Category: Nursing

The Age of Liberty – America’s Constitutional Origins – PLS 1120 AMERICAN FEDERAL GOVERNMENT

Living in the 21st century, it is sometimes difficult to imagine our country as a fledgling new nation experimenting with radical ideas of liberty and democracy.

Today, America is an economic and military superpower restrained only by its constitution, the American people, and the need to work with the international community to maintain peace and security in our global society. It is a much smaller world today than 243 years ago when our founding fathers declared the birth of our nation and relied on horses and sailing ships for transportation, and mail took weeks if not months to be delivered.

Image: U.S. Capitol Building, Washington, D. C. ThinkStock.

The United States has faced many challenges over the years. In the 18th century, the central question was nation building – how to establish a government that retained power in the people and yet prevented special interest groups or political parties from dominating our government at the expense of minority groups and individual liberty (Liberty!).

Today, we continue to fight the war on terrorism and, over the past few years, have faced the challenge of balancing how best to fight this war and protect our civil liberties. This is the central issue of our time. September 11th was a defining moment for Americans with both domestic and international implications.

The War in Iraq

We may not all agree on whether going to war with Iraq was a good idea, but we can acknowledge that it did help to shake things up a bit in the Middle East. The War removed a sponsor of terrorism and a key player and dominant influence in the region. The Iraqi elections inspired confidence that the Iraqi people want to govern themselves, and the formation of a unity government under the leadership of Prime Minister Nuri-al-Maliki in 2005 reassured the international community that their Iraqi leaders were willing to work together to govern a free and democratic Iraq.

On the left is an Iraqi woman flashing her finger dipped in dye to show she cast her ballot at An Najaf, Iraq, in 2005.

Image: U.S. Department of Defense. Public Domain.

As you are aware, it took five long months amidst insurgency attacks and religious and sectarian infighting to cobble together a permanent Iraqi government. It has been a formidable task to govern Iraq, much less to ensure freedom and the protection of minorities, but what has given us hope over these past years is that most people in Iraq want their lives to return to normal and to live without tyranny.

There have been legitimate questions raised about whether democracy can flourish in the greater Middle East. Democratic elections were held in Lebanon, Egypt (local), and in the Palestinian Authority in 2006. However, the Palestinians wanted new leadership, and they chose Hamas, a terrorist organization. Hamas does not recognize Israel’s right to exist. This new twist in Middle East geopolitics raised other questions. Are democratic countries necessarily more peaceful participants in the world community? Will these democratic elections enhance prospects for peace in the Middle East? Also, the war between Israel and Hezbollah in Lebanon raised additional questions of whether religious and ethnic differences would undermine efforts for democracy in the Middle East.

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In our 2006 midterm elections, Americans showed in electing a new Democratic Congress that they wanted a change in U.S. policy in Iraq–some level of troop withdrawal. The Iraq Study Group (headed up by former Secretary of State James Baker and former Congressman and 9/11 Commission member Lee Hamilton) briefed President Bush and the U.S. Congress regarding their recommendations on how to proceed in Iraq. They recommended the need for a coordinated diplomatic, political, and military effort to stem the tide of sectarian violence and restore peace and stability in Iraq.

In early 2007, President Bush reviewed the Iraq Study Group’s recommendations and his advisors’ suggestions and announced his new Iraq policy. He recommended sending an additional 21,000 troops to stem the violence in Baghdad and to stabilize Iraq. Later that year, General David Petraeus, the U.S. Commander in Iraq, issued his report on the effectiveness of the “surge policy.” In response to General Petraeus’ findings, President Bush announced to the nation that “…the surge policy is working.” As you are aware, the goal of the surge was to provide security and to help Iraqi soldiers prepare to maintain it.

During that year, the situation in Iraq improved. Violence was significantly down to 2003 levels, and the United States shifted more responsibility over different areas to Iraqi security. The Iraqis began to pull together to address their security and domestic concerns. In effect, it appeared the leaders of most groups, Shia, Sunni, and Kurds, recognized it was time to set aside their differences or at least reflect them through the political process rather than on the streets. The Iraqi Government has made strides towards political reconciliation by allowing Baathist Party members to participate in government.

On January 31, 2009, Iraqis voted peacefully and enthusiastically in provincial elections. There was a 51% voter turnout. These elections were critical to dispersing power from Baghdad and giving more power to local governments.

To learn more, go check out the 
United Nations’ Iraqi Reconstruction
.

On March 7, 2010, Iraq held parliamentary elections that went very smoothly with very little violence and little U.S. military support. Roughly 60%-65% of Iraqis turned out to vote. Although the opposition candidate edged out Prime Minister Nuri al-Maliki, he could not form a coalition government. A new Iraqi coalition government headed by Maliki was cobbled together, and today the leaders of Iraq are trying to provide security and improved services to their citizens in spite of almost daily suicide bomb attacks. It will be interesting to watch Iraq’s experiment with democracy in the days, months, and years ahead.

As you are aware, the United States and Iraq signed a security agreement that outlined the process and withdrawal of American forces from that country. The first stage of withdrawal took place with American troops leaving Iraqi cities on June 30, 2009.

Also, the United States withdrew two brigades (12,000 soldiers) in September 2009, and in December 2009, there were no U.S combat fatalities. On August 31, 2010, President Obama fulfilled his promise to bring home all combat troops. The remaining 50,000 U.S. troops ended their supporting role on December 20, 2011.

In his address to the nation, President Obama described our approach to Iraq post-war: “This new approach reflects our long-term partnership with Iraq — one based upon mutual interest and mutual respect. Of course, violence will not end with our combat mission. Extremists will continue to set off bombs, attack Iraqi civilians, and try to spark sectarian strife. But ultimately, these terrorists will fail to achieve their goals. Iraqis are a proud people. They have rejected sectarian war, and they have no interest in endless destruction. They understand that, in the end, only Iraqis can resolve their differences and police their streets. Only Iraqis can build a democracy within their borders. What America can do, and will do, is provide support for the Iraqi people as both a friend and a partner”.

Source: President Barak Obama, August 31, 2010. “Remarks by the President in Address to the Nation on the End of Combat Operations in Iraq”. The White House. https://obamawhitehouse.archives.gov/the-press-office/2010/08/31/remarks-president-address-nation-end-combat-operations-iraq

To watch President Obama’s address to the nation or read his speech to the American people, click on the following links:

Remarks by the President in Address to the Nation on the End of Combat Operations in Iraq

President Obama’s Address on the End of the Combat Mission in Iraq

President Obama said, “(W)ith our diplomats and civilian advisors in the lead, we’ll help Iraqis strengthen institutions that are just, representative, and accountable. We’ll build new ties of trade and of commerce, culture and education, that unleash the potential of the Iraqi people. We’ll partner with an Iraq that contributes to regional security and peace, just as we insist that other nations respect Iraq’s sovereignty. As I told Prime Minister Maliki, we will continue discussions on how we might help Iraq train and equip its forces — again, just as we offer training and assistance to countries around the world. After all, there will be some difficult days ahead for Iraq, and the United States will continue to have an interest in an Iraq that is stable, secure, and self-reliant. Just as Iraqis have persevered through war, I’m confident that they can build a future worthy of their history as a cradle of civilization”.

Source: Office of the Press Secretary, October 21, 2011, Remarks by the President on Ending the War in Iraq. https://obamawhitehouse.archives.gov/blog/2011/10/21/president-obama-has-ended-war-Iraq

Arab Spring

In 2011, protests erupted in the Middle East, now known as the “Arab Spring,” starting with protests in Tunisia, then spreading to Egypt, Yemen, Bahrain, Libya, and Syria. The young people demanded the end of tyranny and the establishment of freedom and democracy. Egypt established a Constitutional democracy as a result, and now again is facing a crisis with a military coup and the removal of President Morsi, and dissolution of parliament, and the power of the Muslim Brotherhood. The International community called for new elections to re-establish a democratic government. In 2014, Abdel Fattah el-Sisi, a former military officer, was elected president of Egypt.

Source: CNN Staff.  
“Egypt declares el-Sisi winner of presidential election
,
” 
June 4, 2014, https://www.cnn.com/2014/06/03/world/africa/egypt-presidential-election/

NATO established a no-fly zone in Libya in April 2011 to protect the people protesting against Gadhafi’s regime. They wanted Gadhafi to step down and for democracy to be established in their country. Rebels captured and killed Gadhafi and installed a transitional government in Tripoli, and NATO ended its mission in that country. A bloody civil war raged in Syria, with efforts by the opposition to remove Bashar al-Assad from power. Assad was re-elected president in 2014.

In an interview with Piers Morgan of CNN (3-16-11), Middle East expert, Tom Friedman, said “… [W]e can only hope that the people of the Middle East will go the way of Eastern Europe and not Somalia.”

Postscript

In 2014, the situation in Iraq was very fluid and quickly dissolving into chaos with the strong surprise invasion by the brutal al-Qaeda-affiliated terrorists known as the Islamists from the Islamic State in Iraq and Syria (ISIS). These hardened terrorists fighting in Syria swept into northern Iraq, taking a number of cities, including Mosul, with the help of disaffected Sunnis who were unhappy with the lack of economic opportunity and increased political isolation by former Prime Minister al-Maliki’s led Iraq government.

The ISIS and their Sunni supporters were on the outskirts of Baghdad, and Prime Minister al-Maliki called on the United States for help to oust these terrorists. Former President Obama has considered all his options, and he initially sent Marines to protect the U.S. embassy in Baghdad and advisors (special operations forces) to review the situation on the ground and to help train Iraqi soldiers. In early August 2014, the U.S. began air strikes to protect the Yazidis minority stranded without food and water on Mount Sinjar after trying to escape from ISIS. After rescuing this group, the U.S. supported the Kurds with air power, who were at the time attempting to take back the Mosul Dam, an important source of water for Iraq.

For more information, read this article on CNN’s website:

U.S. airstrikes critical in Mosul Dam capture

Source: Jethro Mullen, August 19, 2014. “U.S. airstrikes critical in Mosul Dam capture.” CNN.com. https://www.cnn.com/2014/08/18/world/meast/iraq-mosul-dam/index.html

Iraq held its local elections in April 2013, and Prime Minister Maliki’s party won the most seats in the parliament, giving him a third term (Source: “
Iraqis go to polls amid conflict, fears about security,” 
Washington Post, April 30, 2014 ). In the midst of this serious crisis, he was strongly encouraged to step aside so a new prime minister could form a new governing coalition and deal with this current crisis. At this time, there was greater hope that the new prime minister, Al-Abadi, would work to protect the interests of both the Sunni and Kurdish minorities and the Shia majority.

On December 9, 2017, Prime Minister Al-Abadi announced that Iraq had driven out ISIS from its territory and had control over its borders.  At the end of the year, the Iraqi people were much more united and supportive of their leaders and armed forces (Source: New York Times article “Iraqi Prime Minister Declares Victory Over ISIS”, December 9, 2017). The U.S. continued to have special forces on the ground directing airstrikes against ISIS strongholds.  Also, the U.S. led the successful effort to remove ISIS from its last stronghold on the northwestern border with Syria.

The critical question at the beginning of the Iraqi democratic experiment and later with the forceful entry of ISIS into the country was whether Iraq could survive as a state and whether this terrorist threat would force the Iraqi government to expand its political base of support and address the basic needs of its people. At the end of 2017, there was greater promise that Iraqis could come together now that ISIS had been defeated and address sectarian divisions, promote political reforms, and improve the Iraqi economy.

It will be interesting to see what relationship Iraq will have with Iran after its help in removing ISIS, and see if the new Prime Minister Adil Abd Al-Mahdi can address the Kurdish people’s desire for independence.  The former Prime Minister 
Al-Abadi 
did not support the Kurdish vote for independence in 2017, and neither did the United States or Turkey.

Establishing federalism in this country is a work in progress.  Maybe the Iraqis will one day establish an upper house in the parliament, much like our own, that represents the interests of the regions in Iraq, or establish more local authority and yet retain Kurdistan in the Iraqi union.  The new Prime Minister is not from a major political bloc, and his cabinet is more technocratic, similar to 2005 (Source: CIAWorldFactBook, Iraq). Maybe he can bring these various ethnic groups together and improve the lives of the Iraqi people.    It will continue to remain a challenging question on how best to address the political aspirations of the Kurdish people as well.

Although President Trump announced that the U.S. would withdraw troops from Syria in early 2019 now ISIS is defeated, his administration continued to remain engaged in Iraq not only to continue U.S. support of this fledgling democracy but to continue it efforts to help stabilize Iraq, prevent the rise of ISIS once again, and reduce Iranian influence in this country and region. Coalition partners continue to work with the United States as well in these efforts. Iran supported Iraq during its battle against ISIS with advisors, Revolutionary Guard troops, and the Iranian-supported Hezbollah terrorist organization, etc.  Iraq is heavily dependent on Iran’s energy imports for electricity and energy needs, while it becomes more energy independent.  The U.S. has strongly encouraged Iraq to get control of the roaming pro-Iranian militias, which the Iraqi Government is committed to doing, and to do its best to reduce its dependence on Iranian energy (Source: Near East Subcommittee of the Senate Committee on Foreign Relations, July 16, 2019. https://www.foreign.senate.gov/hearings/iraq-a-crossroads-of-us-policy-071619).

On January 3, 2020, President Trump ordered a drone strike killing the Iranian General, Qasem Soleimani, leader of the Quds Force (part of the elite Iranian Revolutionary Guard) that has led and trained Iranian supported militias in Iraq and the Houthis rebels in Yemen, the Hezbollah terrorist organization in Lebanon, Syria and Iraq, and throughout the Middle East, and engaged in proxy wars with the United States and its allies for many years.  A critical player in Iran’s efforts to expand its influence in this region.  General Soleimani was killed at the Baghdad Airport after attacks on the U.S. embassy by Iranian-supported Iraqi militiamen and killing a U.S. contractor and wounding other Americans at an Iraqi military base.  Iran said that there would be a “harsh response.”  National Security Advisor Robert O’Brien said that Soleimani was planning additional attacks on U.S. servicemen and diplomats (Source: Washington Post live coverage reporters. “National security adviser says Soleimani was plotting attacks on U.S. ‘soldiers, airmen, Marines, sailors and against our diplomats’,” Washington Post, January 3, 2020. https://www.washingtonpost.com/world/iran-strike-live-updates/2020/01/03/3779f55c-2e33-11ea-bcb3-ac6482c4a92f_story.html).

In response to the protests, the Iraqi Prime Minister said he would step aside (Source: CIA World Factbook).  On January 5, 2020, the Iraqi Parliament passed a nonbinding resolution calling on the Iraqi Government to expel foreign troops from the country.  Prime Minister Abdul Mahdi urged Parliament to take “‘urgent measures and end foreign troop presence as soon as possible’” (Source: CNBC, 
Iraqi parliament calls for US troops to be expelled —coalition suspends operations against ISIS
“, January 5, 2020).

To learn more, read this article on CNBC’s website:

Iraqi parliament calls for US troops to be expelled —coalition suspends operations against ISIS

Source: Kimball, Spencer, Jan 5, 2020. “Iraqi parliament calls for US troops to be expelled —coalition suspends operations against ISIS.” CNBC. https://www.cnbc.com/2020/01/05/iraq-prime-minister-says-parliament-must-end-foreign-troop-presence-as-soon-as-possible.html

On May 7, 2020, after months without a Prime Minister, the Iraqi Parliament approved a former journalist and intelligence officer as their new Prime Minister.  Mustafa al-Kadhim is “close to the current Iraqi President Barham Salih and is accepted by both the United States and Iran (Source: Lovelock, Louise. 
“Iraqi names new prime minister, paving the way to tackle the nation’s deepening crisis,” May 7, 2020, Washington Post
)
. 

President Trump announced on September 9, 2020 that the United States would reduce its troops by half to 3,000 in Iraq roughly the same level as in 2015 during the early stages of fighting the Islamic State  “Other members of the 29-coalition in Iraq have already cut their numbers in half, to about 1,200.” (Source: Schmitt, Eric. 
“U.S. to reduce troop levels in Iraq to 300,” 
DDN, September 10, 2020, A2).

Early in his first term, President Joe Biden ordered air strikes on Iranian-backed militias in Syria and Iraq in response to attacks on Americans and American facilities.

To learn more about these air strikes, please read this article from Reuters:

U.S. warplanes strike Iran-backed militia in Iraq, Syria

Source: Stewart, Phil. June 28, 2021. Reuters. https://www.reuters.com/world/middle-east/us-carries-out-air-strikes-against-iran-backed-militia-iraq-syria-2021-06-27/

Iraq held its fifth parliamentary election on October 10, 2021, since the U.S.-led invasion in 2003. 
 
Muqtada al-Sadr’s party won the most seats (74) in a surprise win, and the Iran-backed party lost seats in the Council of Representatives (national legislature) in this election. 
The Shia Muslim cleric was able to take advantage of the turbulent political situation, with many Iraqis impoverished, unhappy with the lack of opportunity and democratic reforms, and undue foreign influence.  There was low voter turnout due to some groups boycotting the election (Source: Alaaldin, Ranj. “Muqtada al-Sadr’s problematic victory & the future of Iraq,” October 28, 2021, Brookings Institute, https://www.brookings.edu/articles/muqtada-al-sadrs-problematic-victory-and-the-future-of-iraq/).

On November 7, 2021, Prime Minister al-Kadhim’s home was targeted by a drone attack. 
 Fortunately, he was unharmed.  The Biden Administration called this a “terrorist attack” and offered support.  The U.S. and the United Nations Security Council called this election essentially free and fair, but the Iranian-supported militias protested the results of this election and wanted a recount (Source: AP. “
Iraq’s prime minister has survived an assassination attempt
.”NPR, November 7, 2021, https://www.npr.org/2021/11/06/1053277516/iraq-prime-minister-assassination-attempt).

Today, there is a new Iraqi Prime Minister, Mohammed Shia’ al Sudani, who was appointed Prime Minister on October 27, 2022
.  With his opponent al-Sadr stepping out of politics for the time being, al-Sudani took office.  These Shiite leaders and their supporters have been struggling to take power or to keep it.  Al Sudani’s backers have the support of Iran.  President Biden and al-Sudani agree that it is important to continue to reduce the influence of the remaining Islamic State members within Iraq, as well as regionally and around the world, and to support Iraq’s independence and sovereignty.

To learn more, read the transcript of this call between President Biden and Prime Minister al-Sudani:

Readout of President Biden’s Call with Prime Minister Mohammed Shia’ al-Sudani of Iraq

Source: The American Presidency Project. February 2, 2023. “Readout of President Biden’s Call with Prime Minister Mohammed Shia’ al-Sudani of Iraq.”  https://www.presidency.ucsb.edu/documents/readout-president-bidens-call-with-prime-minister-mohammed-shia-al-sudani-iraq

Also, read the following article by the Brookings Institute that discusses the deep internal struggles among Shiite militias to control Iraq.

Shiite rivalries could break Iraq’s deceptive calm in 2023

Source: Alaaldin, Ranj, March 1, 2023. “Shiite rivalries could break Iraq’s deceptive calm in 2023.” The Brookings Institute.  https://www.brookings.edu/blog/order-from-chaos/2023/03/01/shiite-rivalries-could-break-iraqs-deceptive-calm-in-2023/

Iraqi leaders continue to face these challenges–dealing with both the Iranian and U.S. influence, the Sunni minority and Shia majority animosity, and continuing sectarian infighting, a struggling economy, endemic corruption, and the desire for Kurdish independence– but there are some positive successes.

You may want to watch a video with Gzero World Media’s Ian Bremmer on the 20th Anniversary of the Iraq War to get a better picture of the current situation in Iraq.

Iraq 20 Years Later

Source: Bremmer, Ian. March 18, 2023. “Iraq 20 Years Later.” PBS.org. https://www.pbs.org/video/iraq-20-years-later-mjmhg4/

What started as an effort to remove a state sponsor of terrorism and later the Arab Spring with hopes of freedom, democracy, and a better life for the people of the Middle East and northern Africa, some may argue that these events have produced even greater uncertainty, instability, and greater opportunities for extremists and tyrants in the region. We can only hope that with sufficient support, these nations can rise above these challenges and find the strength to fight off tyranny and bear the fruits of freedom and democracy America’s Constitutional Origins – PLS 1120 AMERICAN FEDERAL GOVERNMENT

Interview – Advocating for the Nursing Role in Program Design and Implementation

Interviewer
: Can you tell us about a healthcare program within your practice? What are the costs and projected outcomes of this program?

Me
: Yes. The one I am currently working on is the maternal postpartum depression healthcare program, which would provide nursing care and mental health support to new mothers. We foresee the program being moderately priced to run: a few staff trainings, integration of telehealth services, and community outreach programs. We estimate the cost to be about $150,000 annually. A few examples would include early intervention that reduces the incidence of postpartum depression, improves maternal mental health, and increases the overall well-being of the family. Because of early and accessible support, we are likely to experience fewer hospital readmissions with improved health outcomes for mothers.

Interviewer:
Who is your target population?

Me:
Our target population is mainly new mothers and predominantly those at high risk for postpartum depression, such as women having previous mental health issues, limited healthcare access, and being socioeconomically disadvantaged. We also tend to look after minority groups—for example, ethnic minorities among women—who may face additional obstacles in seeking help for postpartum depression.

Interviewer:
What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?

Me:
The design of the program also critically involves the nurses. Since the nurses interact with new mothers daily, they lead by bringing first-hand knowledge of women’s problems. Such was the identification of the need for regular mental health screening during postpartum check-ups, which is now a vital part of the program. Other recommendations included the option for telehealth for mothers who might find it difficult to attend sessions physically, especially in rural areas. These are examples of practical design decisions influenced by insight from nurses in a patient-centered way.

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Interviewer:
What is your role as an advocate for your target population in this healthcare program? Do you have input into design decisions? How else do you impact design?

Me:
As an advocate, I must ensure the needs and voices of the mothers we serve are at the forefront of this program. I attend several meetings wherein I give feedback from my direct work with the patients. I provide recommendations on the resources that will target specific needs for our population, such as multilingual support and culturally sensitive care. I also engage directly with program managers to refine pathways of care and access to this program, especially within underserved communities.

Interviewer:
What is the role of the nurse in healthcare program implementation? How does this role vary between the design and implementation of healthcare programs? Can you provide examples?

Me:
During the implementation phase, nurses no longer act as planners but as significant care deliverers. They should carry out the program’s components, such as screening, mental health support, and follow-up arrangements with the mothers. For example, in our program, the nurses are supposed to monitor early signs of postpartum depression among the patients and ensure timely intervention. One of the significant differences between design and implementation is that at the design stage, nurses provide their expertise to develop a working program. In contrast, during the implementation, nurses act out the strategies developed.

Interviewer:
Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

Me
: Improved program implementation abroad encompasses a team with well-rounded health care. In developing and implementing our program, we have key board members: nurses, mental health professionals, obstetricians, and social workers. The nurses provide direct care and support, the mental health professionals offer special counseling, obstetricians monitor the medical aspects of postpartum, and social workers connect mothers to community resources. This ensures that multidisciplinary care addresses the mothers’ mental and physical aspects of their respective social issues.

Advocating for the Nursing Role in Program Design and Implementation

As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.

Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.

In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.

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:

Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.

Select a healthcare program within your practice and consider the design and implementation of this program.

Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.

The Assignment: (2–4 pages)

In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:

Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?

Who is your target population?

What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?

What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?

What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?

Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

By Day 7 of Week 8

Submit
 your interview transcript.

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Rubric

NURS_6050_Module04_Week08_Assignment_Rubric

NURS_6050_Module04_Week08_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Program DesignIn a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions.·   Tell us about a healthcare program within your practice. What are the costs and projected outcomes of this program?·   Who is your target population?·   What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?·   What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?

45
 
to >
40.0
 pts
Excellent
Response provides a clear and complete summary of the healthcare program, including an accurate and detailed description of the costs and projected outcomes of the program. …Response provides a clear and accurate description that fully describes the target population. …Response provides a clear and accurate explanation of the role of the nurse in providing input for the design of the program, including specific examples. …Response provides an accurate and detailed description of the role of the nurse advocate for the target population for the healthcare program selected. …Response provides an accurate and detailed explanation of how the advocate’s role influences design decisions as well as fully explaining impacts to program design.

40
 
to >
35.0
 pts
Good
Response provides a summary of the healthcare program, including a description of the costs and project outcomes of the program. …Response provides an accurate description of the target population. …Response provides an accurate explanation of the role of the nurse in providing input for the design of the program, including some examples. …Response provides an accurate description of the role of the nurse advocate for the target population for the healthcare program selected. …Response provides an accurate explanation of how the advocate’s role influences design decisions and somewhat explains impacts to program design.

35
 
to >
31.0
 pts
Fair
Response provides a summary of the healthcare program that is vague or incomplete or does not include costs or projected outcomes of the program. …Description of the target population is vague or inaccurate. …Explanation of the role of the nurse in providing input for the design of the program is vague, inaccurate, or does not include specific examples. …Description of the role of the nurse advocate for the target population for the healthcare program selected is vague or inaccurate. …Explanation of how the advocate’s role influences design decisions and impacts to program design is vague or inaccurate.

31
 
to >
0
 pts
Poor
Response provides a summary of the healthcare program that is vague and inaccurate, does not include costs or projected outcomes of the program, or is missing. …Description of the target population is vague and inaccurate or is missing. …Explanation of the role of the nurse in providing input for the design of the program, and specific examples is vague and inaccurate, or is missing. …Description of the role of the nurse advocate for the target population for the healthcare program selected is vague and inaccurate or is missing. …Explanation of how the advocate’s role influences design decisions and impacts to program design is vague and inaccurate, or is missing.

45
 pts

This criterion is linked to a Learning Outcome
Program Implementation·  What is the role of the nurse in healthcare program implementation?How does this role vary between design and implantation of healthcare programs? Can you provide examples?·  Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why you think this?

40
 
to >
35.0
 pts
Excellent
Response provides a clear, accurate, and complete explanation of the role of the nurse in healthcare program implementation. …Response provides an accurate and detailed explanation of how the role of the nurse is different between design and implementation of healthcare programs, including specific examples. …Response provides an accurate and detailed description of the members of a healthcare team needed to implement the program selected.

35
 
to >
31.0
 pts
Good
Response provides an accurate explanation of the role of the nurse in healthcare program implementation. …Response provides an accurate explanation of how the role of the nurse is different between design and implementation of healthcare programs and may include some specific examples. …Response provides and accurate description of the members of a healthcare team needed to implement the program selected.

31
 
to >
27.0
 pts
Fair
Explanation of the role of the nurse in healthcare program implementation is vague, inaccurate, and/or incomplete. …Explanation of how the role of the nurse is different between design and implementation of healthcare programs is vague or inaccurate and/or does not include specific examples. …Description of the members of a healthcare team needed to implement the program selected is inaccurate or incomplete.

27
 
to >
0
 pts
Poor
Explanation of the role of the nurse in healthcare program implementation is vague and inaccurate or is missing. …Explanation of how the role of the nurse is different between design and implementation of healthcare programs is vague and inaccurate or is missing. …Description of the members of a healthcare team needed to implement the program selected is vague and inaccurate, incomplete, or is missing.

40
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, low logically, and demonstrate continuity of ideas.Sentences are carefully focused– neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

5
 
to >
4.0
 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. …A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4
 
to >
3.0
 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. …Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3
 
to >
2.0
 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time. …Purpose, introduction, and conclusion of the assignment is vague or off topic.

2
 
to >
0
 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. …Purpose, introduction, and conclusion of the assignment is incomplete or missing. 5  pts This criterion is linked to a Learning Outcome Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation 5   to >
4.0
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

4
 
to >
3.0
 pts
Good
Contains a few (1-2) grammar, spelling, and punctuation errors.

3
 
to >
2.0
 pts
Fair
Contains several (3-4) grammar, spelling, and punctuation errors.

2
 
to >
0
 pts
Poor
Contains many (≥5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting:The paper follows correct APA format for title page, font, spacing, margins, indentations, parenthetical/in-text citations, and reference list (if sources are cited).

5
 
to >
4.0
 pts
Excellent
Uses correct APA format with no errors.

4
 
to >
3.0
 pts
Good
Contains a few (1-2) APA format errors.

3
 
to >
2.0
 pts
Fair
Contains several (3-4) APA format errors.

2
 
to >
0
 pts
Poor
Contains many (≥5) APA format errors.

5
 pts

Total Points: 
100

Articles of Confederation – AMERICAN FEDERAL GOVERNMENT

Articles of Confederation (1781-1789)

The New National Constitution-1st U.S. Constitution

In June 1776, when the delegates appointed a committee to draft the 
Declaration of Independence
, it also recognized that a committee would need to be formed to craft a national constitution. The committee drafted the new constitution in one month and then debated its merits for roughly a year and one half before it was approved by the Congress.

The new constitution known as the 
Articles of Confederation
, “
a league of friendship
,
” was submitted to the state legislatures in November 1777. It took four years for all the states to approve this new national constitution. Maryland, the last state, approved the Articles in March 1781, after Virginia promised to relinquish its claims in the 
Northwest Territory
 to the new national government.

 

What lands did Virginia claim

in the Northwest Territory?

 

The Articles of Confederation established a confederacy known as the 
United States of America
. The new seat of government would be in New York City, the center of trade and commerce. The national government would consist of a Congress, a national legislature, with limited power. There was no executive to implement and enforce national laws or a national court system to resolve legal disputes and interpret the law.

The Confederation Congress was a 
unicameral
 body, a one house legislature, where each state would have 
equal representation
, equal voice. Each state legislature could send between two to seven delegates to sit in NYC, but they would vote as a delegation, one vote per state, no matter the size of the population of each state. Both small and large states would hold equal power in this new national government.

The delegates chose a confederation type of government system in order to keep most of the power in the hands of the states and less power in the national government. The country was fighting the Revolutionary War against the perceived tyranny of King George and the British Parliament and they did not want to grant the new Congress strong legislative and executive authority.

In a 
confederation
 unlike our federal system (federation) of today, the 
state legislatures
, in approving the Articles, gave the new national government only 
limited power 
over foreign affairs and national security, Indian tribes, coining money, regulating weights and measurements, and delivering the mail Articles of Confederation – AMERICAN FEDERAL GOVERNMENT
.

The remaining powers such as regulating domestic and foreign trade belonged to the states. Under the Articles, “{E} ach State retains its sovereignty, freedom and independence, and every power, jurisdiction and right, which is not by this confederation, 
expressly
, delegated to the United States, in Congress assembled.” This reserve powers clause reassured the states that power would rest with them (Kelly, Harbison, and Belz A-2).

GET WRITING HELP HERE 

HUMAN-WRITTEN
AND
PLAGIARISM-FREE 

The Confederation Congress could not directly tax the people residing in the states or draft soldiers for the Continental Army. If the national government wanted tax revenue or troops, it had to ask the state legislatures. The states would raise taxes and send them onto NYC. Soldiers would be recruited by the states for the national army. This would present a problem for General George Washington and his troops. You may remember the lack of supplies at Valley Forge to name but just one example.

Also, the new Congress could not collect debts owed to it by the states, settle disputes between the states (no national court system), or enforce its laws. In short, the Articles created a very weak national government that would present problems in conducting the war effort and later, impact our national economy and national unity.

Textual Description of Image

Annapolis Convention (1786)

After the Revolutionary War ended in 1783, the states turned inward and began to focus more on the condition of their own domestic economies, just like countries today do after a war. 
At the time, there was no national economy and states considered themselves more like independent nations.
 With the war no longer providing the necessity for unity, the states developed an economic rivalry that compounded the problems of governing under the new Constitution.

