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NURS 8100 Discussion Federalism’s Impact on Policy

NURS 8100 Discussion Federalism’s Impact on Policy

NURS 8100 Discussion Federalism’s Impact on Policy

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Introduction

The Board of Nursing in Miami, Florida, is a regulatory body whose functions include ensuring that nurses are fully qualified to conduct their activities within the state in various ways. The board is mandated to monitor, discipline, educate, license, and rehabilitate nurses. In Miami, nurses are mandated to ensure that they are capable of delivering quality care to all patients in various healthcare environments (Fraser & Melillo, 2018). However, failure to abide by the stated board’s standards results in forfeiting nurses’ licenses and disabling them from practicing within the state.

I appreciate your post and thoughtful points. Nurses should have a voice in politics because we are in the trenches and since we are firsthand witnesses have the best voice to not only policies that will affect nursing and healthcare but also to patient care. Haidrani (2017) interviewed a nurse practitioner who has been involved in policy making changes and she reports that it not only has increased the vision of nurses but has expanded her view as well. True initially when entering into this foreign world of politics it may seem difficult but there is no better way to learn than to get into the thick of it. Nurses have a duty to advocate for patients and nurses (and healthcare) alike.

The Nurse Practice Act enacted by the State’s legislature provides a framework for enhancing safe and professional nursing services and offers nurses with an environment of protection to all patients. Other responsibilities of nurses in Miami under the Florida Board of Nursing include determining the health status of patients concerning risk principles and nursing leadership of patients through the performance of general duties. Based on additional laboratory outcomes of patients, physical evaluation and background, APNs should recognize and determine with the approval of the suitable physician, appropriate types of disease in the context of the specified processes (Kung, & Rudner, 2015). They should also conduct procedures frequently accepted via the established protocols to provide patients with insensitivity to pain during diagnostic, surgical, or obstetric clinical processes (Fraser & Melillo, 2018). These processes include ordering and the delivery of spinal, regional and general anesthesia; inhalation methods and agents; intravenous methods and agents; and methods of hypnosis. Also, Advanced Practice Nurses (APNs) in Miami, Florida, are authorized to sustain life functions all through the anaesthesia healthcare process and to use adequate mechanical support devices (Joel, 2017).

Moreover, APNs should always be accountable for all patients during practice and identify the appropriate delegation of responsibilities about their obligation to render quality care to all patients (Holly, Salmond &Saimbert, 2016). APNs owe similar duties to self as to others, including the liability to enhance safety and integrity, maintain competence, and to create room for personal and professional growth and development. Advanced Practice Nurses in Miami, Florida are also required to participate in identifying, maintaining and enhancing the healthcare environments as well as conditions of recruiting conducive to the provision of appropriate and quality healthcare services about the values of the profession through collective and individual action (Fraser &Melillo, 2018). Finally, a licensed nurse is required to participate in the advancement of the nursing profession through contribution to education, practice, knowledge development, and administration. As a result, APNs should work cordially with other health specialist and the public in enhancing the national, community, and global attempts to achieve healthcare needs (Kung, & Rudner, 2015).

Although the functions of APNs in Miami, Florida are well updated, I was not aware that APNs have emerged to be a major force in evidence-based practice as a result of their increased knowledge of the relevance and immunology to emerging therapies such as utilization of published standards of care and establishment of rules and procedures common to the current world of nursing practice (Holly, Salmond & Saimbert, 2016). APNs are tasked with the role of being principal investigators in clinical trials through coordination of research efforts, conducting physical assessments as well as ensuring patients adhere to the set health protocols. Additionally, I realized that APNs are patient’s advocates as they are involved in negotiations on behalf of patients with insurance agencies, employers as well as other external agencies (Joel, 2017).  As a result, APNs provide patients with situational and emotional support as advocates for nursing and other medical staff. Finally, in Miami, Florida, APNs are mandated to prescribe medications and are also tasked with the role of assessing, diagnosing, evaluating and following-up patients. Therefore, APNs are required to demonstrate a high level of understanding of multiple sclerosis, its course, management, disease treatment and modification as well as conducting diagnostic tests.

References

Fraser, M. A., & Melillo, C. (2018).Expanding the Scope of Practice of APRNs: A Systematic Review of the Cost Analyses Used. Nursing Economics36(1), 23-29.

Holly, C., Salmond, S., & Saimbert, M. (Eds.).(2016). Comprehensive Systematic Review for Advanced Practice Nursing.Springer Publishing Company.

Joel, L. A. (2017). Advanced Practice Nursing: Essentials for Role Development.FA Davis.

Kung, Y. M., & Rudner Lugo, N. (2015). Political Advocacy and Practice Barriers: A survey of Florida APRNs. Journal of the American Association of Nurse Practitioners27(3), 145-151.

