Chat with us, powered by LiveChat Assignment: Advocating for the Nursing Role in Program Design and Implementation As their names i | Max paper
  

Assignment: 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.

PLEASE READ THE PREPARATION INSTRUCTIONS

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: (4–6 pages) not including the title and reference page and reference at least 4

In a 4- to 6-page paper, create an interview transcript of your responses to the following interview questions: Introduction and conclusions.

· 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?

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

· Chapter 5, “Public Policy Design” (pp. 87–95 only)

· Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137–146)

· Chapter 9, “Interprofessional Practice” (pp. 152–160 only)

· Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183–191 only)

Advocacy (nursingworld.org)

S i x t h E d i t i o n

Jeri A. MilsteAd, Phd, rN, NeA-BC, FAAN
NANCy M. short, drPh, MBA, BsN, rN, FAAN

heAlth PoliCy
and PolitiCs A Nurse’s Guide

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Library of Congress Cataloging-in-Publication Data

Names: Milstead, Jeri A., editor. | Short, Nancy Munn, editor.
Title: Health policy and politics : a nurse’s guide / [edited by] Jeri A. 
   Milstead, Nancy Munn Short.
Other titles: Health policy and politics (Milstead)
Description: Sixth edition. | Burlington, MA : Jones & Bartlett Learning, 
   [2019] | Includes bibliographical references and index.
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Subjects: | MESH: Legislation, Nursing | Health Policy | Politics | Nurse’s 
   Role | United States
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Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

Acknowledgments . . . . . . . . . . . . . . . . . . . . x

Contributors . . . . . . . . . . . . . . . . . . . . . . . . xi

Chapter 1 Informing Public
Policy: An Important
Role for Registered
Nurses . . . . . . . . . . . . . . 1

Jeri A. Milstead, Nancy M. Short

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

How Is Public Policy Related to
Clinical Practice? . . . . . . . . . . . . . . . . . . . . .2

Healthcare Reform at the Center
of the Public Policy Process . . . . . . . . . 11

Developing a More Sophisticated
Political Role for Nurses . . . . . . . . . . . . . 11

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Discussion Points . . . . . . . . . . . . . . . . . . . . . 13

References . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 2 Agenda Setting: What
Rises to a Policymaker’s
Attention? . . . . . . . . . 17

Elizabeth Ann Furlong

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Overview of Models and
Dimensions . . . . . . . . . . . . . . . . . . . . . . . . 23

Summary Analysis of a National
Policy Case Study . . . . . . . . . . . . . . . . . . 32

Theory Application to the
Nebraska Nurse Practitioner
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . 32

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Discussion Points . . . . . . . . . . . . . . . . . . . . . 34

References . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Online Resources . . . . . . . . . . . . . . . . . . . . . 36

Chapter 3 Government Response:
Legislation . . . . . . . . . 37

Janice Kay Lanier

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Process, People, and Purse
Strings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Playing the Game: Strategizing
for Success . . . . . . . . . . . . . . . . . . . . . . . . . 50

Thinking Like a Policymaker . . . . . . . . . . . 52

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Discussion Points . . . . . . . . . . . . . . . . . . . . . 55

References . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Chapter 4 Government
Response:
Regulation . . . . . . . . . 57

Jacqueline M. Loversidge

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Regulation Versus Legislation . . . . . . . . . 58

Health Professions Regulation
and Licensing . . . . . . . . . . . . . . . . . . . . . . 60

The State Regulatory Process . . . . . . . . . 66

The Federal Regulatory Process . . . . . . . 72

Current Issues in Regulation
and Licensure: Regulatory
Responses . . . . . . . . . . . . . . . . . . . . . . . . . 78

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Discussion Points . . . . . . . . . . . . . . . . . . . . . 81

References . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Chapter 5 Public Policy
Design . . . . . . . . . . . . . 87

Catherine Liao

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 87

The Policy Design Process . . . . . . . . . . . . 90

Contents

iii

Research Informing the
Policy Process . . . . . . . . . . . . . . . . . . . . . . 91