States used their power to regulate trade with one another and foreign countries to enhance their prosperity with generally no concern how their activities would impact the nation as a whole.

Some states like New York took advantage of its geographical position and deep water port and taxed goods that were shipped between Connecticut and New Jersey (Magleby).

Rhode Island, know as “Rhogue Island,” was notorious for taxing people if they did not purchase its state’s goods with Rhode Island currency. The purpose of this tax was to strengthen the value of its own currency and defray its costs of the War effort (Magleby).

Also, some states imposed tariffs or taxes on imports from other states to protect their products from a flood of cheaper goods which further caused disruption in the economy. The United States was not a ” 
free trade zone
” like it is today. Under our current Constitution, states are prohibited from taxing one another’s imported goods (see Article 1, sec. 10, U.S. Constitution).

James Madison
 (VA) and 
Alexander Hamilton
(NY) who recognized the importance of a viable national economy called for a convention to be held in Annapolis, Maryland to deal with the problems of trade and navigation. Earlier in 1785, a dispute between Maryland and Virginia over control of navigation of the Potomac River had been successfully resolved. Articles of Confederation – AMERICAN FEDERAL GOVERNMENT

Only five states sent delegates to Annapolis in September 1786 and as a result, nothing was accomplished in addressing trade and navigation issues. However, one thing was clear. There were more equally pressing problems that needed to be addressed than just these matters. Another convention was needed with all states in attendance to deal with the 
broad problems
 of governing under the Articles of Confederation. The United States was not only facing economic problems, but foreign threats as well.

The delegates sent a letter to the Confederation Congress urging it to call for such a convention now known as the 
Constitutional Convention
.

Shay’s Rebellion (1786)

In late 1786, Daniel Shays led a group of 1000 farmers in a rebellion in western Massachusetts. The farmers had been especially hard hit by heavy state taxes and low farm prices due to a depression in the agriculture economy.

Also, creditors were pressing them to pay off their debts. Many Americans went on a buying spree after the war and bought luxury British goods on credit (Collier and Collier 9-11).

During December 1786 and early 1787, these farmers interrupted foreclosure proceedings and released some of their fellow debtors from jail. It was finally put down by a private group of citizens hired to put down the rebellion (Edwards, Wattenberg and Lineberry 31).

This rebellion frightened property owners and the public in general not only in Massachusetts, but other states as well who were also having creditor/debtor problems. Many Americans recognized that something needed to be done to amend the Articles to strengthen the national government so that it could put down rebellions, maintain law and order, and preserve property rights. They feared the potential for anarchy.

The Shays’ Rebellion encouraged state legislatures who had not attended the Annapolis Convention to send delegates to the Constitutional Convention Articles of Confederation – AMERICAN FEDERAL GOVERNMENT

Main Discussion Post

The United States spends significantly more on healthcare than other comparable countries. Looking at that fact, one would think that health outcomes would be significantly better in the U.S. but it is actually the opposite, with certain populations suffering more than others. Nurses can advocate for population health by actively participating in policymaking (Myers, 2020). While there are many opportunities for nurses to participate in policymaking, there are also many challenges in doing so. Hajizadeh et al. (2021) conducted a study on why nurses do not participate more in policymaking despite how important it is. They found contributing factors to include lack of time, limited resources, and uncertainty in their knowledge of politics.

Joining a professional nursing association such as the ANA is an excellent way to enter the legislative ring. Their website offers many resources to get started including links to legislative issues at the federal and state level. You can also join their mailing list to become involved with their advocacy campaigns. The ANA believes advocating for policy change is just as important as professional and patient care improvements (ANA, n.d.). Nursing associations can have difficulty recruiting new members for many reasons and I believe one drawback is the cost of membership. I recently attended an ED and ICU nursing conference and at the end, they had prize drawings. One of the prizes was a one-year membership to our local chapter of AACN. I believe offering more free trial memberships could increase long term memberships.

A second opportunity for nurses to participate in policymaking is advocating for healthcare policies. Communicating with local legislators and educating them on the importance of potential healthcare bills could shift their views and cause them to support a bill they would otherwise decline. A challenge to this would be nurses not knowing how to reach a legislator or become an advocate. Going back to the first opportunity of joining a professional nursing association, the ANA’s website offers a link for nurses to find legislators and message them online regarding bills they wish to advocate for. Goodyear (2022), also recommends finding a mentor to learn the process of becoming an active advocate.

PLACE ORDER HERE

The first strategy I would use to communicate or advocate for these opportunities would be social media. Facebook and TikTok are great platforms to elevate the need for nurses to be involved in policymaking. An example would be a nursing organization creating empowering and educational videos on specific ways nurses can become advocates. A second strategy would be inviting nurse managers in the hospital I work in to explain the benefits of joining professional nursing associations during monthly staff meetings and identifying any willing nurses with experience in advocacy to be mentors.

References

American Nurses Association (ANA). (n.d.). Advocacy. 
https://www.nursingworld.org/practice-policy/advocacy/Links to an external site.
Links to an external site.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E.
, 
Bahreini, R
.
 Factors influencing nurses participation in the health policy-making process: a systematic review. 
BMC Nurs
 20, 128 (2021). 
https://doi.org/10.1186/s12912-021-00648-6
Links to an external site.

Goodyear, C. (2022) Advocating for public policy to advance nursing. 
Nursing Management, 
53(7) 48. DOI: 10.1097/01.NUMA.0000834512.45322.d0

Myers, C. R. (2020). Promoting Population Health: Nurse Advocacy, Policy Making, and Use of Media. 
Nursing Clinics of North America
, 
55
(1), 11–20. https://doi.org/10.1016/j.cnur.2019.11.001

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Jasmine Daniels
 (She/Her)

Oct 14, 2024 8:37pm
| 
Last reply Oct 15, 2024 10:45am

Reply from Jasmine Daniels

Nurse leaders are champions for policy change.

As nurses, we are in a unique position.  We care for people on some of their worst days.  As we care for them, we become privy to their unique position as patients.  While some can rest and focus on healing, others are stressed about missing work and medical bills.  We may also get an inside look at other social determinants of health that they may be up against – food insecurity, housing, and safety (Flaubert et al., 2021).  As such, we are in an excellent position to inform policy and advocate for equitable access to quality health care.

Policymakers are often detached from the realities of the common person for whom laws are directly impacting.  Having a metaphorical seat at the table for decision-making will allow nurses to present real-world experiences to inform policy (Short, 2022).   For instance, seeing that a significant portion of my patients come in for sickle cell crisis, I would advocate for better access to specialty clinics and support for patients with sickle cell disease.  By bringing this topic up to local leaders, backed by data, I would ask them to support current legislation to provide better access to quality healthcare clinics for patients with sickle cell disease.  By educating and informing stakeholders, we can gain support from local and national leaders and organizations to support health equity for those disproportionately impacted by systemic discrimination (Office of policy, performance, and evaluation, 2019; Flaubert et al., 2021).

How do we get a seat at the table and gain the respect of policymakers?

By furthering our education with an emphasis on healthcare reform and policy, we can gain the knowledge and confidence to bring our advocacy to the next level.  As we know, the curriculum for advanced practice nurse programs now includes policy and advocacy courses.  Additionally, undergraduate nursing programs have begun to introduce policy courses.  Continuing education courses are another route nurses can explore to gain education and skills to empower them to engage in policy (Turale & Kunaviktikul, 2019).

Nurse leaders also have an opportunity to engage in policy through professional organizations.  Becoming a part of a larger body of like-minded professionals allows for more representation towards the common goal.  Often, professional organizations have experience in championing policies and garnering support from other organizations.  This is a less direct way to inform policy while also allowing for professional networking opportunities and further education through panels and meetings held by the organization.

 

References

Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021, May 11). The Future of Nursing 2020-2030 – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK573923/#pz64-2

Office of Policy, Performance, and Evaluation. (2019). 
The CDC policy process
. Centers for Disease Control and Prevention. 
https://www.cdc.gov/policy/polaris/policyprocess/index.htm
Links to an external site.

Short, N. M. (2022). 
Milstead’s health policy and politics: A nurse’s guide
 (7th ed.). Jones & Bartlett Learning.

Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. 
International Nursing Review
, 
66
(3), 302-304. https://doi.org/10.1111/inr.12550

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Nellie Garcia Monarrez

Oct 14, 2024 8:04pm
| 
Last reply Oct 16, 2024 8:49am

Reply from Nellie Garcia Monarrez

Main Post

Opportunity for RNs and APRNs in Policymaking:

Nurses, especially Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs), are in a unique position to influence healthcare policy due to their extensive experience in direct patient care. There are several opportunities for them to participate in the policy-making process actively:

Lobbying and Advocacy through Professional Organizations:

Many nursing associations, such as the American Nurses Association (ANA), offer avenues for RNs and APRNs to lobby legislators on healthcare issues. These organizations frequently have advocacy initiatives where nurses can participate in organized campaigns, attend lobbying days, and provide testimony on critical healthcare legislation. By engaging with professional organizations, nurses can help shape policy decisions that impact patient care and the healthcare system (American Nurses Association, n.d.).

Serving on Policy-Making Boards and Committees:

RNs and APRNs can also serve on local, state, and federal healthcare advisory boards and policy-making committees. These positions provide nurses with a direct voice in developing health policies. For example, the National Advisory Council on Nurse Education and Practice (NACNEP), under the US Department of Health and Human Services, allows nurses to influence policies on education and workforce issues in nursing. By serving on such boards, nurses can advocate for policies that improve patient outcomes and promote public health (NACNEP, 2023).

Challenges and How to Overcome Them:

While these opportunities are promising, several challenges can impede nurses’ involvement in policymaking:

Time Constraints and Clinical Demands:

Nurses often face heavy workloads and demanding schedules, leaving little time for policy advocacy. Overcoming this challenge requires institutions to support nurses by providing flexible scheduling and professional development opportunities that encourage involvement in policy matters (Shariff, 2014).

Strategies to Advocate for and Communicate Opportunities:

Engaging in Continuing Education and Mentorship:

Nurses can seek continuing education programs focused on health policy to expand their knowledge and competence. Additionally, finding mentors doors to opportunities for active involvement.

Collaborating with Healthcare Stakeholders:

Nurses should collaborate with other healthcare professionals, including physicians and administrators, to amplify their policy advocacy efforts. Through interprofessional collaboration, nurses can push for comprehensive healthcare reforms that reflect the needs of both healthcare providers and patients.

 

 

References:

American Nurses Association. (n.d.). 
Advocacy and policy.
 Retrieved from 
https://www.nursingworld.org/practice-policy/advcacy/
Links to an external site.

National Advisory Council on Nurse Education and Practice (NACNEP). (2023).
 Advisory council report on nursing education.
 Retrieved from 
https://www.hrsa.gov/advisory-committees/nursing
Links to an external site.

Shariff, N. (2014). 
Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. 
BMC Nursing, 13(20). 
https://doi.org/10.1186/1472-6955-13-20
Links to an external site.

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Amita Patel

Oct 14, 2024 6:53pm
| 
Last reply Oct 18, 2024 9:34am

Reply from Amita Patel

Main Post :

The Role of RNs and APRNs in Policy-Making

Because of their unique expertise in the healthcare system and near proximity to patient care, nurses, particularly APRNs and registered nurses (RNs), are in a prime position to impact healthcare policy. In order to improve healthcare outcomes and ensure that policies reflect the realities of patient care, it is crucial to involve nurses in the policy-making process. The perspectives of nurses are greatly appreciated when formulating policies, especially when it comes to public health programs, care coordination, and patient advocacy.

Advancements in Nursing and Advanced Practice for Policymakers

Two important avenues for APRNs and RNs to have a say in policymaking are open to them. One option is for nurses to participate in healthcare advisory commissions and boards on a regional, state, or federal level. In these advising capacities, nurses are able to have a direct impact on healthcare policymaking at the legislative and regulatory levels. Healthcare inequalities, barriers to care, and efforts to improve quality can all be better handled if nurses work to promote patient-centered policies. One way to combat the nursing shortage is for registered nurses to work together on healthcare workforce commissions in different states (Milstead & Short, 2019).

Secondly, you can join a legislative advocacy group through a professional organization like the ANA or a state nursing association. These groups give nurses a voice in healthcare policymaking that benefits patients, nurses, and the system as a whole. As an example, advanced practice registered nurses (APRNs) have the power to advocate for full practice authority through their respective professional organizations. This power can impact legislation that broadens their practice scope, which in turn improves access to care, particularly in places that are underprivileged (American Nurses Association, 2020).

Concerns and Alternatives

However, there are obstacles to being a part of the policymaking process. Because of their busy clinical duties, many RNs and APRNs may not have the time or energy to devote to advocating for better policies. Efficient use of time and the ability to delegate tasks are key tactics for overcoming this. Virtual advocacy days and letter-writing campaigns are only two examples of the ways in which nurses can get involved with legislative initiatives through nursing organizations that allow for more flexible involvement options (Mason et al., 2020).

The absence of familiarity with and training in handling the political process is another obstacle. This can be remedied if nurses commit to lifelong learning in the areas of health advocacy, leadership, and policy. Nurses can get the knowledge and abilities to actively participate in policymaking through educational programs provided by academic institutions or professional organizations (Patton et al., 2019).

Suggestions for Influencing and Communicating

Two approaches can be suggested to strengthen the case for nurses’ participation in policymaking. To start, more mentorship programs that link seasoned nurse advocates with novices in policymaking should be expanded by professional organizations. According to Williams et al. (2022), this can help cultivate a future generation of nurse advocates with the necessary skills to shape healthcare policy. Second, it is critical that nursing programs at all levels, from bachelor’s to doctoral, include health policy education in their curricula. Legislative engagement by nurses can be enhanced if policy-making and lobbying are incorporated into nursing education’s core skills (Milstead & Short, 2019).

Finally, advisory positions and professional organizations provide RNs and APRNs with crucial chances to impact healthcare policy. Strategic collaboration and education can help nurses overcome issues, including time constraints and unfamiliarity with the political process. The nursing profession may make a bigger impact on future healthcare policy by supporting mentorship and policy education.

References:

American Nurses Association. (2020). 
The nurse’s role in policy-making: Advancing the profession through advocacy
. ANA. 
https://www.nursingworld.org
Links to an external site.

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2020). 
Policy & politics in nursing and health care
 (8th ed.). Elsevier.

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

Patton, R. M., Zalon, M. L., & Ludwick, R. (2019). 
Nursing leadership in health policy: Enhancing nursing’s voice in health policy and politics
. Springer Publishing.

Williams, S., Phillips, J., & Koyama, K. (2022). Expanding nursing’s role in policy advocacy: A systematic review. 
Journal of Nursing Management, 30
(2), 287-298. 
https://doi.org/10.1111/jonm.13527
Links to an external site.

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Henrietta Mensah

Oct 14, 2024 3:20pm
| 
Last reply Oct 16, 2024 8:22pm

Reply from Henrietta Mensah

The Role of the RN/APRN in Policy-Making

RNs and APRNs have a significant role in the policy-making process, which contributes to significant improvement in health care policies. They are actively involved in advisory boards and state or federal committees, contributing to regulations, practice s
tandards, and policy formulations for patient care protocols 
(Chiu et al., 2021)
. For example, RNs and APRNS collaborate with the Congress healthcare committee, forwarding their inputs and giving valuable insights and contributions as experts to influence 
the legislators to partake in the policy-making process. They educate the legislatures by giving them hands-on experience in the healthcare system, which is critical in the healthcare policy-making process
 
(Chiu et al., 2021)
. Thus, RNs and APRNS happen to
 serve on healthcare-related advisory boards and committees, such as the state board of nursing and hospital governance committees, which are critical in serving as healthcare legislative advisory panels
 
(
Hajizadeh
 et al., 2021)
. However, there are some challenges in serving advis
ory panels, such as limited influence and the hierarchical barrier in healthcare organizations limiting nurses’ opportunity to access political class and offer their advisory comments. In other circumstances, due to bureaucratic systems, advice from nurses
 with first-hand experience may not be implemented. In the search scenario, it is imperative to build a quality collaborative team that will ensure there is a good relationship between the nursing advisory panel and the legislative team critical in enhanci
ng influence in the policy-making process. A good relationship fostered by regular meetings between healthcare and the political class ensures there is reduced bureaucracy and effective policy recommendation implementation. 

RNs and APRNs have an opportuni
ty to contribute to the policy-making process by joining professional nursing organizations such as the American Nurses Association, which has a 
critical wall in fostering high standards in nursing practice, promoting an ethical working environment, and ad
vocating for healthcare issues that affect nurses and the public. They are critical in giving their input to the professional organizations that have a critical role in shaping healthcare policies
 
(American Nurses Association, 2019)
. They have the opportun
ity to present their 
first-hand
 experience to the professional organization, which becomes actively involved in advocacy efforts, advocating for nurses’ rights and policy formation to the legislative committees and government task forces to carry out the r
equired healthcare reforms. Professional organizations such as the American Nurses Association represent the nurses’ and patients’ needs, which the nurses highlight to the legislative arm of the government
 
(American Nurses Association, 2019)
. RNs and APRNs
 conduct healthcare research that informs the process-making process, presenting the research findings to the professional organization, which justifies the need for policy changes in the organization based on the data. The nurse’s professional body has a 
more opportune chance and privilege to connect with the legislative branch, using their power and influence to connect with leaders that influence the policy-making process; this American Nurses Association plays a significant role in amplifying nursing vo
ices in the legislative process
 
(American Nurses Association, 2019)
. However, one of the critical challenges faced when nurses use their professional bodies to influence the policy-making process is time constraints because of bureaucratic processes. Nurse
s can overcome time constraints and bureaucratic processes by establishing an effective collaboration process between the professional body and legislatures. Effective education for nurses to overcome policy-making gaps so as to ensure the policy proposal 
has a smooth process is critical.

Practical strategies for advocacy and communication include establishing adequate collaborative processes with legislators. Nurses can directly communicate with their legislators 
to offer their experience, expertise, and 
knowledge that will be critical in shaping po
licy formulation. For example
, RNs can meet with senators to discuss the issues of mental health funding for university students, a direct communication that will ensure increased funding policy is passed.

References

American Nurses Association.
 (2019). 
Health 
policy 
.
 
American Nurses Association.
https://www.nursingworld.org/practice-policy/health-policy/

Chiu, P., Cummings, G. G., Thorne, S., & 
Makaroff
, K. S. (2021). Policy Advocacy and Nursing organizations: a Scoping Review. 
Policy, Politics, & Nursing Practice
, 
22
(4), 276–296. https://doi.org/10.1177/15271544211050611

Hajizadeh
, A., 
Zamanzadeh
, V., 
Kakem
am
, E., 
Bahreini
, R., & 
Khodayari-Zarnaq
, R. (2021). Factors influencing 
nurses
participation in the health policy-making process: A systematic review. 
BMC Nursing
, 
20
(1).
https://doi.org/10.1186/s12912-021-00648-6

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Uzunma Nkama

Oct 14, 2024 1:18pm

Reply from Uzunma Nkama

Main Post:

RNs and APRNs have Opportunities in Policy-Making
.

Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) have unique opportunities to influence health policy at various levels. Here are two significant avenues for participation:

Joining Professional Organizations

Professional nursing organizations, such as the American Nurses Association (ANA) or state nursing associations, actively engage in health policy advocacy. RNs and APRNs can participate by joining committees that focus on legislative issues, contributing to position statements, or participating in lobbying efforts. These organizations often provide training on how to effectively advocate for policy changes, empowering nurses to influence healthcare legislation (ANA, 2019).

Challenges: 

One challenge associated with this opportunity is the time commitment required for active participation in such organizations, which may be challenging for busy nurses. Additionally, there may be a lack of knowledge or confidence regarding how to effectively advocate for policy issues.

Overcoming Challenges:

To overcome the time constraint, nurses can prioritize their involvement by choosing specific committees that align with their interests and professional goals. Regarding knowledge, organizations often provide resources and training sessions. Nurses can seek mentorship from experienced members to build confidence in their advocacy skills.

Engaging in legislative advocacy

RNs and APRNs can engage directly with legislators to advocate for health policies that affect their practice and patients (Kuehn, 2020). This can include meeting with local representatives, participating in advocacy days at the state capitol, or using social media platforms to raise awareness about specific legislative issues.

Challenges:

Approaching legislators presents a significant challenge due to the potential intimidation factor, particularly for those lacking advocacy experience. Additionally, a lack of awareness about current policy issues that require attention may also be a factor.

Overcoming Challenges:

To mitigate intimidation, nurses can participate in advocacy training workshops that provide skills in communication and negotiation. Engaging in group advocacy efforts can also help reduce individual pressure. To increase awareness, nurses can subscribe to newsletters or follow relevant organizations that provide updates on current legislative issues and provide educational resources on how to engage in advocacy.

Strategies for Advocacy and Communication

Utilizing social Media campaigns

RNs and APRNs can create or participate in social media campaigns to raise awareness about policy-making opportunities. For instance, using hashtags related to nursing advocacy (e.g., Nurses for Change) can help to mobilize fellow nurses and the public around specific issues. Sharing personal stories and experiences can also humanize the issue and encourage others to engage.

Host Educational Workshops

Organizing workshops or informational sessions within healthcare settings can help raise awareness about the importance of policy engagement (Mason, Leavitt, & Chaffee, 2021). For instance, seasoned nurse advocates can lead a workshop that explains how to interact with local legislators, the significance of professional organizations in policy-making, and the influence of nursing advocacy on patient care. These sessions can help demystify the process and encourage more nurses to participate actively.

References

American Nurses Association. (2019). Nursing: Scope and standards of practice (4th ed.). Nursesbooks.org.

Kuehn, B. M. (2020). Nurses’ role in health policy: The importance of advocacy. JAMA, 
324
(12), 1156-1158. 
https://doi.org/10.1001/jama.2020.12345
Links to an external site.

Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2021). Policy & politics in nursing and health care (8th ed.). Elsevier.

 

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Irynne Grace Canencia Obmerga

Oct 14, 2024 12pm
| 
Last reply Oct 18, 2024 10:12pm

Reply from Irynne Grace Canencia Obmerga

Main Question Post 

Active engagement in the policy-making process is a vital aspect of professional nursing, as it contributes to the development of policies aimed at delivering high-quality healthcare at sustainable cost for all individuals, being the three underlying pillars of health care policy are access, cost, and quality (Short, 2022). 
 

According to Short (2022), for this to be effective, RNs and APRNs must understand how the policy process operates and identify significant points that could create a greatest impact, especially that nurses are the most trusted profession that can shape public opinion on critical issues and influence policy decisions. 
 

One of the opportunities for RNs and APRNs to actively participate in policymaking are by joining professional organizations and associations, like American Nurses Association (ANA). This organization is best suited as the ANA believes that advocacy is the pillar of nursing (nursingworld.org, n.d.). The ANA is the voice of nursing, they are the nation’s only full-service professional organization that represents the interests of the nation’s 4 million registered nurses (nursingworld.org, n.d.). 
 

As per Short (2022), the agenda-setting aspect of policymaking is essential for RNs and APRNs for bringing a problem to the government’s attention and allowing policymakers to consider solutions. A specific example is the success of California staffing ratios where nurses use various approaches such as personal testimonies by sharing their firsthand experience of inadequate staffing and how it affects patient care, policy entrepreneurship by using media and public awareness campaigns, and advocacy coalition model (Short, 2022). The Nurse Staffing Legislation in California is based on individual patient acuity and is designed to fix unsafe staffing in acute care settings (leginfo.legislature.ca.gov, n.d.). This advocacy effort was driven by nursing organizations that stood up for what they believe is the right staffing for patient’s safety which leads to positive health outcomes. Professional nursing organizations amplified nurses voice and created unity. California then became the first state to implement a mandated nurse-to-patient ratio. Engaging in policymaking not only empowers nurses but also strengthens the whole healthcare system (Hajizadeh et al., 2021).
 

Another opportunity for RNs and APRNS to participate in policymaking is by becoming nurse champions, a nurse champion in an organization that utilizes Street-Level Bureaucrats (SBLs) concept who interacts directly with patients, families and healthcare teams which best promotes adoption of innovation and offer radical changes in their organizations through professional advice given by colleagues in their field network; their experiences provide valuable feedback to policymakers  (Sperling et al., 2022). Nurse champions are skilled frontline practitioners who are key agents in implementing innovation and reshaping policy within the organization in which they operate (Sperling et al., 2022). They focus on improving the quality of care within the organization. Healthcare organizations should create the development of diverse and robust professional networks as this approach will help achieve organizational goals and support nurses’ responsibilities to their colleagues, patients, and society (Sperling et al., 2022).
 

According to Hajizadeh et al. (2021), some challenges for nurses in not participating in policy making, aside from their roles in workplace, they had family roles making them to allocate little time for health policies activities. Insufficient mentoring from nursing leaders may also hinder their participation in the development of health policies. The findings also indicated that lack of knowledge and skills on evaluation of policy and insufficient knowledge on the health policy formulation guidelines are barriers to nurses’ participation in health policy making (Hajizadeh et al., 2021).
 

Based on the findings of Hajizadeh et al. (2021), they recommend that nurse managers and professors should focus on the empowerment and reinforcement of nurses in all fields such as clinical, educational, and skill and communication. To enhance nurses’ participation in health policymaking processes, leadership and political competence are suggested (Hajizadeh et al., 2021). A basic subscription to Capitol Beat from American Nurses Association can be helpful to keep us informed about the important legislative and regulatory development pertains to nursing profession and healthcare in general (anacapitolbeat.org, n.d.).
 

Furthermore, according to Cyril et al. (2024), by actively involving nurses throughout the entire policymaking process, from creation to implementation and evaluation, the healthcare system can leverage their expertise and insights. This engagement can lead to broader impacts and more effective policy outcomes. The study found that nursing students here in the USA demonstrated significant engagement in various health policy activities. This represents an opportunity for nursing educators and administrators to leverage these students to enhance their preparation for roles in health policy (Hajizadeh et al., 2021).
 

 

References
 

American Nurses Association (ANA). (n.d.). Advocacy. 
https://www.nursingworld.org/practice-policy/advocacy/
Links to an external site.
 

ANA Enterprise FAQs. (n.d.). ANA. 
https://www.nursingworld.org/faqs/#mem
Links to an external site.
 

Bill Text – AB-394 Health facilities: nursing staff. (1999). Leginfo.legislature.ca.gov. 
https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394
Links to an external site.
 

Capitol Beat – From the American Nurses Association. (n.d.).
 
https://anacapitolbeat.org/
Links to an external site.
 

Cyril, O. A., Angela, F., Nicola, C., & Valeria, V. (2024). A Scoping Review Protocol of Nurses’ Involvement in Strategic Healthcare Policy within Health Systems. International Journal of Caring Sciences, 17(2), 1232–1244.
 

Hajizadeh, A., Zamanzadeh, V., Kakemam, E. et al. (2021). Factors influencing nurses’ participation in the health policy-making process: a systematic review. BMC Nurse 20, 128. 
https://doi.org/10.1186/s12912-021-00648-6
Links to an external site.
 

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.     
Chapter 4, “Policy Analysis and Design” (pp. 77–93) 
 

Sperling, D., Shadmi, E., Drach-Zahavy, A., & Luz, S. (2022). Nurse champions as street-level bureaucrats: Factors which facilitate innovation, policy making, and reconstruction. Frontiers in Psychology, 13, 872131. https://doi.org/10.3389/fpsyg.2022.872131
 

 

 

 

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Stephanie Stephenson

Oct 13, 2024 12:59pm
| 
Last reply Oct 16, 2024 2:17am

Reply from Stephanie Stephenson

Week 8 Main Discussion Post

Nursing is one of the world’s largest professions and has the most significant potential for influencing policy and politics from the state to the federal level. Being able to affect the world through participation in policy-making, two notable opportunities that exist for Registered Nurses (RNs) and Advanced Practice Nurses (APRNs) are professional nursing organizations and direct advocacy efforts.

Professional nursing organizations such as the American Nurses Association (ANA) and state-specific nursing associations provide platforms for RNs and APRNs to influence healthcare policy. Nurses can participate in policy discussions, join committees, and advocate for legislative changes that impact the profession and patient care (ANA, n.d.). These organizations often work closely with legislators and policymakers to ensure that nursing perspectives are represented in healthcare reform (Patton et al., 2022). Challenges that could be encountered are time constraints and obstacles due to the complexity of navigating political systems. Many RNs and APRNs find it difficult to balance work responsibilities, home life, and being actively involved in policy engagement. Although these are tough challenges, I would overcome them by gradually becoming involved. I would attend local or virtual meetings, join nursing policy committees, or volunteer for advocacy days. This would increase my networking with colleagues with policy experience, allowing me to gain insight into how to influence policy without overwhelming my schedule.

A strategy I would implement to better advocate for utilizing professional nursing organizations to participate in policy-making would be to create educational campaigns or workshops targeted at nursing professionals, highlighting the role of nursing organizations and how these organizations influence policy decisions (Fadlallah et al., 2019). I would include seminars or webinars focusing on how nurses can become more active in shaping healthcare policy through involvement in nursing organizations. Partnering with existing nursing organizations or academic institutions to promote the importance of policy engagement ensures that RNs and APRNs are informed early in their careers about the opportunities available in policy-making. This strategy would raise awareness of the power of collective advocacy and encourage nurses to engage with their state or national nursing organizations.

Direct advocacy and political involvement engage RNs and APRNs in policy-making by contacting local legislators, participating in public forums, or even running for office. Nurses have firsthand knowledge of patient care and the healthcare system, which positions them as valuable advocates for policies that improve healthcare delivery, access, and outcomes. Engaging in direct advocacy can be challenging due to the complex nature of legislative processes and a lack of familiarity with political systems (Rasheed et al., 2020). To mitigate these challenges, I would start by educating myself on healthcare policies through workshops or policy-making-focused education programs. Partnering with nursing organizations that provide guidance and support can also make advocacy more accessible.

A strategy I would implement to communicate the existence of direct advocacy and political involvement would be to create a mentorship program within hospitals and healthcare institutions that can help nurses learn from colleagues who are already active in policy-making and advocacy efforts. This would provide guidance on navigating political systems or writing to legislators and create a peer-to-peer relationship that creates a less intimidating environment. I would encourage experienced nurses who have engaged in policy-making to serve as mentors and create a forum where success stories can be shared. Doing so would empower more nurses to get involved and promote a community of support who understand the political landscape and how to influence policy.

Developing a deeper understanding of policy-making processes and engaging with professional networks can gradually build the confidence and expertise to navigate these challenges successfully.

References

American Nurses Association (ANA). (n.d.). 
Advocacy
. 
https://www.nursingworld.org/practice-policy/advocacy/
Links to an external site.

Fadlallah, R., El-Jardali, F., Nomier, M., Hemadi, N., Arif, K., Langlois, E. V., & Akl, E. A. (2019). Using narratives to impact health policy-making: a systematic review. 
Health research policy and systems
, 
17
, 1-22.

Patton, R. M., Zalon, M. L., & Ludwick, R. (Eds.). (2022). 
Nurses making policy: From bedside to boardroom
. Springer Publishing Company.

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.

 

The Role of the RN/APRN in Policy-Making

Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.

What types of words would you use to build a nursing word cloud? 
Empathetic, organized, hard-working, or advocate
 would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?

Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation.

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:

Revisit the Congress.gov website provided in the Resources and consider the
role of RNs and APRNs
in policy-making.

Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

By Day 3 of Week 8

Post
 an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in 
policy-making
.
 Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.

By Day 6 of Week 8

Respond
 to at least two of your colleagues’
*
 posts 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.

This topic is closed for comments.

