Public Policy Exam 1

In general, how do leaders exercise legitimate power? a. issuing formal requests b. maintaining credibility c. making requests in a demanding tone d. keeping aware of information that is relevant and that may be needed by the organization e. keeping aware of subordinates' actions

A

The primary bases of positional power include all of the following EXCEPT a. referent power. b. legitimate power. c. reward power. d. coercive power. e. All of these are bases of positional power.

A

________power is granted by virtue of one's position in the organization. a. Legitimate b. Reward c. Coercive d. Expert e. Referent

A

Health equity

Efforts to ensure all people have full and equal access to opportunities that enable them to lead healthy lives

Politics

- Use of relationships and power - Gain ascendancy among competing stakeholders - Influence policy and allocation of scarce resources

Empowerment Example:

- Uses consensus build instead of authoritative directives to staff - Forming of coalition to build and share decision-making to guide process

The Community

- group of people who share something in common - interact with one another - may exhibit a commitment to one another - or share a geographic boundary

Three Streams in Kingdon's Model

1. Problem stream 2. Policy stream 3. Political stream

Professional ethics built around 3 essential components:

1. Purpose 2. Expected professional conduct 3. Skills and outcomes expected in professional practice

4 Components of Political Skill

1. social astuteness 2. interpersonal influence 3. networking ability 4. apparent sincerity

Preparation steps

1.Analyze the strategic situation and context 2.Define the ends 3.Determine the means 4.Formulate the ways 5.Assess

Framing for content

more difficult, use of a compelling personal story may gain some attention

Coordinate care

-Across people functions activities, locations, and time -Ensure active patient participation

Create value

-increase patient health outcomes and satisfaction -decrease medical errors, costs and waste

What are some examples of nurses working in the community sphere of framework for action?

-provides opportunities for nurses to influence health and social policies at a local/community level -nurses can help identify health problems/collaborate Ex-planning boards, civic organizations, parent teacher organizations

5 principles of bioethics

1. Autonomy 2. Non-maleficence 3. Beneficence 4. Justice 5. Fidelity

Promote health in three ways:

1. Change health behaviors and shape public policy 2. Media advocacy 3. Framing

How nurses should not use the media (Social Media)

1. Complain About or Comment on the Health of Patients 2. Post Photographs of Patients 3. Rant About Place of Employment 4.Use Offensive Language and/or Voice Offensive Comments

Four cornerstones of the Affordable Care Act

1. Create value 2. Coordinate care 3. Expand access 4. Reform payment

Upstream factors care in Social Determinants of Health

1. Economic stability 2. Neighborhood and physical environment 3. Education 4. Food 5. Community and social context 6. Health care system

Phases in the Policy Process

1. Formulation phase 2. Implementation phase 3. Modification phase

Types of Policies

1. Health Policies 2. Social Policies 3. Private Policies 4. Allocative Policies

Steps involved in Political Analysis:

1. Identification of the issue (who, what, when, where, how) 2. Gather information, decide what you know and what is missing 3. Context of issue, stage is crucial 4. Political Feasibility Analysis 5. Stakeholders 6. Economics and resources 7. Value Assessment 8. Networks and/or Coalitions 8. Power

Advocacy outside the clinical setting

1. On a National Level 2. On a State Level 3. On a Local Level

Types of advocacy:

1. Patient advocacy 2. Professional advocacy 3. Political advocacy

Types of healthcare policies:

1. Patient care policies bodily fluid exposure 2. Employee health and safety policies 3. Tobacco free workplace 4. Security 5. Data privacy, IT security 6. Drug handling 7. Administrative/HR policies

3 Phases of Longest's Policy Cycle Model

1. Policy Formulation 2. Policy Implementation 3. Policy Modification

The Nurse Effective Use of Media

1. Position yourself as a trusted source 2. Create your own media outlet 3. Know your medium and your message 4. Debunk falsehoods and avoid "Gotcha" moments

Nurses must advocate for

1. Themselves 2. Their clients 3. Their subordinates 4. Their profession

Forces that shape health and social policy

1. Value 2. Politic 3. Policy Analysis and Analytics 4. Advocacy and Activism 5. Interest Groups and Lobbyists 6. The Media 7. Presidential Power

What are the requirements to be politically competent?

1. deep knowledge 2. political antenna: learning how to navigate differences "agree to disagree" 3. use power (bring the truth) recognize who has the power (policy makers) they can make changes, join nursing coalitions

What are the four spheres in the framework for action?