RE: Discussion – Week 8

Federalism’s Impact on Policy

The overall division of the US health care system is something that must be discussed.  There are different models of financing and services that are presented within the US health care system.  Policy making is something that is done within the US health care system but done on many different levels of the government.  This is a shared responsibility.  When you have many different hands in the process of policy making then it does take time.  This process can be perceived as slow.  People have to meet, make choices, need to time to respond in able to make the best choices for policy making.  The purpose of this discussion is to discuss the role of the federal government in health care policy making.

On a federal level the law that comes to mind is the Affordable Care Act of 2010.  The law stated that each state needed to expand eligibility for Medicaid.  “The lay also required insurers to cover healthcare services within a standard set of benefits and prohibited coverage denials based on preexisting conditions” (Public policy in Michigan, n.d.).  Even though the Affordable Care Act is a federal policy its very individual on a state level.  As far as Michigan goes there has been positive shift.  “Between 2013 and 2016 the number of uninsured individuals in Michigan declined by 50.8%.  About 284,000 individuals in Michigan were enrolled in health plans offered through the health insurance exchange in 2017.  Enrollment in Medicaid amounted to about 2.4 million in May 2017” (Public policy in Michigan, n.d.).  On a state level the program that will be discussed is the Michigan’s Medicaid program.  This program allows individuals with low incomes to have access to health insurance.  This is an example of how Medicaid is a nationwide program but it’s jointly funded by the federal government and the states.  Medicaid is a separate program from Medicare.

The advantages of both programs are the increase amount of insured people and additional funding at both levels.  “Federalism, mode of political organization that unites separate states or other polities within an overarching political system in a way that allows each to maintain its own integrity. Federal systems do this by requiring that basic policies be made and implemented through negotiation in some form, so that all the members can share in making and executing decisions” (Britannica, T. Editors of Encyclopedia, 2020). Therefore, the Affordable Care Act and Michigan’s Medicaid Program are a good example of the implications of federalism.  The federal government’s involvement on health care policy should be mostly financial and insurance basis.  What works in healthcare in some places would not work for others, therefore it is not feasible to make healthcare policies at a federal level for more individual issues.  “The question of financial accessibility in the comparator federations is somewhat more complicated to treat, and all three perform less well here than on the other HCF performance criteria” (France, 2008).

Reference:

Britannica, T. Editors of Encyclopedia (2020, May 14). federalismEncyclopedia Britannica. https://www.britannica.com/topic/federalism

France, C. (2008). The form and context of federalism: Meaning for health care financing. Journal of Health Politics, Policy & Law, 33(4), 649-705.doi: 10.1215/03616878-2008-012

Public policy in Michigan. Ballotpedia. (n.d.). Retrieved April 23, 2022, from https://ballotpedia.org/Public_policy_in_Michigan#Healthcare_information

NURS 8100 Discussion Federalism’s Impact on Policy

The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant. Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure?

This week, you will examine the federal government’s role in health-care policymaking.

To get ready:

Examine this week’s Learning Resources, with a focus on the France article and textbook readings.
Determine two nursing or health care policies that meet similar needs, one at the federal level and the other at a lower level of government (state or local).
By Day 3

Post a unified response that addresses the following points:

Give an example of two policies that meet comparable needs and were enacted at different levels of government (i.e., federal, state, or local).

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What are the benefits and/or drawbacks of this duplication? What are the implications of federalism in this example? Provide literature backing for your stance.
How much involvement should the federal government have in health-care policymaking? Give specific examples to back up your claim.

Read a few of your coworkers’ postings.

By Day 6 of NURS 8100 Discussion Federalism’s Impact on Policy

Respond in one or more of the following ways to at least two of your colleagues:

Pose a probing question that is supported by further background information, facts, or research.
Share an insight gained from reading your coworkers’ postings, synthesizing the information to bring fresh viewpoints.
Use readings from the classroom or your own Walden Library research to offer and defend an opposing viewpoint.
Use your own experience and further research to validate a notion.
Make a recommendation based on further evidence gathered from readings or after synthesizing multiple postings.
Expand on your colleagues’ posts by offering new insights or opposing viewpoints based on readings and evidence.

Note: For formal Discussion question posting and response grading requirements, please consult the Syllabus and Discussion Rubric.

Return to this Discussion in a few days to read the replies to your first post. Take note of what you learned and/or any insights you acquired as a result of your colleagues’ comments.

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NURS 8100 Discussion Federalism’s Impact on Policy

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Submission and Grading Information
Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 8 Discussion]

Historically, the elderly and the disabled receive long-term care in institutionally setting because Home and Community Base Care services (HCBS) were less available. However, in the 1980s, an amended federal law passed a federal-state Medicaid waiver authority for states to expand HCBS services to cover individuals at risk for institutionalized care (Musumeci et al., 2020). These individuals will receive broader services that were not allowed by Medicaid state plans. The HCBS 1915 (c) waivers authorized states to provide targeted services to populations such as seniors, people with physical or developmental disabilities, and individuals with specific conditions such as HIV/AIDS or traumatic brain injuries(Merryman et al., 2015). Essential to note every state’s eligibility requirement and criteria are different; however, HCBS waivers are limited to three years but may extend five years for those dually enrolled in Medicaid and Medicare (Merryman et al., 2015).

