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Policy and Politics: Navigating Nursing's Political Voice
- 2. Policy, Politics and You: Act with intention unifying Nursing’s Political Voice Todd M. Grivetti, MSN, RN, CCRN, CNML Clinical Nurse Manager Regional Neurosciences Center Poudre Valley Hospital Ft. Collins, CO
- 3. House Keeping Please Turn your Cell phones and pagers to Vibrate.
- 4. Disclosure Statement As a member of AACN’s Speaker’s bureau I have received an honorarium from AACN for this presentation. I have no other vested interest(s) from any other organization.
- 14. Health Policy
- 15. Health Policy
- 26. Values Framework Politics Politics Values Evaluation Implementation Policy Alternatives Goals Agenda Politics Values
- 30. Identify your Policy & Political Resources
- 32. Four Spheres Framework Community Government Organizations Workplace
- 45. Four Spheres – Professional Org’s. International Council of Nurses
- 83. Legislation 2010 What is currently in the works?
- 98. Political Resources How to identify the issues at hand to allow you to Act With Intention
- 102. American Organization of Nurse Executives www.aone.org
- 104. American Association of Critical Care Nurses www.aacn.org
- 105. AACN Resources Capwiz Home Page
- 106. AACN - Resources Capwiz Elected Officials
- 107. American Association of Critical Care Nurses http://www.capwiz.com/criticalcare/home
- 108. International Council of Nursing www.ich.ch
- 109. Joint Commission
- 111. Joint Commission
- 112. Institute for Healthcare Improvement - IHI
- 114. IHI – Critical Care
- 115. Robert Wood Johnson Foundation www.rwjf.org/publichealth
- 116. Robert Wood Johnson Foundation www.rwjf.org/healthreform
- 122. Estes Park, CO Fish Creek – Steamboat Springs, CO
- 123. Questions & Answers Contact Information: Todd M. Grivetti, MSN, RN, CCRN, CNML [email_address]
Notes de l'éditeur
- Policy encompasses the choices that a society, segment of society, or organization makes regarding its goals and priorities and the ways it allocates its resources to attain those goals. Policy choices reflect the values, beliefs, and attitudes of those designing the policy (Mason, Leavitt, Chafee, 2007 p.3).
- ICN – International Council of Nursing
- Reference: ENCYCLO Online encyclopedia – http://www.encyclo.co.uk/define/social%20policy.
- Organizational policies: are applicable to specific organizations, for example to: - their resources - their staff their operations include policies - made by an organization that affect the organization as a whole - made by sections of an organization that affect the internal operations of those sections may also be public policies if they affect the public at large
- Audience participation: What does the term politics mean to you? Where do you see politics being used predominantly? Who is involved in nursing policy/politics within your own organizations? What is the importance of being active in these decisions?
- Points: Gilligan (1982) and Pinch (1996) – Caring is not gender based: Women do not “own” nurturing, compassion and caring. To view caring as “female” trivializes the concept and precludes it from being integral to policymaking.
- A values framework for politics and policy process. This figure illustrates the steps in the policy process. Politics can influence the process in any step. Both the politics of policy development and the policy itself are grounded in and influenced by values.
- Prenatal care: Prenatal care cost relatively little compared with high cost of neonatal intensive care – Lowest birth weight infants cost an average of $250,596 (Cuevas, Silver, Brooten, Youngblut, Bobo, 205). Once the infant is stabilized – sent home without a guarantee the mother will receive support she needs. Mandatory Overtime: Used to ensure adequate staffing for nursing care – The policy fails to reflect caring about patients or nurses – Shown to be harmful to patients Found nurses working mandatory overtime have an increased number of medication errors Nurses who are single parents – must decide whether to commitment between their patients or their children. Nurse to Patient Ratios: Hospitals cite financial constraints in their argument against improving nurse-patient ratios Rothberg, Abraham, Lindenauer & Rose (2005) – report that the cost of nurse staffing as a safety intervention finding that the “cost per death averted” with a staffing ratio of 1:4 was not as expensive as that of a Pap test or the use of thrombolytics after and MI. Two procedures which are viewed as a standard of care and reimbursed accordingly. (Mason, Levitt, Chaffey, (2007). Summary – If nurses want institutions and government to develop policies that reflect nursing’s values, then nurses must be a part of the decision making process --- The Political Process
- 1. Power – Men tend to embrace hierarchic models of power -”Power grabbing” or power over. Whereas women tend to gravitate to power with , sharing 1. Transformational Leadership – popular with both sexes – espousing the style that embraced collaboration, creativity and empowerment. Mason, et.al (1991) identified three components for the political empowerment of nurses: 1. Consciousness raising about the sociopolitical realities of a nurse’s life and work within society. 2. A sense of self-efficacy and self-esteem regarding nurse’s ability to participate in the policymaking process. 3. Development of skills to influence the policymaking process: knowing how to use the traditional methods as well as new methods of relating to power and politics.
