How Does Public Policy Affect Nursing Home's Financing And Ability To Deliver Services To Patients?
Nurs Forum. 2020 Oct 6 : 10.1111/nuf.12514.
Engaging nurses in wellness policy in the era of COVID‐xix
Robert L. Anders
1 School of Nursing, University of Texas, El Paso Texas, USA,
Received 2020 Jul 9; Revised 2020 Sep x; Accustomed 2020 Sep 14.
Abstract
Nurses take a unique place in redesigning the time to come of healthcare, especially later experiencing wellness policy failures with the coronavirus disease 2019 pandemic. Nurses consistently outperform other professions to bask a decades‐long reputation as the almost trusted profession. Nevertheless, the nursing voice is missing at a public level; representation in governments and boardrooms negligible. While nurses carry out wellness policy, rarely are they involved informing policy. While substantial dialog on wellness arrangement reform, regulatory changes, care coordination, and wellness information technology occurs, nursing'south presence is absent-minded. The barriers are many: a lack of political sophistication, family, and work demands limiting time, and a lack of confidence. Using the Yoder‐Wise Framework for Planned Policy Alter, opportunities for engagement at each footstep in the procedure are made clear. Workplace opportunities provide entry‐level representation and exposure to the machinations of governance. Nursing professional associations provide similar opportunities. For many nurses, social media, while non without its risks, offers a familiar and attainable platform by which to appoint patients, the public, and policymakers in planned, strategic steps to create policy change and improve healthcare for patients.
Keywords: action steps to policymaking, barriers to policymaking, COVIID‐19, executive roles, governance, health policy, nursing empowerment, nursing voice, patient advocacy, policymaking, politics, social media
1. INTRODUCTION
Nurses in directly clinical exercise have a long history of championing the needs and rights of their patients. Advocacy is at the heart of the nursing process, all the same advocacy on a broader societal level by nurses is not equally evident. Nurses are not timid about advocacy, often defending the rights of the patient even when that advocacy may exist misaligned with the needs of others, including the nurse's employer. Nurses execute their advocacy responsibilities by developing clinical and emotional competency to complete a critical deliverable: safe, optimal patient care. 1 Nurses have the skills and courage, forth with public respect for their work, to be involved and influential in wellness policy evolution. 2
Co-ordinate to the World Health Organization, "Health policy refers to decisions, plans, and actions that are undertaken to attain specific health care goals within a society. An explicit wellness policy tin can attain several things: it defines a vision for the time to come, which in turn helps to establish targets and points of reference for the curt and medium‐term. Information technology outlines priorities and the expected roles of dissimilar groups, and information technology builds consensus and informs people." 3 The purpose of this article is to articulate the importance of clinical nurses' appointment in health policy and provide an overview of some barriers front line nurses may have regarding participation in health policy. A secondary aim is to provide some social media guidelines that nurses can apply for appointment in health policy development. The utilise of the Yoder‐Wise Framework for Planned Policy Alter 4 provides a model to frame the give-and-take and guide the policy interventions.
ii. CLINICAL NURSES AND HEALTH POLICY
Nurses, peculiarly those engaged in direct clinical practice, are people of action who rarely take the time to view issues faced through a socio‐political lens. 5 Nurses may lack knowledge of the political process and have a limited understanding of how to leverage powerholders and thought leaders. Access to policymakers may exist express. All these skills are necessary to impact the development and ultimate passage of health legislation. If nurses consider becoming involved in the political process to abet for policy, an absence of understanding about elected officials and their respective positions on health care may be a hindrance. The process is decidedly complicated and access to data mystifying. Researching pending wellness legislation and its implications present an overwhelming task that is fundamentally intimidating. Nurses need to be well informed and to accept the capacity to speak with authority across every aspect of the health policy process.
Additionally, there are barriers related to traditional gender roles, expectations, and nursing's traditional vocalisation in the evolution of health policy. Gender‐based roles can be a crucial factor in predetermining and shaping health systems, outcomes, and policy. Some of these roles include traditional childcare responsibilities, many nurses who are women confront, along with potentially having to treat elderly parents. Information technology would be challenging to achieve public policy targets without confronting outdated gender roles and gender inequality inside and outside health systems. six The ability to speak with authority while navigating gender‐based role expectations and conflicts can be learned with education, experience, and mentoring.
