Policy

Entry level APRNs as DNP was proposed in what year? What progress has been made to implement proposal? What barriers have been identified?

-2004 American Association of Colleges of Nursing called for establishment of DNP. Proposed APNs be elevated from MSN to DNP by 2015 -Growth seen in DNP program across US -Barriers: lack of standardization of DNP program, uncertainty over NP vs DNP practice, lack of preparation for graduates for faculty role -Great need for research on nursing education. Call for double number of nurse with doctorates by 2020

Components of high-quality health care

-Adequate access to care (reduced=worse health outcomes) -Adequate scientific knowledge (treatments of uncertain safety/efficacy may cause harm and cost money) -Competent health care workers (skills to diagnose and treat. medical negligence is failure to meet standard of practice) -Separation of financial and clinical decisions (fee-for-service encourages performance of services; reward fewer services) -Organization of health care institutions to maximize quality (adequate, competent staff)

Collective strategies for change in the work place

-Adoption and implementation of framework for change. Provides guidance for making work environment proactive to change. Transparency within organization and employee commitment to change. -Kotter Eight Stages of Change: sense of urgency, create guiding coalition (key stakeholders), develop strategy/vision, communicate vision clearly & often, empower action, generate short-term wins to sustain momentum, consolidate gains & produce more change (reevaluate), anchor new approaches in culture -Why change fails: history- lack of commitment and follow-through, trust in leadership (resistance is normal) -Success of changing process related more to leadership of organization than organization structure

Four principles of medical ethics

-Beneficence: obligation to help those in need, intent of doing good -Nonmaleficence: duty to do no harm/minimize harm -Autonomy: Right of patients to make choices regarding their health care -Justice: Concept of treating everyone in a fair manner, distribute equally

Patient-centered medical home concept

-Blends comprehensive care with quality and reimbursement -Model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety -Reimbursement supporting system-based vs. volume-based care (payment based on process of care delivery assuring positive outcomes rather than volume of patients seen by provider) -Concept of medical home natural fit with nursing -Any care model seeking to understand patients and their health as whole within context of their lives places the patient at the center of care

Impact of budget on health policy

-Budget reflects POTUS' national agenda and provides picture of funding for influencing policy. Potential access point for policy change -Federal budget collaborates between exec and legislative branches. Policy advocates much be familiar with budget process (structure and timeline). Appropriation process provides key access point (regulated expenditure)

Define rationing. How does it apply to health care?

-Conscious policy of equitably distributing needed resources that are limited supply. Fair distribution of limited resources. Not all beneficial care provided to all patients (organ transplants, ICU beds) -Not all cost control is rationing. Reduces effective medical care, painful cost control -No rationing should take place until all wasteful practices are curtailed.

Cost-control strategies

-Control price inflation (control fees, provider incomes) -Eliminate ineffective/inappropriate care -Administrative wastes (stop doing things of no clinical benefit, encourage innovation) -Innovation and cost savings (less costly ways of same or better outcomes) -Prevention (less costly than disease) -Cost-effectiveness analysis

Barriers to increasing enrollment in nursing programs

-Faculty shortage: programs cannot accept enough students to meet workforce demand -Limited funding, lack of clinical sites, lack of qualified faculty. Nurses can earn more in clinical practice than teaching.

Major components of access to health care

-Financial (lack of insurance, underinsured, income) -Non-financial (lack of prompt access, gender, race/ethnicity)

Key components of the patient protection and ACA

-Improves health insurance coverage -Expands insurance options (employers with more than 50 employees must provide minimum benefits, Medicaid and CHIP expansion) -Increase number of insured Americans (tax penalties, <26yo covered as dependents) -Payment systems reform (value-based, enhance payments to PCPs) -Coordination of care and prevention (no copays for preventative services, funding for community health initiatives)

Roles of various impact groups in healthcare policy

-Interest group: collection of people pursuing common interests by influencing political processes. Empowers citizen involvement, influences elections/votes/societal opinion/policy process -Provide information -Financial support

Formal process of legislation

-Intro of bill by member of Congress. Idea can come from anyone, 2 year deadline. Attention is called to a problem, and appropriate sponsor to introduce (within jurisdiction) is selected. ANYONE can come up with bill idea. -Authorization and appropriation process. Establishes purposes and guidelines for program, limits amount of spending (doesn't provide actual funding). Appropriation enables spending. -Floor action. After bill reported out of committee, placed on calendar and scheduled for floor action. After debate, vote. -Conference action. Identical bills must be passed in both chambers. Agreement on provisions, conference report written. -Executive branch. Signs bill into law, veto it, or return with no signature with objections. Bill becomes law if president does not sign within 10 days time of receipt. -Regulations. Shaped by law and ongoing input. Administrative agencies (executive branch) enact, enforce, and adjudicate own rules and regulations.

