NR 506 Healthcare Policy Week 1 Discussion The Four Spheres of Political Action in Nursing

Please discuss the four spheres of political action in nursing. In addition, please develop a brief argument sharing how these spheres are interconnected and overlapping by applying an example from your practice.  What are some ethical considerations here?

The original framework for Action had four spheres of influenced. The four spheres were: the workplace, the government, organizations, and the community (Chaffee, Leavitt, and Mason, 2014).  The term workplace has been broadened to include the workforce now as well.  Organization has been expanded upon as well to now include “associations and interest groups.”

Each of the four spheres are part of a broader and more complex system (Chaffee, Leavitt, and Mason, 2014). Nurses can be big influences within a community by identifying problems, forming strategies, and advocating for change (Chaffee, Leavitt, and Mason, 2014). Nurses can get involved in their community to have their voice be heard on issues involving nursing and healthcare.

As far as the workforce and workplace goes, there are several different settings a nurse can work in. Nurses can work in hospitals, clinics, schools, factories, etc. but they must all abide by certain laws and other factors that are set forth by their state or by their scope of practice.
As for the workplace and workforce, we as nurses must follow the same guidelines regardless of where we work. While our job descriptions can vary significantly depending on the type of nursing we practice,  we must still only practice what is outlined within our scope of practice.

I do all of the new RN orientation at our hospital. One thing we have began to incorporate in our orientation is to have nurses familiarize themselves with the Illinois Nurse Practice Act to look at what is in our scope of practice as a nurse.  I was very intrigued to find after years of nursing that I was not aware with certain things listed within.

Government- The government responds to and funds disasters. They also regulate much of healthcare, therefore how government views health policy is important because the government has a large influence over nursing practices.

With all of the regulations set forth by payers as well as CMS, it is necessary to follow the guidelines set forth by these agencies.  One example within my practice that comes to mind is documentation.  There are many different required fields of documentation that must be completed on each patient. VTE prophylaxis, immunization status, and sepsis screening  are a few areas that must be addressed on each patient at the time of admission. Another thing that comes to mind is documentation on swing bed patients.  Certain things that seem pretty small can actually be very important when it comes to receiving payment. For swing bed patients, it is necessary that the nurse or CNA charts the number of people required to assist the patient in getting out of bed.  If the correct documentation is not completed, the entire stay can be seen as unnecessary and payment can be refused. I teach all nursing students and new employees how important a simple step of documenting the number of people it takes to transfer or ambulate a patient. As mentioned, this is a very simple step, but can mean a huge difference.

Nurses can also become involved in lobbying for what they believe in or in changes they think need to happen.

Organizations – There are many organizations within nursing. They work together for the good of their cause.  Resources  can be shared which can promote networking and can limit the amount of resources used by each organization. When organizations work together, they can be much stronger and have more opportunities.  At our hospital, our CEO works with many local hospitals and organizations to build strong relationships so we can build off of one another. Working together can save time, money, and resources, and eliminate having multiple people researching the same information for potential changes.

Community-  It is important for nurses to become involved in their community to help to promote change when needed, or to stand up for what is current if they feel no change is needed. Nurses can both volunteer and have paid positions where they work to influence policy and changes within policy.

I currently do not have any involvement in my community other than speaking to prospective students about nursing, but many people throughout history have voiced their concerns to promote a change.

As with anything, there can be ethical concerns. Some ethical concerns that would involve government, community, and organizations would be having an ulterior motive or any conflict of interest in what the nurse is promoting or how they are choosing to speak on certain topics.  Like many things within politics, there is always a concern that someone is financially backing a person and that those people have a personal interest or have something to gain by their involvement. An example I can think of is I used to work with a physician who was the Medical Director of a local nursing home. He refused to send his patients to any nursing home other than the one he was the Medical director of. He worked with the community to promote this nursing home, but it all came back to the fact that he had personal involvement as well as financial gain from his involvement.