1. government 2.workplace/workforce 3. associations/interest group 4. community

Social Policies

Actions to deal with social problems

Expand care

Affordable, portable transparent health insurance to all individuals to have choice, control, and peace of mind

A guideline for using legitimate power is a. engaging in role modeling. b. maintaining credibility. c. making requests politely but confidently. d. verifying compliance.e. revealing accomplishments and awards.

C

A person in the organization has the ability to given bonuses to employees as part of a corporate compensation program. This is an example of ____ power. a. referent b. legitimate c. reward d. expert e. coercive

C

Offering incentives that are desirable to workers is an example of how to effectively use ____ power. a. referent b. legitimate c. reward d. expert e. coercive

C

Drug handling

Controlled substances, toxic waste

Health Policies

Crafted by Government to influence health or health care

Private Policies

Crafted by non-governmental agencies

____ power exists when a person has valuable skills or knowledge. a. Legitimate b. Reward c. Coercive d. Expert e. Referent

D

Explain what is meant by health disparities and healthcare disparities. What ethical concerns are raised by these disparities?

Differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups.exist between education levels, socio-economic classes, ethnic groups, genders, insured vs. uninsured groups, etc. o When there is a significant difference between groups o Several organizations that try to track disparities o Ex. Genders with heart attacks, females are more likely to have worse outcomes than men o Reason for identifying disparities - concerning b/c why is this different o Biggest - people that are uninsured have a lot worse health outcomes

Health disparities

Differences in health outcomes among groups of people

Health inequities

Differences in health that are avoidable, unfair and unjust. Affected by social, economic, and environmental conditions

Allocative Policies

Distribute resources and benefits provided to a distinct group at the expense of other to achieve public object or redistribution of wealth Example: Medicare > Benefit the elderly

Beneficence

Doing good or causing good to be done; kindly action

Administrative/HR policies

Dress code, attendance, code of ethics, vacation, sick leave

Data privacy, IT security

HIPPA

Employee health and safety policies

Health and safety on the job eg occupational hazards OSHA, PPE's

Tobacco free workplace

Healthy workforce, smoking policies

The future of Nursing: Leading change, Advancing Health

High quality patient-centered care for all will require remodeling main aspects of health care system, especially nursing

Patient Care Policies and Procedures

How to handle bodily fluid exposure

On a Local Level

In school districts, educate parents, staff, promote selection of a School Nurse of the Year, send a press release, highlight successes of local school nurses

Security

Infant abduction, how to handle suspicious persons

When and who introduced Triple Aim?

Introduced in 2008 by Don Berwick and his colleagues of the IHI

Conscientious Objection

Involves practitioners not providing certain treatments to their patients, based on reasons of morality or "conscience." •Right to refusal, protection of moral integrity, preservation of autonomy as individuals •Moral integrity - acting against our beliefs would constitute a form of betrayal or loss of self-respect Example include, refusal to offer termination of pregnancy, especially late term termination,

IOM recommendations

Nurses need to be able to 1. Practice to the full extent of their education and training 2. Achieve high levels of education and training through an education system that promotes seamless academic progression 3. Participate as full partners with physicians and other health care professionals, in redesigning health care systems 4. Develop better data collection and information infrastructure for effective workforce planning and policy making

What can the nurse do - advocacy letters

Nurses' expertise and empathy are valued in the health care setting Can contribute to advancing the profession Advocate by acting and speaking as one collective voice Letters should be written to congressman and senators to advocate for a cause - Business format template - Should be limited to ≤2 pages - Identify oneself as a nurse - Share personal knowledge about the cause - Ensure you thank the person who you are writing to

Policy Stream

Refers to what might be done about the problem-that is, the possible alternative policies • Goals and ideas of subsystems • Solution proposed must be hitched on identifiable, timely and urgent problem

Expert Power Example:

Software engineer recently hired to lead the development of a new interactive 3-D action video game, experienced, go-to guy

On a National Level

Speaking with Senators or Representatives about national legislation, such as the Student to School Nurse Ratio Act

On a State Level

Speaking with state senators or representatives about the importance of school nursing.