The process of educating nursing students may take implications for understanding the absenteeism of a maturing nursing vox. Nursing students progress more than apace when engaged by communities of exercise. Nurse educators can develop, support, and orient novices into a culture to provide a sense of belonging. 7 To support nursing students in a culture of advocacy for wellness policy change, nursing curricula at both the undergraduate and graduate levels should include course work and, ideally, practical experiences in how nurses can influence health policy. 8
Front‐line nurses may believe it is incommunicable to create policy change at the national or even local level; many may think their part is besides small to make a difference in health policy. However, the engagement front line nurses have with patients, and other healthcare professionals, make them platonic healthcare policy advocates. ix
The challenge for nurses is to find a way to appoint in policymaking that is accurate to nursing's ancestry, values, and professional conscience. The role of a nurse mandates the ability to manage competing demands and the skills to problem‐solve to provide quality outcomes. Nurses are subject affair experts (SME) as they are an authority in a specific clinical area of practice. They have appropriate bookish educational activity and clinical expertize to serve as experts in sharing their knowledge with policymakers and others. x The noesis nurses at the front‐line of patient care take related to their clinical practice should be shared with health policymakers. Nurses, when heard by powerbrokers, will add value to determination making effectually health system reform, regulatory changes, intendance coordination, and wellness information technology. Every bit SMEs, the puzzler remains how all-time to leverage the well‐earned status equally experts yet observe forums that nowadays a low risk‐low barrier to entry opportunities. Options are limitless. Taking on the role of SME, when combined with the Yoder‐Wise Planned Policy Framework 4 helps clinicians understand opportunities to become involved in policy change at different points in the policy process.
three. YODER‐WISE MODEL AND PLANNED POLICY CHANGE
The Yoder‐Wise model 4 provides a framework for how front‐line nurses can use planned policy changes within the context of the coronavirus pandemic, a current instance of uncertain and chaotic times (see Figurei). This framework focuses on nine steps to help nurses better understand how to apply their skills to plan and implement change, even under chaotic atmospheric condition, while recognizing the full scope of the process for an constructive policy to be achieved. Each step in this process builds on and integrates with the other steps. When viewed as a whole, the steps in the policy framework outline the critical elements that need to be addressed for policy work to succeed. This framework applies beyond care sites to local, state, and federal organizations. For different settings, the players modify, and the cycle may differ, but the process remains the aforementioned.
The framework for planned policy change
4. CORONAVIRUS DISEASE 2019 Case—HOW TO Employ SELECTED STEPS IN YODER‐WISE MODEL
Using the coronavirus disease 2019 (COVID‐xix) pandemic as an example, the first iv steps of the model are illustrated in the discussion. The precipitator, step one in the framework, 4 was the novel coronavirus, severe astute respiratory syndrome coronavirus ii. Its sudden and widespread advent created a crunch that undermined the ability of nurses to evangelize safe, evidence‐based care to patients with the virus while maintaining their own personal condom. A critical point, step two in the framework, occurred as nurses and others at times did non have access to personal protective equipment (PPE) and ventilators for their patients. The apparent failure to adequately plan for the pandemic by health care institutions and government officials contributed significantly to the magnitude and urgency of the disquisitional situation. The nurse'due south assessment, step three in the framework, encompassed the extent and impact the lack of PPE and other medical supplies and equipment had on the quality of care provided. In addition, nurses knew their health and the health of those around them was at risk.
The need for policy advocacy regarding the lack of PPE and the consequences of the hospital and public health unpreparedness is urgent. The remainder of this give-and-take reflects on how nurses can use a variety of avenues, including social media, to apply another components of Yoder‐Wise's framework 4 for planned policy change.
5. NURSING Advancement
Despite nursing's intrinsic involvement in the advancement of the individual patient, the nursing vox is oft not heard at a public level. Nursing's interest in improving wellness and health care for all patients at a government level is but an extension of the advancement work. The piece of work is central to the nursing procedure. 11 The COVID‐19 pandemic unintentionally created an urgent need for nurses to abet for changes in health policy.