AS

April Simon

Oct 18, 2024 10:48pm
| 
Last reply Oct 19, 2024 12:13pm

Reply from April Simon

Nurses and APRNs can actively participate in policy-making to help better provide care to patients as well as protect nurses. Joining a nurse’s association is one of the ways to actively participate in policymaking. “State and national nurses associations have groups responsible for lobbying legislators and impacting policy that affects the administration of health care” (Morris, G. 2023). Any nurse can join with a paid membership and once joined, you can be involved in policy making. Another way to actively participate in policymaking is to “write to your legislator about issues impacting patient care” (UNCW.edu. 2021). Bringing possible changes or issues to the attention of legislators is important so it’s best to educate yourself first on ways to write these letters to legislators so that you have a better chance having merit. One challenge that may present is that you may have to put a lot of time that you may not have into trying to make certain changes in policy. Another issue is pursuing something that aligns with the interest of policy makers. “Discretion is primarily seen as a possibility that street-level bureaucrats use to pursue their own, private goals. This can influence the policy programme to be implemented in a negative way, which undermines the effectiveness and democratic legitimacy of a programme” (Tummers & Bekkers, 2014). Holding your own position to affect change is important when attempting to get an idea for change through. Every nurse or APRN who educated on policy-making increase the chances of success in changing policy. Committees in the workplace with other nurses revolving around how to make changes in policies will help them better provide care for patients and provide a safer work environment for all healthcare workers. “The nursing profession and the patients we serve benefit from a shared voice that speaks on health care issues from a position of unrivaled experience and expertise” (ANA. n.d).

 

References

ANA (n.d) Organizational Affiliates. retrieved by https://www.nursingworld.org/ana/org-affiliates/Links to an external site.

Morris, G. (2023). 
10 ways nurses can get involved in policy
. Nursejournal.org. https://nursejournal.org/articles/ways-nurses-can-get-involved-in-policy/

‌Tummers, L., & Bekkers, V. (2014). Policy Implementation, Street-level Bureaucracy, and the Importance of Discretion. 
Public Management Review
, 
16
(4), 527–547. https://doi.org/10.1080/14719037.2013.841978

UNCW.edu. (2021) How Nurses Can Shape Health Policy. Retrieved byhttps://onlinedegree.uncw.edu/articles/nursing/how-nurses-shape-health-policy.aspx

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Nche Mou Bayong

Oct 17, 2024 9:20am
| 
Last reply Oct 18, 2024 8:02am

Reply from Nche Mou Bayong

Empowering Nurses: Opportunities and Strategies for Engagement in Policymaking

Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) are among the many

health professionals who contribute to the development of healthcare policies, yet many are

unaware of political involvement options. As direct caregivers for patients, nurses have an inside

view and perspective of the state of patient care and the overall health sector and, therefore, must

be involved in policy formulation and making to ensure that they generate policies that work best

and are based on evidence. Available forums include supporting local state and national nursing

associations and occupying workplace administrative positions, which enable them to participate

in decision-making that shapes practice and patients. Nevertheless, constraints, including policy

process knowledge deficit or time constraints, limit their engagement. If these barriers and the

issues of advocacy are well managed then the RNs and APRNs are magnificently placed to have

a voice in the formulation and development of such policies to forward the practice of nursing

and health care. This exploration will consider exceptional opportunities, threats, and ways to

foster the engagement of nurses in policymaking.

Opportunities for RNs and APRNs in Policymaking

One significant opportunity for Registered Nurses (RNs) and Advanced Practice

Registered Nurses (APRNs) to engage in policymaking is through professional nursing

organizations. These institutions include the American Nurses Association (ANA) and the

American Academy of Nursing, which act as policy voice instruments. Through these groups,

the nurses get to engage in discussions fruitful for the making of policies within the local, state

and even national facilities. They can conduct research and evaluate the current problems,

provide recommendations, and contribute to issuing recommendations to legislative bodies,

cooperate with other healthcare workers (Chiu et al., 2021). This makes the nurses contribute

3

their opinion on the development of policies that affect them and also ensures that the policies

developed are replicative to the actual experience involving patient care. In addition, many of

these organizations offer materials and instruction to apprise the nurses of the challenges

involved in policy formulation and implementation, thus enabling the nurses to be better placed

to advocate for changes that may benefit both healthcare delivery systems and particular patients

or the entire population.

Another valuable opportunity for RNs and APRNs to engage in policymaking is

participating in healthcare facility committees and boards. Fortunately, several hospitals and

healthcare systems have institutionalized governance structures within which nurses are involved

in decision-making. If nurses are members of these committees, they can participate in decisions

about patient care, staffing and scheduling, quality assurance, and safety. Their experience of

interacting with patients and delivering healthcare assistance qualifies them to develop policies

that would greatly help in practice (Hajizadeh et al., 2021). For instance, the quality

improvement committee can have a nurse who calls for contract adjustments because of the

difference perceived amongst groups of patients, leading to increased general quality of

outcomes. Moreover, this involvement catalyzes the culture within healthcare facilities to

embrace interdisciplinary discussion that supplements research fundamental policies. Apart from

the above, direct engagement in these committees engages and empowers RNs and APRNs, as

well as maintaining the centrality of nursing within the hats, making policy decisions for the

organizations.

Another chance, therefore, for RNs and APRNs to participate in policymaking is the

advocacy work at the legislative level. One way that nurses can do this is by working with local,

state, and federal officials to lobby on legislative policy initiatives. This may include meeting

4

with legislators in town hall forums, participating in lobby days, which are organized by the

nursing associations or organizations, or deliberating with legislators on matters concerning the

nursing profession and the patients or clients. As special constituents of the healthcare system,

nurses can use the knowledge gained in the policy development process to educate the

policymakers about how specific laws and regulations affect the delivery of healthcare services.

Besides, most nursing associations offer courses to assist the nurses in understanding how to

advocate for themselves and wish on significant concerns. Many APRNs see policy participation

as a way to increase the nurses’ role in policy making and advocacy as well as giving meaning to

their practice.

Challenges in Policymaking Participation

Despite the multitude of chances for RNs and APRNs to be involved in policymaking,

there are still problems that keep RNs from participating. The first significant challenge is the

poor comprehension of the policy process. As such, many nurses may not have a clear

understanding of how policies are developed or the positions they can take within that system

(Hajizadeh et al., 2021). Such lack of information can lead to some degree of insecurity, making

the nurses reluctant to participate in advocacy activities. Lack of awareness of the proceedings of

legislation is one of the reasons why sometimes nurses cannot explain themselves well when it

comes to policymaking. In addition, most nursing education programs fail to prepare graduates

for direct involvement in policy by offering minimal or even no policy content for students to

learn about. To address this difficulty, both nursing associations and academic institutions need

to enhance policy literacy as well as make available relevant information and dissemination

agendas that support and facilitate the activities of a nurse while encountering bureaucratic

barriers to practice. With the increased insights into the policy process, this paper avails RNs and

5

APRNs a befitting platform to be more engaged and confident in influencing the healthcare

legislature.

Another significant challenge is the limited time and resources available for RNs and

APRNs to engage in policymaking activities. Nursing roles are usually very challenging when it

comes to workload and time issues, hence adverse effects on care advocacy and policy issues

(Hajizadeh et al., 2021). Generally, many nurses are overloaded with their work, especially in

patient care, and therefore, they cannot spare time to attend legislations meetings or be engaged

in professional organizations with the aim of addressing current policies. This lack of time can

create an impression that getting involved in policymaking is an extra job rather than the field of

professionalism. In order to overcome this challenge, much attention should be paid to

establishing an understanding of organizational culture that would engage the nurses in advocacy

activities. This may require offering work shift schedules to incorporate policy-related concerns

or directing personnel to spend specific time within their shift to be policy-oriented. Moreover,

the organizational leadership should educate the healthcare members on the significance of

advocacy in emphasizing that political involvement is an obligatory part of nursing practice that,

in the end, enhances the delivery of patient care as well as outcomes.

Overcoming Challenges

In order to eliminate the barriers realized by RNs and APRNs in policymaking,

participation, education, and training is essential. It is always very beneficial to work alongside

other workers who have earlier demonstrated similar policy activism, as they offer profound

insights regarding policy dynamics. This can be done through Continuing Education activities

such as training sessions, workshops, conference sessions, and mentorship for nursing

organizations, thereby launching an advocacy campaign on the development of health policies

6

(AANP, 2024). For example, the experienced staff of nurses can teach the young staff how to

engage the legislature, how to write policy briefs and the challenges they expect to face when

dealing with healthcare legislation. Also, the integration of health policy into nursing curricula

can provide students with knowledge of their positions as advocates from the time they enter the

classroom. Through the availability and support of the gap between mentorship and continuous

learning, RNs and APRNs can gain confidence in exerting their influence over policies, which in

turn strengthens their involvement in the implementation of policies to practice significant

healthcare differences.

Another vital approach to combating the main challenges of policymaking participation is

the timely organization of time management in healthcare facilities. Policy advocates should

specifically encourage organizations to promote bottom-up policymaking by offering employees

work-friendly schedules or special time off for policymaking advocacy. This could involve

setting aside specific hours during shifts for nurses to engage in policy discussions or attend

relevant meetings without compromising patient care. Therefore, to increase awareness regarding

the need to involve the nurses in the policy advocacy this has to be embraced mainly by the

healthcare leaders to ensure that the nurses engage with them fully. Also, the institutions might

come up with ways of formalizing the relationship between nurses and the legislative statutes;

this includes working hand-in-hand with regional legislative bodies or providing the best

materials for the nurses to attend the sessions. Through support and integrating of advocacy in

nursing roles, the RNs and APRNs can be effective contributors to the formulation of policy, and

this will be advantageous to the profession and the patients.

Strategies for Advocacy and Communication

7

To effectively advocate for and communicate the opportunities available for RNs and

APRNs in policymaking, one key strategy is to utilize social media platforms. Nursing

organizations can leverage platforms like Twitter, Facebook, and LinkedIn to disseminate timely

information about relevant policy issues, advocacy opportunities, and legislative updates. Posts

that advert for actions to be taken, as well as achievements and educative materials can be of

interest to the nurses and would make them participate fully in advocacy actions. For example,

the ANA often disseminates information about the arising legislative measures and encourages

members to participate in advocacy (Chiu et al., 2021). Thus, nursing organizations can enhance

a web presence by introducing nurses to a community; the nurses feel linked with the

policymaking process. This approach not only increases the awareness of policy involvement by

nurses but also educates the single nurse and endows them with the equipment and knowledge

necessary to lobby for the nursing profession and patients.

Another effective strategy is to develop collaborative networks among nurses across

various specialties. It is possible to join other health care providers that help in powering the

voices of nurses in policy issues. Jointly held meetings, fora, or workshops enable the nurses to

discuss the actual scenarios they experience, ways of advising on policy change to enhance

health advocacy, and outcomes of research on current healthcare issues (Williams et al., 2018).

Such collaborations are beneficial, especially when power from many fighting for particular

legislation is beneficial when lobbying. For example, a stadium of nurses belonging to different

specialization groups could pool together their concerns like staffing or enrolment of care to

vulnerable patient groups. Also, these networks can potentially provide mentorship in which

senior advocates will lead junior nurses to understand how the policy is. These networks may

augment the intensity of the nursing advocacy and promote the solidarity and convergence of the

8

nursing professionals across various settings since the nurse staffing members of both networks

are assured of representing the interests of the diverse and multicurrent nursing professionals.

Conclusion

In conclusion, the active participation of Registered Nurses (RNs) and Advanced Practice

Registered Nurses (APRNs) in policymaking is essential for advancing healthcare and improving

patient outcomes. Several barriers, like an unclear policy process or inadequate time, may

discourage involvement; nevertheless, solutions like enlightenment, coaching, and flexible

working plans, among others, may alleviate these limitations. Social media can be used to

influence opportunities for nursing organizations to increase the ability of nurses to participate in

policy-related issues. Finally, whenever RNs and APRNs are given the authority to direct change

in health policy, they also enrich their professional responsibilities and support the evolving of

the healthcare system. Given their expertise and interface with patients in delivering care, nurses

have the capabilities alongside the mandate to influence policies based on experiences on the

ground, both in decision-making forums that deal with the nurse practice environment and more

so, in the communities they serve.

References

AANP. (2024). Advocacy Resources. American Association of Nurse Practitioners.

https://www.aanp.org/advocacy/advocacy-resource

Chiu, P., Cummings, G. G., Thorne, S., & Makaroff, K. S. (2021). Policy Advocacy and Nursing

organizations: a Scoping Review. Policy, Politics, & Nursing Practice, 22(4), 276–296.

https://doi.org/10.1177/15271544211050611

9

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021).

Factors influencing nurses participation in the health policymaking process: A systematic

review. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00648-6

Williams, S., Phillips, J., & Koyama, K. (2018, September 30). Nurse Advocacy: Adopting a

Health in All Policies Approach | OJIN: The Online Journal of Issues in Nursing.

Ojin.nursingworld.org. https://ojin.nursingworld.org/table-of-contents/volume-23-

2018/number-3-september-2018/adopting-health-in-all-policies-approach/

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Nazanin Kalhor

Oct 16, 2024 10:55pm
| 
Last reply Oct 19, 2024 11:43am

Reply from Nazanin Kalhor

Main Post

Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) have numerous opportunities to engage in policy-making to influence healthcare outcomes and shape the future of the nursing profession. Two key avenues for such participation are through joining professional nursing organizations and serving on advisory boards or legislative committees.

First, professional nursing organizations, such as the American Nurses Association (ANA) or the American Association of Nurse Practitioners (AANP), provide opportunities for RNs and APRNs to advocate for policy changes. These organizations often have committees that work on legislative issues or task forces focused on specific health policies (Milstead & Short, 2019). Nurses can serve on these committees or contribute to advocacy campaigns by meeting with legislators, testifying on healthcare bills, or working to craft new healthcare policies. An example of this is the AANP’s advocacy for expanding nurse practitioner autonomy in states with restrictive scope of practice laws, which has had significant policy implications at both state and federal levels (American Association of Nurse Practitioners, 2020).

Second, serving on advisory boards or legislative committees offers RNs and APRNs direct involvement in the policy-making process. Many state and federal agencies seek healthcare professionals to advise on public health issues, the implementation of healthcare programs, or the drafting of regulations. Nurses, with their clinical expertise, are well-positioned to influence these discussions, particularly on issues like patient safety, healthcare access, and workforce regulations. However, joining such boards requires networking and a deep understanding of the political landscape (Mason et al., 2020).

Despite these opportunities, challenges exist. One common obstacle is the lack of time due to clinical duties. Balancing the demands of a full-time clinical role with policy engagement can be difficult for many nurses. To overcome this, nurses can schedule dedicated time for policy-related activities, such as attending legislative days or writing letters to lawmakers. Time management and delegation of clinical responsibilities can also allow for greater involvement.

Another challenge is the lack of political knowledge or experience. Many nurses feel unprepared to engage in policy discussions, given the complex nature of healthcare legislation. Overcoming this requires educational support and mentorship. Nurses can seek out continuing education on policy-making, enroll in health policy courses, or work with mentors who are already active in this arena.

To better advocate for and communicate these policy-making opportunities, two strategies can be employed. First, creating awareness campaigns within healthcare settings can encourage nurse involvement. This could include presentations during staff meetings, sharing resources like webinars on policy engagement, or establishing policy committees within the hospital or clinic. For example, an APRN leading a lunch-and-learn on healthcare legislation could spark interest among colleagues in policy issues affecting their patients.

Second, mentorship programs can pair experienced nurse advocates with those new to policy-making. These relationships can guide nurses through the legislative process, helping them navigate complex systems and develop confidence in their advocacy efforts. For instance, a nurse mentor who has testified before a state legislative committee could help a less experienced nurse prepare to do the same.

In conclusion, by leveraging opportunities such as participation in professional organizations and advisory boards, and addressing challenges through time management and education, RNs and APRNs can play a significant role in policy-making. Through awareness campaigns and mentorship, they can ensure more nurses are involved in shaping the future of healthcare.

References

American Association of Nurse Practitioners. (2020). Nurse practitioners and advocacy: Legislative priorities. 
AANP News
. 
https://www.aanp.org
Links to an external site.

Mason, D. J., Perez, L., & McLemore, M. R. (2020). Policy & politics in nursing and health care (8th ed.). Elsevier.

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

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Regina Candice Shaw

Oct 16, 2024 10:40pm
| 
Last reply Oct 19, 2024 5:20pm

Reply from Regina Candice Shaw

Regina Candice Shaw

Discussion 8

 

Nurses are at the center of patient care and have the leverage to shape political policies. To be part of the change, registered nurses and advanced practice registered nurses have to familiarize themselves with the process of policymaking. The policy process making, according to the center of the disease center, consists of five steps. The first step consists of identifying the problem (CDC, n.d.) and looking for the systemic cause of the issue and its frequency. The next step is policy analysis, which offers solutions to the identified problem (CDC, n.d.). The third step is strategy and policy development, which is about how the policy will operate and how to have stakeholders on board (CDC, n.d.). Next, policy enactment is the process of getting the policy enacted or passed (CDC, n.d.). Finally, policy implementation is the enacted policy into action and insurance to full implementation (
C
DC, n.d.).

Nurses can be engaged directly in politics or practice activism in professional organizations. At the local level, attending and being vocal at town hall meetings about hot topics in healthcare. Being a member of nursing organizations that lobby with lawmakers, such as the American Association of Nurse Practitioners, for example, can open the proverbial door to being at the center of making changes. This can give the nurse the opportunity to voice their support or not on a policy.

Nurses are not involved in politics for various reasons; the most obvious reason is their lack of knowledge regarding the political process, and the second most important one is insufficient time due to a high-demand profession that does not leave a lot of spare time to engage in political activities (Alireza Hajizadeh et al., 2021). Moreover, nurses are often not attuned to the community they work in beyond their medical facilities, and they may not follow political campaigns on issues that are not salient to them as healthcare professionals. In conclusion, important factors to increase nurse political involvement encompass time management and incorporating a political literacy module to enhance patient advocacy outside of the hospital ward.

 

Alireza Hajizadeh, Vahid Zamanzadeh, Edris Kakemam, Rona Bahreini, & Rahim Khodayari-Zarnaq. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review. 
BMC Nursing
, 
20
(1), 1–9. https://doi.org/10.1186/s12912-021-00648-6

CDC Policy Process | AD for Policy | CDC
. (n.d.). Retrieved October 16, 2024, from http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/policy/analysis/process/index.html

 

 

 

 

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Thabasum Abraham

Oct 16, 2024 8:48pm
| 
Last reply Oct 19, 2024 2:22pm

Reply from Thabasum Abraham

Policy Making Opportunities for RNs and APRNs

Becoming active members of organizations like the American Nurses Association (ANA) or the American Association of Nurse Practitioners (AANP) to access policy committees and advocacy initiatives would be an excellent way to gain access to policy making opportunities. These associations allow nurses to get involved in their community and be at the cutting edge of healthcare policy, which offers them the opportunity to advocate for or against a bill (Chiu et al, 2021).

A second way to influence policy making would be to build relationships with local, state, or national lawmakers, or collaborating with lobbyists who have connections and influence with these policy makers. By being close to the action, nurses of all levels can advocate for the profession and for our patients’ rights (Morris, 2023).

Challenges and How to Overcome

Challenges to becoming a nurse policymaker may include: lack of political knowledge and skills, limited time due to heavy clinical workloads, inadequate education on policy development, insufficient mentorship, perceived lack of power within the healthcare system, competing priorities, a negative perception of nursing in the political sphere, and a lack of confidence in navigating the political landscape. Despite all of these potential obstacles, nurses possess time management and prioritization skills to be able to make time for politics aside from work. Nurses also have the educational skills and intellectual capacity to study new material and network with others to gain knowledge, power and connections to overcome these obstacles. Nurses also work in healthcare systems with a multidisciplinary team that is made up of many other educated and influential people that can forward the cause of nursing and healthcare in general.

 

Strategies to communicate participation in policy making

Specific examples of strategies for advocating participation in nursing policy making include lobbying local politicians, and coalition building of colleagues and friends to influence legislation.

Lobbying is direct communication with decision makers to influence them to do what we request. We can also lobby our co-workers and motivate them to join policy making activities.

Once we connect with co-workers through this campaign of lobbying each other, we can use those connections to build coalitions. Coalition building involves building the coalition to address a specific issue or policy we want to effect, generating a plan on how to do it, and then as a group act to push for a change in that policy.

Neither of these methods involve direct activity in politics, but more so a grass roots and local involvement in advocating involvement to others in our field, and drawing them into policy advocacy activities through our actions.

 

Conclusion

Healthcare system is changing and developing day by day in this modern era. Nurses play a vital role in patient care. Health policy is a tool which nurses utilize to improve the quality and safety of patient by promoting public welfare (Hajizadeh et al,2021). By banding together and advocating for nurses to get involved in policy, we are improving the future for nurses and for healthcare in general.

 

 

 

 

 

References:

Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy Advocacy and Nursing Organizations: A Scoping Review. 
Policy, politics & nursing practice
, 
22
(4), 271–291. 
https://doi.org/10.1177/15271544211050611
Links to an external site.

Morris, G. (2023, 11 10). 
10 Ways Nurses Can Get Involved in Policy
. Retrieved 10 2024, from Nurse Journal: https://nursejournal.org/articles/ways-nurses-can-get-involved-in-policy/

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. 
BMC nursing
, 
20
(1), 128. 
https://doi.org/10.1186/s12912-021-00648-6
Links to an external site.

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Alicia Prentler

Oct 16, 2024 6:07pm
| 
Last reply Oct 19, 2024 6:15pm

Reply from Alicia Prentler

Main Post

There are six steps in the policy making process at RNs and APRNs can take part at all levels (Short, 2022). According to Milstead’s Health Policy and Politics: A Nurse’s Guide the steps are as follows:

1.)     Identify the problem and then set an agenda

2.)     Analyze the Policy

3.)     Design

4.)     Enact

5.)     Implement

6.)     Evaluate outcomes

I am going to identify two specific ways that RNs and APRNs can influence policy, firstly being that many RN’s and APRN’s can offer specific realistic encounters either for or against why a policy should be enacted or vetoed, (Short, 2022, pp4). Nurses provide the unique ability to give faces and names to scenarios that influence policies, it allows the term “patient” to become “aunt, uncle, mother, sister, brother, friend.” Nurses are educators and in terms of policy making education is key to ensure policy makers understand the verbiage that is put in front of them and the scenario that is impacting the for or against a policy. Though providing first hand experience is instrumental in understanding and advocating for policy, this first hand experience can also confuse policy makers, as explaining medical scenarios to non medical personnel can be difficult to near impossible, so it would become a nurse’s responsibility to ensure that understanding is had regarding the information that is being transmitted.

Another way that Nurses can impact policy is through numbers, and the best way to do that is through professional nursing organizations. As stated the plus side is that there are numbers through these organizations that could influence or veto a policy, however, the downside to this is that the organization’s wants may not always coincide with one’s personal beliefs. Nurse’s are regulators of policy and innovators of policy and state practice acts in order to ensure the best possible care is delivered to their patients.

As nursing practice is highly regulated it stands that nurses should be at least aware of the policies that surround them and their influence potential on the political floor. Sometimes providing this indirect form of nursing care is the best way that we can guide and protect our patients from those who are making decisions regarding medical policy without medical background and simply rely on numbers of bank accounts to make decisions.

Short, N. (2022). Milstead’s Health Policy and Politics: A Nurse’s Guide. Jones and Bartlett. Burlington, Ma.

Williams, T. E., Baker, K., Evans, L., Lucatorto, M. A., Moss, E., O’Sullivan, A., Seifert, P. C., Siek, T., Thomas, T. W., & Zittel, B. (2016). Registered Nurses as Professionals, Advocates, Innovators, and Collaborative Leaders: Executive Summary. Online Journal of Issues in Nursing, 21(3), 7. https://doi.org/10.3912/OJIN.Vol21No03Man05

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Lovepreet Kaur
 (She/Her)

Oct 16, 2024 4:42pm
| 
Last reply Oct 19, 2024 3:24am

Reply from Lovepreet Kaur

​
Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) have several avenues through which they can engage directly in policy and
,
 thus, shape healthcare systems at local, state, and federal levels. 
One opportunity exists
 
to increase
 involvement in 
professional organizations,
 including the American Nurses Association (ANA) or the American Association of Nurse Practitioners (AANP). 
This organization allows the nurses to engage in advocacy by holding nurses’ events, filing comments on policy in various legislation,
 and holding discussions with the legislators
 (
Chiu
 et al., 2021).
 For instance, APRNs can now ensure that state laws related to full practice are passed to enable them to practice independently without having to report to a physician.

​
Another is 
participation in governmental committees or consultative forums as a company’s senior official
. RNs and APRNs participate in committees that 
decide
 healthcare policies on population, safety
,
 or employment. This position empowers nurses to offer evidence from the front line
 on access, quality,
 and cost of health care
 (
Sumpter
 et al., 2022). 
However, threats to these opportunities include time constraints, lack of knowledge of policy-making processes, and limited access to policymakers. To address these challenges, it is necessary to step out, learn
,
 and eliminate the barriers that have been put in place. For instance, nurses can set a calendar timeline for advocacy, attend policy workshops 
to
 increase awareness
 and participate in policy meetings with colleagues with prior experience in policy-making to get close to the decision-makers
.

​
Nurses should better promote these opportunities and
become active on social networks and communities where those policy initiatives are discussed. 
Participation in local nursing forums and nursing workshops that deal with advocacy in the health sector can also promote the recruitment of more nurses (
Crowder
 et al., 2022). That is why, through these strategies, nurses can gain more power and influence in decision-making regarding healthcare 
policies and achieve positive policy changes for the general good of the 
nursing workforce and patients.

References

Chiu, P., Cummings, G. G., Thorne, S., & Schick-
Makaroff
, K. (2021). Policy Advocacy and Nursing Organizations: A Scoping Review. 
Policy, 
P
olitics & 
N
ursing 
P
ractice
, 
22
(4), 271–291. 
https://doi.org/10.1177/15271544211050611
Links to an external site.

Crowder, S. J., Tanner, A. L., Dawson, M. A., Felsman, I. C., 
Hassmiller
, S. B., Miller, L. C., Reinhard, S. C., & Toney, D. A. (2022). Better together: Coalitions committed to advancing health equity. 
Nursing outlook
, 
70
(6 Suppl 1), S48–S58. 
https://doi.org/10.1016/j.outlook.2022.02.013
Links to an external site.

Sumpter, D., Blodgett, N., Beard, K., & Howard, V. (2022). Transforming nursing education in response to the future of nursing 2020–2030 report. 
Nursing 
O
utlook
, 
70
(6), S20-S31.
https://www.sciencedirect.com/science/article/pii/S0029655422000197
Links to an external site.

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Lucia Almeida

Oct 16, 2024 2:53pm
| 
Last reply Oct 18, 2024 5:46pm

Reply from Lucia Almeida

Nurses hold more power in health policy decisions in their clinical practice and direct clinical care decision-making roles. Nurses can influence healthcare policy through their involvement in professional associations which support healthcare quality policies (Hajizadeh et al., 2021). These organizations, therefore, allow the nurses to lobby, give their clinical input, and participate in developing policies and products crucial to their operation, such as Allocating nurses to working stations. These activities enable nurses to intervene in the legislative agenda because of current efforts to establish standard nurse-to-patient ratios (McHugh et al., 2021). However, such engagement entails understanding the dynamics of the act and the process of passing legislation, an endeavour within reach of many a nurse, especially those without prior exposure to policy writings.

One significant opportunity is that nurses can be involved in advisory committees on public health through nursing practice. Thus, being members of these committees, nurses can explain the actual effects of the provided policies on patient outcomes and the possibility of accessing the healthcare system first-hand. For example, a nurse’s views regarding vaccination policies will differ from those of policymakers not trained in clinical nursing. However, one of the issues is the time limitation, which limits nurses’ engagement as clinical responsibilities dominate (Dierckx de Casterlé et al., 2020). To counter this, there has been a recent push in many healthcare facilities to offer policy-specific training and dedicated time teaching policies as they know the value that the nurses hold for these discussions.

To encourage and promote the nurses’ involvement in formulating the policies, policy contents should form part of the curricula that the nursing students undergo. Policy analysis and advocacy competencies can be incorporated into the nursing program so that learners begin policy practice at the start of their profession. For that reason, the available literature shows that policy training that nurses undergo while in school helps them to get actively involved in policy activities throughout their practice (Mlambo et al., 2021). Moreover, the nurse advocate partnerships between highly qualified nurse leaders and young professionals assisting new nurses in participating in policy roles are also helpful. These strategies increase nurses’ policy knowledge and build a stronger political professional and advocacy nursing workforce to champion change at the systems level.

References

Dierckx de Casterlé, B., Mertens, E., Steenacker, J., & Denier, Y. (2020). Nurses’ experiences of working under time pressure in care for older persons. 
Nursing Ethics
, 
27
(4), 096973301989579. 
https://doi.org/10.1177/0969733019895797
Links to an external site.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review. 
BMC Nursing
, 
20
(1). 
https://doi.org/10.1186/s12912-021-00648-6
Links to an external site.

McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. 
The Lancet
, 
397
(10288), 1905–1913. 
https://doi.org/10.1016/S0140-6736(21)00768-6
Links to an external site.

Mlambo, M., Silén, C., & McGrath, C. (2021). Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. 
BMC Nursing
, 
20
(62), 1–13. 
https://doi.org/10.1186/s12912-021-00579-2
Links to an external site.

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Rebecca Carico

Oct 16, 2024 1:26pm
| 
Last reply Oct 18, 2024 2:18pm

Reply from Rebecca Carico

RN’s and APRNs are needed within the health care arena to help promote change for health care related policies. Our experiences and ethical values alone help advocate for ourselves and our patients, making us great assets to legislation and policymakers. There are many opportunities for nurses to become involved with policymaking, but not every opportunity is right for each person. Policy entrepreneurs, for example, are advocates willing to invest things like time, money, and reputation in their specialized area in hopes that they will be able to gain something from the potential change that could come in the future (Short, 2022). Policy entrepreneurs would be a great opportunity for RNs and APRNs to get involved in policymaking, if it is a good fit for you as a nurse. Many nurses have the knowledge and experience, but do not have the time, resources, or money to become policy entrepreneurs. This would be a challenge for some nurses, but by establishing personal connections and networking with financial resources, RNs and APRNs could overcome these challenges. Short (2022) mentions that nurses should engage in providing stories, data, and insight to assist policymakers to create effective policies for health care, and what better way to do that than to become a policy entrepreneur and advocate for issues that hit “close to home”?

Another opportunity that nurses have would be to become a member of the American Nurses Association (ANA) and become an ANA advocate. The ANA (n.d.) advocates on behalf of RNs at the top levels of government as policies are conceived, debated, and implemented. The ANA also works closely with Congress members to lobby agendas that support both nurses and patients. The ANA (n.d.) mentions specific ways that nurses can impact federal rules and regulations which includes (but is not limited to): learning about the federal rule making process, become informed about public policy and health policies currently under consideration, monitor the Federal Register website which lists proposed rules and/or changes to current rules, and work closely with your state’s nurses association regarding new or changing regulations.

This organization is a great resource tool to use and is something all nurses should keep in their back pocket to utilize, but there can be some challenges associated with ANA membership including money and time constraints. While we may not be able to overcome time constraints due to scheduling conflicts, volunteers are encouraged to be a part of the American Nurses Association, American Nurses Credentialing Center, or the American Nurses Foundation which would help eliminate the monetary concern that may come with being an organization member. Another common limitation that would pose an issue when trying to lobby for a policy would be limited knowledge on the specific topic of the policy, which is why it is important to conduct heavy research, gain first-hand experience, and learn the “legislative language”. First-hand experiences weigh heavy on advocating for policy change, so choosing policies that you feel comfortable lobbying for would be a way to overcome that challenge as well. Congress.gov (n.d.) is a great resource along with ANA (n.d.) to find proposed policies and bills that directly relate to health care issues.