There can be a lot of ethical dilemmas within the workplace. Some can be as simple as the nurses and physicians not seeing eye to eye. Other ethical dilemmas could be the nurses feel like they have an inequitable workload (Bajwa, Hamid, Kanwal, Rhalid, and Mubarak, H. (2016).  This is something that is especially on my mind right now. Our hospital census has been almost double what it normally is for almost four months. Nurses are feeling overworked and as if their workload is more than they can handle. There is constant talk of this. Many good nurses have left recently due to this complaint.  One argument is that even with the increased census, the nurses still take much smaller patient loads than many of the neighboring hospitals are required to take.  But because our nurses have been a little “spoiled” the last several years with a lower census, they now are not satisfied with a normal full patient load. The major dilemma becomes 1) are our patients being taken care of and 2) can how do we focus on being profitable while satisfying the nurses.

References:

Chaffee, M., Leavitt, J., & Mason, D. (2014). Policy & Politics in nursing and health care. (Sixth Edition.) St. Louis, Missouri. Elselvier.

Bajwa, M., Hamid, S., Kanwal, R., Rhalid, S., & Mubarak, H. (2016).  Ethical issues faced by nursing during nursing practice in District Layyah, Pakistan. Diversity & Equality in health care. Retrieved from: http://diversityhealthcare.imedpub.com/ethical-issues-faced-by-nurses-during-nursingpractice-in-district-layyah-pakistan.php?aid=10616

Sample Answer 2 for NR 506 Healthcare Policy Week 1 Discussion The Four Spheres of Political Action in Nursing

The four spheres of action can be linked to the idea of family centered care. The government is the ones who set the universal standards of healthcare. They are the ones who are in control of programs like Medicare, Medicaid, and WIC just to name a few. Since they are providing for these programs, they are going to set the expectation for what care is appropriate; if they do not think something is correct, then they will simply not pay. Hospitals are always having to keep this concept in mind, which is where the workplace comes into play. If a patient receives a pressure ulcer while in the hospital, the government will not pay for that treatment. They say the hospital is the cause, thus making the hospital be at a loss for that treatment. Interest groups for the medical professionals and for the organizations are also behind these movements because they want to help prevent these issues from arising. Lastly, the community has to do with the patients themselves. The government makes information about healthcare providing systems available to the patient from things like the rate of hospital inquired infections, amount of pressure ulcers, and success rates. The patient can then make their own decision on where to receive care. All four of these spheres do intertwine with one another.

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Sample Answer 3 for NR 506 Healthcare Policy Week 1 Discussion The Four Spheres of Political Action in Nursing

The organization has a standard of care for their organization of how patients and their families are to be treated and the fact that we now practice family centered care. We actually have a parent based counsel that meets once a month and discusses family centered care in our organization and what is working well and what we can focus on making better.  Healthcare workers from each division are on that group also.  I know that we take government insurance and with that we must provide great care and allow convenient access to quality and safe care (CQC, 2016).  The government expects that you will be given good care and be able to be involved in the decision making of the care every step of the way (CQC, 2016). The government tracks hospital organization trough a website at www.cqc.org.uk , this website publishes details of how the hospital services regulates and meets government standards of quality and safety (CQC, 2016).    In giving this care the community is aware and through thus we get more referrals.  If for some reason we do not provide the quality of care and safest care required we could lose our funding (Hughes, 2011).  The four spheres relate to each other and are intwined.  We need all four spheres to work together to be complete and produce change (Hughes, 2011).

Hughes, R., (May 31, 2011) “Overview and Summary: Patient-Centered Care: Challenges and Rewards” . The Online Journal of Issues in Nursing, 16 (2).

doi: 10.3912/OJIN.Vol16No02ManOS

Care Quality Commission. (2016).  Retrieved from https://www.gwh.nhs.uk/media/147361/6436_cqc_hospitals.pdf (Links to an external site.)

Sample Answer 4 for NR 506 Healthcare Policy Week 1 Discussion The Four Spheres of Political Action in Nursing

The organization has a standard of care for their organization of how patients and their families are to be treated and the fact that we now practice family centered care. We actually have a parent based counsel that meets once a month and discusses family centered care in our organization and what is working well and what we can focus on making better.  Healthcare workers from each division are on that group also.  I know that we take government insurance and with that we must provide great care and allow convenient access to quality and safe care (CQC, 2016).  The government expects that you will be given good care and be able to be involved in the decision making of the care every step of the way (CQC, 2016). The government tracks hospital organization trough a website at www.cqc.org.uk , this website publishes details of how the hospital services regulates and meets government standards of quality and safety (CQC, 2016).    In giving this care the community is aware and through thus we get more referrals.  If for some reason we do not provide the quality of care and safest care required we could lose our funding (Hughes, 2011).  The four spheres relate to each other and are intwined.  We need all four spheres to work together to be complete and produce change (Hughes, 2011).

