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

This program is a course that provides educational information in identifying, understanding and how to respond to signs of mental health problems and substance use disorders. This will train and equip you with knowledge and skills. By knowing the signs of mental illness, approach the person, provide support, know what is helpful for the situation, encourage to seek help. It is created to disseminate and emphasize an open and accessible program for the non-mental health professional. Training participants include teachers, professors, coaches, healthcare professionals, resident advisors, and family members of the patient who have mental health issues. This is an 8–12-hour training course and is either focused on young people or adults.

The program has been evaluated and there are levels of evidence which are stated below:

  • Level I: is the systematic review of randomized controlled trials. The researchers explore all different areas and pool the statistics to look for consistency of the result. Study shows that participants are confident and skilled with better knowledge and attitude towards mental health problems.
  • Level II: it is a randomized controlled trial where the researchers made sure that it is the interventions that makes it difference. One group was scheduled to train but not sure whether they will be able to get in the training right away or 12 months later (waitlist control). Everyone would get the training, and if the groups had similar improvements at different times, it would indicate the effectiveness of the training.
  • Level III-1: the result is from a well-designed trial where participants are randomized.
  • Level III-2: there are two pre-existing groups who received different interventions at the same time and the outcomes were compared.
  • Level III-3: it is from comparative studies that includes historical control where old and new data are being compared. Two or more studies that do not have no control group but recruit people with similar characteristics and measures differences before and after interventions are given.
  • Level IV: the evidence is from case studies with both pre and post-test outcomes. In post-test study, a group of people who received MHFA training might provide data on using their skills and knowledge onto someone. In pre-tests, people’s skills and knowledge were measured prior to receiving the training.

One approach they use is meta-analysis that provides rigorous systematic process to quantify the overall result of the treatment to summarize independent studies (Wong et al., 2015). There were 15 studies that resulted in improvement of mental health knowledge, reduces stigma, and increases helping behaviors, increases confidence, in approaching with mental health issues.

The MHFA implementation resulted 68%-88% of trained mental health first aiders used their skill when on contact with someone who is experiencing mental health illness, and it raises awareness of mental health.

Social determinants are about understanding how certain circumstances of their lives and work shape their health outcomes and it gives direct and indirect impact to mental health. These circumstances are world health inequalities including lower life expectancy, increase child mortality, burden of diseases among disadvantaged population. They found out that poor and disadvantaged populations are most affected by mental disorders with low socioeconomic status from anxiety, stress, unsecure and unpredictable living conditions. There are a lot of factors that are associated with mental health problems such as discrimination, familial relationships, and many others. Mental illness can also impact social determinants, including homelessness, school dropout, marital instability, and economic insecurity. Having mental health problems can affect educational performance, employment capacity, and justice that can limit opportunities. Also, a barrier to socioeconomic improvement, and increase mental health disorder risk (AlegriA et al., 2018).

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

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

Policy Evaluation Opportunities for RNs and APRNs

As nurses, we have extensive training on the nursing process, and because of this, we are knowledgeable on the essential step of evaluation (Milstead & Short, 2019). Like all the other steps of policy design, as nurses, we must collaborate and engage with political leaders on opportunities to assist with the evaluation process. According to Milstead and Short (2019), the step of evaluation offers feedback by identifying areas of improvement, validated resources and is a vital aspect of reforming the US healthcare system (pp.116). Two opportunities RNs and APRNs may assist with the evaluation process are joining a clinical research team and writing and presenting evaluation reports. According to Glasgow et al. (2003), there are two types of research: the efficiency and effectiveness of a program. Both focus on “does the program do more harm than good.”

The difference between efficiency and effectiveness research is that efficiency look at delivering the program under optimal conditions, whereas effectiveness research looks at delivery under real-world conditions (pp. 1261). Within a research group, an individual will be asked to contribute to data collection, comprehend the data, and report the data (Milstead & Short, 2019). Having professional experience in the research subject area gives validity to the research trial. That is why it is important to have healthcare experts such as RNs and APRNs part of research teams. Writing the formal report emphasizes the evaluation method and results (Milstead & Short, 2019). According to Milstead and Short (2019), the final step in the evaluation process is then distributing the data to other professionals, interdisciplinary teams, the consumer such as patients, and stakeholders such as political leaders. This type of scholarly assessment data is distributed in peer-reviewed articles in professional journals or books (Shiramizu et al., 2016). As RNs and APRNs, we have a professional obligation to policy evaluation to develop solutions to promote access, cost-effective, and quality healthcare for our nation (Laureate Education, 2018).  

