and assist with the dispersion of accurate evaluation results Milstead and Short (2019). Leadership roles, like that of nurses, at times are met with adversity.

Challenges

There can be several challenges during program planning more so if the program is not completed in a tried format. This can be burdensome on program planning; however, most can be alleviated. Some of these challenges are out of the hands of the researcher and others are more apparent. For example, at times, the new policy may go through congress quickly or too slow with the respective audience, either the branch of government or the public, requesting the evaluation results quicker than anticipated Milstead and Short (2019).  Also, when comparing the context of other policies, deficiency of suitable data results may exhibit making it difficult to determine the effect Milstead and Short (2019). Some evaluation results can be unexpected and can divide communities creating a new focus regarding social or health policies Milstead and Short (2019).  Take COVID-19 for example, where some regions were being hit much harder than others and that required refocus and replanning for the safety of everyone. Limited resources or not having the appropriate person to complete the evaluation could also jeopardize program evaluations Milstead and Short (2019). According to Laureate Education (2018b), while measuring the efficiency or effectiveness of a program that did not yield expected results can result in inaccurate results. Fortunately, there are available steps nursing and other vital personal can integrate to decrease or alleviate the above-listed challenges.

How to Overcome Challenges

For program planning, one can be proactive to prevent problems that occur during the program evaluation from a nursing standpoint. Assigning a “point person” to the program is instrumental for the success of a program for they are a professional analyst who is accountable for compiling and creating the evaluation (Milstead & Short, 2019, p. 122). Other strategies available to nurses to guide effective evaluation and overcome challenges include the following. Implementing and applying a series of predetermined questions to the research program will address some challenges before they occur Agency for Healthcare Research and Quality (AHRQ, 2021). For example, is the bill or program doing what it is intended to do? How was the data collected and analyzed? Was the data reviewed by a trustworthy research team? Is it unbiased and complete Laureate Education (2018b)? Furthermore, AHRQ (2021) has compiled several questions to answer during the development of the plan. Some of these include “Who needs to act on the results and who will make decisions based on the results?” (AHRQ, 2021). Ethical issues need to be addressed and governed during the program building to ensure reliability and effectiveness.

Laureate Education (2018a) discusses ethics and advocacy and a point addressed is when a program is implemented, the creation of another implication can be created to address the ethics component of it.  For example, it could have been argued that when the needle exchange program went into effect that there would be more drug users. Instead, to address the ethics component, this program had a triple purpose with two ultimately addressing the risk of increased drug users. These included addressing the overdose with drug treatment options, needle exchange, and training addicts to revive those that have overdoses Laureate Education (2018a). In addition, available to nurses is the “Five-step framework” to guide policies and programs with guidelines regarding public health actions (Centers for Disease Control and Prevention, n.d.).

Strategies to Advocate or Communicate the Existence of these Opportunities

            To any plan, or project created or altered, strategies are available to communicate the existence of the prior discussed opportunities. To address ethical issues, there is professional organizations that provide ethical guidelines for evaluation CDC (n.d.).  For example, American Counseling Association, the American Psychological Association, and other professional organizations have available a series of ethical principles questions and principles that nurses should utilize while implementing and creating their planning Milstead and Short (2019). Milstead and Short (2019) have a list of strategies that can be used during the project planning that are directly related to communication approaches. These include using the most suitable methods during the evaluation, such as the CDC framework for program evaluation. Also, to identify key participants and multiple other vital members with the overall aim, and address conflicts rapidly. Lastly, habitually connecting with members throughout the execution and evaluation cycle of the project is critical Milstead and Short (2019). These strategies when combined with other beneficial theories and guidelines can have a positive effect on the entire process of project planning from beginning to end Milstead and Short (2019).

References

Agency for Healthcare Research and Quality. (2021). Elements of an Evaluation Plan. Retrieved from ahrq.gov

Centers for Disease Control and Prevention. (n.d.). Program Performance and Evaluation Office (PPEO). Retrieved from cdc.gov

Laureate Education (Producer). (2018a). Peter Beilenson: Ethics and advocacy [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018b). 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.

Evaluation Topic

            The Patient Protection and Affordable Care Act of 2010 (ACA) was enacted in 2010 by former President Obama (HealthCare.gov, n.d.). The main focus of the ACA was to decrease healthcare costs, make healthcare insurance more affordable, and improve the quality of care (Milstead & Short, 2019). This act helped thousands of people gain more access to healthcare and made sure that even those with pre-existing conditions could still get health insurance (Somers, 2021). This has been a beneficial healthcare reform act for the past decade.

Outline of the Evaluation

            The ACA has been evaluated by both qualitative and quantitative data. Data has shown the ACA to be a success. Some of the quantitative data that were measured included the number of people uninsured, the cost of healthcare, the reduction of uncompensated care, and the number of people with pre-existing conditions who were able to get health insurance (Center on Budget and Policy Priorities, 2019). A couple of the qualitative data that were measured included the number of people satisfied with their healthcare coverage and self-reported health overall (Center on Budget and Policy Priorities, 2019).

Social Determinants

            The ACA greatly improved many social determinants. The social determinants that were improved include healthcare access and quality and financial security. Since the enactment of the ACA, more than 12 million people were able to become insured or become Medicaid beneficiaries (Somers, 2021). With more people being insured, they now have the coverage to get preventative healthcare, pay medical bills, fill medications, and not skip tests or treatments due to the costs. Financial security was improved. It has been shown that the number of people who had problems paying medical bills and the number of people who did not fill a prescription fell by 17% and 27% respectively (Center on Budget and Policy Priorities, 2019). With the increased number of people who were able to get healthcare coverage, they had more money to be able to fill prescriptions and pay medical bills. By being able to pay their medical bills, this also decreased the amount of debt people would incur from getting medical treatment.

References

Center on Budget and Policy Priorities. (2019). Chart book: Accomplishments of affordable care act. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act

HealthCare.gov. (n.d.). Affordable care act (ACA) – glossary. Glossary | HealthCare.gov. https://www.healthcare.gov/glossary/affordable-care-act/

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

Somers, S. (2021). The Affordable Care Act: Reflections on 10 Years. Network for Public Health Law. https://www.networkforphl.org/news-insights/the-affordable-care-act-reflections-on-10-years/

Rubric Detail

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Name: NURS_6050_Module01_Week01_Discussion_Rubric

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	Excellent	Good	Fair	Poor
Main Posting	45 (45%) – 50 (50%)Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%)Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%)Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 34 (34%)Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	10 (10%) – 10 (10%)Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)Does not post by day 3.
First Response	17 (17%) – 18 (18%)Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%)Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%)Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%)Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	16 (16%) – 17 (17%)Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%)Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	12 (12%) – 13 (13%)Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%)Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	5 (5%) – 5 (5%)Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)Does not meet requirements for participation by posting on 3 different days.

Total Points: 100