Various political ideology

-Liberalism: develop own capacities to the fullest extent. John Stuart Mill. Individual rights and freedom of though and expression, conditionally. Democracy= individuals partake in political decision making. -Conservatism: Stability & structure. Pattern of domination and power. Strong government role. -Socialism: Karl Marx. Look to state for policies to protect workers. Equality regardless of roles. Classless society. Communist and democratic socialist -Contemporary: Conservatism= oppose rapid and fundamental change. Liberalism= expand government role helping people

Two conceptual models for policymaking

-Longest's Policy Cycle Model: Interrelated model, highly dynamic. Captures incrementalism (conservative approach to decision making, limits individual power). Three phases= Policy formation (framing problem), Implementation (rule-making of policy developing), Policy modification (revisit) -Kingdon's Policy Streams Model: Problem stream (values), Policy stream (goals), political stream (factors in political environment). Must stream through open policy window at the same time.

Strategies for malpractice reform

-Malpractice liability system: financially compensate people who have suffered medical injuries seeking care, prevent healthcare professionals from negligently causing harm. Reform: -Tort reform: placing limits on malpractice awards paid to patients (reduce claims, can be unfair to those with worse injuries) -Alternative dispute resolution: substitute meds and arbitration for jury trials. More compensation possible to injured parties by reducing legal cost and shifting to scientific over emotional dispute. -No-fault reform: provides compensation for injury regardless of whether due to negligence. Panel of experts rather than jury (cheaper). Physicians more inclined to disclose medical error. -Enterprise liability: institutions responsible for compensating on no-fault basis, creates incentives for institutions to improve quality of care provided. Hospitals and HMOs responsible-financial incentive for quality improvement. Compensated whether or not negligence.

US government health programs

-Medicaid: healthcare for low income -Medicare: healthcare for 65yo + -Children's Health Insurance Program (CHIP): poor kids -Veterans Affairs -TRICARE: healthcare for active-duty military and fams -State Healthcare Financing: responsible for public health programs. Regulate health insurance, providers, and public health activities -Local/county level: Protect public health

Disparity of mental health treatment historically and policy created to address this

-Mental health parity: equivalence of coverage for mental health treatment and visits within insurance plans -Barriers: stigma, late or missed diagnosis, inadequate care, not seeking treatment, cost of care. Leads to loss of productivity -Mental Health Parity Act 1996: self-funded health plans and fully insured group plans. NO substance abuse benefits -Mental Health Parity Addiction Equity Act 2008: Employers must offer mental health and substance abuse coverage at same level as medical/surgical coverage. No requirements on which conditions covered as long as at parity with medical coverage. -Medicare Improvements for Patients Act: supplemented health parity laws for Medicare recipients -Gaps: does not include recovery services :( -ACA is important vehicle for improving access and fragmentation issues -Challenges to implementation- lack of public awareness of policies for mental health coverage

Various sources of professional regulation

-Nursing boards (license qualification, CEUs, discipline) -Health and Human Services (protects health of all Americans, administrative agencies regulate) -Centers for Medicare and Medicaid -Joint Commission (certification requirements meeting standards, survey and accreditation process for improved patient outcomes) -Federal, state, local law (health codes and laws) -Organizational policy (employer policies and procedures, protocols for standardization and consistency)

Traditional and new health care payment models

-Out-of-pocket: simplest, direct purchase by consumer, need vs. luxury, unpredictability makes this difficult. Health insurance solves unaffordability, but fueled issue with rising cost. People use healthcare more, providers charge more. -Individual private insurance: third party insurer, premium payment, insurer pays provider. Never became dominant because of huge administration cost. ACA requirement. -Employment based private insurance: employers pay premium. Companies competing for workers offer health insurance as fringe benefit. Tax-dedudctible for business. ACA- fee discourages employers from dripping employee health insurance. -Government financing: difficulty affording private insurance, low income, elderly (Medicare and Medicaid)