In response to the COVID-19 pandemic, President Biden signed the American Rescue Plan Act (ARPA), which provides $1.9 trillion for several provisions to include in the pandemic relief package (Miller & Beauregard, 2022). This legislation will significantly impact state and federal health policies and programs, such as federal funding for state Medicaid spending on HCBS. The ARPA will provide a one time10% increase in federal matching payment to states’ HCBS to supplement state expenditure which would only be available for a year(Miller & Beauregard, 2022. Therefore, states would have the flexibility in overlapping with federal policies targeting HCBS to specific populations. Nonetheless, the ARPA ensures that states benefit from the federal investment for HCBS to achieve the best outcomes for Medicaid beneficiaries to receive high-quality, cost-effective, person-centered care in their home (Watts et al., 2020).

Duplication Advantages & Disadvantages

The advantage to the federal-state funding of HCBS is that it provides states with good flexibility to utilize these funds that align with the priorities of local policies (Musumeci et al., 2020). As a result, states will be able to enhance their HCBS models (Watts et al., 2020). Furthermore, states taking advantage of access to federal funds will also address the shift in demand for healthcare needs because of COVID public health emergencies (Miller & Beauregard, 2022). On the other hand, states will need to determine how they will sustain this investment once the expiration of federal matching.

Implications of Federalism

Nevertheless, the enactment of the American Rescue Plan Act (ARPA) with the inclusion of increasing state funds to HCBS foreshadowed the United States as a federalist system. Oversight of health policy decisions responsibility is shared among federal and state in areas of administration and funding. The state and federal are jointly responsible for the healthcare financing for the health and long-term care of low-income populations with the appropriate balancing of these responsibilities (Collins, & Lambrew, J2019). However, federalism contributes to the fragmentation of the U.S healthcare system due to the different financing and service delivery modes, leading to duplication of services.

Federal Government Involvement in Healthcare Policymaking

According to Bialik (2018), the Pew research reported that 60% of American believe that the federal government should be responsible for ensuring healthcare coverage for all Americans. Essentially, the federal government plays a central role in the oversight and shaping of the American health care arena to develop policies that support cost-effective quality programs for the population’s health needs. Therefore, the federal government should maximize its involvement given its unique position as regulators, healthcare purchasers, sponsors of applied healthcare research, healthcare provider education, and healthcare providers (Crowley et al., 2020). Furthermore, federal leadership is a crucial stakeholder having extensive healthcare programs and market influence, which helps acquire sustainable healthcare reform and better quality and value in healthcare (Gluck & Huberfeld, 2018). For instance, the federal government has been a critical player in establishing Medicare and Medicaid to ensure access to insurance coverage for a large segment of the population, legislation for employer-sponsored health insurance, and expanded federal healthcare programs (Collins & Lambrew, 2019 ). Currently, the federal leadership plays a pivotal role in the Affordable Care Act by expanding health insurance coverage to the uninsured. Hence, the federal government plays an essential role in promoting healthcare services that contribute to healthcare efficiency and saving, so the federal government should maintain a central role in healthcare policymaking.

References

Bialik, K. (2018). More Americans say government should ensure health care coverage. Universal Health Care94.

Collins, S. R., & Lambrew, J. M. (2019). Federalism, the Affordable Care Act, and health reform in the 2020 election. The Commonwealth Fund.

Crowley, R., Daniel, H., Cooney, T. G., Engel, L. S., & Health and Public Policy Committee of the American College of Physicians*. (2020). Envisioning a better US health care system for all: coverage and cost of care. Annals of Internal Medicine172(2_Supplement), S7-S32.

Gluck, A. R., & Huberfeld, N. (2018). What is federalism in healthcare for. Stan. L. Rev.70, 1689.

Merryman, M. B., Miller, N. A., Shockley, E., Eskow, K. G., & Chasson, G. S. (2015). State adoption of Medicaid 1915 (c) waivers for children and youth with autism spectrum disorder. Disability and health journal8(3), 443-451.

Miller, E. A., & Beauregard, L. K. (2022). Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs. Journal of Aging & Social Policy, 1-15.

Musumeci, M., Watts, M. O., & Chidambaram, P. (2020). Key state policy choices about Medicaid home and community-based services. Kaiser Family Foundation.

Watts, M. O., Musumeci, M., & Chidambaram, P. (2020). Medicaid home and community-based services enrollment and spending. Kaiser Fam Found.

Name: NURS_8100_Week8_Discussion_Rubric Grid View
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Excellent Good Fair Poor

RESPONSIVENESS TO DISCUSSION QUESTION

Discussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

CONTENT KNOWLEDGE

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.

CONTRIBUTION TO THE DISCUSSION

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.

Points Range: 5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

Points Range: 4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.

Points Range: 0 (0%) – 3 (10%)
Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.
Total Points: 30
Name: NURS_8100_Week8_Discussion_R