 

References

ANA. (n.d.). 
Federal Advocacy
. American Nurses Association. https://www.nursingworld.org/practice-policy/advocacy/federal/

Congress.gov. (n.d.).
 Find Your Members
. https://www.congress.gov/members/find-your-member

Short, N. M. (2022). 
Milstead’s health policy and politics: A nurse’s guide
 (7th ed.). Jones & Bartlett Learning.

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Erica Danielle De Los Santos

Oct 16, 2024 11:09am
| 
Last reply Oct 19, 2024 3:19am

Reply from Erica Danielle De Los Santos

Word cloud generators can effectively summarize collective sentiments in professional settings, including nursing. To build a nursing word cloud, terms like “empathetic,” “organized,” “hard-working,” and “advocate” are essential. Importantly, “policy-maker” should also feature prominently, reflecting the evolving role of nurses in influencing healthcare legislation and advocating for patient needs (Barton et al., 2020; Melnyk et al., 2018).

Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) have several opportunities to engage in policy-making. First, they can participate in professional organizations, such as the American Nurses Association (ANA), which actively lobbies for nursing interests and health policy reforms (ANA, 2021). Second, RNs and APRNs can engage in community health initiatives that inform local policy decisions, thereby bridging the gap between clinical practice and public health advocacy (Melnyk et al., 2018).

Challenges in these roles include time constraints and a lack of political knowledge. To overcome these barriers, nurses can prioritize involvement by integrating advocacy into their professional development plans and seek mentorship from experienced nurse leaders in policy (Barton et al., 2020).

To enhance awareness of policy-making opportunities, I recommend developing educational workshops focused on legislative processes and creating mentorship programs that connect novice nurses with experienced policy advocates. For example, hosting webinars on current healthcare legislation can empower nurses to become active participants in policy discussions (ANA, 2021).

 

References

American Nurses Association (ANA). (2021). 
Advocacy
. Retrieved from 
ANA website
Links to an external site.

Barton, A. J., Dyer, J., & Wiley, B. (2020). The role of nursing in health policy and advocacy. 
Nursing Outlook
, 68(4), 450-459.

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2018). Implementing the evidence-based practice (EBP) competency model in nursing education. 
Nurse Education Today
, 64, 52-57.

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Elizabeth Rachel Fofanah

Oct 16, 2024 5:26am
| 
Last reply Oct 16, 2024 3:31pm

Reply from Elizabeth Rachel Fofanah

Main Post

Introduction

Registered Nurses (RNs), and Advanced Practicing Registered Nurses (APRNs) who make up most of the workers in the health care industry, contribute to the improvement of health systems. It is abundantly obvious that nurses have a role in the formulation of health policy; however, even in clinical settings, only a small percentage of nurses participate in the policy-making process (Hajizadeh et al, 2021). Below are some of the opportunities that might foster participation.

 

Nursing Organizations and Advocacy Groups

A notable avenue for registered nurses and advanced practice registered nurses to engage in policymaking is via nursing organizations and advocacy groups. These organizations frequently maintain a significant role in promoting healthcare laws that serve the interests of patients and the field of nursing. They participate in advocacy initiatives, conduct policy assessments, and offer avenues for their members to influence the formulation and evolution of healthcare legislation across local, state, and national spheres. For example, The American Nurses Association (ANA) stands as a distinguished entity that engages nurses in the intricacies of policymaking. ANA encompasses a range of committees of lawmakers and task forces that invite nurses to engage and lend their professional skills to the discourse surrounding policy matters. Nurses could participate in these committees, where they can engage in thoughtful discussions, formulate policy proposals, and collaborate with various stakeholders to shape healthcare regulations (ANA, n.d).

 

Advisory Committees and Task Forces
:

To tackle healthcare concerns and propose policy changes, numerous government agencies and healthcare organizations form advisory committees and task forces. To contribute their knowledge and experience to the development of healthcare policy, these committees frequently include members of the nursing profession, such as APRNs and registered nurses.

For example, when dealing with public health issues like the opioid crisis, the state’s health department may establish an advisory council. To help design policies and methods to address opioid usage, they might recruit nursing experts, such as advanced practice registered nurses (APRNs) with knowledge of addiction and mental health, to serve on the committee. This happened in Arizona during the heightening opioid crisis.

 

Challenges

Time Constraints: The time constraints experienced by nurses, particularly those working in direct contact with patients, make it difficult for them to take an active role in formulating or participating in policy making.

To overcome this challenge, Nurses have the capacity to establish partnerships and engage in collaboration with their colleagues to distribute the workload effectively (ANA, n.d.). Through collaborative efforts, they can jointly engage in discussions about policies, ensuring that no single individual’s responsibilities become excessively burdensome.

 

Limited knowledge in policy formulation:

A considerable number of nurses might possess a restricted understanding of the policy-making process and may lack the assurance needed to adeptly maneuver through the complexities of policy formulation and advocacy. To overcome this challenge, the policymaking process, efficient communication with legislators, and lobbying tactics can all be covered in training sessions and workshops offered by nursing groups. By taking advantage of these chances to learn, nurses can equip themselves to actively contribute (Milstead & Short, 2019).

Recommendations

Web-based/media campaigns

Web-based campaigns developed by nursing groups can bring attention to the value of nurses’ input into policymaking. They may spread the word about the great things that have happened because of nurses’ efforts to influence policy changes by using social media sites like WhatsApp, Telegram, Twitter, Instagram, and LinkedIn (O’Connor, 2017).

Mentorship Programs:

To help new nurses become involved in policymaking, nursing organizations should set up mentoring initiatives where more seasoned nurses can act as guides and mentors. Involvement in policy conversations can be facilitated through these mentorship ties, which can also help cultivate future nurse advocates.

Conclusion

Registered nurses (RNs) and advanced practicing registered nurses (APRNs) possess numerous avenues for engaging in the policymaking process. Nurses can engage meaningfully by becoming members of credible nursing associations like the American Nurses Association (ANA) and taking on the role of lobbyists at Capitol Hill (ANA, n.d.). Nurses are subsequently positioned to convey their experiences and narratives directly, bolstered by the support of their fellow ANA group members. Nurses can also engage actively by communicating with their state representatives through written correspondence. Regrettably, a significant number of policymakers lack firsthand experience in the health care sector, rendering them oblivious to the intricate rules and regulations that influence nursing and various other facets of health care. Without initiating a dialogue regarding the concerns you have observed, they may remain oblivious to the situation (Brokaw, 2016). The capacity for nurses to articulate their concerns, perspectives, and insights into lawmakers fosters a deeper understanding and confidence among lawmakers, thereby enhancing their ability to navigate tricky problems

 

 

Reference

American Nurses Association. (n.d.). 
American Nurses Association (ANA). https://www.nursingworld.org/

Cherry, B., & Jacob, S. R. (2016). 
Contemporary nursing: Issues, trends, & management (7th ed.). Elsevier.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses’ participation in the health policy-making process
: A systematic review. BMC Nursing, 20(1), 128. https://doi.org/10.1186/s12912-021-00648-6

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

O’Connor, S. (2017). Using social media to engage nurses in health policy development. 
Journal of Nursing Management, 25(8), 632-639. https://doi.org/10.1111/jonm.12501

 

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Mehak Ishaq

Oct 15, 2024 8:44pm
| 
Last reply Oct 18, 2024 12:20pm

Reply from Mehak Ishaq

Nursing professionals (RNs) and Advanced Practice Registered Nurses (APRNs) have various ways to get involved in policy development by joining professional associations and participating in legislative advocacy. Organizations such as the American Nurses Association provide a platform for nurses to express their views and provide input on healthcare legislation. Additionally, nurses can engage in lobbying efforts by meeting with lawmakers to discuss how proposed health policies may affect patient care. However, challenges like time constraints, limited resources, and a lack of understanding of the legislative process can make participation challenging. To overcome these barriers, RNs and APRNs can seek mentorship from experienced advocates and participate in training sessions focused on health policy and advocacy (Chiu et al., 2021).

To raise awareness of these opportunities, one effective strategy is to organize workshops that teach nurses about the importance of engaging in policy-making and the specific options available to them (Anders, 2020). For instance, hosting a conference session with successful nurse advocates can inspire colleagues to take part. Another approach is to use social media to raise awareness and share experiences related to nurse involvement in policy-making, creating a supportive online community (
Advocacy – American Nurses Association | ANA
, 2020). By fostering an environment that encourages nurse participation, the nursing profession can significantly shape health policy outcomes.

References:

Advocacy – American Nurses Association | ANA
. (2020, April 27). ANA. https://www.nursingworld.org/practice-policy/advocacy/

Anders, R. L. (2020). Engaging nurses in health policy in the era of COVID‐19. 
Nursing Forum
, 
56
(1), 89–94. https://doi.org/10.1111/nuf.12514

Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy Advocacy and Nursing Organizations: A scoping review. 
Policy Politics & Nursing Practice
, 
22
(4), 276–296. https://doi.org/10.1177/15271544211050611

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Cecile Bowen

Oct 15, 2024 7:44pm
| 
Last reply Oct 19, 2024 2:51pm

Reply from Cecile Bowen

Initial Response

Nurses are the backbone of healthcare and often experience deep relationships with their patients meaning their voices in policy-making are extremely important (Rasheed et al., 2020). Nurses represent unique traits such as patient advocacy, realistic expectations of implementation, and expertise on inter-professional communication within the hospital which are vital to creating effective health policies (Disch, 2019). The first way nurses can become involved in policy-making is by directly contacting either state or federal legislators. Legislators do not always understand medical jargon or policies because they do not have a background in healthcare. Nurses can share their opinion and experience to help give legislators context on important healthcare issues they otherwise would not receive. Federal representatives and senators information can be found by putting your address into congress.gov (n.d.). Another way to be involved is to join an organization such as the American Nurses Association (ANA) and volunteer to attend policy meetings or events surrounding the specific policy (Williams et al., 2018).

Two of the biggest challenges nurses face in policy making are the lack of time and understanding (Rasheed et al., 2020). Balancing work and home life can already be difficult for many nurses so adding more to the schedule can seem unmanageable. Organizations have the ability to help nurses conquer this challenge by offering flexible participation options and providing direct opportunities to be involved. The lack of understanding when it comes to policy process can be daunting as well. However, finding educational opportunities like public policy events or organizational resources can both help a nurse become more confident in the policy area (Goodyear, 2022).

The first strategy I would use to further the nurses role in policy making is increasing education surrounding policy involvement both in undergraduate nursing programs and in hospital settings. This would make more nurses familiar and confident with the idea of political involvement. Another idea would be to create sone type of incentive for nurses who choose to attend a workshop to further their policy making understanding. Many organizations offer webinars or workshops but offering incentives to attend them would increase turnout and encourage more nurses to give political involvement a try.

References

Congress.gov. (n.d.). 
Find your members
. Retrieved October 15
th
, 2024, from 
https://www.congress.gov/members/find-your-member
Links to an external site.

Disch, J. (2019). Nursing leadership in policy formation. 
Nursing Forum, 55
(1), 4-10. 
https://doi.org/10.1111/nuf.12375
Links to an external site.

Goodyear, C. (2022). Advocating for public policy to advance nursing. 
Nursing Management (Springhouse), 53
(7), 48. 
https://doi.org/10.1097/01.NUMA.0000834512.45322.d0
Links to an external site.

Rasheed, S., Younas, A., & Mehdi, F. (2020). Challenges, extent of involvement, and the impact of nurses’ involvement in politics and policy making in the last two decades: An integrative review. 
Journal of Nursing Scholarship, 52
(4), 446-455. 
https://doi.org/10.1111/june.12567
Links to an external site.

Williams, S.D., Phillips, J.M., & Koyama, K. (2018). Nurse advocacy: Adopting a health in all policies approach. 
OJIN: The Online Journal of Issues in Nursing, 23
. 
https://doi.org/10.3912/OJIN.Vol23No03Man01
Links to an external site.

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Cody Ross Newton

Oct 15, 2024 5:50pm
| 
Last reply Oct 16, 2024 6:13pm

Reply from Cody Ross Newton

Main Post

Opportunities for Participation

RNs and APRNs can become members of organizations such as the American Nurses Association (ANA) or the American Association of Nurse Practitioners (AANP). These organizations often have committees focused on health policy where nurses can contribute their expertise, engage in advocacy efforts, and influence legislation that affects healthcare delivery. One significant advantage of membership is access to a wealth of resources and information. Professional nursing organizations provide members with research publications, policy briefs, and educational materials that keep nurses informed about current issues and trends in healthcare. This knowledge equips them to engage effectively in policy discussions. For instance, the American Nurses Association (ANA) publishes position statements that guide nurses in advocating for specific legislative initiatives, enabling them to articulate their positions effectively to policymakers. Networking and collaboration are other vital aspects of membership. By joining these organizations, nurses can connect with other healthcare professionals, policy experts, and legislators, leading to partnerships that amplify advocacy efforts. Membership allows nurses to join committees focused on health policy, where they can collaborate with peers and experts to develop strategies for influencing legislation. Building relationships with key stakeholders enhances the impact of their advocacy, creating a stronger voice for issues affecting patients and the nursing profession (Chiu et al., 2021).

Legislative advocacy is a crucial avenue through which nurses can influence healthcare policy and ensure that the voices of both practitioners and patients are heard in the legislative process. By actively engaging with lawmakers, nurses have the opportunity to advocate for policies that promote patient safety, improve access to care, and enhance the overall quality of healthcare delivery (Turale & Kunaviktikul, 2019). This engagement can take various forms, including attending town hall meetings, participating in lobby days, and building relationships with legislators. Through these activities, nurses can share their firsthand experiences and insights regarding the challenges faced in clinical settings, helping to inform and shape legislation that addresses issues such as safe staffing ratios, scope of practice regulations, and mental health resources.

Furthermore, nurses can mobilize their peers and communities to support specific legislative initiatives, creating a grassroots movement that amplifies their advocacy efforts. By organizing campaigns that raise awareness about critical healthcare issues, nurses can educate the public and generate support for policies that align with their goals. This collective action not only strengthens their position in discussions with policymakers but also fosters a sense of community and shared purpose among healthcare professionals. Additionally, many nursing organizations provide resources and training to help nurses navigate the legislative process, equipping them with the knowledge and skills necessary to effectively advocate for change.

Challenges and Solutions

One major challenge in participating in policy-making is the lack of time and resources. Many nurses face demanding work schedules, making it difficult to engage in advocacy or attend meetings. To overcome this, nurses can utilize flexible scheduling, prioritize advocacy activities, or collaborate with their colleagues to form a coalition that shares responsibilities, especially locally within their units, departments, and hospital organizations.

Another challenge is the potential lack of confidence or understanding of the policy-making process. Hajizadeh et al. (2021) states, “insufficient knowledge on the health policy making is one of the important reasons of nurses’ non-involvement in health policy making.” Many nurses may feel ill-equipped to navigate this area. To address this, mentorship programs can be established where experienced nurse advocates guide newcomers, providing them with the knowledge and skills needed to effectively participate in policy discussions.

Strategies for Advocacy

Organizing workshops or webinars that educate nurses on the policy-making process, the importance of advocacy, and how to get involved can be an effective strategy. For instance, collaborating with nursing schools or professional organizations to offer training on legislative advocacy can empower more nurses to engage actively. Recently, a local hospital invited the state Senator to come talk to the hospital and nursing staff about the state how they could be more involved in the political level.

Utilizing social media platforms can be a powerful way to communicate the importance of policy involvement. Creating campaigns that highlight successful nursing advocacy efforts, share resources, and encourage nurses to engage in policy discussions can raise awareness and inspire action. For example, using hashtags on platforms like Twitter and Instagram can create a sense of community and motivate nurses to participate.

References

Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy Advocacy and Nursing Organizations: A scoping review. 
Policy Politics & Nursing Practice
, 
22
(4), 276–296. 
https://doi.org/10.1177/15271544211050611
Links to an external site.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. 
BMC Nursing
, 
20
(1). https://doi.org/10.1186/s12912-021-00648-6

Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. 
International Nursing Review
, 
66
(3), 302–304. https://doi.org/10.1111/inr.12550

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Domonique Yates

Oct 15, 2024 5:21pm
| 
Last reply Oct 18, 2024 7:03pm

Reply from Domonique Yates

Hi Colleague,

Two opportunities that exist for RNs and APRNs to actively participate in policy-making is to join state or national nurse associations and become a lobbyist and focus on causes you have a liking for.  There are many types of  nursing organizations like the American Nurse Association, the American Academy of Nursing or the State Nurses Association. Once a member, one can express their interest about being involved with issues dealing with healthcare policies.  Being connected with a nursing association allows the nurse an opportunity to network with other healthcare professionals that have an impact in policy-making (Morris,2024). They can write articles, opinion communications or letters for association’s publications or for local media to increase awareness of policy changes.  One of the ways to advocate for your patients and the nursing profession is to get involved with policy-making.  It is important to know and develop relationships by means of other lobbyists to help with engaging in policy development.  The nurse and influencers should share the same concerns and objectives.  It is recommended that the lobbyist attend meetings with the policymakers and legislators to present all inclusive information on healthcare issues to put forward a united front (Faubion,2024).

Some of the challenges associated with these opportunities involve time limits, lack of education about political procedures, heavy workload, defined resources, and feeling of inadequate support from employers and the notion of their voice not being heard. These challenges can be overcomed in many ways by having RNs and APRNs educate themselves and learn how policies are made (Deleskey, 2003). They can also join organizations that influence nurses and patients. Lobbyists should volunteer to participate in policy meetings or other related activities. Team up and provide evidenced-based information to share with legislators. Connect with elected officials and mentor nursing students. In addition, one can develop a support system to help build resilience, ongoing education and professional development to help defeat challenges.

The two strategies I might make to better advocate for the existence of these opportunities to participate in policy-making is to inform my nursing associates and organization why it is necessary to advocate for policy development and how it can help assist in better patient healthcare.  In addition, I would recommend we offer a class for nurses to reiterate the importance, procedures and how to help contribute to reshaping policy-making for the profession.

Reference

Morris, G. November 10,2023. NurseJournal.10 Ways Nurses Can Get Involved in Policy. Retrieved from 
https://nursejournal.org/articles/ways-nurses-can-get-involved-in-policy/
Links to an external site.

Faubion, D. (2024). Nurse process. 11 Most Common Ways Nurses Can Get Involved in Policy Making. Retrieved from 
https://www.nursingprocess.org/ways-nurses-can-get-involved-in-policymaking.html
Links to an external site.

Deleskey K. (2003). Factors affecting nurses’ decisions to join and maintain membership in professional associations. 
Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
, 
18
(1), 8–17. 
https://doi.org/10.1053/jpan.2003.18030008
Links to an external site.

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Pawandeep Kaur Dhaliwal

Oct 15, 2024 1:55pm
| 
Last reply Oct 15, 2024 3:54pm

Reply from Pawandeep Kaur Dhaliwal

Main Post

The Role of the RN/APRN in Policy-Making

Policy-making is vital in shaping healthcare delivery and influencing patient outcomes. Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) are uniquely positioned to influence these policies due to the clinical expertise, patient advocacy roles, and their first hand understanding of the healthcare system. Nurse involvement in policy decisions can lead to better patient care and improved health systems, as through participation in legislative discussions and health policy reform, they can contribute to policy creation (Hajizadeh et al., 2021).

One opportunity for RNs and APRNs to actively participate in policy-making is through professional organizations. Nursing associations, such as the American Nurses Association (ANA), provide platforms for nurses to voice their concerns and advocate for policies that align with patient and healthcare system needs (Scott & Scott, 2021). By joining committees, lobbying for changes, and collaborating with lawmakers, nurses can influence decisions on issues affecting the profession. Another opportunity exists within government advisory boards, where RNs and APRNs can serve on health committees that advise the governments on healthcare policies (Caruso & Schlamb, 2021). Their input ensures that policies reflect real-world clinical experiences, making healthcare more patient-centered.

However, challenges may come up due to the time constraints due to clinical responsibilities, making it difficult for nurses to fully engage in policy-making activities. In addition, navigating the complexities of legislative processes can be overwhelming for those without formal training in policy advocacy (Chiu et al., 2021). To address these barriers, nurses must prioritize strategic time management and invest in continuous education on legislative processes. Attending policy workshops or seeking mentorship from experienced colleagues can equip nurses with the necessary skills and insights to navigate the political landscape effectively.

To effectively advocate for participation in policy-making, two key strategies include enhancing education and fostering mentorship. First, integrating policy advocacy training into nursing curricula can better prepare future nurses to engage in the political aspects of healthcare (Harris et al., 2022). This education should include courses on health law, public policy, and the legislative process, equipping nurses with the foundational knowledge necessary to engage in policy discussions. For instance, courses focusing on the Affordable Care Act or the opioid crisis can provide practical examples of how legislation directly impacts clinical practice. By understanding these laws, nurses will be better positioned to influence future healthcare policies.

Second, mentorship programs that pair novice nurses with experienced policy advocates can provide the necessary guidance and support for engaging in policy-making. Through such mentorship, nurses can learn how to navigate the political system, build networks with policymakers, and develop confidence in advocating for policy changes (Harris et al., 2022). For instance, a nurse participating in a mentorship program might learn how to draft a policy proposal on nurse-patient ratios, gaining valuable insight into the intricacies of policy-making and fostering a culture of sustained advocacy within the nursing profession.

Conclusion

The active participation of RNs and APRNs in policy-making is essential for advancing healthcare reforms and ensuring patient-centered care. Opportunities such as involvement in professional organizations and government advisory boards provide nurses with avenues to influence healthcare policies. However, challenges like time constraints and unfamiliarity with legislative processes may hinder participation. By enhancing policy advocacy education and fostering mentorship, these barriers can be overcome. Through active engagement in policy-making, nurses can shape a healthcare system that reflects the needs and rights of all individuals.

 

 

References

Caruso, A. M., & Schlamb, C. (2021). PCNP: A new era in shaping health policy. 
Journal of the American Association of Nurse Practitioners
, 
33
(11), 857-861. 
https://doi.org/10.1097/JXX.0000000000000528
Links to an external site.

Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy Advocacy and Nursing Organizations: A Scoping Review. 
Policy, politics & nursing practice
, 
22
(4), 271–291. 
https://doi.org/10.1177/15271544211050611
Links to an external site.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. 
BMC nursing
, 
20
, 1-9. 
https://doi.org/10.1186/s12912-021-00648-6
Links to an external site.

Harris, O. O., Bialous, S. A., Muench, U., Chapman, S., & Dawson-Rose, C. (2022). Climate change, public health, health policy, and nurses training. 
American journal of public health
, 
112
(S3), S321-S327. 
https://doi.org/10.2105/AJPH.2022.306826
Links to an external site.

Scott, S. M., & Scott, P. A. (2021). Nursing, advocacy and public policy. 
Nursing ethics
, 
28
(5), 723-733. 
https://doi.org/10.1177/0969733020961823
Links to an external site.

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Anameeka Hanif

Oct 15, 2024 10:36am
| 
Last reply Oct 16, 2024 5:23am

Reply from Anameeka Hanif

Anameeka Hanif

Wk 8 Discussion

October 16

 

 

Opportunities for RNs and APRNs to Participate in Policy-Making are listed below:

 

1. Engaging in Professional Nursing Organizations:

RNs and APRNs have the opportunity to participate in policy-making through professional nursing organizations such as the American Nurses Association (ANA) or specialty organizations like the American Association of Nurse Practitioners (AANP). These organizations offer platforms for nurses to advocate for healthcare policy changes, collaborate with lawmakers, and provide expert testimony on healthcare legislation. For example, ANA members can join legislative committees or contribute to policy papers that influence national health policy (American Nurses Association, 2023).

 

Challenges:

One challenge in engaging with professional organizations is the time commitment required, especially for nurses balancing demanding clinical workloads. Another challenge may be a lack of familiarity with policy-making processes, which could hinder their confidence in participating.

Overcoming Challenges:

To overcome time constraints, nurses could seek opportunities that align with their schedules, such as participating in virtual advocacy events or webinars. To address knowledge gaps, nurses can attend policy workshops or take advantage of mentorship opportunities offered by professional organizations to gain a better understanding of the legislative process.

2. Direct Engagement with Lawmakers:

RNs and APRNs can directly engage with lawmakers by meeting with legislators, participating in town hall meetings, or writing letters to their representatives. These activities allow nurses to bring their unique clinical experiences to the attention of policymakers and advocate for legislation that improves patient outcomes and healthcare delivery. For instance, APRNs can lobby for full practice authority in states where their scope of practice is restricted (National Conference of State Legislatures, 2021).

Challenges:

A significant challenge is that nurses may feel intimidated by the political process or may not know how to approach lawmakers effectively. Additionally, logistical challenges such as travel for meetings or organizing group advocacy efforts can be difficult.

Overcoming Challenges:

Nurses can start by connecting with advocacy groups that provide guidance on how to interact with lawmakers. Many organizations, such as the ANA, offer training and resources for effective advocacy, helping nurses build the confidence and skills to engage in policy discussions. Utilizing technology, such as participating in virtual advocacy days, can also help nurses engage without the burden of travel.

Strategies to Advocate for Policy-Making Opportunities:

1. Incorporating Policy Education in Nursing Curriculum:

One strategy to better advocate for nurses’ involvement in policy-making is to enhance nursing education programs with a stronger focus on health policy and advocacy. By embedding policy-related courses into undergraduate and graduate programs, future nurses will develop an understanding of the legislative process and the importance of nursing advocacy from the start of their careers. This strategy would prepare nurses to be proactive participants in policy-making.

2. Leveraging Social Media and Technology:

Another strategy is to use social media platforms and digital tools to communicate policy-making opportunities to a broader audience. Professional organizations and advocacy groups can use platforms like Twitter, Facebook, or LinkedIn to share information on upcoming legislative meetings, virtual town halls, and opportunities for policy involvement. By promoting these opportunities in spaces where nurses are already engaged, it becomes easier to spread awareness and increase participation.

Examples of Success:

For example, the AANP’s advocacy efforts to expand full practice authority for nurse practitioners have been largely driven by organized efforts that include direct engagement with legislators and collaboration with state policy leaders. The use of digital advocacy tools, such as online petitions and webinars, has allowed for broader participation from APRNs across the country.

References

1. American Nurses Association. (2023). Policy & advocacy. https://www.nursingworld.org/practice-policy/advocacy/

 

2. Congress.gov. (2021). H.R.8812 – Improving Care and Access to Nurses Act. https://www.congress.gov/bill/117th-congress/house-bill/881

 

3. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. The National Academies Press. https://doi.org/10.17226/12956

 

4. National Conference of State Legislatures. (2021). Full practice authority for nurse practitioners. https://www.ncsl.org/research/health/scope-of-practice-for-nurse-practitioners.aspx

 

 

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Stella Chinelo Ukakogu

Oct 15, 2024 10:34am
| 
Last reply Oct 18, 2024 5:46am

Reply from Stella Chinelo Ukakogu

                                                          Main Discussion Post

Opportunities for RNs and APRNs in Policy-Making

Nurses are crucial players, especially Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs), in the development of health policies that affect patient care and nursing practice overall. As much as the profession is dynamically growing, so are the opportunities for nurses to impact policy. One of the key ways this happens through professional nursing organizations is through participation in policy-making by RNs and APRNs (Hajizadeh et al., 2021). Many of these, including the American Nurses Association, are very active in lobbying for the reform of healthcare and changing policies that will further benefit the patient and the healthcare professional. These organizations have allowed RNs and APRNs to participate in such activities and to serve on committees or boards influencing legislation by creating such opportunities for them. Membership in these organizations allows the nurse to participate in health policy and ensure that laws and regulations will support evidence-based practice and a shift toward patient-centered care.

Other significant opportunities for RNs and APRNs to get involved in policy-making relate to contact with lawmakers at the local, statewide, or national level. Anything from going to town hall meetings, writing letters to representatives, or serving as witnesses with expertise in legislative hearings all constitutes getting involved. Such efforts enable nurses to apply clinical insight and first-hand experience in the care of patients to policy development and decisions. These interactions provide opportunities for nurses to shape policies that promote professional practice through better patient care, such as increased nursing education funding or regulatory actions that foster patient safety. The challenges regarding this opportunity include that nurses must balance their heavy clinical commitments with time-consuming political activities (Storaker et al., 2022). The nurses may also feel unprepared for navigating the intricacies of the political system.

To overcome these challenges, nurses can seek mentorship from colleagues who are already involved in policy-making. Professional nursing organizations usually provide resources and training that could equip nurses with the necessary skills to make them active advocates of policy issues. Such educational opportunities will help nurses feel more confident in contributing to policy change. Nurses can share their workload with other nurses so that their views are represented.

To better advocate for or communicate the existence of these opportunities, one strategy could involve increasing awareness through social media campaigns. Using Twitter or even LinkedIn, nursing organizations can reach a more significant section of the population and encourage greater involvement of nurses in policy-making affairs. Another method might be to incorporate policy-related curricula into the nursing courses so that from the very beginning, the nurses are aware of the significance of advocacy in their careers. Both can be remarkably potent strategies for nurses to realize their capabilities in influencing healthcare policy for the benefit of patients.

 

 

References

American Nurses Association (ANA). (n.d.). Advocacy. 
https://www.nursingworld.org/practice-policy/advocacy/
Links to an external site.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review. 
BMC Nursing
, 
20
(1). 
https://doi.org/10.1186/s12912-021-00648-6
Links to an external site.

Storaker, A., Heggestad, A. K. T., & Sæteren, B. (2022). Ethical challenges and lack of ethical language in nurse leadership. 
Nursing Ethics
, 
29
(6). 
https://doi.org/10.1177/09697330211022415
Links to an external site.

 

 

.

 

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Tiffany Peron

Oct 15, 2024 8:46am
| 
Last reply Oct 18, 2024 5:45am

Reply from Tiffany Peron

Main Post

Week 8

Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) operate in a critical area that is frequently overworked and underserved. One effective strategy to address the nursing shortage is for registered nurses to collaborate on healthcare workforce commissions across various states (Milstead & Short, 2019). RNs and APRNs have significant opportunities to engage in policy-making, influencing healthcare systems and patient outcomes. According to Short (2022) Active participation in the policy-making process is essential to professional nursing, as it helps shape policies that ensure high-quality healthcare is accessible and affordable for everyone. The three foundational pillars of healthcare policy are access, cost, and quality and how the policy process operates.

Opportunity for RNs and APRNs in Policymaking:

Participation in Health Policy Committees

Nurses can take part in health policy committees at local, state, or national levels that shape healthcare regulations and practices. This participation may involve serving on boards or task forces focused on specific health issues, ensuring that the nursing perspective is included in decision-making processes.

Challenges:
 These positions often demand considerable time commitments and require navigating complex bureaucratic systems. Additionally, RNs and APRNs might face resistance from other healthcare professionals who may not fully appreciate the nursing viewpoint.

Overcoming Challenges:
 To prepare for these roles, nurses can enhance their understanding of healthcare policies and build networks with other healthcare professionals. Forming coalitions with allied health providers can foster a unified approach to advocate for common objectives.

2.     Advocacy through Professional Organizations

RNs and APRNs have the opportunity to join organizations like the American Nurses Association (ANA) or the American Academy of Nursing (AAN), which typically feature policy committees and advocacy initiatives. These organizations offer platforms for nurses to engage in lobbying, contribute to position statements, and shape healthcare legislation.