The Design Issue . . . . . . . . . . . . . . . . . . . . . . 92

Policy Instruments
(Government Tools) . . . . . . . . . . . . . . . . 93

Behavioral Dimensions . . . . . . . . . . . . . . . 95

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Discussion Points . . . . . . . . . . . . . . . . . . . . . 97

References . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Chapter 6 Policy
Implementation . . . 101

Leslie Sharpe

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 101

Federal and State Policymaking
and Implementation 101 . . . . . . . . . . 103

Implementation Research . . . . . . . . . . . 104

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Discussion Points . . . . . . . . . . . . . . . . . . . . 112

References . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Chapter 7 Health Policy and
Social Program
Evaluation . . . . . . . . 115

Anne Derouin

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 116

Nurses’ Role in Policy/Program
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . 117

Challenges to Effective Policy
and Program Evaluation . . . . . . . . . . . 122

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Discussion Points . . . . . . . . . . . . . . . . . . . . 128

References . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Online Resources . . . . . . . . . . . . . . . . . . . . 130

Chapter 8 The Impact of
EHRs, Big Data, and
Evidence-Informed
Practice . . . . . . . . . . . 133

Toni Hebda

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 134

Electronic Resources: Their
Relationship to Health Care . . . . . . . 135

Big Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Implications for RNs, APRNs,
and Other Healthcare
Professionals . . . . . . . . . . . . . . . . . . . . . . 145

References . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Chapter 9 Interprofessional
Practice . . . . . . . . . . . 151

J. D. Polk, Patrick H. DeLeon

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 151

References . . . . . . . . . . . . . . . . . . . . . . . . . . 152

The Evolving Interprofessional
Universe . . . . . . . . . . . . . . . . . . . . . . . . . . 152

What Is Interprofessional
Collaboration? . . . . . . . . . . . . . . . . . . . . 152

Core Attributes of Interprofessional
Education . . . . . . . . . . . . . . . . . . . . . . . . . 153

The “Team 4” Concept . . . . . . . . . . . . . . . 155

The Future of IPE and
Interprofessional Collaboration . . . . 159

References . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Interprofessional Collaboration
to Influence Policy . . . . . . . . . . . . . . . . 160

Bipartisan–Bicameral Action . . . . . . . . . 160

Personal Reflections . . . . . . . . . . . . . . . . . 163

Discussion Points . . . . . . . . . . . . . . . . . . . . 169

References . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Suggested Readings . . . . . . . . . . . . . . . . . 169

Chapter 10 Overview: The
Economics and
Finance of
Health Care . . . . . . 171

Nancy M. Short

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 173

Economics: Opportunity Costs . . . . . . . 174

Finance: Does More Spending
Buy Us Better Health? . . . . . . . . . . . . . 174

Economics: Health Insurance
Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Finance: Health Insurance
Exchanges . . . . . . . . . . . . . . . . . . . . . . . . 177

Finance: Healthcare
Entitlement Programs . . . . . . . . . . . . . 180

iv Contents

Finance: Payment Models . . . . . . . . . . . . 183

Economics: Information
Asymmetry . . . . . . . . . . . . . . . . . . . . . . . 184

Finance: Comparative Effectiveness
Research and Quality-Adjusted
Life-Years . . . . . . . . . . . . . . . . . . . . . . . . . . 186

Finance: Bending the Healthcare
Cost Curve Downward . . . . . . . . . . . . 188

Discussion Points . . . . . . . . . . . . . . . . . . . . 188

References . . . . . . . . . . . . . . . . . . . . . . . . . . 190

Online Resources . . . . . . . . . . . . . . . . . . . . 191

Chapter 11 The Impact of
Globalization: Nurses
Influencing Global
Health Policy . . . . . 193

Dorothy Lewis Powell, Jeri A. Milstead

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 194

Globalization and Its Impact on
Nursing and Health Care . . . . . . . . . . 195

The Importance of Understanding
the Cultural Context . . . . . . . . . . . . . . . 201