Hughes, R., (May 31, 2011) “Overview and Summary: Patient-Centered Care: Challenges and Rewards” . The Online Journal of Issues in Nursing, 16 (2).

doi: 10.3912/OJIN.Vol16No02ManOS

Care Quality Commission. (2016).  Retrieved from https://www.gwh.nhs.uk/media/147361/6436_cqc_hospitals.pdf (Links to an external site.)

Sample Answer 5 for NR 506 Healthcare Policy Week 1 Discussion The Four Spheres of Political Action in Nursing

After completing this week reading assignment, I learned the four spheres of political action in nursing which include the community, workplace, government, and professional organizations. Each spheres function independently but collaboratively helps shape health and social policies. The community addresses issues and concerns that affect a group of individuals with a common interest who interacts with one another. Nurses who work closely with the community can help identify problems while advocating for change. The workplace/workforce influence policies within an internal organization that affects nursing and patient care. It is through our employer’s policies and procedures that guides our nursing practice. The government has a significant role in influencing nursing as a profession. It shapes policies regarding health and social issues that affect healthcare. Professional organizations are legislative and policy committees that shape nursing current and future practice. Each organization increases effectiveness of advocacy and share common interests that are influential not only nursing association but other non-medical association as well.
According to South Caroling Nurse, a new era of nurse licensure in the United States is occurring with the progression of the enhanced Nurse Licensure Compact (eNLC). The eNLC allows a nurse to have one multistate license to practice in both their home and remote states via person or telehealth (South Carolina Nurse, 2017). In reviewing this topic, it was apparent how the four spheres overlap and interconnect with one another. The nurses represent the community in this example, as they have a common interest for the eNLC. The workplace includes the place of employment such as acute hospital setting, outpatient care facilities, nursing homes, community health centers, schools or patient’s home. The government includes the National Council of State Boards of Nursing (NCSBN), who over sees the regulations regarding the enhance Nurse Licensure Compact. The professional organization such as American Nurses Association (ANA), advocate for policies that support members of the nursing profession and their interests (ANA, 2018).

American Nurses Association. (2018). Interstate Nurse Licensure Compact. http://www.nursingworld.org 
South Carolina Nurse. (2017). Enhanced nurse licensure compact (eNLC) enactment: A modern nurse licensure solution for the 21st century. 24(4). 23

Participation Guidelines

Due Date: First initial posting to the required threaded discussion topic is due by Wednesday, 11:59 pm MT. Peer and instructor responses are due by Sunday 11:59 pm MT. All posts for week 8 are due by the close of class on Wednesday 11:59 pm MT. Please note that the late assignment policy does not apply to the threaded discussions.

Total Points Possible: Varies with course, please see specific course syllabus. These guidelines are for a required threaded discussion worth 50 points. Please note that week 8 will be worth only 25 points.

Requirements:

Description of the Assignment

1. Initial posting: This is defined to be the initial post in which the student responds to the required threaded discussion topic. The first posting by a student within the required discussion area is considered to be the initial posting and will be evaluated using the rubric criteria. Scholarship in communication is expected. Required scholarly source(s) provide specific information that thoroughly address the required topic. For the initial posting, one scholarly source must be presented. The scholarly source must be an outside source. The student may use the required course textbook (s), assigned readings and lesson information in the initial post; however, these are not considered outside scholarly sources.

The initial posting must occur before Wednesday, 11:59 pm MT. Initial postings must be at a minimum of 300 words. References do not apply toward word count. ONLY in Week 8, the initial posting must be a minimum of 200 words with a scholarly reference. It remains due by Wednesday, 11:59 pm MT

2. Peer responses: As part of the threaded discussion requirements, the student must provide a substantive response to a peer. Substantive responses pose new ideas, ask questions, and/or generally add to the discussion topic in a meaningful and constructive way.

The peer response must occur on a separate day from the initial posting and instructor response (see below). This peer response must occur before Sunday, 11:59 pm MT. This response does not require a scholarly reference unless information is paraphrased and/or direct quotes are used, then APA guidelines apply. Peer responses must be a minimum of 150 words. References do not apply toward word count.