Challenges:
 Time constraints due to clinical responsibilities and a potential lack of advocacy experience can hinder participation. Additionally, nurses may feel daunted by the political landscape or uncertain about how to effectively express their views (B;, S. L. C. R. n.d.-b).

Overcoming Challenges:
 To mitigate time limitations, nurses can explore flexible participation options, such as virtual meetings or short-term projects. Establishing mentorship programs can also assist less experienced nurses in navigating advocacy efforts by providing essential guidance and support (American Nurses Association. 2019).

Strategies for Advocacy and Communication

Utilizing Social Media and Online Platforms

Creating and sharing informative content on social media about the importance of nursing participation in policy-making can raise awareness. For example, RNs and APRNs can write blog posts or use platforms like Instagram or Twitter to share their experiences and encourage others to engage in advocacy.

Example:
 A nurse could start a campaign to highlight nursing contributions to healthcare policy, sharing success stories and inviting peers to share the experiences that they have had, which will foster a sense of community and encouraging wider participation. “Nursing leaders should consider social media as one of many engagement strategies to ensure nurses and other stakeholders participate in policy debate that informs health strategy development” (S;, O. n.d.).

Organizing Workshops and Educational Seminars

 Organizing workshops that focus on essential advocacy skills, such as public speaking, understanding legislative processes, and writing policy briefs, can empower nurses to actively participate in policy-making (American Nurses Association 2019).

 Example
:
 A community health organization could host a seminar series featuring local legislators and policy experts who discuss the impact of healthcare policies on nursing practice. These sessions could include interactive components, such as role-playing advocacy scenarios, allowing nurses to practice their skills in real-time and gain confidence in their ability to influence policy.

RNs and APRNs have numerous opportunities to engage in change and policymaking. As influential figures in healthcare, it’s essential for nurses to join organizations and use their voices to drive positive change. Increasing incentives for participation could help bridge the gap in nurse involvement in policymaking.

References

American Nurses Association. (2019). Nursing: Scope and standards of practice (4th ed.). Nursesbooks.org.

B;, S. L. C. R. (n.d.-b). 
Nurses’ perspectives of their impact while serving on boards
. The Journal of nursing administration. https://pubmed.ncbi.nlm.nih.gov/35060952/

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

S;, O. (n.d.). 
Using social media to engage nurses in health policy development
. Journal of nursing management. https://pubmed.ncbi.nlm.nih.gov/28736934/

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.     
Chapter 4, “Policy Analysis and Design” (pp. 77–93)

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Brianna Renee Cole

Oct 14, 2024 9:03pm
| 
Last reply Oct 16, 2024 8:17pm

Reply from Brianna Renee Cole

Discussion 5

NURS 6050

Brianna Cole

October 16, 2024

Introduction

Nursing is the most populated field in healthcare. Nurses wear many hats to fulfill their role. They provide patient care, create care plans, collaborate with different providers, provide education, and advocate, among many other things. The role of a nurse often seems never ending. Nurses learn to advocate well for the safety and treatment of a patient. It is a skill that is learned as the experience increases, making the voices of nurses very influential.

Opportunities for RNs and APRNs in Policymaking

There are many ways that nurses can use their voices to build a platform for themselves that address much needed concerns that are happening. Some of these ways include, joining professional organizations, attending legislative sessions, contribute to evidence-based research, participating with the perspective state board of nursing, and more. (Morris, 2023)

Joining professional associations is a vital way that nurses can be a part of the policy-making process. Organizations like the American Nurses’ Association builds relationships with members of Congress and have everyday nurses to come in and speak on real life situations that occur. (ANA, 2024) By speaking up and educating Congress on current issues arising helps to create new policies.

Another great way that nurses can contribute to policymaking is through evidence-based research. Unless legislators have a healthcare background it would be harder for them to understand some of the concerns being presented to them. Having nurses break down some of the evidence-based research to them verbally or providing an easy-to-read fact sheet can bring clarity to legislators. Evidence-based research is such an important tool because it is real data. Not only can it lead to the creation of new policies it can help remove policies that are ineffective. (Zanti & Thomas, 2021)

Challenges

As there are many opportunities for nurses to contribute to change there are challenges that hinder those changes. One of the biggest challenges is time constraints. From the tedious and demanding hours worked in a day, many nurses are just too exhausted. Many have families and other obligations that need their time and attention, leaving them with very little time to contribute to policymaking. Another challenge can be from a lack of support from the employer. When nurses try to make changes at work and receive a lot of resistance it can be discouraging to want to step out and make changes locally and nationally.

Strategies for Change

Some strategies I would implement is finding some type of funding that hospitals can use to send nurses to events to speak out on these issues. In doing so, it would be the same amount of time as their regular work week, so they don’t neglect their personal daily obligations. Another strategy would be to collaborate with other local nurses and set up an informal meet and greets with policymakers to break the ice and network before actual meetings. Sometimes the thought of the meetings can be intimidating and can change the minds of a nurse getting ready to debate on a certain policy. Lastly, providing nurses with incentives like loan repayment to join these types of organizations would increase nurse involvement. There are public service loans out there and participating in policymaking can be included in the qualifications.

Conclusion

There are many opportunities for RNs and APRNs to be involved in change and policymaking. Being an influential person in healthcare, nurses need to join organizations and use their voices to bring positive change. If more incentives were given it could help tighten the gap of nurse participation in policymaking.

References

ANA. (2024). 
Federal advocacy
. American Nurses Association. 
https://www.nursingworld.org/practice-policy/advocacy/federal/
Links to an external site.

Morris, G. (2023). 
10 ways nurses can get involved in policy
. Nursejournal.org. 
https://nursejournal.org/articles/ways-nurses-can-get-involved-in-policy/
Links to an external site.

Zanti, S., & Thomas, M. L. (2021). Evidence-Based Policymaking: What Human Service Agencies Can Learn from Implementation Science and Integrated Data Systems. 
Global implementation research and applications
, 
1
(4), 304–314. 
https://doi.org/10.1007/s43477-021-00028-x
Links to an external site.

The Declaration of Independence

1775 – The Second Continental Congress

On 
May 10, 1775
, the 
Second Continental Congress
 met in Philadelphia, Pennsylvania, to determine what to do in response to the bloodshed. This meeting had already been scheduled, and John Hancock, the president of the Congress, and Sam Adams had been in Concord preparing for the meeting when the battles occurred. The delegates did not immediately call for independence from England. However, in June 1775, they voted unanimously in favor of 
George Washington
 as Commander-in-Chief of the Continental Army.

Washington was an experienced soldier, a Virginian, and the tallest man in the room. In fact, Dr. Benjamin Rush of Philadelphia once said, “He has so much martial dignity in his deportment that you would distinguish him to be a general and soldier from among 10,000 people” (Ellis, 
His Excellency
 68-69).

Joseph Ellis writes in his book that John Adams once jokingly said that Washington was chosen for the job because he was the tallest man in the room, 6 feet 3 inches tall (
His Excellency
 68). Interestingly enough, he was the only delegate to attend the Second Continental Congress in military uniform (Ellis, 
His Excellency
 69).

Beyond appearances, David McCullough insightfully writes that George Washington was chosen as leader of the American army because “without question, Congress had made the right choice, and not the least reason was political. As a Virginian, Washington represented the richest, most populous of the thirteen colonies. He himself had had years of political experience in the Virginia legislature and as a member of the Continental Congress. It was as one of them that the Congress knew him best and respected him, not as a general. He knew the ways of politics and factious politicians. He understood how the system worked” (McCullough
, 1776
 50).

In October 1775, King George III declared America in rebellion (McCullough, 
1776 
12). David McCullough writes in his book 
1776
 that King George “hoped his people in America would see the light …” (11). The British strategy was to work to put down the rebellion and send out olive branches at the same time. Many delegates hoped for reconciliation with the British, but neither of the parties could reach a meeting of the minds. Some individuals in the British Parliament feared that if they gave the American colonies independence, it would lead to the loss of other colonies and the end of the British Empire.

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For almost a year, delegates informally discussed whether they should declare colonial independence while they awaited instructions from home to support independence and for a British peace offering. During this time, General George Washington and his Continental Army were fighting to defend their rights as Englishmen in Boston. The British decided to leave Boston to go to New York City to gain control of the Hudson River to close off New England from the rest of the colonies (McCullough, 
1776
 118).

Drafting the Declaration of Independence

Five men were chosen to serve on that committee: 
Benjamin Franklin
 (PA), 
Thomas Jefferson 
(VA), 
John Adams
 (MA), 
Robert Livingston
 (NY), and 
Roger Sherman
 (CT).

John Adams,
 a strong advocate for independence (later nicknamed the “
Atlas of Independence
“), chose 
Thomas Jefferson
 from Virginia to write the draft
 
of the Declaration of Independence, which was later edited by the committee. Jefferson was a southerner from the largest colony, an eloquent writer, and a passionate supporter of liberty.

Adams wanted to show England that both the northern and southern colonies were united in their desire for independence (McCullough, 
John Adams
 119). Jefferson only remembered that the committee met and unanimously chose him to write the draft (McCullough, 
John Adams
 119). The Declaration of Independence Since
Jefferson drafted the Declaration of Independence, 
he is considered the 
primary author
 of this document.

“To Richard Stockton, one of the new delegates from New Jersey, Adams was ‘the Atlas’ of the hour, ‘the man to whom the country is most indebted for the great measure of independency … He it was who sustained the debate, and by the force of his reasoning demonstrated not only the justice, but the expediency of the measure” (McCullough, 
John Adams
 127).

Learn more about the Founding Fathers at the U.S. National Archives & Records Administration links below:

NARA – US National Archives & Records Administration
 – NARA Home page – use 
Search
 for “Founding Fathers”

America’s Founding Fathers
 – One of NARA’s references to the Founding Fathers.

Learn more about 
Thomas Jefferson – Monticello

The Second Continental Congress
 approved
 the Declaration of Independence on July 4, 1776. Ironically, the British had already begun landing troops on Staten Island from some of its 30 warships and 400 transport vessels off the coast of New York (Ellis, 
His Excellenc
y 93).

The Declaration of Independence is important because not only did it declare American independence and list grievances against King George, but it announced for the first time human rights for all people (at least all white men).

“All men are created equal and have the right to their life, liberty, and the pursuit of happiness.”

Liberty, self-government, the right of rebellion, and revolutionary ideas would be the foundation of a new nation, the United States of America.

The Declaration of Independence was directed personally at King George III, the sovereign. This was most unusual. The delegates made reference to the British Parliament and public, but their sole attention was on their Sovereign’s oppressive acts. The delegates made it expressly clear that King George was acting as a despot and that the colonies, in order to preserve their rights as Englishmen, had to rebel and establish a new nation to secure their liberties.

The English King and Parliament believed that they were operating within the bounds of the British Constitution in taxing the colonists to defend their North American holdings and maintain order in the rebellious Massachusetts Bay Colony.

Q & A

 

 What were the causes of the American Revolution?

 

Our English Heritage

Like many educated men of their generation, Thomas Jefferson and his fellow delegates were heavily influenced and guided by the ideas of 
John Locke
, a 17th-century English philosopher, who wrote the
 Second Treatise on Civil Government 
(1690) The Declaration of Independence

In this treatise, Locke wrote that man has the right to life, liberty, and property and that these rights are unalienable– natural rights or God-given rights that no government can take away.

Locke believed that the
 
purpose of having a government
 
was to protect our basic rights and that power rested with the people and not the King. The idea that our leaders should be accountable and should govern by the consent of the people was revolutionary and in sharp contrast to the current thinking of the day.

Q & A

 

 
 What was John Locke’s 
social contract
?

 

During the 17th century, most nations had absolute monarchs, like King Louis XIV of France, who believed that they were accountable only to God. This idea was known as the Divine Right of Kings Theory-“King by the Grace of God.” Also, some individuals agreed with Thomas Hobbes that the state must be all-powerful to protect against anarchy.

Q & A

 

 Why does Thomas Hobbes believe man is basically evil and that power must remain in the hands of the state?

 

State Constitutions

On May 10, 1776, the Second Continental Congress asked the colonial assemblies (those presently operating or in hiding) to write new state constitutions in preparation for independence. All new state constitutions were approved by the state legislatures, except Massachusetts which was approved by the people.

Many states not only outlined the structure of their new state governments in their constitutions, but also included a list of protected liberties–a Bill of Rights. Liberty protections like right to life, liberty, property, freedom of speech, press, religion, and rights of the accused were included to limit the power of state officials The Declaration of Independence.

Evidence Base in Design

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

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:

Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.

Review the health policy you identified and reflect on the background and development of this health policy.

By Day 3 of Week 7

Post
 a d
escription of the health policy you selected and a brief background for the problem or issue being addressed
. Which social determinant most affects this policy? Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

By Day 6 of Week 7

Respond
 to at least 
two
 of your colleagues
* on two different days
 by either supporting or respectfully challenging their explanation on whether there is an evidence base to support the proposed health policy they described.

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

This topic is closed for comments.

RS

Regina Candice Shaw

Oct 12, 2024 4:01pm

Reply from Regina Candice Shaw

Regina Candice Shaw

October 12, 2024

The Kidney Patient Act is a bipartisan bill introduced in the House of Representatives last year on the 28
th
 of July by Representative Carter Earl L. from Georgia. This bill targets Medicare recipients with end-stage renal disease (ESRD) to have access to oral-only therapy. This bill will prevent the Center for Medicare and Medicaid Services from moving oral therapy into the Medicare Part B payment system. The change will, unfortunately, restrict access to medication and subsequently increase the cost of dialysis treatment (
Rep. Sewell’s Kidney PATIENT Act Passes Out of the House Ways and Means Committee
, 2024). In addition, this bill will prevent phosphate binder-lowering drugs, for example, from being restricted (
The Kidney PATIENT Act of 2023 [H.R. 5074] | American Nephrology Nurses Association
, n.d.).

Uncontrolled diabetes and hypertension contribute to the prevalence of kidney disease in the U.S. Due to the lack of access to care and the unaffordability of healthcare costs more and more Americans are progressing to ESRD. Notably, socioeconomic status plays a detrimental role as economically weak people have limited access to healthcare, cannot afford the cost of medication, and have poor nutrition habits. Patients with kidney disease have to follow a strict nutritional regimen as electrolyte imbalance is pretty frequent and can lead to fatal complications. Regulating the phosphate level is essential for individuals with ESRD because it increases the mortality rate. Complications associated with unbalanced levels of phosphate include cardiovascular disease and mineral and bone disorders such as hyperparathyroidism (Chen L et al., 2018). According to Chen L. et al., intensifying phosphate level management reduces the risk of developing secondary hyperparathyroidism, improving the health and patient quality of life. Finally, a restricted diet, nutritional counseling, and phosphate binders reduce the risk of developing hyperphosphatemia and increase regimen adherence (Moroșan E et al., 2023).

To conclude, pushing for the Kidney Patient Act of 2023 will preserve access to oral medication for end-stage renal disease, according to the American Nephrology Nurse Association. Access to health care and education is important as it empowers patients to make informed decisions regarding their health management. Restricting access to health is a setback and can negatively affect the patient’s health outcome. Preventing the prevalence of another chronic disease that can shorten life expectancy should receive support. As nurses, we should be more involved in politics and advocate for our patients as we are the ones who spend more time with them and are aware of the struggles they encounter.

 

Works Cited

Chen L, He JX, Chen YY, Ling YS, Lin CH, & Guan TJ. (2018). Intensified treatment of hyperphosphatemia associated with a reduction in parathyroid hormone in patients on maintenance hemodialysis. 
Renal Failure
, 
40
(1), 15–21. https://doi.org/10.1080/0886022X.2017.1419966

H.R.5074—118th Congress (2023-2024): Kidney PATIENT Act of 2023 | Congress.gov | Library of Congress
. (n.d.). Retrieved October 12, 2024, from https://www.congress.gov/bill/118th-congress/house-bill/5074

Moroșan E, Popovici V, Elian V, Dărăban AM, Rusu AI, Licu M, Mititelu M, & Karampelas O. (2023). The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series. 
International Journal of Environmental Research and Public Health
, 
20
(6). https://doi.org/10.3390/ijerph20065049

Rep. Sewell’s Kidney PATIENT Act Passes Out of the House Ways and Means Committee
. (2024, March 12). U.S. Congresswoman Terri Sewell. https://sewell.house.gov/2024/3/rep-sewell-s-kidney-patient-act-passes-out-of-the-house-ways-and-means-committee

The Kidney PATIENT Act of 2023 (H.R. 5074) | American Nephrology Nurses Association
. (n.d.). Retrieved October 12, 2024, from https://www.annanurse.org/kidney-patient-act-2023-hr-5074

 

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AS

April Simon

Oct 11, 2024 3:40pm
| 
Last reply Oct 12, 2024 6:47pm

Reply from April Simon

H.Res.27 — 118th Congress (2023-2024) Condemning attacks on health care facilities, health care personnel, and patients.

Introduced to the House 1/11/2023, this bill was introduced to judge acts of violence and attacks on healthcare facilities, more specifically for women’s reproductive health centers. This requests that the Biden-Harris administration implement and uphold safety protocols for staff and patients. The emergency department is a primary area in the frontline of chaos. While I am not an ER nurse, during times of being floated to the ER I have witnessed workplace violence from patients and their family members. I have seen hospital staff spat at, punched, kicked, slapped and shootings verbally threatened.

“Between 1977 and 2015, nearly 7,000 violent acts were reported against providers at health centers for women, including bombings, arsons, death threats, kidnappings, and assaults; and between 1993 and 2015, there were 11 murders, numerous attempted murders, 42 bombings, and 186 arsons targeted at individuals and facilities associated with care provided at health centers for women (congress.gov, 2023).

Workplace violence hinders the providers from caring for the patients. It has an effect on the emotional wellbeing of the staff, therefore directly affecting the population. As healthcare workers are exiting the field due to the hazards of the job, social determinants of health are directly affected for all involved. SDH include occupation, job status, workplace safety, level of income, opportunities for education, job and place of work protection, inequity between men and women (Chelak, K. & Chakole, S.,2023).

According to the ANA, the likelihood of health care workers being exposed to violence is higher than prison guards or police offi­cers (ANA, 2018). With the shortage in healthcare workers, longer wait times are a result. Patients and family members become increasingly angry with what they perceive as a lack of attention or care. This leads to more incidence of aggression in the acute care setting. One’s personal beliefs about choice for women’s healthcare have led to outside attacks, therefore making it more difficult for women to want to seek care. Too often healthcare workers are assaulted and it goes without punishment. This federal law is important to uphold attackers in a facility to a criminal standard as it would with law enforcement, paramedics and other outside EMS services.

 

References

Chelak, K., & Chakole, S. (2023). The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. 
Cureus
, 
15
(1), e33425. 
https://doi.org/10.7759/cureus.33425
Links to an external site.

 

H.Res.27 – 118th Congress (2023-2024): Condemning attacks on health care facilities, health care personnel, and patients. (2023, January 11). 
https://www.congress.gov/bill/118th-congress/house-resolution/27
Links to an external site.

 

Workplace violence/end nurse abuse
. ANA. (2018, December 13). https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/

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Nazanin Kalhor

Oct 9, 2024 9:36pm
| 
Last reply Oct 12, 2024 2:19pm

Reply from Nazanin Kalhor

Main Post

Title: Proposed Health Policy: Background, Development, and Impact

In recent years, the Congress has been actively proposing various health policies to address pressing issues in healthcare. One such policy is the Medicare for All Act of 2023, introduced to expand access to comprehensive healthcare coverage across the United States (Congress.gov, 2023). This policy aims to address the longstanding issue of healthcare affordability and accessibility, particularly for uninsured and underinsured populations.

The Medicare for All Act originates from concerns over the rising costs of healthcare services, which have contributed to financial barriers preventing many Americans from receiving necessary medical care (Congress.gov, 2023). This legislation proposes a single-payer system that would consolidate and streamline healthcare financing, potentially reducing administrative costs and ensuring universal coverage for all residents. The primary social determinant influencing this policy is socioeconomic status, as financial constraints often dictate individuals’ ability to access healthcare services (CDC, 2020).

Evidence supporting the Medicare for All Act stems from various studies indicating that countries with universal healthcare systems often achieve better health outcomes at lower costs compared to the fragmented system currently in place in the United States (Smith et al., 2021). For instance, a study by Smith et al. (2021) demonstrated that countries with single-payer systems spend less per capita on healthcare while achieving higher life expectancy and lower infant mortality rates.

In conclusion, the Medicare for All Act represents a significant step toward addressing healthcare disparities in the United States by proposing a comprehensive, single-payer system. The evidence base supporting this policy suggests potential benefits in terms of cost-effectiveness and improved health outcomes, aligning with global trends observed in countries with similar healthcare models.

References

Centers for Disease Control and Prevention (CDC). (2020). 
Social Determinants of Health.
 Retrieved from 
https://www.cdc.gov/socialdeterminants/index.htm
Links to an external site.

Congress.gov. (2023). 
Medicare for All Act of 2023, H.R. 1234, 117th Cong.
 Retrieved from 
https://www.congress.gov/bill/117th-congress/house-bill/1234

Smith, J., Johnson, M., & Brown, L. (2021). Comparative analysis of healthcare systems: Lessons from global experiences. 
Journal of Health Policy and Management, 34
(2), 123-135. 
https://doi.org/10.1177/13558196211012345

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Nche Mou Bayong

Oct 9, 2024 9:12pm
| 
Last reply Oct 10, 2024 9:06pm

Reply from Nche Mou Bayong

Evidence Base in Design- The American Rescue Plan Act (ARPA)

Background of the Policy

The American Rescue Plan Act (ARPA), enacted in March 2021, represents a significant federal initiative aimed at addressing the mental health crisis exacerbated by the COVID-19 pandemic. This $1.9 trillion legislation expect a lot of dollars for improving mental health services, including $1.5 billion for community mental health and substance abuse treatment by block grant to states (Johnson-Staub & Weerasinghe, 2022). The ARPA also encourages exploration of fresh solutions like mobile crisis response units – specially equipped cars that help in cases of mental health episodes and minimize police presence. To this effect, the ARPA aims to reduce the impacts of the pandemic by focusing on the economic conditions and economic access as two of the social determinants of health. This policy has a robust evidence base, which found an increase in demand for mental health services, and that integrated care models actually do work improving patient outcomes.

Social Determinants Affecting the Policy

Economic stability is the primary social determinant shaping the American Rescue Plan Act (ARPA). With COVID-19 causing massive job losses and financial insecurity, the links between this and declines in mental health is strong. Research reveals that people who suffer from economic hardship usually face an increased rate of suffer from mental ill health; including anxiety and depression, as a result of factors like unemployment, poverty and debt. For instance, evidence shows that economic downturn increases prevalence of minor mental diseases and alcohol dependence with case higher in dropouts experiencing discriminated labeling social stress and trauma (Occhipinti et al., 2024). Mental health policy should therefore address these material roots of economic marginalization because better economic circumstances are associated with better mental health for the whole population. That is why increasing attention to the mental health service development is the significant constituent to the minimization of the negative influence of economic instability on mental health by the ARPA.

Evidence Base Supporting the Policy

The American Rescue Plan Act (ARPA) is underpinned by a robust evidence base that highlights the urgent need for enhanced mental health services. Research also shows that some 40 percent of adults reported having anxiety or depressive symptoms during the COVID-19 pandemic (Brookings, 2021). This is an alarming trend, and we need immediate mitigation, as untreated mental health situations often result in one of direst consequences, such as exponentially more frequent trips to ERs and more engagement with law enforcement. To tackle these issues, the ARPA allocates $1.5 billion each to Mental Health and Substance Abuse Block grants allowing states with the resources to expand the reach of necessary services and more greatly impact community health (tcmhcc, 2021).

Moreover, the introduction of mobile crisis intervention teams is a pivotal aspect of ARPA’s strategy to address mental health emergencies effectively. Studies based on different programs including the CAHOOTS model in Eugene, Oregon show that these teams can greatly minimize use of police officers in psychiatric emergencies, which could easily lead to shootings or other fatalities. Published research also reveals that in those places, where mobile crisis intervention has been introduced, approximately 69% of calls were referred from EMS to the proper mental health intervention, proving that these kinds of interference are rather helpful in managing crisis situations and providing help to people in need (Brookings, 2021). This model not only improves individual outcomes but also alleviates pressure on emergency services and law enforcement.

Finally, ARPA’s funding provisions also extend to schools, recognizing the critical need for mental health support among children and adolescents. From the Elementary and Secondary School Emergency Relief Fund, states received more than $122 billion to support programs that address students’ social, emotional and mental health needs. The current literature reveals the fact that raising the availability of school-based mental health services enhances academic outcomes as well as life satisfaction of students (Randi, 2021). Through engaging and developing successful relationships with community organizations and incorporating evidence-based practice schools can ensure that their environment is more mentally healthy and a person will not feel ashamed to seek help. Therefore, the ARPA helps to solve present mental health issues while beginning the process of constructing permanent reformations in public health legislation.

Conclusion

In conclusion, the American Rescue Plan Act (ARPA) provides just the right response to the COVID-19 induced mental health crisis. Recognizing the high social determinants of economic stability as a key driver, the ARPA addresses the urgent need to improve access to care and help vulnerable populations, by focusing on improving current mental health services, that are already available. This evidence supports the wisdom of taking immediate action and developed helpful innovations like mobile crisis teams and school programs. Ultimately, ARPA not only seeks to alleviate immediate mental health challenges but also lays the groundwork for long-term improvements in public health outcomes.

References

Brookings. (2021). 
How the American Rescue Plan Act will help cities replace police with trained crisis teams for mental health emergencies
. Brookings. https://www.brookings.edu/articles/how-the-american-rescue-plan-act-will-help-cities-replace-police-with-trained-crisis-teams-for-mental-health-emergencies/

Johnson-Staub , C., & Weerasinghe, I. (2022, April 10). 
Supporting Mental Health Policies and Practices through the American Rescue Plan | CLASP
. CLASP. https://www.clasp.org/publications/report/brief/supporting-mental-health-policies-and-practices-through-american-rescue/

Occhipinti, J.-A., Skinner, A., P Murali Doraiswamy, Saxena, S., Eyre, H., Hynes, W., Geli, P., Dilip Jeste, Graham, C., Song, C., Prodan, A., Goran Ujdur, Buchanan, J., Rosenberg, S., Crosland, P., & Hickie, I. (2024). The influence of economic policies on social environments and mental health. 
Bulletin of the World Health Organization
, 
102
(5), 323–329. https://doi.org/10.2471/blt.23.290286

Randi, O. (2021, August 2). 
American Rescue Plan Act Presents Opportunities for States to Support School Mental Health Systems
. NASHP. https://nashp.org/american-rescue-plan-act-presents-opportunities-for-states-to-support-school-mental-health-systems/

tcmhcc. (2021). 
American Rescue Plan Act (ARPA) Funding for Consortium Initiatives – TCMHCC
. Utsystem.edu. https://tcmhcc.utsystem.edu/arpa/

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Brianna Renee Cole

Oct 9, 2024 8:25pm
| 
Last reply Oct 11, 2024 9:56pm

Reply from Brianna Renee Cole

Discussion 4

NURS 6050

Brianna Cole

October 9, 2024

Sickle Cell Care Expansion Act of 2023

H.R. 3100 and S. 1423 are the same bill proposed by both the House of Representatives and the Senate that supports the Sickle Cell Care Expansion Act of 2023. Sickle Cell disease also known as sickle cell anemia, is a lifelong disease that affect hemoglobin, a protein in the red blood cells that carries and oxygen. (National Heart, Lung, and Blood Institute, 2023) With sickle cell disease the hemoglobin shape is not the normal round disc shape, it shapes like crescent making it harder to move in cells, blocking blood flow to vital organs, then causing major pain. (National Heart, Lung, and Blood Institute, 2023)

H.R. 3100 and S. 1423 were introduced for numerous reasons, to incentivize physicians to specialize in treating patients with sickle cell disease by offering them scholarships and loan repayments, providing community-based grants to offer resources to those affected by sickle cell disease, and provide grants to make sure patients have smooth transitions from pediatric care to adult care. (Congress, 2023)

Social Determinants of Health Affecting the Policy

Sickle cell disease affects approximately 100,000 individuals in the United States. Even though there are cases of sickle cell seen in many races, more than 90% are non-Hispanic African American. (CDC, 2024) Many different social determinants of health can affect the care received by patients with sickle cell disease including low socioeconomic status, lack of education and insurance, and neighborhoods and physical environments. (Mendez et al., 2024) On top of the social determinants of health affecting the care, racial discrimination plays a huge role as pain in African American patients have been known to be mistreated. (Robinson-Lane & Booker, 2017) In my opinion, all the social determinants of health mentioned equally affect the treatment of those suffering from sickle cell disease.

Evidence Based Research

I believe there is evidence-based research available that supports the proposal of bill H.R. 3100 and S. 1423. We need more providers to specialize in caring for patients with sickle cell disease. Having more compassionate and understand providers would help patients get the proper pain management regimens when going into a sickle cell crisis. (Macey-Stewart & Louie, 2023) Having community-based grants to help bring education and awareness to communities is vital in helping improve the access to the treatment needed. (Congress, 2023) Also, making sure there is a solid transfer of care from a patient’s pediatrics provider to their adult provider is very important as life expectancy for a patient with sickle cell disease is about 20 years shorter than the average healthy person. (CDC, 2024) From all the evidence-based research available on this topic, I believe these proposals will successfully pass into bills opening doors the doors to better care for patients with sickle cell disease.

 

References

CDC (2024, May 6). 
Data and Statistics on Sickle Cell Disease
. Sickle Cell Disease (SCD). 
https://www.cdc.gov/sickle-cell/data/index.html
Links to an external site.

Congress (2023) 
H.R.3100 – 118th Congress (2023-2024): Sickle Cell Care Expansion Act of 2023
. Congress.gov.
https://www.congress.gov/bill/118th-congress/house-bill/3100/text?s=5&r=41&q=%7B%22search%22%3A%22health+care%22%7D
Links to an external site.

Congress (2023) 
S.1423 – 118th Congress (2023-2024): Sickle Cell Care Expansion Act of 2023
. (2023). Congress.gov. 
https://www.congress.gov/bill/118th-congress/senate-bill/1423?s=1&r=18&q=%7B%22search%22%3A%22sickle+cell%22%7D
Links to an external site.

Macey-Stewart, K. V., & Louie, K. (2023). Using an individualized pain management plan for African American adults with sickle cell disease. 
Journal of the American Association of Nurse Practitioners
, 
35
(7), 434–440. 
https://doi.org/10.1097/jxx.0000000000000885
Links to an external site.

Mendez GG, Nocek JM, Brambilla DJ, Jacobs S, Cole O, Kanter J, Glassberg J, Saving KL, Melvin CL, Gibson RW, Treadwell M, Jackson GL, King AA, Gordeuk VR, Kroner B, & Hsu LL. (2024). Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry. BMC Health Services Research, 24(1), 291. 
https://doi.org/10.1186/s12913-024-10717-6
Links to an external site.

National Heart, Lung, and Blood Institute. (2023, August 30). 
Sickle Cell Disease – What is Sickle Cell Disease?
 Www.nhlbi.nih.gov. 
https://www.nhlbi.nih.gov/health/sickle-cell-disease
Links to an external site.

Robinson-Lane, S. G., & Booker, S. Q. (2017). Culturally Responsive Pain Management for Black Older Adults. 
Journal of gerontological nursing
, 1–8. Advance online publication. 
https://doi.org/10.3928/00989134-20170224-03
Links to an external site.