Problem Stream

The various bits of information available on a problem, whom it affects, and in what ways. • focusing policymakers on one out of many specific problem • Values vs cost and quality

Triple Aim

Value based healthcare system that aims to: -Improve population health -Improve patient experience -Reduce per capita cost

Reward Power Example

Weight loss clubs give out prizes for weight loss goals

Allocation

decisions made on distribution of resources

Justice

fairness

Fidelity

faithfulness; loyalty

Resources

financial, could include human resources, time, physical space

Framing for access

focusing on what is newsworthy about an issue

Apparent Sincerity

high levels of integrity, authenticity, sincerity genuineness

Scarce

limits to available resources

To be an advocate means to:

o Assess the client's point of view and prepare to articulate this point of view o Speak or write in favor of, and/or support of urge by argument o Alert to, take action in instances of incompetence, unethical, illegal practices by any health care team member

Social Astuteness

one's behaviors to others and interpreting others behaviors

influencing

opportunities to shape outcome of a process

Patient advocacy

requires nurses to "stick your neck out" and "stand between the patient and someone else

To ensure policy competency:

· AACN publishes necessary curriculum content and expected competencies of all nursing school graduates from baccalaureate, master's, doctor of nursing practice, and research doctorate (PhD) programs they credential · Serve as a framework for 21st century nursing practice in care of individuals, families, communities, and populations · Content builds on nursing knowledge, theory, and research

Overcome barriers to successful advocacy:

· Good self-concept · Strong values · Confidence · Use of collective voices · Expectation and routine behavior · Increase comfort level with raising voices for patient and society

Policy

•Authoritative decision making related to choices about goals and priorities of the policy making body •Public - constructed as a set of regulations •Workplace - practice standards •Organizational - governance mandates •Research - ethical behaviors •Community - ordinances •Direct individuals, groups, organizations, systems toward the desired behavior and goal

Health Policy:

•Authoritative decisions made in legislative, judicial, or executive branches of government •Intended to direct or influence actions, behaviors, and decisions of others •Encompasses the political, economic, social, cultural and social determinants of individuals and populations •Attempts to address the broader issues in health care

Rules for Successful Personal Interactions

•Build rapport and relationships not enemies •Have real dialogues (conversations with a center not sides) •Coordinate, align actions and values •Think together •Listen to possibilities •Control yourself

Key Principles for Strategic Conversations

•Clearly state, define and stay focused on goal and interests •Appeal to and shape the interests of the other person •Frame the issue in a way that it is understood •Seek mutual agreement •Bargain •Mobilize social pressure by third parties •Anticipate possible actions of the other persons •Generate options •Evaluate options using a fair process •Decide and gain commitment for the decision

Strategic Conversations

•Conversations between leaders not just exchanging information •Purpose is to change behaviors and attitudes of others •Critical in policy making •Competitive in nature •Leaders have to be proactive

Analyze the strategic situation and context

•Determine your audience •Do your homework to understand what positions they bring to the meeting •Google them, read about them, what they stand for, values, beliefs, interests •What have they written about •What are their relationships among others in the meeting

Determine the means

•How feasible is it that you will accomplish your goal? •How will it be done, what tools are needed? •Is there compelling data that is right and appropriate? •Do you have the right forum? •Are you talking to the right influencers?

Policy Analysis:

•Investigation of issues including background, purpose, content •Effects of various options within a policy context •Effects of relevant social, economic, political factors

Formulate the ways

•Orchestrate the means or capabilities to achieve goal •Be agile and flexible •Knowledge is power •Research the issue thoroughly

Challenges

•Other parties not reciprocating •Don't allow for counterarguments •Assert forceful positions •Attack on ideas •There is no way to win a disagreement by action out: be prepared and know what your BATNA is

Strategy for Effective Communitcation

•Preparing •Strategic Conversations •Negotiation

Negotiation

•Preparing - most important step •Identifying the interests of both - how are they seeing the issue •Identifying suitable options - are there other solutions, be open to suggestions •Establish standards - reaching a mutually acceptable decision •Identify alternatives - purpose is not always to reach an agreement, explore whether you can pursue your "best alternative to a negotiated agreement" (BATNA)

Define the ends

•What is your goal? •What you want to attain? •What are your interests? •Are you changing, introducing or ending a policy? •Whatever the goal, clearly identify the interests, threats

Change health behaviors and shape public policy

◦ Public education - acquire information they lack ◦ Social marketing - used to shift personal attitudes and values ◦ Media advocacy - targets public policy

Create you own media outlet

◦Consistent sharing of perspective on policy matters ◦Linking to reliable sources ◦Use ways to get issues onto the public's agenda eg: writing op-eds, reframe issues that is already getting media attention

Positioning as a trusted source

◦Decide on how you can be found ◦Gain credentials ◦Become an expert in your field ◦Use personal and clinical experience ◦Get your message across ◦Use social media to build relationships with journalists