Techniques for effective use of media

-Position yourself as an expert (credentials, experience) -Get your message across (analysis, planning) -Blogging (personal experience and opinions) -Digital media and social networking

Four recommendations of the IOM The Future of Nursing: Leading Change, Advancing Health

-Practice to full extend of nurses's education and training -Achieve high levels of education and training through education system promoting seamless academic progression -Participate as full partners, with physicians and other professionals, in redesigning healthcare system -Develop better data collection and information infrastructure for effective workforce planning and policy making leadership, appreciation of nurse perspective on policy

Cost-containment efforts

-Regulation vs. competition -Regulatory control of taxes controls public expenditure for healthcare. Public despises tax hikes- political anchor against healthcare inflation. Private insurance premiums increase >10%/year -Competitive makes people more cost-conscious with health insurance purchasing. Compete on basis of price. Pressures plans to restrain premium prices and overall costs. -Managed care: System that shifts HC delivery and payment from open-ended access by fee-for-service toward provider as a gatekeeper of patient healthcare and assumes degree of financial responsibility for care. Implies spending will be controlled, quality, and accessibility.

Limitations government employees have on influencing policy

-The Hatch Act of 1939, Act to Prevent Pernicious Political Activities. US federal law, main provision prevents government employees from engaging in partisan political activity. Regulatory aspects limit political activity of civilian nurses and other health professionals working in variety of government agencies. -Political activity limited to protect employees from coercion by corrupt politicians and political organizations -Nonpartisan workplace and protection from coercion. Nurses must know provisions and regulations to avoid violating through position in government

Methods of improving quality health care

-Traditional quality assurance (licensure, accreditation, peer review, joint commission) -Clinical practice guidelines (recommendations for clinical treatment, provides foundation) -Measuring practice patters/outcome measures -Continuous QI (teams gather data and implement solutions to problems) -Computerized information systems -Public reporting of quality -Pay for reporting -Financially neutral clinical decision making (balance incentives)

Three dimensions which health care systems are evaluated

1. Quality: the degree to which health services increase likelihood of desired outcomes and consistent with current knowledge. The Future of Nursing IOM, quality improvement 2. Access: ability to obtain/afford/convenience/acceptable/effective/timely healthcare 3. Cost: price of good/services, insurance cost, state/nation spending

Fiscal year

A 12-month pd, October 1st through September 30th, for planning the federal budget

What is "fee for service"?

A payment model where services are unbundled and therefor paid separately. based on quantity not quality of service. Incentive for physicians to provide more treatments.

Describe Medicare plans A, B, C, and D (remember, greater than 65yo)

A: Hospitalization, some skilled nursing facilities, home health care, hospice B: Eligible for part A, electing to pay premium for B. Physician services, outpatient services, supplies and home care, equipment, lab services, therapy C: Medicare Advantage Program, private health plan receiving extra services (vision, hearing) D: Voluntary, subsidized outpatient prescription drug program. Gaps in program

Why do upstream factors matter?

Address to reduce health disparities. Influence development and progression of illness Health of population significantly determined by social factors (not just access, coverage, cost, and quality of care)

Advocacy in nursing and political settings

Advocacy- plead the cause of another Nursing- social justice, preforming functions adequately and safely Patient advocacy, patient rights -Issue advocacy: promoting improved patient outcomes without advocating for any one individual (coalitions, access to care, disease prevention) -Nursing profession advocacy: advocate for patients through advocating for profession (safe workplace, safeguard scope of practice) -Community and public health advocacy: mitigate social determinants of health, promote health (justice, social infrastructure, quality of environment, nature of human relationships)

Describe the role of media in policy

Affects how and what we think. Reframes public policy issues and mobilizes support. Transforms behaviors, shapes attitudes and beliefs. -One-to-many model: One broadcaster sending out one message to mass audience. Challenged by the internet. Large corporations own outlets and control what is released. Mass media doesn't allow users to create/distribute own content with messages they find important. -Many-to-many model: Opportunities for feedback and interaction, social media. Prosumption (combo of consumption and producing). New way to use technology with broad implications for health media, policy, and politics.