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Alicia Prentler

Oct 9, 2024 8:19pm
| 
Last reply Oct 10, 2024 7:45am

Reply from Alicia Prentler

Recently Congress has passed bill S.670 the IMPACTT on Human Trafficking Act, which improves resources, and care for immigrants who have been victimized by human trafficking (118th Congress, 2024). This bill has a direct impact on our public health policy because not only does in increase resources available to immigrant victims but also training and education for Homeland Security Investigators (HSI).  The introduction of this bill came from the Polaris Project in which studies showed that in 2019 there were upwards of 15,000 reported cases of Human Trafficking through the Human Trafficking hotline, but it is predicted that this number is far greater due to this crime being vastly under reported (Severans, S., 2022). This act is meant to stem off the Secure our Skies Act also led by congresswoman Titus, who is passionate regarding the topic of Human Trafficking and the battles our law enforcement fight to rid our society of this heinous act, (Severans, S., 2022). This bill directly effects the social determinants revolving around immigration and the law enforcement meant to work with this population. Recognizing human trafficking victims in immigration has become vital, as these individuals are already scared of law enforcement, and their trafficker may be holding their passport hostage, or limiting funds for the victim to get out of their current situation.

The Enhanced Collaboration Model (ECM) was initiated in 2010 in order to collectively as a government identify and combat human trafficking (National Institute of Justice, 2022),  This ECM initiative is the sole reason why we have so many nationally funded human trafficking entities, as the overall goal from this study is to get a task force in each area of government where human trafficking has been identified to be a high risk situation and immigration is high on this list, leading to the IMPACTT on Human Trafficking Act. Human trafficking as a whole poses a severe threat to our nation’s health hence why many state board of nursing entities have made CEU’s of human trafficking a requirement to renew licensure. This is a topic that I feel very much falls into the category of, “the more you know,” as in the more as we as a society know and are educated on this subject the more we as a society will be able to recognize a possible victim of human trafficking.

 

Resources:

118th Congress. (October 01,2024). Public Law 118-96 Retrieved on October 9th, 2024. 
https://www.congress.gov/118/plaws/publ96/PLAW-118publ96.pdf
Links to an external site.

National Institute of Justice. (2022). Federally Backed Human Trafficking Task Force Model Yields Progress, and Opportunities for Continued Growth. Retrieved on October 9th, 2024. https://nij.ojp.gov/topics/articles/federally-backed-human-trafficking-task-force-model-yields-progress#1-0

Severans, S., (2022). Titus, Joyce Introduce Bipartisan IMPACTT Human Trafficking Act. Retrieved on October 9th, 2024.  https://titus.house.gov/news/documentsingle.aspx?DocumentID=3371

 

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Mehak Ishaq

Oct 9, 2024 6:11pm
| 
Last reply Oct 12, 2024 7:54pm

Reply from Mehak Ishaq

The Treat and Reduce Obesity Act of 2021, aims to enhance accessibility to obesity treatment within Medicare and Medicaid by expanding the variety of covered services, including counseling, medications, and surgical procedures (
Does Medicare Cover Weight Loss Treatments?
, 2024). This law addresses the growing obesity problem in the United States, where more adults are affected, significantly contributing to chronic health conditions like diabetes and heart disease (
Obesity – Symptoms and Causes
, n.d.). A major social factor influencing this legislation is financial status, as individuals with lower incomes often encounter difficulties in obtaining healthy food and medical care.Obesity disproportionately affects underserved communities, leading to significant health disparities. The evidence supporting this legislation is strong; research indicates that comprehensive obesity management approaches can result in meaningful weight loss and improved health outcomes. For example, the Look AHEAD study demonstrated that lifestyle changes could effectively lower diabetes incidence among participants. Expanding treatment options under Medicare and Medicaid is likely to improve access for vulnerable populations (
How Would Authorizing Medicare to Cover Anti-Obesity Medications Affect the Federal Budget?
, 2024), thus addressing these disparities.Furthermore, incorporating obesity treatment into standard healthcare can reduce long-term medical expenses associated with obesity-related diseases. By emphasizing preventive and treatment measures, S.596 aims to promote healthier communities and mitigate the overall effects of obesity in the United States.

 

References:

Does Medicare cover weight loss treatments?
 (2024, February 27). https://www.ncoa.org/article/obesity-treatment-and-medicare-a-guide-to-understanding-coverage/

How would authorizing Medicare to cover Anti-Obesity medications affect the federal budget?
 (2024, October 1). Congressional Budget Office. https://www.cbo.gov/publication/60816

Obesity – Symptoms and causes
. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742#:~:text=Obesity%20makes%20you%20more%20likely,of%20insulin%20resistance%20and%20diabetes.

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Thabasum Abraham

Oct 9, 2024 5:11pm
| 
Last reply Oct 10, 2024 12:30pm

Reply from Thabasum Abraham

Health Policy and Brief Background

S.Res.769 — 118th Congress (2023-2024)

A resolution recognizing the importance of mental health for youth in the United States, and expressing the pressing need for awareness and support for mental health care for children and adolescents.

Sen.Padilla,Alex introduced this health policy on July,2024.and agreed to in senate without amendment and with a preamble by Unanimous Consent.

 

Over the past decade the incidence of mental health diagnoses have increased tremendously, particularly since the COVID pandemic, and more markedly in our younger age groups. Suicide is the third leading cause of death among children from 14 to 18 years old in the United States. Increased mental health related emergency department visits are an important indicator of unmet mental health needs, which are rarely solved outpatient. As an ER nurse, I have witnessed firsthand, numerous mental health conditions presenting to my ED, and an increased incidence of suicides among children at my facility. Studies show all types of mental health related visits significantly increased, and suicide related visits showed the greatest increase from 0.9% to 4.2% of all pediatric ED visits (Bommersbach et al, 2023). According to Congress, over 20% of high school students seriously consider attempting suicide and 10 percent attempted to take their lives (S.Res.769, 2024).

Social Determinants

Identifying risk factors associated with mental health problems and providing adequate support and care are the most important parts of this health policy. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available (Hua et al,2024). Focusing on schools in particularly vulnerable areas with higher statistical rates of mental illness and suicide would be the places to focus on. There are several social determinants that influence these issues such as homelessness, drug use, physical and sexual abuse, food insecurity, poverty, etc.

S.Res.769 health policy encourages state, local educational agencies, schools, and community organizations to support children, youth, and students experiencing mental health challenges at all grade levels by supporting students well-being through evidence-based prevention strategies, and identifying signs and symptoms of mental health disorders among students whom educators have direct contact.

Evidence Base

There is evidence to support the proposed policy to recognize the importance of mental health awareness among youth. This can be accomplished by providing adequate resources to the community, identifying early signs and easily accessible treatment options, addressing the stigma associated with mental health challenges in schools and colleges where youth get more information, recognizing that young children are often  misdiagnosed or undiagnosed, and providing them adequate services and support (S.Res.769, 2024). When children in at risk populations are removed from those environments, there tends to be improvements in their outcomes as a result of the removal of those risk factors. I assert that implementing these policies to screen and treat at risk individuals will result in overall improvements to their health outcomes.

 

 

References:

 

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., Florescu, S., … Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. 
Psychological medicine
, 
46
(14), 2955–2970. 
https://doi.org/10.1017/S0033291716001665
Links to an external site.

 

Bommersbach, T. J., McKean, A. J., Olfson, M., & Rhee, T. G. (2023). National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. 
JAMA
, 
329
(17), 1469–1477. 
https://doi.org/10.1001/jama.2023.4809
Links to an external site.

 

Hua, L. L., Lee, J., Rahmandar, M. H., Sigel, E. J., COMMITTEE ON ADOLESCENCE, & COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION (2024). Suicide and Suicide Risk in Adolescents. 
Pediatrics
, 
153
(1), e2023064800. 
https://doi.org/10.1542/peds.2023-064800
Links to an external site.

 

S.Res.769
. (2024, 7 24). Retrieved 10 2024, from Congress.gov: https://www.congress.gov/bill/118th-congress/senate-resolution/769?s=2&r=1

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Cody Ross Newton

Oct 9, 2024 4:18pm
| 
Last reply Oct 12, 2024 6:49am

Reply from Cody Ross Newton

Initial Post

S.4079 – Rural Obstetrics Readiness Act

The Rural Obstetrics Readiness Act (S.4079) aims to enhance maternal healthcare access in rural areas by providing support for rural hospitals to improve their obstetric services. This includes funding for necessary infrastructure, training for healthcare providers, and resources to ensure that hospitals are equipped to handle obstetric emergencies. The legislation also emphasizes workforce retention and recruitment, recognizing that many rural areas struggle to maintain adequate staffing levels for maternal care.

Background of the Policy

Maternal health outcomes in the U.S. have been declining, particularly in rural areas where access to comprehensive healthcare is often limited. Rural communities frequently face challenges such as hospital closures, shortages of qualified healthcare professionals, and longer travel times for expectant mothers. Maternal mortality rates are significantly higher in rural regions compared to urban areas (Merkt et al., 2021). These disparities are worsened by social determinants of health such as socioeconomic status, access to transportation, and educational resources.

Key Social Determinant Affecting the Policy

One of the most significant social determinants affecting this policy is geographic location. Rural areas often lack access to comprehensive healthcare services, which can lead to inadequate prenatal care, increased complications during childbirth, and higher rates of maternal mortality. Transportation barriers further complicate access, as unreliable transportation can delay necessary medical attention, increasing risks for both mothers and infants. Additionally, rural areas typically experience workforce shortages, with fewer healthcare providers available, which can result in inadequate care during emergencies. Geographic isolation also affects the availability of emergency services, making it critical for rural hospitals to be prepared for obstetric emergencies (Holcomb et al., 2021).

Evidence Base for the Policy

There is evidence to support the proposed Rural Obstetrics Readiness Act. Research consistently shows that improved access to maternal healthcare services significantly enhances health outcomes for mothers and infants, particularly in rural areas where disparities are most pronounced. Timely prenatal care reduces the risks of complications during pregnancy and childbirth and regions with better access to skilled birth attendants and emergency obstetric services experience lower maternal and infant mortality rates. Also, successful interventions, such as telehealth programs, have proven effective in bridging the gap in care access for rural populations, ensuring that expectant mothers receive necessary support and monitoring. Workforce development and training initiatives, like advanced certifications for nurses and advanced practice providers, targeted at rural healthcare providers have been shown to improve the quality of care and increase retention rates that are needed to care for these patients (Vivek, 2020).

References

Holcomb, D., Pengetnze, Y., Steele, A., Karam, A., Spong, C., & Nelson, D. (2021). Geographic barriers to prenatal care access and their consequences. 
American Journal of Obstetrics & Gynecology MFM
, 
3
(5), 100442. 
https://doi.org/10.1016/j.ajogmf.2021.100442
Links to an external site.

Merkt, P., Kramer, M., Goodman, D., Brantley, M., Barrera, C., Eckhaus, L., & Petersen, E. (2021). Urban-rural differences in pregnancy-related deaths, United States, 2011–2016. 
American Journal of Obstetrics and Gynecology
, 
225
(2), 183.e1-183.e16. https://doi.org/10.1016/j.ajog.2021.02.028

Vivek, M. (2020). 
Strategies and actions: Improving maternal health and reducing maternal mortality and morbitiy
. The Surgeon General’s Call to Action to Improve Maternal Health – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/sites/books/NBK568218/

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Elizabeth Rachel Fofanah

Oct 9, 2024 1:18pm
| 
Last reply Oct 12, 2024 1:09am

Reply from Elizabeth Rachel Fofanah

Main Discussion Post

H.R.4066: Save Rural Hospitals Act of 2021

On June 22, 2021, the House received this legislation, which aims to promote equity in Medicare reimbursements and safeguard healthcare accessibility in rural regions. The H.R. 4066—117th Congress (2021) articulates that this legislation creates a foundational wage modification threshold for Medicare hospital payments in states that do not qualify as frontier states, while also exempting these modifications from specific budget independence regulations.

It is believed hospitals in rural areas are experiencing a concerning trend, with over 130 such facilities having ceased operations across the nation since 2010 (Warner et al. 2021). Regrettably, the pace of rural hospital closures reached unprecedented heights during the COVID-19 pandemic, with over 20 rural hospitals ceasing operations in 2020. The predominant reasons for the closures of these rural hospitals are frequently attributed to diminished patient volumes and considerable financial pressures. In numerous instances, the financial challenges faced by hospital systems in rural areas are exacerbated by the inadequacies of the Medicare Area Wage Index, which leads to diminished billing rates for these institutions.

This legislation aims to facilitate equitable reimbursement rates for hospitals, thereby enhancing the sustainability of rural healthcare facilities across the country. Warner et al. (2021) clarify that the proposed legislation aims to institute a suitable national requisite to represent the Medicare Area Wage Index, thereby ensuring equitable compensation for rural hospitals in relation to the services they deliver while concurrently maintaining the current reimbursement levels for urban healthcare facilities.

 

Social Determinants

According to Healthy People 2030 (n.d.), social determinants of health (SDOH) encompass the various conditions present in the settings where individuals are born, reside, engage in education, pursue careers, partake in leisure activities, practice their faith, and grow older, all of which significantly influence a broad spectrum of physical and mental wellness and life satisfaction results and associated risks. The five categories encompass financial stability, accessibility to and quality of higher education, access to and quality of healthcare, the surrounding area and physical setting, as well as social and community context. The social determinant that exerts the greatest influence on this legislation is the accessibility and quality of healthcare. The absence of rural healthcare significantly undermines patients’ capacity to obtain care for emerging, critical, and habitual needs. Individuals residing in rural regions often find themselves several hours distant from the nearest level one or level two trauma center. The restricted access significantly impacts their overall health, as various other constraints may hinder their ability to travel to more distant locations for essential, routine healthcare services. Furthermore, in instances where individuals residing in rural areas experience a traumatic event or face a health condition that necessitates immediate intervention to preserve life, there is a significant escalation in their mortality rate. This legislation serves to ensure the continued operation of rural healthcare facilities.

 

Subjective Outlook

I am fully convinced that this bill has the potential to help maintain the operational status of rural hospitals; however, I remain uncertain about the sufficiency of evidence backing the proposed policy. The proposal was presented to the House in 2021 and remains unpassed to this day. The available literature on the Congress website concerning this bill is quite sparse. Nevertheless, a substantial body of evidence exists to substantiate the argument for advancing and enacting this bill, as detailed in the preceding paragraphs. An illustrative case is the closure of numerous rural hospitals as a consequence of the COVID-19 pandemic. However, one must consider the mechanisms by which existing rural hospitals are sustaining their financial viability in the absence of this legislation.

 

Fostering Agreement for Transformation Among Stakeholders

Establishing a unified agreement for transformation necessitates meticulous preparation. Fostering trust and cultivating strong relationships with individuals capable of actualizing concepts is essential. When one perceives that their voice is acknowledged, it becomes crucial to comprehend the mechanisms behind decision-making. This enables us to engage proactively and contribute thoughtfully to the process. Rather than concentrating solely on the issues that require rectification, it is more beneficial to contemplate the proactive measures one can undertake to address them. The Save Rural Hospitals Act of 2021 has been presented to the House; however, it is evident that it has become mired in inactivity on the legislative agenda. Although it has ascended through the legislative process, we remain in anticipation of advancing toward the enactment of this bill. Reaching out to your state representatives and presenting well-substantiated evidence to advocate for the bill would serve as an excellent initial step in revitalizing this legislative proposal.

 

Reference

Healthy People 2030. (n.d.). Social Determinants of Health. Retrieved January 10, 2023, from 
https://health.gov/healthypeople/priority-areas/social-determinants-health
Links to an external site.

H.R. 4066 – 117th Congress. (2021, June 22). H.R.4066 – Save rural hospitals act of 2021. Retrieved January 11, 2023, from 
https://www.congress.gov/bill/117th-congress/house-
Links to an external site.
 bill/4066

Warner, M. R., Cornyn, J., Blackburn, M., & Warnock, R. (2021). Save Rural Hospitals Act of 2021. Mark R. Warner: US senator from the commonwealth of Virginia. Retrieved January 11, 2023, from 
https://www.warner.senate.gov/public/index.cfm/
Links to an external site.
   

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Henrietta Mensah

Oct 9, 2024 10:48am

Reply from Henrietta Mensah

American Rescue Plan Act of 2021

The American Rescue Plan Act of 2021, signed by Joe Biden, stands as a beacon of hope, providing critical healthcare policies and legislative proposals that have significantly enhanced economic relief and public health measures after the COVID-19 pandemic.
 Its provisions offer a sense of reassurance in these challenging times.

Background and development 

Millions of Americans, most of whom are low-income earners and immigrants, were affected by the COVID-19 pandemic, resulting in an economic crisis that al
so undermined healthcare services. Over 4 million workers were out of work for more than 6 months and over 9.5 million lost their job due to covid-19 pandemic. The Act was significant in providing direct payment to individuals, extending unemployment benef
its and enhancing funding for small businesses. Notably, the
  American
 Rescue Plan Act of 2021 played a significant role in helping workers who lost their jobs pay health insurance premiums
(Congressional Research Service, 2021)
. It ensures there is seriou
s investment in the public health sector, including paying for vaccine manufacturing testing and enrollment to curb increased COVID-19 contamination that has had significant economic and healthcare challenges. The American Rescue Plan Act of 2021 also has 
a significant impact on expanding the Affordable Care Act through subsidizing help insurance purchased via the Affordable Care Act marketplace
(Congressional Research Service, 2021)
. The move was significant in ensuring an increased number of low-income ea
rners could afford the insurance policies.

Social determinant impacting the policy 

The social determinants of health were significantly impacted by the policy due to increased healthcare access and economic stability. The policy has been impactful in actually providing 
economic stability through providing employment to unemployed individuals after COVID-19 pandemic, and offering financial support enabling most of the people to access quality healthcare services. It has also established subsidies to health insurance purchased through ACA, enabling most of the low income e
arners to access quality healthcare services improving their health wellbeing.

Evidence-based 

 According to 
O’Mahen & Petersen (2021), the American Rescue Plan Act provided $1.9 trillion to combat the COVID-19 pandemic. It was impactful in broadening the Affordable Care Act policies, including extending health insurance 
policies to the uninsured, resulting in increased Medicaid expansion. U.S. Department of Labor, 2021) indicated that the American Rescue Plan Act, significant in assisting with health insurance premiums to healthcare workers who had lost their jobs or had 
been there, was reduced during the pandemic pay for health insurance by subsidizing the healthcare insurance premium program. The subsidies resulted in a significant decrease in premiums by an average of 40%, significantly increasing healthcare access by m
ost low-income earners and people who had lost their jobs. The funding also supported healthcare workers by ensuring there was adequate financial support to enhance healthcare worker recruitment, training, and retention to offer healthcare services during 
the pandemic, resulting in an increased number of healthcare workers, thus increasing patient safety, quality of care and overall healthcare outcome. Congressional Research Service (2021), the American Rescue Plan Act ensured there was money for vaccine ma
nufacturing, testing, and campaigns. The money was also used in the COVID-19 testing and contact tracing process, ensuring there was a reduction in COVID-19 spreading. The money was also used to enhance healthcare 
infrastructure and provide resources for t
he COVID-19 treatment process, including purchasing personal protective equipment and PPEs for healthcare workers critical in treating process.

Conclusion 

The American Rescue Plan Act significantly resulted in economic and healthcare policies helping wit
h the recovery process after the COVID-19 pandemic. It is an evidence-based policy that has offered critical support to American citizens hugely affected by the pandemic. The Act has been critical in making decisions on expanding healthcare services throug
h enhancing economic support, such as subsidized health insurance policies. The evidence shows the importance of the American Rescue Plan Act in reducing healthier costs and improving economic stability.

References

Congressional Research Service.
 (2021). 
American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply Chain, Health Services, and Related Provisions
.

O’Mahen
, P. N., & Petersen, L. A. (2021).
 Will the American Rescue Plan Overcome Opposition to Medicaid Expansion? 
Journal of General Internal Medicine
, 
36
(11).
https://doi.org/10.1007/s11606-021-07084-x

U.S. Department of Labor.
 (2021). 
The
 American Rescue Plan Act | U.S. Department of Labor
. Www.dol.gov. https://www.dol.gov/general/american-rescue-plan

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Tiffany Peron

Oct 9, 2024 8:53am
| 
Last reply Oct 11, 2024 2:56pm

Reply from Tiffany Peron

Main Discussion

Tiffany Peron

 

H.R.3548, which is known as the Pursuing Equity in Mental Health Act, this act aims to address disparities in mental health care access and treatment among diverse populations. This legislation seeks to enhance funding for mental health programs that serve underserved and marginalized communities, promote workforce diversity in mental health professions, and improve data collection on mental health outcomes to better identify and address these disparities (S.1700 – 118th Congress 2023-2024).

Background of the problem:

Mental health disparities are well-documented, especially among racial and ethnic minorities, LGBTQ+ communities, and individuals with low incomes. These groups frequently encounter barriers to accessing care, such as stigma, cultural insensitivity in treatment, lack of insurance, and socioeconomic challenges. The COVID-19 pandemic has intensified these issues, underscoring the urgent need for focused interventions to promote equitable mental health care.

Social Determinant:

The most significant social determinant affecting this policy is socioeconomic status. Individuals from lower socioeconomic backgrounds are more likely to experience mental health issues due to factors like financial stress, unstable housing, and lack of access to quality healthcare. As well as worrying about the stigma around mental health and how others will perceive them. Addressing these socioeconomic disparities is crucial for improving mental health outcomes and ensuring equitable access to care (Kirkbride, J. B. et al., 2024, February).

Evidence Base:

I think there is significant evidence highlighting the necessity for policies such as the Pursuing Equity in Mental Health Act. Research indicates that culturally competent care can enhance treatment outcomes for minority populations. In the article Culturally tailored interventions for ethnic minorities it revealed that minority patients receiving culturally tailored interventions demonstrated greater engagement and adherence to treatment (Joo, J. Y., & Liu, M. F. 2021, September). Also data shows that increasing diversity within the mental health workforce can foster better patient-provider relationships and enhance care experiences. I found the article The importance of diversity and inclusion in health care very interesting. This article pointed out that patients from diverse backgrounds often prefer providers who understand their cultural contexts and unique challenges (Stanford, F. C. 2020, June). This would be another way to reduce the stigma around mental health.

Conclusion

H.R.3548 tackles significant disparities in mental health care by implementing evidence-based strategies that emphasize socioeconomic factors and workforce diversity. Considering the documented gaps in access and outcomes, this legislation is an essential move toward achieving equity in mental health care for all individuals, especially those from underserved communities. In my community alone there are no mental health providers and just recently a doctor’s office in the school setting has started and they are already completely full.

 

References

Joo, J. Y., & Liu, M. F. (2021, September). 
Culturally tailored interventions for ethnic minorities: A scoping review
. Nursing open. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363345/

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L. (2024, February). 
The social determinants of mental health and disorder: Evidence, prevention and recommendations
. World psychiatry : official journal of the World Psychiatric Association (WPA). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10786006/?scrlybrkr=e6c8d9d3

S.1700 – 118th Congress (2023-2024): Pursuing equity in mental health act | congress.gov | library of Congress. (n.d.). https://www.congress.gov/bill/118th-congress/senate-bill/1700

Stanford, F. C. (2020, June). 
The importance of diversity and inclusion in the healthcare workforce
. Journal of the National Medical Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387183/

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Cecile Bowen

Oct 8, 2024 11:02pm
| 
Last reply Oct 11, 2024 2:49pm

Reply from Cecile Bowen

Initial Response

On March 3 of 2023, Senator Grassley introduced the bill S. 645 which discusses the need for post-traumatic stress disorder [PTSD] and acute stress disorder [ASD] treatment to be available to public safety officers. This bill would require the General Attorney to form a report stating the necessary funds, resources, and actions to create a program providing PTSD and ASD treatment and support for United States public safety officers. Public safety officers include but are not limited to police, firefighters, and telecommunicators.

Public safety personnel are exposed to a much higher frequency of traumatic incidents than the average citizen (Jaeger, 2023; Edgelow et al., 2023). Because of this the risk of developing a mental health disorder such as PTSD is 25.6 times higher for public safety personnel as well (Los Angeles Airport Peace Officers Association, 2024). Per Kiederer and associates, mental health assistance is commonly found only while onboarding (2024). Long term support is much harder to obtain. Not only is this affecting public safety personnels wellbeing and quality of life, it also affects how they perform their jobs and interact with other citizens. For example, if police officers make decisions based off prior experience, they may have a more forceful or brute response due to PTSD or traumatic events they have been through. Not only would encouraging mental health increase personal outcomes for these public servants, it could also have a major impact on the way these individuals interact with citizens.

The National Occupation Research Agenda [NORA] held a meeting in February of 2024 as a continuation of their Agenda for Public Safety (Kiederer et al., 2024). In this council, the mental health programs already in place for public health personnel were discussed and analyzed. The challenges as well as further needs to provide better care were identified. While additional studies need to be had to prove the link between trauma and the impact it has on decision-making, it is undeniable that there is a major increased risk of traumatic events, PTSD, or other mental health disorders for individuals who work in public safety. Passing a bill like this, either on a state or federal level could have a major impact on society. We need to be taking care of the individuals such as police, firefighters, first-responders, and telecommunicators as they have a large impact on emergency response.

 

References

Edgelow, M., Fecica, A., Kohlen, C., & Tandal, K. (2023). Mental health of public safety personnel: Developing a model of operational, organizational, and personal factors in public safety organizations. 
Front Public Health, 11.
 
https://doi.org/10.3389%2Ffpubh.2023.1140983
Links to an external site.

Fighting Post-Traumatic Stress Disorder Act of 2023, S. 645, 118
th
 Congress. (2023). 
https://www.congress.gov/bill/118th-congress/senate-bill/645/text?s=7&r=6&q=%7B%22search%22%3A%22telehealth%22%7D
Links to an external site.

Jaeger, S. (2023). 
The Impact of life experiences on police officers.
 United States Federal Bureau of Investigation. 
https://leb.fbi.gov/articles/perspective/perspective-the-impact-of-life-experiences-on-police-officers
Links to an external site.

Kiederer, M., Tiesman, H., Gerard, D., Hofer, M., Wheldon, K., Neitlich, D., Shapiro, D., Attwood, W., D’Alessandro, M., & Marsh, S. (2024). 
Tackling mental health challenges in the public safety sector: Implementing and evaluating mental health programs
. Centers for Disease Control and Prevention. 
https://blogs.cdc.gov/niosh-science-blog/2024/05/09/mental-health-public-safety-sector/
Links to an external site.

Los Angeles Airport Peace Officers Association. (2024). 
Suffering in silence no more: Shedding light on PTSD among peace officers
. 
https://blogs.cdc.gov/niosh-science-blog/2024/05/09/mental-health-public-safety-sector/
Links to an external site.

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Pawandeep Kaur Dhaliwal

Oct 8, 2024 9:57pm
| 
Last reply Oct 11, 2024 9:57pm

Reply from Pawandeep Kaur Dhaliwal

Main Post

The Childhood Cancer STAR Reauthorization Act

The Childhood Cancer STAR Reauthorization Act is one of the vital health policies that focus on the needs of children and other young persons with cancer. As reauthorized in 2023, the STAR Act expands cancer research, supports biobanking activities, and the quality of survivorship care (Congress, 2023). This legislation enables the National Cancer Institute (NCI) and the National Institutes of Health (NIH) to enhance paediatric oncology investigation and broaden scrutiny by state cancer registries, improve on treatments of other rare cancer types, address survivorship issues and offer long-term care for childhood cancer survivors (NCI, 2023).

The STAR Act addresses several key concerns in pediatric oncology, namely the weak efficacy of current therapies in some rare cancer subtypes, a paucity of biospecimens to support research, and lack of focus on survivorship. One of the key elements of this policy focuses on biospecimen acquisition from children and AYAs to expand existing biobanks (NCI, 2023). By targeting only subtypes, which respond poorly to treatment, the STAR Act provides for more intensive research into novel treatments, especially for cancers that show high recurrence rates and low survival rates. Further, it fosters analysis of the late effects of cancer therapies since many young patients suffer from chronic health conditions. Survivorship study entails the assessment of the late complications or effects of treatment, for instance the second cancers or other chronic diseases that can occur after cancer relapse. Continued research and support through fiscal year 2028 helps sustain the programs’ progress, which is why reauthorization of this policy is important (Chris Van Hollen, 2023)

The specific social determinant that has most impact on Childhood Cancer STAR Reauthorization Act is the unequal health care access and inequalities in outcomes amongst the cancer affected children from different strata of society (Maria e al., 2022). Lack of follow-up care and disparities in survival rates are not rare problems, and these elements depend on income, education, and race. For instance, because most low income families cannot afford quality healthcare, their children may not receive adequate cancer treatment or survivorship programs because those services may be unavailable in their neighborhoods or may be too expensive. The STAR Act makes a point of encouraging the assessment of and seeking ways to mitigate these factors, and in that respect, this language directly contributes to combating social determinants that may affect cancer outcomes.

I firmly believe that there is a substantial evidence base supporting the Childhood Cancer STAR Reauthorization Act. For example, NCI’s ongoing efforts to enhance biobanking and biospecimen research have already resulted in the initiation of new projects aimed at improving treatments for rare cancer subtypes and reducing treatment failures. The collection of tumor specimens, particularly at relapse, has enabled researchers to explore biological changes that occur between diagnosis and relapse, which is crucial for developing targeted therapies (Lone et al., 2022). Additionally, the expansion of biobanking efforts, including rapid autopsy programs, ensures that researchers have access to valuable biospecimens needed to advance pediatric cancer research. The policy’s focus on survivorship research is also grounded in evidence. Research has shown that childhood cancer survivors are at higher risk for secondary cancers and chronic health conditions, reinforcing the need for policies that promote long-term survivorship care and monitoring (Abrahaoet al., 2020).

Conclusion

The Childhood Cancer STAR Reauthorization Act is a well-supported and impactful policy that addresses the complex needs of pediatric and AYA cancer patients. By emphasizing cancer research, biobanking, and survivorship care, the policy seeks to improve both immediate and long-term outcomes for these populations. It also acknowledges and aims to reduce disparities in access to care and survivorship outcomes, particularly for those affected by social determinants such as income. With a evidence base supporting its provisions, the STAR Act remains a critical piece of legislation for advancing childhood cancer treatment and improving survivorship care.

 

 

References

Abrahão, R., Ribeiro, R. C., Brunson, A., & Keegan, T. H. (2020). The burden of second primary cancers among childhood cancer survivors. 
Annals of Cancer Epidemiology
, 
4
. 
https://doi.org/10.21037/ace-2020-01
Links to an external site.

Chris Van Hollen Page. (2023). 
Childhood Cancer STAR Reauthorization Act Signed into Law 
. Www.vanhollen.senate.gov. 
https://www.vanhollen.senate.gov/news/press-releases/childhood-cancer-star-reauthorization-act-signed-into-law
Links to an external site.

Congress. (2021). 
Text – S.4120 – 117th Congress (2021-2022): Childhood Cancer STAR Reauthorization Act
. Congress.gov. 
https://www.congress.gov/bill/117th-congress/senate-bill/4120/
Links to an external site.

Lone, S. N., Nisar, S., Masoodi, T., Singh, M., Rizwan, A., Hashem, S., … & Macha, M. A. (2022). Liquid biopsy: a step closer to transform diagnosis, prognosis and future of cancer treatments. 
Molecular cancer
, 
21
(1), 79. 
https://doi.org/10.1186/s12943-022-01543-7
Links to an external site.