Nurse Involvement in Policy
Decisions . . . . . . . . . . . . . . . . . . . . . . . . . 203

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 204

Discussion Points . . . . . . . . . . . . . . . . . . . . 205

References . . . . . . . . . . . . . . . . . . . . . . . . . . 211

Chapter 12 An Insider’s Guide to
Engaging in Policy
Activities . . . . . . . . 215

Nancy M. Short, Jeri A. Milstead

Strategies to Recognize Political
Bias in Information Sources . . . . . . . . 215

Creating a Fact Sheet . . . . . . . . . . . . . . . . 217

Contacting Your Legislators . . . . . . . . . . 219

Example of a Fact Sheet . . . . . . . . . . . . . 220

What to Expect When You Visit
Your Policymaker . . . . . . . . . . . . . . . . . . 223

Preparing to Testify . . . . . . . . . . . . . . . . . . 224

Participating in Public Comment
Periods (Influencing
Rule Making) . . . . . . . . . . . . . . . . . . . . . . 226

How to Write an Op-Ed . . . . . . . . . . . . . . 227

For Serious Thought . . . . . . . . . . . . . . . . . 230

Recommended Nonpartisan
Twitter Feeds . . . . . . . . . . . . . . . . . . . . . . 230

Recommended
E-Subscriptions . . . . . . . . . . . . . . . . . . . 230

Influential Organizations
Affecting Health Policy . . . . . . . . . . . . 231

How to Become a Change Agent
in Policy: Betty Sturgeon—One
Exemplary Nurse’s Story . . . . . . . . . . . 232

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Contents v

© Visions of America/Joe Sohm/Photodisc/Getty

Preface

This is a contributed text for healthcare professionals who are interested in expanding the depth of their knowledge about public policy and in becoming more sophisticated in their involvement in the political and
policy processes. The scope of the content covers the whole process of making
public policy within the broad categories of agenda setting; government response;
and program/policy design, implementation, and evaluation. The primary focus
is at the federal and state levels, although the reader can adapt concepts to the
global or local level.

▸ Why a Sixth Edition?
The Sixth Edition began with succession planning, when Dr. Nancy Short became
co-editor and took on the serious job of planning for this and future editions.
Dr. Short’s expertise and credentials demonstrate her comprehensive viewpoint,
and she is dedicated to the continuation of this broad-based text on the whole
policy process. As founding editor/author, I could not have turned over this text
to just anyone. Nancy is an astute editor, has asked relevant and incisive questions,
and has been encouraging to me personally. It has been a real pleasure for me to
work with her and get to know her deep intellect and caring personality.

The Sixth Edition also introduces new authors with fresh perspectives, all
of whom have a significant experiential basis for their expertise. We welcome
Dr. Leslie Sharpe, Dr. Toni Hebda, Ms. Catherine Liao, Dr. Anne Derouin, and
Dr. Dorothy Powell. We also delight in those who have continued to contribute
to this text over the years: Dr. Elizabeth Furlong, Ms. Jan Lanier, Dr. Jaqueline
Loversidge, Dr. J. D. Polk, and Dr. Patrick DeLeon. They build on the work of
Ardith Sudduth and Dr. Patricia Smart, who retired, and of Dr. Marlene Wilken,
Dr. Kimberly Galt, Troy Spicer, and Elizabeth Barnhill. We pledge to continue
to challenge our readers to understand the serious business of making public
policy and demonstrate their commitment to a democratic republic through their
advocacy and involvement. We welcome your comments—let us know how this
text has influenced your practice.

▸ Target Audience
This text is intended for several audiences:

■ Doctoral and master’s-level students in nursing can use this text for in-depth
study of the full policy process. Works of scholars in each segment provide a
solid foundation for examining each component. This text goes beyond the

vi

narrow elementary explanation of legislation, however: It bridges the gap
by supporting understanding of a broader policy process in which multiple
opportunities for involvement exist.