Deficit

Amount of spending that exceeds total revenues in 1 fiscal year

Aspects of the "Triple Aim"

Balanced approach to examining healthcare delivery problem allowing identification of system problems and direct resources to activities that can have the greatest impact. -Improving population health -Improving patient care experience -Reducing per capita cost Compels systems to broaden focus toward more integrated care (e.g. preventative care)

Upstream factors that impact policy

Broad range of issues, other than health care, that can undermine or promote health Undermine: gender, health services, working conditions, education/literacy, physical and social environments, personal health practices, genetics, culture, SES Promote: safe environment, adequate housing, access to healthy foods, thriving community

Chronic care policy and the medical home model

Chronic conditions leading cause of death in world. Treatment is 75% of healthcare budget. Seeking to improve quality of care and support reimbursement model for quality, not quantity, of care. Will result in lower cost, higher quality Nursing- comprehensive patient-centered care

Process of perfecting legislation in committee

Committees are the centers of policymaking. Conflicting points discussed, refined and amended. Only 15% of bills referred out for consideration. -Standing committee: permanent jurisdiction of content area -Select committee: Address special concerns, cannot report out -Joint committee: Between house and senate, work together to address differences in bills -Chair: majority party who decides agenda and conducts meetings -Handle of bill: approve, rewrite or revise, report if unfavorable, take no action killing bill -Hearings: gather info and views, identify problems, gauge support/opposition, build public record addressing problem -Markups: modified through amendments to clean up problems or errors. Pressure from interests groups. Conducted in public. -Reports: committee report accompanies each bill, intent of legislation

What is the "doughnut hole"?

Coverage gap- major problem for patients with chronic illness needing several medications. Medicare prescription coverage (Part D) After a certain amount spent on covered drugs, you must pay all costs out of pocket until you hit yearly limit, and then plan covers cost again.

Describe the role of evidence in policymaking, including pitfalls and benefits

Data and research valuable in understanding health policy and developing solutions. Evidence will link with policy solution and significance of situation. Heirarchy= appropriateness of evidence for health policy. Health services research can be very effective in developing policy options. Main goal of HSR is to identify most effective ways to deliver high quality, cost effective, safe care across systems. Evidence can support opposition. There can be a lack of clarity of what evidence is needed.

Debt limit

Debt ceiling, how much total debt government can accumulate or owe. Raising debt limit enables government to pay for things it has legally committed to funding in the past, does not authorize new spending commitments

Define insurance deductible and co-insurance

Deductible- amount individual pays for healthcare services before insurance begins to pay Coinsurance- share of the costs of HC services. Start paying after deductible is met. Plan and individual share costs (e.g. 70/30) Copayment- fixed amount individual pays for HC service when receiving it

Define lobbying

Direct influence of public officials and their decisions -Political management of information -Educating, shaping opinions, and offering data and analyses -Substantial business

Roles of state and local government

Each state has its own, unique constitution and individual state laws. They cannot conflict with federal law or with US Constitution. -State Executive Branch: Governor, Lt Governor, elected officials. Prepare state budget to present to legislature, manage approved budget, veto power (can eliminate parts of bill whereas President must veto whole bill), state agencies (translating laws into regulations), regulation of health professionals. -State Legislative Branch: check and balance of executive branch -Local government: counties, cities, towns, villages. Vital link between local citizens and the state and nation. Grant money for health initiatives from health policy. Nurses have increased opportunity to influence policy.

Definition of policy analysis

Examination of object or process to understand it better. Assess problem and determine possible solution. Look at background, purpose, content, effects of various options within policy context and relevant social/economic/political factors. Determines most desirable policy choice

Mandatory spending

Federal spending based on existing laws rather than budgeting process. Spending for social security and Medicare based on eligibility rules. Not part of annual appropriations process.

Role of gender in political philosophy

Feminism- rejection of male centered. Focuses on unique needs of women. Sees patriarchal and androcentric bias in social and cultural traditions. Calls for consideration of women's perspective. Can divide people based on gender.

Purpose of professional regulation

Government has obligation to protect citizens, which is the reason nursing is a regulated profession. Regulating provides public accountability, keeping patients safe and ensuring competence

What is a political action committee?

Groups organized to engage in political activity, but not endorsed by a particulat candidate or political party -May be sponsored by businesses, labor unions, or special interest groups for purpose of raising and spending money to support or denounce legislative initiatives -Established to channel money to candidates

Health care disparities and attempts to address them

Health disparities: differences in incidence, prevalence, mortality, and burden of disease among specific population groups Health equity: highest level of health for all people -ACA: increases number insured, increased access, decreases health disparities -Patient-centered medical home: preventative services -Community health centers: allocated funds for operation and development

Value based health care

Healthcare delivery model, paid on quality of care and patient outcomes. Differs from fee-for-service where payment based on delivered service. Measures health outcomes against cost of delivering them. Rewards improved clinical quality and resource usage. Challenges the way healthcare is delivered.