3. Instructor response: The student must respond to an instructor’s follow-up questions. The instructor’s question may be directed to the student or may be a question directed to another student in the section. The response must be comprehensive and scholarly in nature. Instructor responses must be a minimum of 150 words. References do not apply toward word count.

The response to the instructor must occur on a day different from the initial post and a day different from the peer response. Responses to the instructor must occur before Sunday, 11:59 pm MT.

4. For week 8 only: Students are expected to post a peer response or an instructor post but are not required to do both. These posts must be a minimum of 100 words. References do not apply toward word count. The peer or instructor response must be on a different day than the initial post and must occur before Wednesday, 11:50 pm MT due to the shorter week.

Posting Requirements:

1. The initial posting must be provided before Wednesday, 11:59 pm MT.
2. The initial posting must have at least one scholarly outside source that is cited within the posting and referenced. Required course textbooks, assigned readings and lesson information are not considered to be outside scholarly sources.
3. Initial posting must be a minimum of 300 words; peer responses and instructor responses a minimum 150 words.
4. The peer responses and instructor responses must be provided before Sunday, 11:59 pm MT.
5. All postings are substantive and relate to the graded threaded discussion topic.
6. Only one small quote (15 words or less) within the entire initial posting is accepted.
7. Postings must occur on 3 separate days.
8. For week 8 only: the required postings are amended due to the shorter week. Two posts are required. One initial post and either a peer response or an instructor response. Initial post must be a minimum of 200 words and the peer or instructor response must be a minimum of 100 words. Both posts are required to be on two separate days. All posts must be made by Wednesday, 11:59 pm MT

Criteria for Content

• Scholarliness: In this category, the student will conduct a search of the current databases and locate valid, relevant, and reliable information for the required topic. Each reference must be scholarly.
• Application of Course Knowledge: In this category, the student demonstrates the ability to analyze and apply principles, knowledge, and information learned in the course lesson and outside readings. This information is then applied to a real-life professional situation as an example.
• Interactive Dialogue: In this category, the minimum requirements are to provide an initial posting to the graded threaded discussion topic by Wednesday, 11:59 pm MT of each week. In addition, one peer response and one instructor response are required. These postings must be completed by Sunday, 11:59 pm MT of each week. The initial posting, peer response, and instructor response must be on 3 separate days.
• Grammar, Syntax, APA: Proper grammar, APA, and syntax is required for all posts. Students should follow the APA Manual 6th Edition. Additional APA information is available in Course Resources.

  

• Participation Requirement: One initial posting, one peer response and one instructor response (for a total of 3 posts for the week) are required on 3 separate days.
• Participation Deadline: The student must provide a substantive response to the graded threaded discussion topic. This must be posted by Wednesday, 11:59 pm MT of each week. Peer and instructor responses must be posted by Sunday, 11:59 pm MT.
• For week 8 only: the required postings are amended due to the shorter week. Two posts are required. One initial post and either a peer response or an instructor response. Initial post must be a minimum of 200 words and the peer or instructor response must be a minimum of 100 words. Both posts are required to be on two separate days. All posts must be made by Wednesday, 11:59 pm MT.

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Criteria for Format and Special Instructions

1. Instructor reserves the right to submit any threaded discussion posting to TurnItIn in order to verify the originality.
2. When journals are used as the outside source of information, it is preferred that the journal be peer reviewed. The Chamberlain online librarian is very helpful in assisting you to find an article related to your topic. If you have questions concerning scholarly sources, please refer to the handout entitled “What is a scholarly source” located under “Course Resources” tab.
3. Web sites vary in quality and scholarship. It is the responsibility of the student to determine the scholarly nature of the web site. If the instructor determines that the site failed to demonstrate scholarship, points maybe deducted. Students are cautioned to use care regarding .com sites. Some .com sites are excellent such as American Heart Association, but others are built by individuals and scholarliness is lacking. It is recommended that you check with your instructor before using a .com website as a reference.
4. Only one small quote (15 words or less) within the entire initial posting is acceptable. It is expected that the student will paraphrase the information when presenting information from a scholarly source. The scholarly source(s) for the paraphrased information must be cited using APA format. Do not include a number of small quotes even if they are just a few words as your instructor considers a quote to be a quote no matter its limited size.
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Grading Rubric