- Utilize your local or national newspaper to identify key issues which need attention. Identify the parties responsible for the any legislation that may be taking place currently. Most newspapers will print a listing of your state’s political figures including those in Washington, D.C. Utilize Professional Organizations are a primary source of up-to-date information on political issues, current legislation, and provide sources to further your research. 1. Utilize your association’s Legislative Action Center page: www.aacn.org/healthpolicy - AACN; www.aone.org/aone/advocacy – AONE; http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues.aspx - ANA;
- 1. List out the workplace policies and procedures manuals.
- TCAB – Strategy for reducing the shortage in nursing staff and improving the quality of nursing care by changing the way care is delivered at the bedside. Joint project with Institute for Healthcare Improvement (IHI) – aimed at changing the work environment of hospitals to support bedside nurses as the key change agent PVHS experience: 2 year involvement with RWJF and IHI in the collection of data. Making changes in the way nurses provide care at the bedside with over 50 processes completed and either adapted or adopted. The simplest – Moving the ice bags from the store room to the pantry where the ice machine is. Saved 2 steps. Second – Incorporating a “resource” nurse for the day/week. This nurse was assigned to do the discharge teaching and medication reconciliations for all patients being discharged. This allowed the other nurses to continue with their patient care duties and not have to worry about assessments and discharges at the same time.
- 1. Government – New EPA regulations for the handling of certain medications: Coumadin, Antibiotics, Nicotine patches, etc… Evolution of small waste bins in the medication rooms to waste these medications in.
- We live in a society in which we are all interconnected; welfare and safety of each one of us depends on the health and welfare of a cooperative and collective enterprise. Provides society with a legal definition of what nursing is, and it defines what nurses may do.
- Jacob Hacker (Yale Political Scientist) – Road to NoWhere after the Clinton administration’s proposal in 1993.
- Knowledge@Wharton – 2008 Presidential Candidates Push Health Care Reform, but who will pay? Senator Clinton’s plan is scaled back from her previous plan in 1993 – 1994. “Hybrid between free-market and her earlier proposal. President Obama calls for a Universal coverage and a mandate that all children be covered. His plan stops short of extending the mandate to adults. $65 billion plan – “National Health Insurance Exchange” – Similar to Hacker’s plan. Senator McCain – Attacks the nations health care problems from the cost control issue. His proposal seeks better management of chronic conditions (diabetes and CAD). The plan calls for hospital and doctor compensation based on performance, starting with Medicare and Medicaid. – Eliminates employer based write-off. Proposes a tax deduction of $2,500 for individuals and $5,000 for families which would go toward the purchase of health insurance.
- As public citizens, chapter members have the right to make their voice heard in government. Chapter members are prohibited from using their membership in AACN or AACN chapters to endorse or oppose a candidate for elective office at any level of government.
- 1. Late 1970’s and early 80’s, nurses recognized they were excluded from important policy developments – Decisions were made that influenced practice without our input
- Mason, Leavitt, & Chaffee – Chapter 3. pp 34-36
- This phase – build on the valuable expertise of nursing and health care leaders in health policy. Policymakers and legislators turn to nursing to be the experts on their health advisory committees. Nursing becomes more involved at the table: Health boards, commissions, appointments to policy-making bodies.
- 1. 111 th Congress – Only three nurses serve.
- Working Nurse (2008). 100 nurses serve in legislation either at the state level or in Congress. Currently there are 10 states that have at least one nurse serving in elected offices: 15 states have two, five states have three, 2 states have at least four nurses and 3 states have at least six or more. a. Montana – 6 b. Minnesota – 7 c. Washington - 8
- Reference: Kubsch, Sternard, Hovarter & Matzke (2004) – in Mason, Leavitt, Chafee (2007). Policy & Politics in Nursing and Health Care . Saunders, St. Louis. Pp. 36-37.
- Wald fought to have rights of children – Argued that it was shameful for a nation to have policies and departments protecting animals but not children.
- The Comstock Act of 1873 was targeted not only at obscenity and “dirty books” but at birth control devices and information on such devices, at abortion, and at information on sexuality and sexually transmitted diseases. It was widely used to prosecute those who distributed information or devices for birth control. In 1938, in this case involving Sanger, Jude August Hand lifted the federal ban on birth control, effectively ending use of the Comstock Law.
- Do not write a letter regarding issue with your state’s practice act to a federal legislator. When writing to a committee chair; Write them at their committee’s address and not their congressional address. Hints: Be brief, be personal, be specific, be polite, and be sure to sign your name and include your address: REMEMBER – Thank you notes are IMPORTANT.
- Salutation: Include formal title and last name. Identify Yourself: Assert your credibilty as a nurse, a member of a specialty or organization, a professional, a registered voter concerned about_____.
- NOTE : When writing to the Chair of a committee or the Speaker of the House – Dear Mr. Chairman or Madam Chairwoman; Dear Madam Speaker or Mr. Speaker;