Know your medium and your message

◦Requires careful analysis and planning ◦Know what is the issue ◦Relevance of the message ◦Appropriate target audience ◦Access to media ◦Interview Follow-up

Health care access

refers to ability to obtain needed services -To receive the right type of care -When needed -At an affordable price

Political advocacy

requires a voice that is used politically to provide patients with the access and quality they deserve

Professional advocacy

requires moments of conflict and discomfort, along with awareness that these were necessary for a final positive outcome

Autonomy

respect of individuals

Non maleficence

to do no harm

Persuasion Power Example:

- A nurse persuade the nursing organization to sponsor legislation or regulation that would benefit the health care needs of her specialty population - Uses skills of persuasion for own personal or professional agenda

Media advocacy

- Apply pressure to advance a social or public policy initiative - Mobilizes constituencies and stakeholders to support or oppose specific policy changes - Focus on individual as an advocate - Aims to change the environment, not just the individual - Defines a primary problem as a power gap

Empowerment

- Arises from all types of power - Share of power to build others - Decentralized decision making - Include others in decision-making activities

Policy Process: First step: defining and framing the problem

- Assessment - history, patterns of impact, resource allocation, community needs - Problem identification - broadening and framing the problem to influence or educate stakeholders at the local, state and federal level - Advocating for better access or funding Example: Nurses working in a nurse-managed clinic are short staffed, affecting wait time they may work longer hours as a solution

Persuasion Power

- Based on the ability to influence or convince others to agree with the opinion or agenda - Leading others to your viewpoint with data

Coercive Power

- Based on the subordinate's fear of the leader - Maintained using threats and punishment - Often considered the most extreme form of autocratic leaders. - Frequent use of reprimands and a hostile attitude, threatening subordinates with the loss of status, loss of employment or in extreme cases physical force - Staff are often scared of being shouted at or being dismissed - This fear empowers the manager/supervisor/project leader

The Media

- Deliver messages paid advertisements, news etc. - Social media - Targets audiences - Gaining attention - Persuasion

Policy Analysis and Analytics

- Examination for better understanding - Analyze and weigh potential solutions

Connection Power

- Granted to those perceived to have important and sometimes extensive connections with individuals or organizations - Person attains influence by gaining favor or simply acquaintance with a powerful person All about networking

Connection Power Example:

- If I have a connection with someone that you want to get to, that's going to give me power - A nurse who attends the same church as the president of the home health agency or member of other organizations

Coercive Power Example:

- Manager's position is based on coercive power can often be effective on labor intensive environments, (factories, call centers) - Mundane nature of the job requires extreme motivation - Managers who use this power threaten to fire or layoff employees who fail to meet their standards -Through gossip or open demands of coworkers when they break the team norms

Advocacy and Activism

- Nurses are strong advocates - Expertise - Diverse and effective strategies (blogging, arguing, gathering media attention)

Presidential Power

- Power of the executive branch of government - Represents the entire nation within the federal government

Information Power Example:

- Project manager may have all the information for a specific project - Managers have access to info not available to peers and subordinates - Share the secret, your power is gone - Different because it's grounded in what you know about the content of a specific situation

Example of Legitimate Power

- Project manager placed in charge of a project team - may delegate tasks - Supervisor over subordinates - can ask for a range of behaviors from new employee - Receptionist insists visitors check in before proceeding to the managers office - One will find this power source useful as you begin leading any team; however, it cannot be relied upon alone to make you an effective leader

Reward Power

- Reward for good work or to motivated employees to work harder. - Compensated for honoring the wishes of a powerful person

Issue Advocacy

- Role of the profession in championing social, economic, legal and environmental factors that influence the health of the population - Extends beyond the hospital or clinic - Best accomplished through the formation of coalitions

Examples of community:

- neighborhood - city - online group with a common interest - faith-based network • Extensive opportunities for nurses to influence health and social policy at the community level • Rich history of community activism • Nurses can identify problems, strategize, mobilize support, advocate change, serve in positions that influence policies (planning boards, civic organizations, parent teacher associations etc.)