Current Challenges in Policy Evaluation

According to Milstead and Short (2019), challenges in the policy evaluation are best addressed early in the policy design process. Knowing the typical challenges can help prevent them and facilitate an optimal policy. The eight challenges in policy evaluations are lack of resources, not having a knowledgeable leader, not engaging the stakeholders, lack of qualified results, precipitous implementation, request from stakeholders for premature results, more inclusive evaluation, and public opinion that can be tainted by social media or poor campaigning (pp. 122-123). Although there are challenges to the evaluation process, it is a crucial step to reshape the US health care system (Milstead & Short, 2019).

Overcoming the Challenges in Policy Evaluation

To overcome the eight challenges in policy evaluation, the RN and APRN must carefully collect, analyze, and distribute reliable data in an unbiased, fully detailed report that focuses on answering the policy objectives (Milstead & Short, 2019). Milstead and Short (2019) state that another way to overcome the challenge of policy evaluation is to attain formal discussions on the policy to prevent the data from being biased, disorganized, or improperly reported to the stakeholders and consumers. Fortunately, all federal healthcare policies and programs must go through a rigorous evaluation process that is required by the National Performance Review and the Government Performance and Results Act of 1993. This Act was developed to emphasize accountability, performance measures, and proper results. Last, policy evaluation should focus on short -term and long-term outcomes of the policy design (pp. 118).

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Strategies to Advocate for Policy Review

Two strategies the RN and APRN can provide to advocate proper policy or program evaluation is to exhibit and uphold leadership in the profession of nursing. To accomplish this nurse, need to act professionally in all that they do and prevent informal evaluation or gossip of policy and programs (Milstead & Short, 2019). Another way to advocate for the right policy or program evaluation is to assist with decreasing healthcare costs, provide high-quality patient care, improve population health significance, and promote job satisfaction (Milstead & Short, 2019).

By being one of the most senior nurses in my department, I try to be the best role model and leader for our new graduates and employees. In our facility, we use the LEAN for process improvement in day-to-day work. Many of the process improvement objectives are focused on evidence-based practice and government-based guidelines placed on the facility. The LEAN process is much like a policy design in that there is a framework around the problem, analysis, implementation, and evaluation. When I come to work, I have a positive attitude about the changes that are being made. I only give professional feedback that can optimize proper patient outcomes that are cost-effective and work for the greater good. As well as being a leader in the department related to advocacy, I do my research on any process improvement objectives. That way, I can make informed decisions and have proper discussions with coworkers and managers regarding changes in our facility.

References 

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

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 Health93(8), 1261–1267. https://doi.org/10.2105/AJPH.93.8.1261

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

Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by success: Impact of a clinical and translational research infrastructure program to address health inequities. Journal of Racial and Ethnic Health Disparities4(5), 983–991. https://doi.org/10.1007/s40615-016-0302-4

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 Scholarship52(4), 446–455. https://doi.org/10.1111/jnu.12567

Scott, S. M., & Scott, P. A. (2020). Nursing, advocacy and public policy. Nursing Ethics28(5), 723–733. https://doi.org/10.1177/0969733020961823

Yoder‐Wise, P. S. (2019). A framework for planned policy change. Nursing Forum55(1), 45–53. https://doi.org/10.1111/nuf.12381

The Role of the RN/APRN in Policy Evaluation

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?

Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?

In this Discussion, you will reflect on the role of professional nurses in policy evaluation.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

  • In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
  • Review the Resources and reflect on the role of professional nurses in policy evaluation.

By Day 3 of Week 9

Select an existing healthcare program or policy evaluation or choose one of interest to you.

Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

Post an evaluation topic and a brief description of the evaluation. Discuss how social determinants impact this issue.

Evaluating healthcare systems and policies is essential, and professional nurses play a crucial part in this process. The knowledge and skills of nurses, who are often at the forefront of implementing healthcare programs and policies, can shed light on the efficacy and impact of such initiatives. The Affordable Care Act (ACA) is one healthcare scheme currently in place that could be focused on in this scenario. The federal government enacted this policy with the intention of providing more individuals, especially the uninsured, with access to low-cost medical care (Jackson et al., 2019). The ACA mandated that all Americans obtain health insurance or pay a fine, as well as establishing health insurance marketplaces and expanding Medicaid.

The expansion of healthcare coverage, the decrease in healthcare expenses, and the enhancement of healthcare outcomes are some of the indicators used to evaluate the ACA’s success. These standards were tested in a number of different ways, including polls, data mining, and looking back at healthcare patterns from before the ACA. This policy was aimed at enhancing affordable care for the majority of people in the country. The number of people who became eligible for Medicaid as a result of the ACA, their use of healthcare services, and the effect on healthcare outcomes like hospitalizations and emergency department visits might all be measured in an evaluation.