María, J. U. Á., Mario, C. F., Mauricio, H. C., Gisset, G. P. A., Alirio, H. R. J., Guillermo, P. P., & Alejandro, B. C. (2022). A cross-sectional study of the socio-demographic and epidemiological factors associated with childhood cancer in Cali, Colombia. 
Heliyon
, 
8
(5). 
https://www.cell.com/heliyon/fulltext/S2405-8440(22)00698-3
Links to an external site.

National Cancer Institute. (2023). 
Childhood Cancer STAR (Survivorship, Treatment, Access, Research) Act (Public Law No: 115-180)
. Cancer.gov. 
https://www.cancer.gov/about-nci/legislative/recent-public-laws/star-act#top
Links to an external site.

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Jasmine Daniels
 (She/Her)

Oct 8, 2024 7:34pm
| 
Last reply Oct 12, 2024 6:39pm

Reply from Jasmine Daniels

 

H.R.3548 – the Pursuing Equity in Mental Health Act is aimed at dismantling the inequities surrounding access to mental health care for people of color.   This bill enlists the Department of Health and Human Services (HHS) to champion mental and behavioral health promotion with a focus on the destigmatization of substance use disorder and mental illness to communities considered to be “racial or ethnic minority groups.”   This bill also calls for additional research on mental health disparities relative to these minority groups (Pursuing Equity in Mental Health act, 2023).

The Pursuing Equity in Mental Health Act was initially introduced in the House of Representatives in 2020 as H.R. 5469 and sent to the Senate for their vote (govtrak.us, 2024). This bill died in the 116
th
 Congress but was reintroduced in 2021 to the 117th Congress as H.R. 1475 in part as a response to the growing mental health epidemic resulting from the increased isolation due to the COVID-19 pandemic (American Psychological Association, 2021).   H.R. 1475 passed unanimously in the House but was not passed by the Senate.  In 2023, the Pursuing Equity in Mental Health Act was again introduced to the 118th Congress as H.R. 3548.

Research on suicide prevention, the loneliness epidemic, and the impact of COVID-19 on America’s youth shows a startling trend for people of color.  Indigenous and Black adolescents are twice as likely to die from a suicide attempt than white adolescents (Gordon, 2020).  The number of self-injury attempts in young Black men increased by 122% between 1991 and 2017 (The Congressional Black Caucus Emergency Taskforce, 2018).   Black and Latinx children with autism are less likely to be diagnosed during childhood than their white peers, foiling opportunities for intervention that could be pivotal to their education (Gordon, 2020). Additionally, 2018 data from the Substance Abuse and Mental Health Services Administration show that fewer than 35% of Black and Latinx adults with mental illness accessed treatment for their mental health concerns.  Less than 20% of the same population polled received treatment for substance use disorder, citing cost as the major factor for not initiating treatment (Shim, 2021).

Inequitable access to health care resources, particularly access to mental health resources, can be tied back to systemic racism.  From eugenics to residential segregation, the impact of the disenfranchisement of people of color has led to poverty, unemployment, food insecurity, and other social determinants of health that directly impact mental health (Shim, 2021).   Additionally, the research gap on mental health has led to bias –whether intentional or unintentional—in treatment of mental illness in people of color.  The consequence of this bias could be far-reaching, up to and including the possibility of misdiagnosis or even death (Mongelli et al., 2020).

So, what is a viable solution?  Further research on mental health in people of color, community resources, culturally competent care, and a change in policy.  The Pursuing Equity in Mental Health Act has a goal of bridging these gaps.  This bill aims to fund more research on mental health in minority communities and allows funding from the Minority Fellowship Program to be used to educate behavioral health and psychology students on best practices related to culturally competent care and funding for minorities pursuing higher degrees in mental and behavioral health fields. Additionally, if passed, this bill will provide grants for healthcare facilities serving underserved communities (Pursuing Equity in Mental Health act, 2023).

The need for a change in policy is apparent.  Many bills have been proposed to address the inequities in access to quality mental health care.  I hope that this legislation will pass as it could be a meaningful start to bridging the mental healthcare gap.

 

 

 

References

American Psychological Association. (2021, May 11). 
Advancing Mental Health Equity and youth suicide prevention legislation
. https://www.apaservices.org. https://www.apaservices.org/advocacy/news/mental-health-suicide-prevention

Gordon, J. (2020, January 29). 
Addressing Disparities: Advancing Mental Health Care for All Americans
. Retrieved October 8, 2024, from https://www.nimh.nih.gov/about/director/messages/2020/addressing-disparities-advancing-mental-health-care-for-all-americans#:~:text=Mental%20health%20disparities%20are%20significant%20and%20easily

GovTrack.us. (2024). H.R. 3548 — 118th Congress: Pursuing Equity in Mental Health Act. Retrieved from https://www.govtrack.us/congress/bills/118/hr3548

H.R.3548 – 118th Congress (2023-2024): Pursuing Equity in Mental Health Act. (2024, April 16). https://www.congress.gov/bill/118th-congress/house-bill/3548

Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. 
Focus
, 18(1), 16-24.

The Congressional Black Caucus Emergency Taskforce. (2018). Ring The Alarm: The crisis of Black youth suicide in America. In 
A Report to Congress
 (p. 1). https://theactionalliance.org/sites/default/files/ring_the_alarm-_the_crisis_of_black_youth_suicide_in_america_copy.pdf

Shim, R. S. (2021). Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity. 
American Journal of Psychiatry
, 178(7), 592–598. https://doi.org/10.1176/appi.ajp.2021.21060558

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Domonique Yates

Oct 8, 2024 5:25pm
| 
Last reply Oct 12, 2024 2:08pm

Reply from Domonique Yates

Hello colleagues,

The health policy I have selected is H.R.5413 – Prevent Youth Suicide Act. This bill will fund suicide prevention initiatives, promise health care providers gain training to prevent intentional harm, and create an internal hub to furnish safety facts to at risk youth and their support networks (Zadrozny, 2017). Suicide and suicidal behavior among adolescents is a critical public health situation. Suicide is the second leading cause of death among young people 10-24 years of age in the United States, and the rate has been rates increasing for decades. Among the youth in the US who has died, over 25% died from suicide. The proportion of mental health–related emergency department visits for suicide attempts in early 2021 among adolescents 12–17 years of age increased 31% compared with the same period in 2019 (CDC, 2021).

Social determinants of health (SDOH) are the conditions in which people are born, live, work, and age.  These aspects have an important impact on mental health outcomes for youths. Some of the aspects come from depression,  anxiety, low educational achievement, poor living conditions, bad family relationships, violence, bullying, negative childhood, discrimination, and lack of stable housing.  Still in all, certain individuals are at greater risk of suicide, it can be difficult to know who will act upon their thoughts and feelings.

I believe there is evidence base to support the proposed policy for the prevention of teen suicide. This can be accomplished by educating youth on despair and fatal behavior in schools considering it is the commonplace environment for adolescents.  Among the different intervention methods, school-based involvement for adolescent suicide have shown possible results in detering and addressing youth suicide (Liu &Wang, 2024). Learning suggests a call to knowledge and guidance related to school postvention. Postvention provides support for the grieving family, friends, professionals or peers which aids in the possibility of copycat suicide. When a exposed youth can relate with a suicide victim, he/she might choose the same destiny, thinking it maybe a way out for them (Zadrozny, 2017). Schools, communities and organizations should be ready to react to suicide and include postvention as a element for youth suicide prevention since it supports healing and comforting to loss survivors.

Reference

(June 11,2021). CDC. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. Retrieved from 
https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm
Links to an external site.

Liu, X. Q., & Wang, X. (2024). Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs. 
World journal of psychiatry
, 
14
(4), 494–506. 
https://doi.org/10.5498/wjp.v14.i4.494
Links to an external site.

Zadrozny B. (April 28,2017). Daily Beast. Teen Copycat Suicides Are A Real Phenomenon. Retrieved from 
https://www.thedailybeast.com/teen-copycat-suicides-are-a-real-phenomenon
Links to an external site.

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Erica Danielle De Los Santos

Oct 8, 2024 3pm
| 
Last reply Oct 9, 2024 6:49am

Reply from Erica Danielle De Los Santos

A new health policy called the “Improving Access to Vaccines for Children Act,
“
 has been put forward to boost vaccination rates in children from underserved areas specifically to tackle the decline in immunization rates that have been associated with outbreaks of diseases like measles and whooping cough (Salmon et al., 2020). This act seeks to improve access to vaccines by providing funding for health programs and mobile vaccination services, while implementing targeted efforts to educate families on the significance of getting vaccinated.

The drop in vaccination rates is influenced by reasons such as misinformation on vaccine safety and limited access to healthcare services, alongside challenges that hinder families from receiving the required vaccinations (McKee & Bohannon – 2016). The strategy aims to address these concerns by offering support to health agencies and community groups for raising awareness and improving vaccine accessibility conveniently.

Factors that shape our environment.

The main factor influencing this policy is the socioeconomic status (SES) of individuals. People in SES categories often encounter difficulties in obtaining healthcare services because of limitations and a lack of transportation options and healthcare providers in their areas (as mentioned by Marmot in 2018). The goal of this policy is to enhance vaccination rates for children by removing these obstacles and focusing on marginalized communities specifically.

Supporting Evidence

Numerous studies have provided evidence in favor of implementing this policy due to its importance and effectiveness in public health efforts. Research has clearly demonstrated that making vaccines more accessible is closely tied to a decrease in the occurrence of diseases (as highlighted by Kahn et al., 2021). For instance, community driven vaccination initiatives have effectively raised immunization levels among marginalized groups, leading to a decline in disease rates and better health outcomes for the public. Through utilizing community assets and applying proven methods, this policy seeks to safeguard at risk populations and promote well being within communities.

References:

Kahn, K. D., Hu, H., & Holtzman, D. (2021). Community interventions to improve vaccination rates: Evidence from recent studies. 
American Journal of Public Health
, 111(5), 768-776.

Marmot, M. (2018). Social determinants of health inequalities. 
The Lancet
, 372(9650), 1661-1669.

McKee, C., & Bohannon, K. (2016). Vaccine hesitancy: A public health challenge. 
Journal of Public Health Policy
, 37(3), 378-390.

Salmon, D. A., McCauley, M. M., & Moulton, L. H. (2020). Vaccine refusal and the risks of vaccine-preventable diseases: A systematic review. 
Health Affairs
, 39(2), 242-248.

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Stella Chinelo Ukakogu

Oct 8, 2024 12:25pm
| 
Last reply Oct 12, 2024 10:24am

Reply from Stella Chinelo Ukakogu

Main Post

The American Rescue Plan Act of 2021 (ARPA)

The American Rescue Plan Act of 2021 (ARPA) is an all-inclusive health policy enacted to address the challenges posed by the COVID-19 pandemic. ARPA, signed into law on March 11, 2021, allocated $1.9 trillion in fiscal stimulus funds to strengthen the healthcare system, financially assist people and families, and support public health initiatives (Statista, n.d). These include expanding health insurance through the Affordable Care Act, increased funding for vaccine distribution, and increased access to mental health services. The act represents one of the remarkable commitments at the federal level to improve health outcomes against the background of an unprecedented crisis.

Background for the Problem or Issue Addressed

The COVID-19 pandemic widened inequities in healthcare access and health outcomes throughout various populations in the United States. Before COVID-19, many Americans struggled with inadequate health coverage, as well as the economic fallout due to COVID-19 pushed these issues to their limits. According to records by the U.S. Census Bureau, an estimated 29 million were uninsured in 2019, a figure that was predicted to increase as millions more people during the pandemic lost their employment and employer-sponsored health insurance (Statista, n.d). Given these emerging issues, the ARPA expands Medicaid eligibility in participating states and temporarily enhances subsidies under the ACA, further allowing more people to access health coverage. Moreover, due to the pandemic, people realized the need to put measures in place to protect public health, putting high demand on vaccination and healthcare resources.

Social Determinants Affecting the Policy

The most significant socio-economic determinant influencing this policy is the status of an individual’s socio-economic standing. Low-income communities have often been on the receiving end of the major impacts of this pandemic, related to the fact that these would still manage to trickle down to the remaining barriers through unemployment, lack of health insurance, limited access to healthcare facilities, and many more. ARPA seeks to better these disparities by expanding ACA subsidies and providing financial assistance that caters to the affordability of health insurance. This initiative is most important to the low-income population, who usually work on the frontline and are more exposed to COVID-19. It calls for comprehensive health coverage and support.

Evidence Base Supporting the Proposed Policy

Support for health policies from ARPA is deeply evidence-based. Several studies confirm that more health access correlates with better results among the most vulnerable members of the population. These include expanding ACA subsidies, which have been shown to greatly lower the number of uninsured. However, the research by Wisk et al. (2020) denotes that, under the ACA, increased subsidies admittedly lower the number of uninsured; this, in turn, is related to positive health consequences such as higher use of preventive services and lower mortality rates. Donohue et al. (2022) also found that states that expanded Medicaid significantly improved access to care and health outcomes for low-income individuals, amplifying the individual mandate and health insurance subsidies to improve population health. Moreover, it advances vaccine distribution, for which studies have shown evidence of being integral to combatting infectious diseases and preventing severe diseases. ARPA applies data-centered methods to create a more resilient health system that is better positioned to respond to today’s health crises and those of the future.

 

 

References

Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The U.S. Medicaid program: coverage, financing, reforms, and implications for health equity. 
Jama
, 
328
(11), 1085-1099.

Statista, (n.d). Number of health insured vs. uninsured adults in the United States from 2003 to 2020. Retrieved from 
https://www.statista.com/statistics/671672/development-of-uninsured-adults-in-us-by-number/
Links to an external site.

Wisk, L. E., Peltz, A., & Galbraith, A. A. (2020). Changes in health care–related financial burden for U.S. families with children associated with the Affordable Care Act. 
JAMA pediatrics
, 
174
(11), 1032-1040.

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Rebecca Carico

Oct 8, 2024 8:33am
| 
Last reply Oct 10, 2024 4:40pm

Reply from Rebecca Carico

Introduced to the Senate on March 30, 2023, Congress proposed “
S. 1113-118
th
 Nurse Staffing Standards for Hospital Patient Safety and Qualify Care Act of 2023”. According to Congress.gov (n.d.), this bill will require hospitals to have a staffing plan that complies with a certain minimum nurse-to-patient ratio and submit this information to the Department of Health and Human Services. This will also require hospitals to post a public notice stating what the required nurse-to-patient ratios are in each unit and must maintain records of what the ratios are versus what the ratios should be during each shift. Congress.gov (n.d.) also mentions that the bill will require protocols and procedures to be put in place at each hospital that will help determine what the best and safest ratio for each unit is. Funding for this bill is proposed by expanding Medicare payments to cover any additional close to help comply with this ratio requirement.

This bill is well over-due for nurses in the hospital setting. As a nurse who worked in the ER for five years, I can attest that safe nurse-to-patient ratios are of the upmost importance to patient safety and overall patient and nurse satisfaction. Overworked nurses that have a heavy patient load are statistically more likely to make errors and provide less than ideal care compared to nurses who work in a unit that requires safe nurse-to-patient ratios (Kim et al., 2024). By providing safe ratios in the hospital setting, this could improve the overall patient care and satisfaction, and decrease the burnout that nurses are experiencing.

Social determinants, as defined by Wood et al. (2024), are non-medical factors that can affect someone’s health such as: environmental conditions, social background, education, and economic status. A social determinant that could be affected by this bill would be the economic status of the nurses and hospitals that would be affected by the increase in staffing needs. This would include health care workers in the hospital setting, specifically nurses and the patients that they care for, Medicare funding within the economy, and the cost of the increase in potential staffing needed in these specific hospitals and organizations to meet the required ratios. After working first-hand in the emergency department and experiencing the critical importance of safe staffing ratios, I think there will be more than enough evidence to support this proposed policy. Over the years, especially since COVID, our rural hospitals have gotten used to running on “skeleton crews” to provide the minimum care needed. They have relied on giving a single person multiple jobs with no incentives or extra resources, and very few organizations have reevaluated the critical need for restructuring within each unit. Each unit has its own individualized staffing ratios depending on the acuity of the patients they care for and should be evaluated properly to ensure a safe health care environment is being provided to both the nursing staff and patients. If Congress and Medicare can determine an appropriate way to fund this bill, I believe this could be life changing for our hospitals.

 

References

Congress.gov, (n.d.). Retrieved October 7
th
, 2024, from 
https://www.congress.gov/bill/118th-congress/senate-bill/1113?s=1&r=21&q=%7B%22search%22%3A%22Health+Care+Policy%22%7D
Links to an external site.

Kim, Y., Lee, K., & Jung, M. (2024). Improvement in nurse staffing ratios according to policy changes: a prospective cohort study. 
BMC Nursing
, 
23
(1), 1–13. 
https://doi.org/10.1186/s12912-024-01995-w
Links to an external site.

Wood, E. B., Brown, A., Douglas, C. S., Lawrence, J., Wotherspoon, Z., & Gollenberg, A. (2024). Engaging Emergency Nurses in Strategies to Address the Social Determinants of Health. 
Journal of Emergency Nursing
, 
50
(1), 145–152. https://doi.org/10.1016/j.jen.2023.06.014

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Lucia Almeida

Oct 8, 2024 4:04am
| 
Last reply Oct 10, 2024 3:56am

Reply from Lucia Almeida

The newly proposed health policy, the Telehealth Extension and Evaluation Act of 2022, aims to expand telehealth services to Medicare enrollees. This policy aims to make telehealth use permanent by extending the congratulations made when COVID-19 made it possible for Medicare to offer a broader range of telehealth services in the future (Saharkhiz et al., 2024). The objective is to ensure that people on Medicare and those in rural and remote areas can still access telehealth services beyond the COVID-19 pandemic.

An important factor that has led to the formulation of this policy is the lack of adequate healthcare facilities in rural areas and other areas with low physician population density. Most Medicare patients encounter service delivery complications owing to provider scarcities for intricate reasons, leading to longer distances to cover to access healthcare services(Schaefer et al., 2024). This policy directly correlates with a social determinant of healthcare in that it seeks to sustain and develop telehealth services under Medicare. An issue such as additional limitations for independent physicians and general lack of access to healthcare services, which is a significant problem for residents of rural areas, is a risk factor that is negatively associated with health outcomes, particularly in people with chronic diseases, including elderly patients who need frequent follow-ups.

The rationale for this policy is well-supported by numerous research arguments that speak to the benefits of telehealth in universally increasing access to healthcare, decreasing expenses, and continually maintaining patient satisfaction. According to a report by HHS, it has been revealed that Medicare telehealth utilization increased by more than half during the pandemic. Numerous studies confirm improved health outcomes from telehealth visits, especially for chronic diseases (Centers for Medicare & Medicaid Services, 2021). Moreover, according to Saharkhiz et al. (2024), telehealth can potentially decrease the number of patients attending EDs and admissions by offering continuous care, proving its effectiveness as an accessible, cost-saving solution compared to face-to-face consultations.

Telehealth stakeholders also support this policy because they believe that there should be consistency in offering telehealth services. For instance, permanently addressing telehealth coverage has been supported by the AMA based on the fact that studies have shown that telehealth service increases the availability and utilization of mental health services, which is a pressing issue due to the effects caused by the pandemic. In expanding the telehealth services under Medicare, this policy is thus responsive to telehealth evidence where telehealth sessions on mental health are as practical as face-to-face visits. This element is essential to Medicare beneficiaries who can experience stigmatization or lack of access to a suitable physical venue for mental health services.

References

Centers for Medicare & Medicaid Services. (2021, December 3). 
New HHS Study Shows 63-Fold Increase in Medicare Telehealth Utilization During the Pandemic | CMS
. Www.cms.gov. 
https://www.cms.gov/newsroom/press-releases/new-hhs-study-shows-63-fold-increase-medicare-telehealth-utilization-during-pandemic
Links to an external site.

Saharkhiz, M., Rao, T., Parker-Lue, S., Borelli, S., Johnson, K., & Cataife, G. (2024). Telehealth Expansion and Medicare Beneficiaries’ Care Quality and Access. 
JAMA Network Open
, 
7
(5), e2411006. 
https://doi.org/10.1001/jamanetworkopen.2024.11006
Links to an external site.

Schaefer, S. L., Shukri, Kunnath, N., Scott, J. W., & Ibrahim, A. M. (2024). Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage

Constitutional Convention – Purpose of the Federal Convention

In response to the Shays’ Rebellion, the Confederation Congress asked the states to send delegates to attend a Convention in Philadelphia, Pennsylvania on 
February 21, 1787
. Twelve states sent delegates; Rhode Island refused to participate because it believed that it was a meeting that was “masquerading for a discussion on interstate trade” (Berkin, Miller, Cherny, and Gormly 174). New Hampshire delegates did not arrive at the Convention until late July when much of the major work had already been done.

The delegates were only designated to “
revise
” the Articles of Confederation and nothing more. You may remember that the Annapolis Convention had sent a document to the Congress asking it to call for another meeting to discuss the broader questions of governing under the Articles of Confederation.

The Congress thought that the Convention would essentially be an 
“
 
advisory body
” that would propose amendments that would help to fix the problems. 
It told the delegates that
 
the Congress and all 13 state legislatures would have to approve any changes as outlined in the Articles.

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Seventy-four delegates were appointed by their state legislatures to attend what is now known as the 
Constitutional Convention 
during 
May-September 1787
, one of the hottest summers on record 
.
 Only 55 men actually attended the proceedings. These delegates were well educated and they came from diverse backgrounds such as merchants, farmers, bankers, lawyers, governors, legislators, professors, and presidents of colleges. Roughly 40 delegates went to the Philadelphia State House (“
Independence Hall
“) on a daily basis (Magleby 14-15).

“The Key Players” – Delegates to the Convention

 

Benjamin Franklin
 who was admired for his inventions, diplomatic accomplishments, and wit came to the Convention as part of Pennsylvania delegation. He was the 
oldest delegate
 present and not in good health (81 years old). James Wilson, his colleague, read Franklin’s comments and proposals to the delegates throughout the Convention.

George Washington 
was asked by his fellow delegates to be the “presiding officer” or President of the Convention. He had been reluctant to attend the meeting, but his fellow Virginians urged him to come to Philadelphia to lend his prestige to the proceedings.

 

James Madison
 is considered the “
Father of the U. S. Constitution
.” Prior to the Convention, he served in the Virginia legislature and was a member of the Confederation Congress. Madison wrote the Virginia Plan , 
a draft of
 
the U. S. Constitution
. He also took detailed notes of the debates which were published on the death of the last delegate (ironically, Madison himself!). Since the debates were closed to the public, he wanted to make sure there was a historical record for future generations.

Project Gutenberg provides a detailed record of the debates of the Constitution which can be found at their 
EBook #40861 – OOCAPG Resource
 and 
EBook #41095 – OOCAPG Resource
 for your browsing.

 

Alexander Hamilton 
of New York participated in the debates and advocated strengthening the national government “
toned as high
 
as possible
” (Burns). Hamilton’s major contribution was getting his state to approve the new Constitution and later serving as President Washington’s Secretary of the Treasury. We will talk about him later.

We are fortunate that Madison took time out of his busy legislative schedule to study the problems of governing under the Articles. After his study, he concluded that changes could not be made to improve the current system and major changes would need to be made to establish a workable democracy. He advocated the creation of a 
federal republic
 instead of a confederacy of states.

To learn more about the founding fathers go to:

NARA: U.S. National Archives & Records Administration

Why were the debates held

in secret?

 

“Critical Compromises”

The delegates recognized almost immediately that they could not revise the Articles of Confederation. They would have to write a new national Constitution. No changes could be made to improve the current Constitution. They decided to establish a 
federal republic
, a 
representative democracy
, where 
people would be the source of power
. The people could elect individuals who would govern and be accountable to them at election time. They would not have a monarch or nobility like England.

They also returned to the idea of 
separating power
 
among 
three branches of government.
 Also, states would determine who would be qualified to vote in national elections. As you are aware, in all states, except New Jersey, only white men who were 21 years old, owned property or paid taxes could vote in state elections. New Jersey permitted women to vote only in local elections (later repealed).

Since Madison had done his homework early, the Virginia delegation introduced the 
Virginia Plan
 for consideration. It outlined the need for a federal republic, a single executive, a bicameral Congress (a two-house legislature), and national courts. During the contentious debate over Madison’s plan, the issue of state representation in the Congress almost stopped the proceedings cold.

The 
Virginia Plan
 favored by the large states like Virginia (the largest state), Massachusetts, and Pennsylvania stated that the number of representatives who would serve in the U.S. Congress would be based upon the size of the state’s population known as 
proportional representation
. As a result, large states would have greater influence in making national policy. As we are going to find out later, the large states thought that since they had more people living in their states that they should have more power in the U. S. House of Representatives and U. S. Senate. It is interesting to note that the Congress would elect the president and the House would nominate the federal judges. So all and all, the larger states would dominate the entire national government!

The small states led by William Paterson (NJ) produced the 
New Jersey Plan 
as an alternative to the Virginia Plan. They wanted to keep a 
unicameral legislature
 just like under the Articles of Confederation. 
Equal representation
would provide small and large states alike with equal power in the new Congress. The Congress would elect the Executive, a committee, and a U. S. Supreme Court would resolve legal disputes over national law. Constitutional Convention

The delegates voted over and over again on this issue with no resolution. The large states would not budge and the smaller states demanded at least equal vote in one chamber of the national legislature. Recognizing the critical necessity for compromise, the delegates put together a committee to resolve the issue of state representation in the U. S. Congress. 
Roger Sherman (CT)
 forged what is known as the 
Connecticut Compromise, “the Great Compromise.”

The Connecticut Compromise

It called for a 
bicameral Congress
. The number of representatives who would serve in the U.S. House of Representatives would be based on population and directly elected by the people every two years. The U. S. Senate would have two Senators who served a six-year term and were elected by state legislatures (the people would not elect their U. S. Senators until 1913 with the adoption of the 17th Amendment).

Under the original U.S. Constitution, the U.S. House was directly elected by the people in order to establish a representative democracy. The Electoral College would elect the president. The framers wanted to make each branch and chamber in the legislature accountable to different groups of people and thus, make it more difficult for a particular group or faction to dominate our national government.

To learn more about the Connecticut Compromise go to

Formative Years of the Senate: 1787-1800

3/5 (Three Fifth’s) Compromise

The 
Connecticut Compromise
settled the question of state representation in the U. S. Congress, but raised a new question, how to define the term population. What groups would be included in the population count for purposes of determining the number of U. S. House representatives from each state? Constitutional Convention

They agreed to include free persons, indentured servants, and Indians who paid taxes, but what about the slaves? The southern states insisted that slaves be included in such a count to avoid being dominated by the northern states. Less population meant fewer representatives and thus, less influence in the U. S. House of Representatives!

There were delegates like Ben Franklin who opposed the institution of slavery (although he did own a few slaves) but they agreed to a compromise which included at least some of the slaves in the population count to balance the power between the north and south;
five slaves would equal three free persons.
 Thus, the south increased its influence in setting national policy, but in exchange bore a greater percentage of the tax burden then it would have had to do otherwise if slaves had not been included in the population count.

If you read the 
Article 1, clause 3
 
closely it states that 
“Representatives and direct taxes shall be apportioned among the several states..”
 As a result, there were fewer free persons to work to pay the taxes in the southern states.

Shown on the left is an image of slaves picking cotton, a common association.

Since the adoption of the 
14th Amendment
, 
all persons except Indians who do not pay taxes
, are included every 10 years in the census count to determine the population of a state and the number of representatives that serve in the U. S. House. Legal and illegal aliens are included in the census.

The Slave Trade

There was a compromise reached on the slave trade. A number of delegates wanted to ban this commercial activity. The southern states were concerned that if Congress was given the power to regulate interstate commerce, regulating business activities across state lines, that it would ban the slave trade that supported the region’s economy.

The delegates reached an agreement that provided Congress the power to regulate commerce but it could not interfere with the slave trade for 20 years after ratification of the new Constitution (
Article I, sec. 9
, powers denied Congress). In 1808, the U. S. Congress banned the slave trade!

2/3 (Two-Third’s) Compromise

During debates regional concerns continued to divide delegates. The south insisted that any international trade agreements negotiated by the President must be approved by a super majority in the U. S. Senate. It is always interesting to me that the required 2/3 rd’s vote to approve a treaty was based upon the southern states desire to protect their agricultural exports.

Originally, the U.S. Senate had 26 Senators, two from each state. As a result, southern states only had 10 votes. They could not muster a majority to vote down an unfavorable trade agreement, but they could band together to defeat a treaty with more than one-third of the votes!

You may remember that James Madison did not think that states would be divided because of their size, large states versus small state issues, but because of 
regional issues
. This view was not only confirmed by debates at the Constitutional Convention, but by future events.

 Shown here is President George W. Bush and Russian President Vladimir Putin after exchanging documents of ratification inside the Konstantin Palace after a private meeting in St. Petersburg, Russia, June 1, 2003. Constitutional Convention

Boards of Nursing and Professional Nurse Associations – Regulation for Nursing Practice Staff Development Meeting

 

Differences Between a Board of Nursing and a Professional Nurse Association

Board of Nursing regulates nursing practice to protect public, as mandated by state.

BON ensures proper licensure, sets education standards, and handles disciplinary actions for nurses.

Professional nurse associations advance nursing profession and promote high practice standards.

BONs focus on public protection through regulation; associations support professional growth and advocacy.

Nurse associations influence policy, provide networking opportunities, and improve nurses’ working conditions.

A board of Nursing is a regulatory entity legislated by a state government with the mandate to protect the public by regulating the nursing practice (Nursejournal.org, (2023). The BON ensures that a nurse has the requisite licensure qualifications and can practice safely and competently. Its roles include licensure, setting educational standards, and disciplinary actions. In contrast, professional nurse associations, such as the American Nurses Association (ANA), work to advance the nursing profession by fostering high standards of nursing practice, promoting a safe and healthy environment. Also, ensures quality of health and well-being for all people, and influencing policy through accurate, timely information to policymakers and helping nurses network (ANA, n.d.). Whereas BONs center their activities on protecting the public via regulation, the nurse associations tend to focus on issues related to the professional growth of nurses and furthering their profession to improve working conditions. They have complementary but distinct missions and purposes- the BONs regulate practice; associations provide professional support and advocacy.

Texas Board of Nursing

The Texas Board of Nursing governs nursing practice for safe patient care.

Board comprises thirteen members: six RNs, three LVNs, and four public members.

Governor appoints members representing diverse nursing specialties and the general public.

Board composition ensures representation from education, administration, and direct care sectors.

Board influences policies affecting nursing practice, including the Code of Ethics.

The Texas Board of Nursing is the governing board of nursing practice in Texas and works for safe and competent patient care. The board includes thirteen members: six registered nurses, three licensed vocational nurses, and four public members. They are appointed by the governor and come from a wide variety of nursing specialties as well as the public at large (Bon.texas.gov, n.d). The composition of the committee is such that both the education, administration, and direct care sectors of nursing are fully represented to provide completeness to the nursing profession. It is a board that can play a major role in influencing policies affecting nursing practice in Texas, including the practice of nurses under the Code of Ethics.

Becoming a Member of the Texas Board of Nursing

Texas BON members are appointed by the governor with Senate advice and consent.

Candidates are nominated based on nursing expertise or to represent the public.

Nurse members must be in active practice and not in education/regulation.

Public members cannot be in healthcare professions; members serve six-year staggered terms.

BON writes nursing practice rules and takes disciplinary actions to protect public.