Nurses represent approximately 50% of the global wellness workforce 12 ; even so, nursing representation at the authorities and boardroom level is slim. 13 The importance of the nursing vocalism being heard cannot be overstated. Any other profession cannot replicate the situational knowledge of the healthcare needs of patients that this large workforce offers. Nurses and midwives penetrate geographical, societal, economical, and political landscapes that are immeasurably diverse. That kind of intelligence is essential to properly inform policymakers when making critical decisions about health system reform, regulatory changes, care coordination, and health information technology. Here, agendas are aligned: nurses want these key policy issues to be adequately addressed for their patients to attain optimal health outcomes. Policymakers are acutely enlightened that these issues threaten their ability to deliver a sustainable and accessible healthcare delivery model. 14
The political landscape is perilous for policymakers. Delivering toll‐effective, accessible, notwithstanding sustainable wellness service to the voting public is a formidable challenge. Nursing should hold an exclusive identify in this dialog, particularly at present during the COVID‐xix pandemic. 15 At a time where there is rapidly declining trust with politicians and policymakers, xvi nurses accept a unique opportunity to step into the void. Nurses, for decades, at least in the USA, accept enjoyed consistent recognition as the most trusted profession in Gallup Polls. 5 The public inherently believes that nurses' moral compass protects them from conflicts of interest where fiscal, bureaucratic, or political incentives would otherwise deject judgment. That decades‐long reputation withstands poor press in public opinion as isolated incidents, and this respect serves as our most bankable asset to leverage the nursing vocalism in policymaking.
Meaningful policy change can occur at the institutional level, where nurses are accustomed to functioning. Nurses' involvement in self‐governance within hospitals presents opportunities for staff nurses as well every bit others to participate in the clinical governance at a local level. 17 Clinical governance committees range from policy and procedure committees to infection command prevention and command committees to quality initiatives. These groups offer a unique opportunity for nurses to work with process, workload, personal commitments, and the ability of their nursing vocalisation within these conventions. Similar any clinical skill, competency, or knowledge is gained as nurses progress from novice to skillful clinicians. These committees offer fertile ground for the staff nurse to proceeds valuable experience in employing the Yoder‐Wise Model iv to create health policy in their employment settings related to resource allotment and use of PPE.
Exterior the employment setting, there are opportunities to gain confidence in effecting policy change. Nursing professional person associations that align with clinical subspecialties are ideal for contributing to professional do and leadership. Gaining competency effectually the roles within and the functions of professional associations closely aligns with the political process. Nurses can begin as a member contributing to online discussions, blogs, or social media involvement groups sponsored past the association, so progress to active participation in any number of subcommittees, and finally run for part.
Even so, in that location are other opportunities far more than attainable and intuitive to some. In the Us, l percent of the workforce are millennials, 18 many of whom have a unique gear up of characteristics that tin change the playing field. Millennials want to sympathise the rationale behind organizational decisions. They want to be agile participants of that process and have a desire to exist engaged in social responsibility with less focus on profit and more focus on purpose. Most significantly, however, more than any other generation, millennials understand professional person and social networks as opposed to the traditional hierarchy. 12
In an anonymous survey conducted in the USA of 366 health care workers, 97% owned an electronic device, with 87.9% reporting the use of social media. nineteen Health care workers nether the age of 40 were more involved in social media than those above the age of 40. Eighty‐eight percent of the nurses reported using social media. Nurses also encourage their patients to acquire nearly their clinical atmospheric condition from reputable sources on social media. Millennials have matured with social media as a abiding presence in their lives and understand the ability of a network to leverage change. The COVID‐19 pandemic has presented an opportunity to hear nurses' voices at the policy table using social media.
half-dozen. Stride Iv IN THE FRAMEWORK FOR PLANNED POLICY
Amidst a COVID ‐19 pandemic, the need for nurses to engage in influencing public health policy is urgent. The report of staff having to treat coronavirus patients without adequate PPE is a failure of health policy. While many health care providers and administrators are voicing concerns, it seems their pleas for help go unheard. Nurses and other healthcare providers, forth with their families, friends, and social networks, need to join in advocating for immediate changes in health policy, specially the need to provide admission to PPE and ventilators. Nurses tin best articulate these needs based on their cess of the critical situation and share their insights into possible solutions by leveraging the public trust they relish. Using Yoder‐Wise's four along footstep planning, social media is one artery for this advocacy.
7. SOCIAL MEDIA
Social media is both familiar and accessible for nurses. twenty Social media tin be a identify where millennial digital natives find their political vocalisation. Few people would neglect to recognize the incredible social activism created by hashtags, such equally #MeToo that served to uncover women's shared stories of sexual harassment. Closer to our healthcare home, withal, the viral 2014 #IceBucketChallenge aimed to enhance essential funding for the The states Charity, the Amyotrophic Lateral Sclerosis (ALS) Foundation, by creating sensation almost the deprival of funding to ALS Researchers of Usa $1 one thousand thousand for an innovative project from the US government. 21
The #IceBucketChallenge resulted in over seventeen million people uploading over 10 billion videos viewed by over 440 million people internationally, leading to donations over U.s. $220 million. While non an example of wellness policy, social activism illustrates how public engagement can support funding for such. Information technology seems a like strategy could be useful to abet for advisable wellness policy for the care of COVID‐19 patients.