Framing

- the way an issue is posed; how an issue is framed can significantly affect decisions and judgments. ◦ Getting the issue on the public agenda ◦ Public discussion to gain compliance on contentious point ◦ Defines boundaries of public discussion ◦ Define a new way of thinking ◦ Work hard to understand the values that underpin the issue

Information Power

-Access to and control over important information - "Knowledge is power" - Francis Bacon - The most transitory type of power - A person possesses needed or wanted information - Based on the users data desired by others -involves access to vital info and control over its distribution to others - Access to information - Management and control of information

Political Advocacy

-Active engagement in the political process -Voting -Campaigning -Donation -Lobbying -Educating elected officials on issues

Interest Groups and Lobbyists

-Advantageous to their membership -Advocate on another's behalf

Advocacy Defined

-Defined as the act or process of supporting a cause or proposal -Public support for or recommendation of a particular cause or policy -May be motivated from moral, ethical or faith principles or simply to protect an asset of interest. -Integral part of nursing practice

Primary Care in Social Determinants of Health

-Develop better ways to address SDOH -Enhance health promotion and wellness -Disease prevention -Chronic care management -Nurses critical in shift from disease care to preventative care, health promotion and care coordination

Affordable Care Act (ACA)

-In 2011 2.7 trillion dollars spent on healthcare -Expensive healthcare while performing worse in quality, efficiency, access, and other measures -For 50 years - legislation was unsuccessful in passing healthcare reform until "Obamacare" -Most significant legislation since Medicare and Medicaid in 1965 -Major federal policy, became a political flashpoint -Democrats wants refining, Republicans calls for "repealing and replacing"

Expert Power

-Influence based on special skills or knowledge -Ability to influence others

Referent Power

-Power deriving from one's personal attraction - The ability of a leader to influence a follower based on identification (loyalty, respect, friendship, admiration, affection, or a desire to gain approval) - The charismatic individual has referent power - People follow them because they admire their personality and wish to be like them - Power of an individual over the Team or Followers, based on a high level of identification with, admiration of, or respect for the power holder/ leader -Referent power is gained by a leader who has strong interpersonal relationship skills

Referent Power Example:

-Selecting a mentor who is powerful -Lady Gaga - she has 41.1 million followers on twitter 'little monsters' -Nev Wilshire the Welsh business man - has a loyal band of followers because of his amazing business skills, but also his attitude towards his staff -staff love and respect him, equals happy -sports star

Nurse advocates will:

-Teach patients about their illness -Make sure your patients understand the diagnosis -Work with patients and practitioners to provide the best treatment options -Represent the patient, when the doctor's recommendation differs from the patient's wishes

Legitimate Power

-The power a person receives as a result of his or her position in the formal hierarchy of an organization -Formal authority granted through the organization and job description -Right to power -Makes decision and expect others to follow

Values

-Undergird proposed and adopted policies - Reflect society's values - Conflicts in values - Reflect which values are given priority in specific decisions - Conflicts between values were apparent during the debates on the ACA

What are some examples of nurses working in the associations and interest group sphere of framework for action?

-advocates for policies supporting their members/ issues in groups such as - -ANA, ACCN -provide education, training, networking for nurses -sending a message "with one voice"

What are some examples of nurses working in the workplace sphere of framework for action?

-allocation of resources -workplace policies -internal policies (pt. care guidelines, staffing, procedures) -external policies (state laws regulating nursing licensure, OSHA, ACA)

What are some examples of nurses working in the government sphere of framework for action?

-federal, state, local agencies -running for office -lobbyist-presenting nurse expertise to policy makers -communicating positions to policy makers -participation in grassroot efforts

Networking Ability

-is an adeptness at identifying and developing diverse contacts. - position oneself and take advantage

Referent, expert, informational, and persuasive powers all contribute to a. psychological power. b. personal power. c. position power. d. authority. e. referent power.

B

____ power exists when a person has the ability to punish or harm someone else. a. Legitimate b. Reward c. Coercive d. Expert e. Referent

C

____ power is derived from one's ability to convince others of something. a. Expert b. Reward c. Persuasive d. Informational e. Referent

C

____ power is the least desirable form of power to exercise. a. Referent b. Expert c. Coercive d. Legitimate e. Reward

C

An up-and-coming executive who is charismatic is likely exhibiting ____ power. a. coercive b. emulation c. personal d. referent e. legitimate

D

_____ power is derived from control over access to valuable data. a. Expert b. Reward c. Persuasive d. Informational e. Referent

D

Managers may enhance their referent power by a. choosing subordinates who have backgrounds similar to their own. b. defending subordinates' interests. c. engaging in role modeling. d. treating subordinates fairly. e. All of these.