■ Nurses who work in professional practice in clinical, education, admin-
istrative, research, or consultative settings can use this text as a guide for
understanding the full range of the policy components that they did not
learn in graduate school or may have forgotten. Components are brought
to life through nursing research, real-life cases, and theory. This text will
help the nurse who is searching for knowledge of how leaders of today
influence public policy toward better health care for the future. Nurses in
leadership positions clearly articulate nursing’s societal mission. Nurses,
as the largest group of healthcare workers in the United States, realize that
the way to make a permanent impact on the delivery of health care is to
be a part of the decision making that occurs at every step of the healthcare
policy process.

■ Faculty in graduate programs and other current nurse leaders can use this
text as a reference for their own policy activity. Faculty and other leaders
should be mentors both for their students and for other nurses throughout
the profession. Because the whole policy process is so broad, these leaders
can track their own experiences through the policy process by referring to
the components described in this text.

■ A wide variety of healthcare professionals who are interested in the area of
healthcare policy will find this text useful in directing their thoughts and
actions toward the complex issues of both healthcare policy and public
policy. Physicians, pharmacists, psychologists, dentists, occupational and
physical therapists, physician’s assistants, and others will discover parallels
with their own practices as they examine case studies and other research.
Nurses cannot change huge systems alone. Members of the healthcare team
can use this text as a vehicle to educate themselves so that, together, everyone
in the healthcare profession can influence policymakers.

■ Those professionals who do not provide health care directly but who are
involved in areas of the environment that produce actual and potential threats
to personal and community health and safety will find this text a valuable
resource regarding how a problem becomes known, who decides what to
do about it, and which type of governmental response might result. Envi-
ronmental scientists, public health officials, sociologists, political scientists,
anthropologists, and other professionals involved with health problems in
the public interest will benefit from the ideas generated in this text.

■ Interest groups can use this text as a tool to consider opportunities to be-
come involved in public policymaking. Interest groups can be extremely
helpful in changing systems because their members’ passion for their causes
energizes them to act. Interest groups can become partners in the political
activity of nurses by knowing how and when to use their influence to assist
advanced practice registered nurses (APRNs) at various junctures in the
policy process.

Preface vii

▸ Using This Text
Each chapter in the text is freestanding; that is, chapters do not rely, or necessar-
ily build, on one another. The sequence of the chapters is presented in a linear
fashion, but readers will note immediately that the policy process is not linear.
For example, readers of the policy implementation chapter will find reference to
scholars and concepts featured in the agenda-setting and policy design chapters.
Such is the nature of the public process of making decisions. The material covered
is a small portion of the existing research, arguments, and considered thought
about policymaking and the broader political, economic, and social concepts
and issues. Therefore, readers should use this text as a starting point for their
own scholarly inquiry.

This text can be used to initiate discussions about issues of policy and nurses’
opportunities and responsibilities throughout the process. The case studies
presented here should raise questions about what should have happened or why
something else did or did not happen. In this way, the text can serve as a guide
through what some perceive as a maze of activity with no direction but is actu-
ally a rational, albeit chaotic, system. The case studies and discussion points are
ideal for planning a class or addressing an audience. Many ideas and concepts
are presented, and we hope they serve to stimulate readers’ own creative thoughts
about how to engage others. Gone are the days of “the sage on stage”—the teacher
who had all the answers and lectured to students who had no questions. Good
teachers always have learned from students, and vice versa. Today’s teachers are
interactive, technically savvy, curious and questioning, and capable of helping
learners integrate large amounts of data and information. This text can serve as
a guide and a beginning.

viii Preface

© Visions of America/Joe Sohm/Photodisc/Getty

We continue to thank the staff of Jones & Bartlett Learning for their encourage-
ment and guidance when we were writing the Sixth Edition. Their confidence
in all the contributors has been consistent and unwavering. Christina Freitas,
Product Assistant for Nursing, and Rebecca Stephenson, Product Manager for
Nursing, have kept the authors on track in meeting deadlines and provided astute
editorial assistance.