Value-Driven Healthcare

Improve quality of care while lowering costs. Value is obtaining higher quality for same investment. Performance measurement- central player in and precursor to public reporting and accountability. Public reporting is a national strategy for improving quality of care. Incentives provider to do better.

Define health determinants

Includes the physical environment in which people live and work, people's behavior, people's biology, social factors, and health services.

Structure and benefits of Social Security

Income benefit for retirees who have worked and paid social security taxes for 10 years. Provides retirement, disability, and survivor benefits to wage earners. Eligibility based on work history (years worked and earnings)

Define grassroots mobilization

Indirectly influencing officials through constituency contact

Ethical considerations in policymaking

Intention of moral agent, nature of act, consequences of action, circumstances surrounding act. Ethics and politics have to do with making life better. Politics involves justice in distribution of goods, fairness, and equity. Goodness of action lies in intent and integrity. Wrong to lie, undermines trust.

Define community activism

Means through which individuals, groups, and organizations work together to bring about changes in policies and practices. -Enact social transformation, improve community -Engagement in collaborative, sustained actions focused on changing underlying structures or removing barriers. Distinguishes activism from service. -Social justice, community, consciousness-raising, critical reflection, praxis, and empowerment

Differences between Social Security and Medicare

Medicare provides health insurance coverage for those older than 65. Social Security is responsible for determining Medicare eligibility and automatic enrollment. Both funded by payroll taxes.

Discuss the impact of pharmaceutical industry on health policy

Most profitable industry in the US. US gov does not impose regulated prices on drugs- not allowed to regulate drug prices under Medicare Part D. Drug industry largest contributor within health industry for lobbying

Four components of political skill

Not easily taught or learned, application best. -Social astuteness (observe, attune to diverse social situations, interpret behaviors, self-aware) -Interpersonal influence (convincing personal style, powerful influence, persuasion) -Networking ability (building partnerships with diverse networks for beneficial alliances) -Apparent sincerity (integrity, authenticity, genuine, inspire trust and confidence)

Implications of welfare state for nurses

Nurses can participate in ideological and political debates that shape health policy. Determine where one stands on issues and the underlying ideology forming those views. Base info on sound knowledge.

Relative numbers of nurses, physicians, dentists, and pharmacists nationally

Nurses: 3,000,000 single largest health profession in US, hospital primary employment setting (61%) Physicians: 860,000 active in US Dentists: 146,800 active in US Pharmacists: 280,000 active practicing. 43% community, 23% hospital, remainder in stores

Identify unique aspects of policymaking in the US

One of most complicated healthcare delivery and finance systems. No single entity or authority ultimately responsible for healthcare (mix of public and private). Highly complex, politically polarized. -Federalism: Central authority and constituent political units, source of tension. Fragmented, chaotic approach to solving healthcare problems. Allows state flexibility. Intended to create and sustain highly decentralized locus of authority. Complicated, difficult to reform. -Incrementalism: Proceeds slowly by degrees, conservative approach to decision making. Effective in limiting power or any one person but creates process that is not proactive or goal-oriented. Policies are far easier to stop and obstruct than pass/implement

Methods of value-based payment

Pay-for-performance: achieve high level of performance on measures Bundled payments: episode based rather than fee-for-service. Incentives to eliminate unnecessary cost Care coordination payments: better manage chronic conditions Accountable Care Organizations: overall budget target putting financial risk for expenditures. Incentive to eliminate wasteful spending.

Discretionary spending

Portion of the budget President requests and Congress appropriates every year (education, defense, EPA)

Private health insurance and delivery systems in US

Predominately private in the US operating more like a business. Premiums have risen, more cost-sharing and employees expected to pay greater percentage. Private insurers are powerful political stakeholders- resist attempts to regulate insurance accessibility and affordability. Little government regulation of medical industrial complexes. Interest groups represent industry stakeholders- influence political process at all levels

Define Electoral influence

Primary prevention of policymaking, important activity preceding policy work. -Determines who is elected to shape future policies -Interest groups provide collective voice, PACs provide collective financial support