E

____ power exists when subordinates behave as the manager does and wants because they seek his or her approval. a. Legitimate b. Reward c. Coercive d. Expert e. Referent

E

Interpersonal Influence

adapting to others behaviors

What is conflict?

· Inherent part of interactions between people · Can spark creativity · Can lead to better performance · Awareness of different views · Leads to more thorough policy analysis · Better policy decisions · Maslow hierarchy of needs - one of the basic needs not met all other faculties lie dormant · Humans will always have differences · Conflict grows out of individual views and perceptions · Use knowledge to learn through conflict · Develop skills of listening with an open mind · Understand other points of view · Make better assessments and judgements about actions to take

Barriers to successful advocacy

· Powerlessness - as a predominantly female profession · Fear of punishment · Conflicts of interests · Lack of institutional support · Time-Consuming and significant commitment · Lack of Education and Training · Fear of retribution from employers or governmental organizations Not a routine component of most formal nursing program

How is research used to create, inform and shape policy?

· Research design and dissemination should be used strategically and tactfully · IOM report 2011 "Future of Nursing: Leading Change, Advancing Health exemplifies strategic thinking · Evolution of Research to Advanced Practice Registered Nurses Full Practice Authority (2011-2018 Box 10:1)

Preparing nurses for advocate roles:

· Serving in an advocacy role takes courage · Cultivating that courage requires conversations about the effective dimension of advocacy · Primarily learned in practice settings after graduation · Often involves conflict and communication · Requires sophisticated leadership skills · Emotional intelligence · Self-awareness · Relationship management · Team building · Conflict management · Interprofessional collaboration · Problem solving · Sensitivity · Effective communication skills · Use of influence

Kingdon's 1995 Policy Stream Model

• "Looking for a problem" approach model • "Garbage can model" make way through minefield of debris • Consists of 3 streams that must align to move through the policy process • Concepts: must act when window opens • Problem must come to the attention of the policymaker • Must have a menu of viable policy solution options • Must occur in the right political circumstances

The Government

• Affect lives from birth until death • Funds prenatal care, inspects food, controls safety of toys, cars, operates schools, build highways, regulates transmission on airwaves • Provides for common defense: supplies fire and police protection, gives financial assistance to the poor, aged, others • Responds to disasters, subsidizes agriculture, licenses funeral homes • States determine the scopes of professional activities

Science and Research

• Evidence-based practice and use of scientific findings • Defines the size and scope of a problem • Obtain support • Lobbying • Inform policy debates • Shape choices

Political Stream

• Factors that influence the policy agenda High degree of public importance and low degree of stakeholder

Policy Process: Second step: Getting attention to those who have the power to affect change with solutions

• Generating public interest • Availability of viable solutions • Likelihood of the policy is fair and serves populations at risk • Viability of solution at organizational, community, societal and political level Example: Public interest is a fascinating dynamic that is particularly important in generating changes. Public awareness is often necessary for political action to occur and for the process to be initiated Eg childhood obesity, drunk driving, smoking, gun violence Interest groups such as trade associations, political action committees can stimulate a shift from awareness to action

Longest's Policy Cycle Model

• Health policy is a cyclical process • Continuous, chaotic, incremental • Three Phases • Each phase contain set of actions and activities that produce outcomes or products that influence the next phase

Associations and Interest Groups

• Professional nursing associations plays a significant role in influencing practice • Legislative or policy committees advocate policies supporting members practice and advance interests of their populations • Effectiveness of advocacy • Sharing of resources • Enhances networking and learning • Excellent training grounds for novice nurses to learn about policy and political actions

The Workforce and Workplace

• Work in a variety of settings (hospitals, clinics, schools, private, public sectors, military, research, nursing homes, home health) • Nurses has influence in each of these settings • Staffing • Clinical procedures • Patient care guidelines • State laws regarding licensure • Federal laws such as occupational and safety hazards

Research and Political Will

•Key to moving any issue into public or institutional eye is transforming it into a political issue •Political leaders may offer the issue as important (health care reform) •News events (gun violence) •Constraints to policy change lies in policy issue of federal research dollars to study the issue (gun violence) •Highlighting a problem and getting it on the agenda is not sufficient to advance policy in most cases •Must be political will to devote attention, time and effort to solve problem •Research along with a compelling story must be able to engage legislation on advancing policies •Major policy change is incremental despite research supporting the change •Frustrating to those who advocate for change •Illuminate policy problems •Presents interventions as the solution •Creation of an atmosphere conducive for policymakers •Can enhance, shape valuable insight for nursing within policymaking circles