We also thank the readers of this text for their interest in the policy and
political processes. For those of you who have integrated these components and
concepts into your nursing careers, we applaud you. You will continue to contribute
to the profession and to the broader society. For those readers who are struggling
with how to incorporate one more piece of anything into your role as professional
nurse, remember that you are advancing the cause of your own personal work,
the profession, and healthcare delivery in the United States and throughout the
world every time you use the concepts covered in this text. Nurses are a powerful
force and exercise their many talents to further good public policy—policy that,
ultimately, must improve health care for patients, consumers, and families.

For the wide range of healthcare professionals (dentists, dietitians, phar-
macists, physical and occupational therapists, physicians, physician’s assistants,
psychologists, and others) who may be reading this text for the first time, we
encourage you to collaborate as colleagues in the 21st-century definition of “team”
and integrate policymaking into your practices.

From Jeri: Finally, I want to acknowledge my forever-cheering section—my
four children, their spouses and significant others, and three grandchildren. They
are always there for me and provide continuous support, encouragement, and un-
conditional love. I love you, Kerrin, Sunny, and Heath Nethers, and George Biddle;
Joan Milstead; Kevin Milstead and Gregg Peace; and Sara and Steve, and Matthew,
Cynthia, and baby Colton Lott. You are a fun bunch, and you make me laugh.

From Nancy: I feel very grateful to have had this opportunity to be mentored
by Dr. Jeri Milstead as she plans to step away from her role as the founding editor
(for five editions!) of this text. She is a role model for whom there are not enough
words to describe: Perhaps an “Energizer bunny” metaphor fits best. I wish to
thank my husband, Jim, for his continuous support of all my career endeavors,
including shoulder rubs when I’ve been using a mouse for way too many hours.
I want to acknowledge my children as well: Kolton, Amanda, and Amber have been
consistent cheerleaders while simultaneously acknowledging that health policy may
not be the most exciting choice for light reading. I also wish to acknowledge the
support and inspiration I regularly receive from colleagues and students at the Duke
University School of Nursing—especially from Dr. Terry Valiga. Go Blue Devils!

With gratitude,
Jeri A. Milstead and Nancy M. Short

Acknowledgments

ix

© Visions of America/Joe Sohm/Photodisc/Getty

Contributors
Patrick H. DeLeon, PhD, MPH, JD, is distinguished professor at the Uniformed
Services University of the Health Sciences (Department of Defense) in the
School of Nursing and School of Medicine. He was elected to the Institute of
Medicine of the National Academies of Science in 2008 and served as president of
the American Psychological Association (APA) in 2000. For more than 38 years,
he was on the staff of U.S. Senator Daniel K. Inouye (Democrat‒Hawaii), retiring
as his chief of staff. Dr. DeLeon has received numerous national awards, includ-
ing the Order of Military Medical Merit; Distinguished Service Medal, USUHS;
National League for Nursing Council for Nursing Centers, First Public Policy
Award; Sigma Theta Tau International Honor Society of Nursing, First Public
Service Award; Ruth Knee/Milton Wittman Award for Outstanding Achievement
in Health/Mental Health Policy, NASW; Delta Omega Honor Society Award for
Outstanding Alumnus from a School of Public Health; APA Outstanding Lifetime
Contributions to Psychology Award; American Psychological Foundation Gold
Medal for Lifetime Achievement in the Practice of Psychology; and Distinguished
Alumni Award, University of Hawaii. Dr. DeLeon is currently the editor of Psy-
chological Services and has more than 200 publications to his credit. He earned a
PhD in clinical psychology, along with an MS (Purdue University), JD (Catholic
University), MPH (University of Hawaii), and BS (Amherst College). Dr. DeLeon
also has been awarded three honorary doctorates: PsyD (California School of
Professional Psychology), PsyD (Forest Institute of Professional Psychology),
and HLD (NOVA Southeastern University).

Anne Derouin, DNP, APRN, CPNP, FAANP, is assistant professor at Duke
University School of Nursing. She …

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