RNs and APRNs can participate in the evaluation of policies such as the ACA to ensure the policy is helping to achieve its stated objectives of expanding people’s ability to afford healthcare and bettering their health status. In this ACA, nurses would contribute to the policy evaluation by assessing the impact of policy on patient outcomes, identifying barriers to access, and advocating for relevant changes in the policy (Zhao et al., 2020). Collecting and analyzing data on healthcare utilization, healthcare costs, and healthcare outcomes, including hospitalizations and emergency room visits, allows nurses to examine the effect of the ACA policy on patient outcomes. The policy’s ability to improve people’s health can be gauged with the help of this information. Healthcare access issues that may be addressed by the ACA policy can be identified by these nurses. If nurses notice a deficit in preventative care or mental health services, for instance, they may push for legislative reforms to fill the void (Schaeffer & Haebler, 2019). Lastly, the nursing profession has a unique opportunity to promote policy shifts that expand patient access to healthcare. To reduce healthcare disparities and increase patient access, nurses can collaborate with policymakers and other stakeholders to advance legislation.

Professional nurses play an essential role in the evaluation of healthcare policies and programs because of the unique perspective they bring to the table. Evaluating healthcare policies and programs like the Affordable Care Act is essential for ensuring they are effective in improving health and reducing inequities in healthcare access and outcomes (Scott & Scott, 2021). Income, education level, and race are all examples of social determinants that may have an effect on a person’s ability to gain access to and benefit from medical care. These determinants have to be taken into consideration in the evaluation process as well. So, it is crucial that the evaluation takes into consideration how the Medicaid expansion will affect these social factors. The evaluation may look at how expanding Medicaid has affected health inequalities between groups of different races and socioeconomic statuses, for instance.

By Day 6 of Week 9

Respond to at least two of your colleagues* on two different days by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.

*Note: Throughout this program, your fellow students are referred to as colleagues.

 

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 Scholarship52(4), 446–455. https://doi.org/10.1111/jnu.12567

Scott, S. M., & Scott, P. A. (2020). Nursing, advocacy and public policy. Nursing Ethics28(5), 723–733. https://doi.org/10.1177/0969733020961823

Yoder‐Wise, P. S. (2019). A framework for planned policy change. Nursing Forum55(1), 45–53. https://doi.org/10.1111/nuf.12381

Nurses experience the daily result of policy and politics in health care. They are the largest member of the healthcare workforce and as such can advocate and influence for change. There are numerous ways for nurses to participate in policymaking.

One way is to participate in State and national nurses’ association- the American Nurses Association, the American Academy of Nursing, to name a few. Nursing associations keep a list of members that can write letters and make phone calls to their state and federal representative (Morris, 2023). With the nurse’s personal experience on how policies were implemented on the floor, they can give quality feedback to policymakers or provide useful data for research. Another way is to participate in evidence-based data. Nurses can initiate data-gathering, analyze data, and interpret research for their state and house representatives. They can also develop current research and analyze them in layman’s term and provide recommendations for policy (Morris, 2023).

Unfortunately, there are many barriers that hold back a nurse from participating in policymaking. Family and work demand would be top of the list. Most nurses, after working long hours would prefer to spend their time with family or personal care. Gender-based roles are a big factor as well. Having majority of nurses as women, most assume a more traditional role after work such as childcare or taking care for elderly parents (Anders, 2021). Another barrier would be the nurse’s lack of knowledge of the political process. Their limited understanding about elected officials and their stand on certain health policy.

Nurses are subject matter experts, having specific academic knowledge and clinical experience, nurses are a resource. Enhancing the nurse’s background and professional values, empowering them to not only be a tool but also an influence for the people around them, being the voice of not only their patients but for their peers as well; promote an environment of ownership and partnership. Knowing their worth in the community encourages them to be more involved- that as an individual they can influence change.

To help foster participation in policymaking, I would encourage nurses to further their studies. Enroll in a Master’s program on their respective field, or have a sub-specialty. Expanding once outlook allows you to access more resources and expand your influence. Being a wound specialist for example allows you to access more up and coming studies and equipment,you would be in aposition to give recommendations to doctors and administrators. Another way is to promote advocacy. Tapping on the nurse’s role as advocates and being able to see the health systems’ effectiveness or lack thereof firsthand, is the perfect mouthpiece, an expert that can interpret for policymakers. Being a member of your local nurse association and being able to voice concerns on nurse’s work conditions, raise in wages, or organize symposiums for community outreach.