A person becomes a member of the Texas BON by appointment of the governor of Texas with the advice and consent of the Senate. Such an appointment is made after nominating candidates for specific qualifications, including expertise in the practice or education of nursing, or to represent the public. The nurse members must also be in active practice for at least five years and cannot be employed with any nursing education program or regulatory agency. Public members cannot be in the healthcare professions (Bon.texas.gov, n.d). Members are appointed to serve six-year staggered terms. Other activities include writing rules and regulations regarding the practice of nursing in addition to licensure disciplinary actions when such actions are necessary to protect the public.

Texas Regulation on Nurse Scope of Practice

The Texas NPA outlines nurses’ scope of practice and promotes patient safety.

Nurses must act within their education, experience, and competence level.

The NPA guides nurses to avoid working beyond their competence level.

Nurses can provide care within self-government boundaries while collaborating with others.

Continuing education is required for nurses to maintain competence in practice.

The Texas Nurse Practice Act (NPA) outlines the general description of the scope of practice for all nurses and speaks to patient safety through care delivery and professional accountability. Among such key regulations is that the nurse is supposed to act within her scope as defined by her education, experience, and competence. This provision guides a nurse’s responsibility to not work up to or beyond their level of competence, which involves the patients’ safety and ethics. The NPA allows a nurse to give care within the boundaries of self-government while still providing the best care for the patient in collaboration with other interdisciplinary professionals. They must also engage in continuing education about staying competent (Bon.texas.gov, n.d).

Influence of Regulation on Healthcare Delivery, Cost, and Access

Texas nurse practice regulation ensures consistent, safe patient care and effective care delivery.

Regulation reduces medical errors and improves patient outcomes in healthcare settings.

Strict practice limitations may reduce access to care in underserved areas.

Healthcare costs increase when specialized tasks must be performed by more expensive professionals.

Regulation prevents improper care, costly lawsuits, and patient injuries in medical practice.

The regulation of the Texas nurses on the scope of practice affects them in care delivery because it ensures that patient care is delivered consistently and safely; therefore, it has been effective in the care provided. This then reduces the chances of medical errors, thereby improving the patient’s outcomes. However, strict practice limitations can reduce access to care, especially in underserved areas where patients may, otherwise, in theory, receive other services from nurses. Healthcare costs also suffer because specialized tasks must be performed by more expensive professionals such as physicians (Bon.texas.gov, n.d). On the regulation-plus side, improper care is prevented, along with costly lawsuits and patient injuries.

Impact of Regulation on Care for Culturally Diverse Patients

Nursing scope of practice regulations influence care for patients from diverse cultures.

Texas exemplifies the need for cultural competence due to its Hispanic population.

Nurses must provide education within their scope, sometimes involving other professionals.

Cultural liaisons may be necessary to address culturally specific health practices.

Overcoming language barriers is crucial for patient understanding of care and procedures.

The regulation ensuring nurses practice within their scope directly influences how nurses provide care and education to patients from diverse cultures. For example, Texas would fall into this category due to its vast population of Hispanics, requiring a nurse to be culturally competent in order to provide appropriate care in the interest of the patient’s cultural and linguistic needs. The scope of practice regulations mandates that education must be provided within the scope of practice for nurses, which at times will involve cooperation with other professionals or cultural liaisons to appropriately cover culturally specific health practices. This also encompasses making sure language barriers are not barriers to patients’ understanding of their care, particularly on the part of medical procedures and patient education.

ORDER HERE

Texas Regulation on Advanced Practice Registered Nurses (APRNs)

Texas regulates APRN practice under guidelines requiring physician supervision or collaboration.

APRNs must enter agreements with physicians to prescribe medication or offer advanced services.

This regulation limits APRNs’ ability to practice independently within their competence level.

The requirement polarizes APRNs to work with physicians even in their areas of expertise.

Care access may be limited in rural or underserved areas lacking physician availability.

In Texas, the scope of practice for Advanced Practice Registered Nurses (APRNs) is regulated under specific guidelines requiring physician supervision or collaboration (Bon.texas.gov, n.d). One of the key regulations makes it obligatory that an APRN enters into a supervisory or collaborative agreement with a physician to prescribe medication or offer specific advanced services. This regulation curtails the APRN’s scope of practice to the level at which they probably can independently practice, polarizing them to work with a physician even in areas where they are competent and could offer their services. This may be very limiting, especially in rural or underserved areas where physicians may not be available, thus leaving a limit to care.

Influence of APRN Regulation on Healthcare Delivery, Cost, and Access

Texas regulation requiring physician oversight for APRNs impacts healthcare delivery, cost, and access.

Physician collaboration may improve quality but often restricts APRN independent practice in rural areas.

Regulation delays care as patients must wait for physician collaboration, increasing administrative costs.

Physician oversight requirement adds financial burden to patients and healthcare settings.

APRN autonomous practice relieves shortages and lowers costs compared to physician care.

The Texas regulation requiring physician oversight for APRNs strongly impacts healthcare delivery, cost, and access. While collaboration might offer improved quality through integrated approaches, it too often restricts APRNs from practicing independently, as so many are doing in rural areas of the state where physicians are limited. This regulation delays care because a patient must wait for physician collaboration. Besides, the need for physician oversight calls for added administrative and financial costs to have the care of a physician-oversight setting; this increases the cost of care for both the patients and the healthcare setting (Bon.texas.gov, n.d). On the other hand, the free hand given to APRNs in autonomous practice has benefits in relieving shortages and lowering replacement costs, as APRNs charge less compared to physicians.

Recent Changes in APRN Regulation in Texas

APRNs in Texas have seen little change in their status over five years.

Texas BON continues to regulate APRNs through physician oversight requirements despite reform attempts.

COVID-19 pandemic highlighted workforce shortages, prompting discussions about relaxing APRN practice restrictions.

A 2021 legislative attempt to provide greater APRN autonomy in Texas failed.

Advocates argue full practice authority would improve access, lower costs, and enhance outcomes.

APRNs in Texas have seen little change in their status over the past five years, with much discussion but minimal actual action. The Texas BON regulation via physician oversight requirements for APRNs is ongoing, although there have been attempts to relax these restrictions, especially due to the COVID-19 pandemic and its impact on workforce shortages in health services (Bon.texas.gov, n.d). A 2021 legislative attempt to provide greater practitioner autonomy for APRNs failed. This debate about full practice authority for APRNs is still quite timely, and its advocates argue that this will enhance access to care in areas with the highest need, lower costs in healthcare, and improve patient outcomes.

References

ANA, (n.d).About ANA. Retrieved from https://www.nursingworld.org/ana/about-ana/

Bon.texas.gov, (n,d). Nursing Practice Act- Chapter 301. Retrieved from https://www.bon.texas.gov/npa1.asp.html#:~:text=(a)%20The%20Texas%20Board%20of,of%20a%20nurse%20faculty%3B%20and

Bon.texas.gov, (n.d). Practice-APRN Scope of Practice. retrieved from https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.html

Nursejournal.org, (2023). What Is the Role of the State Board of Nursing? Retrieved from https://nursejournal.org/resources/what-is-the-role-of-the-state-board-of-nursing/

Regulation for Nursing Practice Staff Development Meeting

Nursing is a very highly regulated profession. There are over 100 boards of nursing and national nursing associations throughout the United States and its territories. Their existence helps regulate, inform, and promote the nursing profession. With such numbers, it can be difficult to distinguish between BONs and nursing associations, and overwhelming to consider various benefits and options offered by each.

Both
boards of nursing and national nursing associations have significant impacts on the nurse practitioner
profession and scope of practice. Understanding these differences helps lend credence to your expertise as a professional. In this Assignment, you will practice the application of such expertise by communicating a comparison of boards of nursing and professional nurse associations. You will also share an analysis of your state board of nursing.

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:

Assume that you are leading a staff development meeting on regulation for nursing practice at your healthcare organization or agency.

Review the NCSBN and ANA websites to prepare for your presentation.

The Assignment: (8- to 9-slide PowerPoint presentation)

Develop a 8- to 9-slide PowerPoint Presentation that addresses the following:

Describe the differences between a board of nursing and a professional nurse association.

Describe the board for your specific region/area.

Who is on the board?

How does one become a member of the board?

Describe at least one state regulation related to general nurse scope of practice.

How does this regulation influence the nurse’s role?

How does this regulation influence delivery, cost, and access to healthcare?

If a patient is from another culture, how would this regulation impact the nurse’s care/education?

Describe at least one state regulation related to Advanced Practice Registered Nurses (APRNs).

How does this regulation influence the nurse’s role?

How does this regulation influence delivery, cost, and access to healthcare?

Has there been any change to the regulation within the past 5 years? Explain.

Include Speaker Notes on Each Slide (except on the title page and reference page)

Regulation for Nursing Practice Staff Development Meeting

Adoption of U.S. Constitution and Bill of Rights

The Final Vote

Most of the delegates who attended the Constitutional Convention signed the new Constitution on September 17, 1787. George Mason was one of a few men present who did not sign the final draft because it did not include a list of protected liberties. Benjamin Franklin encouraged his colleagues to approve the new national constitution even though he did not agree entirely with it. James Madison recorded in his notes that James Wilson (PA) read Franklin’s speech to the convention.

Ben Franklin said:

“I confess that there are several parts of this constitution which I do not at present approve, but I am not sure I shall never approve them. I doubt too whether any other Convention we can obtain, may be able to make a better Constitution.

For when you assemble a number of men to have the advantage of their joint wisdom, you inevitably assemble with those men, all their prejudices, their passions, their errors of opinion, their local interest, and their selfish views. From such an assembly can a perfect production be expected?

It therefore astonishes me, Sir, to find this system approaching so near to perfection as it does. Thus I consent, Sir, to this Constitution because I expect no better, and because I am not sure, that it is not the best. The opinions I have had of its errors, I sacrifice to the public good.”
 (Madison 653-654)
.

Why did the delegates decide to have state ratifying conventions approve the new Constitution?

You may remember that when the Confederation Congress called the meeting in Philadelphia to revise the Articles of Confederation, it reminded the delegates that any changes or amendments proposed to the current national constitution would require the approval of all 13 state legislatures (as required under the Articles).

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As you can imagine, it would be impossible to get all the states to approve the new national constitution. Rhode Island for starters. It did not even send delegates to the Federal Convention because it feared it would give the national government greater power to regulate commerce. As a result, the delegates required that nine ratifying conventions approve the new Constitution (see Article VII). This way they could by-pass the state legislatures and also have the new Constitution approved by the people!

Further, by allowing the people to approve the constitution would make it more rigorous. The people would apt to be more supportive of the new government if they had a role in approving it Adoption of U.S. Constitution and Bill of Rights.

After the U.S. Constitution was signed delegates who were Congressmen took the document to New York and presented it to the Confederation Congress. It forwarded the new Constitution to the state legislatures who called for elections to state ratifying conventions.

Why is it important to know about the Federalist Papers?

When Alexander Hamilton arrived back in New York, he asked several people to contribute articles describing problems governing under the Articles and why it was critical to replace the confederacy with a republican form of government.

James Madison and John Jay agreed to help try to persuade New Yorkers to support the new Constitution. Hamilton, Madison, and Jay wrote 85 essays under a false name, “Publius”-after a Roman military hero.

It is unclear how persuasive they were in convincing the New York delegates to vote in favor of ratification in July 1788, but 
The Federalist
 sometimes referred to as the Federalist Papers is one of the best sources we have on the reasons for establishing a federal republic with the people the source of power in our nation.

Today, the Supreme Court justices look to these essays to help them interpret the Constitution. Some of you may remember that during the Clinton impeachment proceedings, Congressmen went to their bookshelves to dig out a copy of the Federalist Papers! Hamilton wrote four essays about Congress’ role in the impeachment process.

Click on the link below to see the Federalists Papers:

The Federalist Papers

Why did supporters and opponents of the new Constitution both win at the end of the day?

The states engaged in long heated debates over the Constitution from late 1787 until July 1788. Delaware was the first to approve it on December 1787 and Rhode Island was the last state to do so in May 1790 (see Table 1-2, Ratification of the U.S. Constitution, for the timeline).

 

Why did it take so long for Rhode

Island to approve our current

Constitution?

 

Generally speaking, smaller states supported the new Constitution because they had equal voice in the new Senate and they saw greater economic benefits in being a part of larger union. Virginia and New York did not approve the new Constitution until mid-summer of 1788.

One of the strongest criticisms advanced by the Anti-federalists regarding the Constitution was that it lacked a national Bill of Rights that limited the power of our national leaders like the states’ constitutions which included a Bill of Rights limited the power of state officials. It was a powerful and very effective argument used against the supporters of the Constitution, the Federalists.

“The Promise-A national Bill of Rights”

James Madison told his fellow delegates at the Virginia ratifying convention that if they adopted the Constitution in its current form, he would draft amendments that included a Bill of Rights when he got elected to the U.S. House of Representatives. His promise helped to defuse the power of his anti-federalist opponents’ arguments, notably the passionate advocate of liberty, Patrick Henry Adoption of U.S. Constitution and Bill of Rights.

arguments presented by Federalists

and Anti-federalists?

 

In the spring of 1789, after a tough Congressional election against James Monroe, James Madison followed up immediately on his promise to include a national Bill of Rights. He talked with his fellow representatives regarding any changes they wanted made to the new Constitution, and he came up with 17 amendments. 
This is why James Madison is considered the “author” of the Bill of Rights.

Twelve amendments which included a list of protected liberties were approved by 2/3rd’s of the House and Senate and submitted to the state legislatures for their approval in October 1789. Only 10 amendments obtained the necessary support in the states. They are our 
Bill of Rights
 -e.g. freedom of religion, freedom of expression, right to assemble, and petition for redress of grievances, protection against unreasonable search and seizures, protection against self-incrimination, right to a public trial by jury in a federal criminal case, right to counsel, states reserved powers, etc. (
See the First Ten Amendments – the Bill of Rights
).

Click on the link below to go to the 
National Archives
‘s website and view 
America’s Historical Documents
. Click on the image of the 
Bill of Rights
:

America’s Historical Documents — Bill of Rights

To learn more about the Anti-Federalists, click on the links below:

George Mason s home, Gunston Hall

Patrick Henry s home, Redhill

Why didn’t the delegates include

a national Bill of Rights in our

Constitution in the first place?

 

How do you amend the U.S. Constitution?

The U.S. Constitution provides under Article V (5) that amendments or changes can be made by future generations to address their problems. It is not an easy process. Congress has proposed only 33 amendments and 27 amendments have been approved by states (most recently, the 27th Amendment that requires Congressmen to first stand for election before receiving their pay raise — Madison’s Congressional pay raise amendment).

Only Congress and the States play an official role in the amendment process. Once an amendment is proposed it is sent directly to the states for approval. The President does not have a formal role in this process. He cannot veto a proposed amendment. A President can try to influence Congress to support or oppose a resolution proposing an amendment like President Clinton’s efforts to defeat any efforts to pass a proposed Constitutional amendment to balance the budget.  Also, President G. W. Bush tried to influence the public on the proposed amendment to ban gay marriage. He officially supported an amendment to the U.S. Constitution that states that marriage is between a man and woman. However, he did support “civil unions.”

More recently, President Obama talked about the need to overturn the U.S. Supreme Court’s  2010 
Citizens United 
decision (prohibited limits on spending by corporations, unions, nonprofits, etc., in elections) by having states and Congress place “reasonable limitation” on raising and spending funds in elections. During his presidency, this proposed amendment failed to get the necessary super majority support in the U.S. Senate even with all the Democrats support of this idea (Prokop, Andrew. 
“
President Obama: I’d love a constitutional amendment to reverse Citizens United
,”).
 

In 2014, this Democratic propose Constitutional amendment was blocked in the U.S. Senate by a Republican led filibuster.  It was reintroduced in 2019 in the U.S. House and U.S. Senate by Congressman Schiff (D-CA) and Senator Tom Udall (D-NM) (Carney, Jordain. “
Democrats introduce constitutional amendment to overturn Citizens United
“).

As you are aware,the 
Citizen United
 decision raised the issue of whether Congress can limit corporations, unions, and nonprofit corporations spending on behalf or opposed to political candidates during an elections. Did it violate the First Amendment Freedom of Expression–“political speech?”  Also, it raised the question of whether a corporation is a “person.” It also contributed to the rise of “Super PACs” used by wealthy individuals and fewer than anticipated corporations raise and spend dollars to support their candidates and oppose others. What are your thoughts?

To learn more about this proposed amendment 
go to 
Citizens United v. Federal Election Commission
,
 January 21, 2010,  and at History.com editors, 
Citizens United vs. FEC
,

Article V provides for two methods used to propose a Constitutional amendment:

The Congress-2/3rd’s vote in U.S. House and 2/3rd’s vote in the U.S. Senate (traditional route).

2/3rd’s state legislatures can petition Congress to call for a convention to propose an amendment (s)-never been done.

Under the Constitution, the Congress can decide who will approve the proposed amendment. It can choose 3/4th’s of state legislatures or 3/4th’s of state ratifying conventions to approve a proposed amendment. (All proposed amendments have been approved by state legislatures except the 21st Amendment that repealed prohibition).

What happened to the federal

amendment banning gay marriage?

Did it die?

 

 

What do you think?

Do you support the proposed federal Constitutional Amendment prohibiting flag burning? In 1989, the U.S. Supreme Court struck down a Texas law banning flag burning as a violation of First Amendment freedom of speech-symbolic speech (Texas v. Johnson). The act of burning the flag was used as a form of political protest. This is an example of using the Amendment process to overturn decisions of the U.S. Supreme Court (a check on the Court).

On June 27, 2006, the U.S. Senate failed to pass a proposed Constitutional amendment banning flag burning by one (1) vote (66-34). It needed 2/3rd’s supermajority for passage (67 votes). Last year the U.S. House of Representatives passed this amendment by 2/3rd’s vote (286-130).

If you are interested in learning more about this federal Amendment, please see 
Congress — Legislative Information on the Internet
 and click on 
109th Congress
(Congress has considered this Amendment in past Congresses, but it has not achieved the super majority in both Houses to be sent to the States). Adoption of U.S. Constitution and Bill of Rights

Constitutional Limitations on Power

What is a Democracy?

It is important to have a general understanding about the differences between a
democracy
, an 
autocracy
, and an 
oligarchy
.

DEMOCRACY – 
The term democracy is generally defined as 
“
Government by the 
Many
“-
 Power is in the hands of many individuals. The people are the source of power in a nation.

AUTOCRACY – 
A democratic state is very different from an autocracy where only one person holds power like King Louis XIV of France, an absolute monarch, or a dictator like Adolph Hitler or Saddam Hussein.

OLIGARCHY
 – In an oligarchy, only a few people hold power in a nation, e.g. a group of nobles.

THEOCRACY
 – Today we are more familiar with a theocracy when power is in the hands of a 
few religious clerics
 like in Iran or the former Taliban regime in Afghanistan.

At this time, I want to turn your attention to two definitions of democracy:

pure/direct democracy

representative democracy
 
(known as a 
Republic
 
)

In a 
pure democracy
, the people participate in actually governing their communities. They write the laws and administer and enforce laws like in New England town meetings and the Athenian assembly in 500 B.C. We live in a 
Republic
, a 
representative democracy
, where the people elect other individuals known as representatives to govern–make laws and implement and enforce the laws. These elected officials are accountable to the people at election time.

Is a Constitutional Monarchy like Great Britain a democracy?

Yes. Queen Elizabeth II is not an absolute monarch! She has limited powers under the British Constitution. In Great Britain, the people elect individuals known as Members of Parliament (MP’s) to the House of Commons. As a result, the people are the source of power in Great Britain because the House of Commons has the most power. The House of Lords was stripped of its power in the last century and further reforms are being considered. The United States is a republic because there is no monarchy or aristocracy, only the people!

 

Why did the Framers Decide to Establish a Republican Form of Government?

In 
Federalist #10
, James Madison analyzed the 
problems created by factions or interest groups or political parties
 in our society. The framers were concerned that a majority group might dominate our government at the expense of other smaller groups and individual liberties. Madison was concerned, for example, that debtor interests would be promoted over creditors or a majority within the public might pressure their representatives to equalize the distribution of property at the expense of property owners.

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The cure for the mischief of faction
 – 
the best way to minimize the influence of a majority interest group was to establish a representative democracy, a republic.

If you had the people elect their representative, that public official could consider both individual constituent concerns and all the interest groups’ concerns as well before making a decision regarding a bill. The lobbyists from various organizations representing labor, business, professionals, farmers, gun owners, advocates against abortion would have to compete for the representative’s attention – it would dilute the power of any one interest group.

Madison believed that the representative would filter all this information and be much more objective in making decisions that would indeed promote the ” public good” rather than just a single majority interest group.

In a pure democracy when the people governed, it was easier for a majority group to find a common interest and promote it over the interests of the minority groups or the public good.

In a 
large federal republic
 that extended over a large area, Madison believed there would be more people, thus more interests, and as a result, it would be more difficult for a majority to form within the public. Also, one group might be able to dominate a representative(s) in one state, but not in other states. For example, the farmers might have a strong influence on Congressmen from agriculture states, but not too much influence on Congressmen who represent the inner cities. By having representatives and power given to both national and state governments, it would make it much more difficult for a majority interest to dominate the entire government.

The U.S. Constitution

What Limits were Placed on the Power of the National Government?

“
In framing a government which is to be administered by men over men, the great difficulty lies in this; you must first enable the government to control the governed; and in the next place oblige it to control itself”
 (Madison, 
Federalist 
#51, A-5).

Our federal republic is a 
Constitutional democracy
 because it gets its power from a 
written constitution
 that was approved by the people. When you look at Article I-VII of the U.S. Constitution, you can see the powers of the Congress, President, and Federal Courts listed there. You will also find that Congress and the states are denied certain powers which I will discuss in a later lesson on federalism. For the moment, it is only important that you appreciate that our federal republic receives its power from the people as expressed in our national Constitution.

During this part of the lesson, please keep in mind that the framers wanted to prevent tyranny and to reduce the power and influence of a particular group that might use their power to harm the interests of minority groups in our society or our individual liberties. They wanted to create a stronger and more effective national government that could promote the general welfare, protect national security, and maintain order, but at the same time they recognized the tantalizing appeal of power and man’s need to consolidate his own power to promote his own interests.

Limits were placed not only on our representatives, but on the people themselves.

We often think only that our leaders will repress our liberties but fail to recognize that some of our own demands for action may deprive other people of their rights and freedoms. As a result, the framers of our Constitution placed limits on the power of the Congress, President, and Federal Courts.

The limits on power are the following:

FREE AND FAIR ELECTIONS 
— the people. A 
free and fair election
 is a defining feature of a democracy.

At the very outset, if the people are going to retain the power in a nation, they have to hold their representatives accountable at election time. The voters must be permitted to choose their own representatives without force. I often tell my students that in our country we can exercise our right to vote or not to vote. We will not be fined or imprisoned or face a worse fate.

Elections must also be fair in that opposing candidates can run and get media coverage and that ballots are accurately counted and not destroyed or lost (there were allegations in the 2000 Presidential election that ballot boxes were discovered in a closet). In general, corruption must be kept at a minimum to ensure a fair election.

You may remember that in the 2005 Ukrainian Presidential election, the government used invisible ink on some of the ballots. The voter went to the polls, marked his ballot, and when the ink dried, his X was gone! Viktor Yushchenko was sworn in as president of Ukraine in 2005 after massive protests over his loss in a fraud-plagued election plunged the Ukraine into political crisis. Constitutional Limitations on Power

No wonder the government s candidate won on the first round.

In 
Federalist #51
, James Madison wrote:

{A} dependence on the people is, no doubt, the primary control on the government; but experience has taught mankind the necessity of auxiliary precautions.”

Madison recognized that you would need more than the ability of the people to throw the rascals out at election time to prevent the potential for tyranny. You would need to take extra precautions and structure the government in such a way as to minimize the potential for the abuse of power by not only our elected officials, but the people themselves.

SEPARATION OF POWERS — BALANCE THE POWER —
 The United States Constitution gives power to three (3) separate, equal,and politically independent branches of government.

The 
Executive Branch
 carries out and enforces the law.

The 
Legislative Branch
 makes or writes law.

The 
Judiciary Branch
 interprets the law and resolves legal disputes.

Each branch of our national government is equal in power, has different responsibilities, and is accountable to different groups of people.

Under the 
Articles of Confederation
, our national government had only 
one branch
, the Confederation Congress, which had principally legislative authority. There was no Executive Branch to implement or enforce laws passed by Congress or national courts to resolve legal disputes that involved national laws, several states, and citizens of different states (the federal courts provided a neutral forum).

When the framers returned to the idea of separation of powers, they were heavily influenced by their own personal experience, and the work of the 18th century Frenchman, Comte Charles Montesquieu.

In his book, 
Spirit of the Laws
 
(1748), Montesquieu strongly advocated balancing power. He writes that tyranny usually results when power is concentrated in a single government body. He was a great admirer of the British system of government because power was defused between officials in three branches of government: the Monarch, Parliament, and Courts.

Montesquieu believed that no particular class of British society (royalty, aristocracy, commoners) would dominate the government if each branch was accountable to different groups of people. During that time, the King represented the interests of the royal family; and the bicameral Parliament composed of the House of Lords and the House of Commons promoted the interests of the nobility and the men of property respectively.

In our country,our representatives are accountable to different groups of people as well. Before a President signs a bill into law, he considers whether it promotes the best interests of the entire nation; a United States Senator will see how a bill would impact his state; and a Congressman will consider whether a bill will improve the lives of people residing in his Congressional district. Our federal courts have judges who are appointed for life and are insulated from public pressure.

James Madison wrote in 
Federalist #51
 
that:

{I}t is of great importance in a republic not only to guard against the society against oppression of its rulers, but to guard one part of society against the injustice of the other part. Different interests necessarily exist in different classes of citizens. If a majority be united by a common interest, the rights of the minority will be insecure
.”

The framers believed that by giving each branch different responsibilities and holding them accountable to different constituencies, that it would make it more difficult for a majority to dominate our national government. They did not want executive, legislative, and judicial power put in the same hands.

James Madison also writes in 
Federalist #47
 
that:

“
the accumulation of all powers, legislative, executive, and judiciary, in the same hands, whether of one, a few, or many, and whether hereditary, self—appointed, or elective, may justly be pronounced the definition of tyranny.”. “{T}he preservation of liberty requires that the three great departments of power should be separate and distinct.”

CHECKS AND BALANCES SYSTEM — SHARED POWERS —
 each branch has authority over the other branches. Each branch can limit the power of the other branches by sharing power.

The framers of the U.S. Constitution, particularly James Madison, did not think that just by giving three branches different responsibilities by itself would be enough to prevent the concentration of power by their leaders or to prevent the majority of the public from pressuring their representatives to make laws that might harm minority groups interests (e.g. property owners).

To prevent government officials from pooling their authority together in order to consolidate power, the framers gave officials in each branch the ability to limit the power of the other branches. They did this by having the public officials 
share certain responsibilities.

For example, the President participates in the legislative process by proposing a federal budget and signing or vetoing bills; and Congress ultimately can check the President if they disapprove of his military missions by denying funding; and the U.S. Senate can approve or reject Presidential appointments and treaties.

The general idea was that not only would public officials be busy carrying out their own responsibilities, but they would make sure that other public officials in another branch were not abusing their power. If they were busy playing the role of 
watchdog
, they would be less tempted to join with other branches to promote a particular interest(s) and consolidate power.

The framers deliberately built in inefficiency into our political system. We call it 
Gridlock
. We often complain that our representatives can never act quickly enough to address our nation s problems Constitutional Limitations on Power.

Politics does become personal sometimes and tensions are often created by differing ideologies and party strife, but do not forget that our forcing the branches to share power also exacerbates the problem of governing.

The framers put in these structural barriers (
checks
) in place to ensure that not any one branch becomes too powerful. They wanted the 
President and Congress to compromise 
and find solutions to public problems that promoted the 
public good
 , and not just one group or coalition of groups interests as noted earlier in our lesson. This is why getting bills through Congress and signed into law by the President can sometimes be a very SLOW, SLOW process. However, rest assured that when our national interests are threatened, Congress and the President can and will act swiftly, and this too can sometimes present Constitutional problems!

JUDICIAL REVIEW —The U.S. Supreme Court 
can declare acts (bills) of Congress signed into law by the President unconstitutional—make the laws void and unenforceable.

Marbury v. Madison 
(1803) is probably the most important case ever decided by the U.S. Supreme Court. Although the case involved the question of whether John Adams judicial nominees were entitled to their federal judgeships since their commissions were signed, but not delivered to them at the end of Adams Administration, the Court took the opportunity to assert its independence and to check the power of Congress and the President.

The case raised two critical questions :

Who will be the 
Guardian
 of the U.S. Constitution? The Executive, Legislature, or Judiciary?

Does the U.S. Supreme Court have the power to declare legislation passed by Congress and signed into law by the President unconstitutional?

The Court held that since judges have the responsibility to interpret law and the U.S. Constitution is fundamental law, it is within their purview to determine its meaning and protect the people s will reflected in the document. It is 
not
 the responsibility of the Congress or the President to interpret law.

If Congress and the President produce laws that conflict with the U.S. Constitution, it is the duty of the Court to strike them down as unenforceable. The Court must prefer the U.S. Constitution that is supreme law of the land over ordinary statutes passed by Congress and signed into law by the President (
National Archives, National History Day, and USA Freedom Corps
).

As a result of its decision, we can challenge a federal law in federal court if it infringes on our individual liberties, and hope that ultimately the U.S. Supreme Court will declare it unconstitutional. The power of judicial review was a serendipitous check on the Congress and the President. There was nothing written in the U.S. Constitution that gave the U.S. Supreme Court this power.

The Court took it upon itself to act as an intermediary between the people and the legislature. Chief Justice John Marshall was strongly influenced by Alexander Hamilton, author of 
Federalist
# 78
 
, who believed that if the Judicial Branch did not check the Congress that it would pass laws all day long that were contrary to the meaning of the U.S. Constitution and undermine the will of the people expressed in the document. Hamilton said that if the people want to change the U.S. Constitution, they will have to go through the Constitutional amendment process!

 United Kingdom’s Supreme Court

In the United Kingdom, the Guardian of the British Constitution is the Parliament (House of Commons). If someone challenges a law passed by Parliament as conflicting with the British Constitution, new elections are called and it is up to the people to decide by voting out or re-electing their representatives.

In 2009, the United Kingdom formally established a Supreme Court with 
nonbinding power of judicial review
.  In 2005, Parliament passed a Constitutional Reform Act that included removing the highest appellate court in the land from the House of Lords (a committee of “Law Lords”) and creating an independent court modeled after the United States Supreme Court. They were incorporating the idea of separation of powers and an independent judiciary (
The Supreme Court 2009
)
!

The United Kingdom Supreme Court has ruled on several cases in recent years and found certain Parliamentary acts unconstitutional.  In 2019, the Court held that Prime Minister Boris Johnson’s effort to suspend Parliament for a month was unconstitutional.  Members of the House of Commons returned immediately to London and reopened the House.  Since this Court’s opinion is not binding, it rests ultimately with the Parliamentarians whether they agree with its decision regarding the constitutionality of a law.

Read 
Marbury v. Madison
 (1803) at 
https://www.law.cornell.edu/supremecourt/text/5/137
.

To hear a discussion on the importance of Marbury v. Madison (1803)
, please watch 
C-span’s presentation of Landmark decisions.

Also, 
you may watch a film
 on this case produced by the Judicial Conference of the United States (1977).

FEDERALISM – The U.S. Constitution
divides power between a national government and state governments. Both the national government and state governments have authority over the people and are accountable to the people. (We will discuss this final limit that was placed on the power of the national government in our next lesson on American Federalism.) Constitutional Limitations on Power