Social media offers an ideal platform for engaging and impacting public policy with limited barriers to entry. It provides nurses a "nursery‐slope" for engaging with the public, informing policymakers, and building a brand about which they experience passionate. Nurses can bypass the bureaucracies of hierarchy. Arabi et al. 22 suggest that nurses can put into the public forum what they stand for, their values, and their message as it pertains to their capacity as wellness experts. The nurse can advocate for the change in wellness system reform, including care coordination and health information technology. Nurses, as experts, with the trust that comes with being a nurse, will begin to be recognized as a legitimate voice in public policy. As knowledgeable clinicians and skilled communicators, nurses are well‐positioned to influence readers, 22 whether they be patients, the public, or policymakers. The strategy can work with the current urgent needs created by the COVID‐19 pandemic. Nurses are at present using social media to advocate for their patients as well as for themselves.
Social media engagement is not without its risks. A Chicago nurse filed a complaint alleging that she had been fired for warning colleagues via social media that the masks the infirmary had provided were inadequate. 23 There are reports of nurses beingness told by their employers to not speak out about their working conditions and the shortage of PPE and ventilators. 24 While engaging in social media, nurses should exist cognizant of their licensing trunk's regulations as well as aware of the nursing Code of Ethics 24 and the principles of testify‐based practice. Situational noesis of the nursing experience should not exist underestimated, so offer a clinical example related to the needs of patients and providers related to COVID‐19 is what nurses tin can uniquely provide. Identifying data near patients is in direct violation of the Health Insurance Portability and Accountability Act Privacy Rule. 25 However, compelling stories of deidentified patients, settings, and conditions can be enormously persuasive.
An example of the use of social media and COVID‐nineteen was a picture of a nurse in Italy that showed the bruises on her face caused by wearing a protective mask. The photo revealed, in office, the emotional and physical furnishings of caring for COVID‐19 patients had on nurses. Another example is nurses taking to social media to speak out most the shortage of PPE. They are gathering around the hashtag #GetMePPE. 26
Owning our position equally an proficient means embracing the age‐quondam aphorism that nosotros are not experts on everything. Kickoff wellness policy advocacy work is a learning process, and nosotros must be prepared to larn as we take our first steps. Those first steps of health policy advancement may begin along unlike avenues: consumer groups, workplace settings, nursing organizations, mentor networks, or with elected officials. The steps should exist organic and authentic to the private: phone telephone call, email, alphabetic character to the editor of a local newspaper, personalized notation to an elected official (see Effigy2).
Guidelines for advancement via social media
8. FINAL THOUGHTS
Ultimately, for a nurse who feels the altruistic pull towards policy development, it is critical to undertake the employ of a policy planning framework such every bit one suggested past Yoder‐Wise. 4 The planning framework guides contemporary problems facing healthcare reform, such as COVID‐19. A keen interest in policy and public advocacy can atomic number 82 to new frontiers. An Australian nurse, Ged Kearney, who once led clinical nursing teaching in a large Australian health service, successfully made the transition from nurse to political leader. 27 Kearny exemplifies the internal struggle nurses take where the dilemma of the health system has directly impacted how a nurse tin deliver care. However, nurses may have limited opportunities to participate in the public debate. The lack of participation belies an ethical duty of concern that the nursing vocalism has in scrutinizing reform, and especially health policy regarding the COVID‐xix pandemic. A lack of or inadequate existing policy direct impacts the nurse's ability to deliver safe and optimal patient outcomes.
At that place may exist a significant lack of nursing representation at the government and boardroom level where decisions are made. However, our innate nursing skills and well‐earned public trust positions nurses ideally to stride up and take control of the public contend. Nosotros can exist an active participant in the process that acutely defines the clinical journey on which nosotros take our patients. In that location are a plethora of options for nurses to enter the public fray. Social media is a viable and easy to utilize forum. To remain silent is a betrayal to the podium of trust that patients have gifted to the states.
Notes
Anders RL. Engaging nurses in wellness policy in the era of COVID‐19. Nursing Forum. 2020;1‐6. 10.1111/nuf.12514 [PMC free article] [PubMed] [CrossRef]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675349/
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