Strategies and models of prevention

Primary: avert occurrence of disease/injury Secondary: early detection and intervention Strategies: Broadest level: measures to address fundamental social determinants of illness. Improving standard of living and social equity (^minimum wage, ^tobacco tax, etc.) Public health interventions to reduce illness (water purification, ^tobacco tax) Provers preform preventative interventions for individuals (screening for HTN, breast exams, prenatal care)

Spheres of influence

Provides visual medium for understanding policy arena. Nurses must work in multiple spheres to shape health and social policy. -The government (positions, agencies, lobbyist, events) -Workforce and workplace (nurses influence allocation of resources) -Associations and interest groups (professional nurse associations) -The Community (activism, identify issues, gather support, work for change)

Role of race in political philosophy

Racial oppression Racial contract- provide path to reform by identifying normative aspects of a revised contract

Revenue

Receipts, funds collected from the public (income tax, social insurance/payroll tax, corporate income tax)

Define political ideology

Set of ideas about politics, all of which are related to one another and that modify and support each other -distinctive views on the organization and functioning of the state -Allows policymakers to convince people that their view will enhance public good

Define 'welfare state' and various types

Share of the economy devoted to government social expenditures. America unique, most healthcare spending comes from private sector. Cornerstone of US welfare system is 1935 US Social Security Act. Types are based on division of responsibilities for social services between private and public sectors and role of central government authority. -Social-democratic: Scandinavia, most social programs publicly administered. Equality of highest standard. -Corporatist: West European nations, social rights and status differentials have endured. Provides state interventions when family capacities fail. -Liberal: US/Canada/Australia, private sponsored benefits dominate

Describe out of pocket payment for services

Simplest mode of financing with direct purchase by individual. Difficult and hard to meet needs of hospitals/physicians reliably

Define economics

Study of how resources are allocated by people operating in the real world, constraints on time/money/knowledge. Study of choices people make under constraints. Opportunity cost- what must be given up to get something else. Supply and demand.

Role of mentor in learning political advocacy

Teaching-learning process through personal experience in a one-to-one, reciprocal relationship between two diverse individuals. -Mentor provides protege with career and psycho-social supports -continuous, goal-directed -mentors= trustworthy, active listeners, accessible, supportive -mentoring is a path to developing tools for political skill, competency, and knowledge

National debt

The total amount of money the federal government owes, result of accumulated budget deficits over years. Link between deficit and debt is large part of deficit bills incurred through previous tax and spending policies creating deficits and long-term debts in the first place

How are APRNs reimbursed for services?

Third-party payers e.g. Medicare, Medicaid, commercial indemnity insurers, MCOs/HMOs, businesses or schools -Difference in Medicare reimbursement- NP rate is 85% that of physicians. Pay provider using fewest resources to provide service. Problem when emphasizing lower cost. -More DNP APNS with strengthen and expand role -Create delivery systems that are patient-centered, longitudinal, and relationship-based. APNs must position themselves at the forefront of new models of care delivery

Define stakeholders

Those directly impacted by specific policy decisions and who may be involved in the policymaking process

Roles and responsibilities of the branches of the US federal government

Three branches for check and balance: -Executive: implement laws and oversee enforcement. The President and the Cabinet (confirmed by congress, oversee by regulating and appropriating funds) -Legislative: formulation of laws from recommendation to the president. Congress (House, Senate), and Committees -Judicial: interpret Constitution and limit powers of the other branches, judicial review

Barriers to successful advocacy

Time-consuming, significant commitment, lack of education and training in advocacy, institutional barriers, fear of retribution

Characteristics of nursing work force

US largest nursing workforce, primarily white females. Nursing shortage by 2030 (baby boomers reaching retirement age) Greater care coordination for prevention if adequate number of nurses Need correct skill set not just right number of nurses Understaffed= patient safety suffers, medical errors increase, nurse burnout. Recruit & retain. Educator workforce- retiring, faculty shortage

Elected policy officials of US, state, and local government and their domains

US: POTUS, US Senators, US Representatives State: Governor, State legislators Local: Mayor, County executives

Definition of politics

Use of relationships and power to gain ascendancy among competing stakeholders to influence policy and allocate scarce resources Concepts: -Influencing: shape outcome of process -Allocation: distribute resources -Scarce: implies limits to resources -Resources: financial, human/personnel, time, physical space Key is aligning health of public with interests of policy maker

Forces that shape policy

Values Politics Policy analysis and analysts Advocacy and activism Interest groups and lobbyists Media Science and research (EBP, define size&scope of issue) Power of president and leaders