NSG 4068: Reaching out a solution

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NSG 4068 Trends in Healthcare Policy

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Reaching out a Solution

This assignment is designed to assist you in developing a thoughtful process for advocating about an issue as a nurse, from identifying a problem that needs to be solved through articulating a process for doing so.

This assignment consists of answering each of the questions listed below from the “Political Analysis and Strategies” chapter of your course textbook. Write each question as a new topic area; then follow with a paragraph or two to answer the question. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources, if any used. This project should be no longer than 4 pages.

Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet. Reflect on the following questions outlined in the “Political Analysis and Strategies” chapter:

  • What is the issue?
  • Is it my issue, and can I solve it?
  • Is this the real issue or merely a symptom of a larger one?
  • Does it need an immediate solution, or can it wait?
  • Is it likely to go away by itself?
  • Can I risk ignoring it?
  • What are the possible solutions? Are there risks to these solutions?
  • What steps would you need to take in order to solve the issue?
  • Does anyone else at the school need to be involved in the solution?
  • Where is the power leverage in the school to reach the preferred solution?

Reaching a solution requires the use of power vested in the nurse. Review Box 9-1 (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.

  1. No Wikipedia, No Health.com, No .com for references.

I like .gov, state boards of nursing and the American Nurses Association websites. I love academic/nursing journal articles. You can also use assigned readings and POLITICO Pulse and Kaiser Health News Morning Briefing.

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CHAPTER 9 Political Analysis and Strategies Kathleen M. White 1 “The difficult can be done immediately, the impossible takes a little longer.” Unknown author, Army Corps of Engineers motto, World War II The knowledge and expertise of nurses regarding health and health care are critical to the political process and the development of health policy. However, the word politics often evokes negative emotions and many nurses may not feel inclined to get involved. Nonetheless, nurses have the skills to be active participants in the political arena for a number of reasons. First, nurses are skilled at assessment, and being engaged in the political process involves analysis of the relevant issues and their background and importance. Second, nurses understand people and, in order to understand an issue, it is critical to know who is affected and who is involved in trying to solve the problem. Finally, nurses are relationship builders and the political process involves the development of partnerships and networks to solve problems. As skilled communicators, nurses have the ability to work with other professionals, patients, families, and their communities to solve health care problems that affect their patients and the health care system. Nurses have much to offer in the political process and need to develop skills in political analysis and strategy to truly make a difference. What is Political Analysis? Political analysis is the process of examining an issue and understanding the key factors and people that might potentially influence a policy goal. It involves the analysis of government and organizations, both public and private; people and their behavior; and the social, political, historical, and economic factors surrounding the policy. It also includes the identification and development of strategies to attain or defeat a policy goal. Political analysis involves nine components. Identification of the Issue The first step in conducting a political analysis is to identify and describe the issue or problem. Identifying and framing the issue involves asking who, what, when, where, and how questions to gather sufficient information to lay the groundwork for developing an appropriate response to the issue. Start with what you know about the issue: • What is the issue? • Is it my issue and can I solve it? • When did the issue first occur, is it a new or old problem? • Is this the real issue, or merely a symptom of a larger one? • Does it need an immediate solution, or can it wait? • Is it likely to go away by itself? • Can I risk ignoring it? Beware of issue rhetoric (Bardach, 2012) that is either too narrowly defining an issue in a technical way, or defining the issue too broadly in a societal way. Decide what is missing from what you know about the issue and gather additional information: • Why does the problem exist? • Who is causing the problem? • Who is affected by the issue? • How significant is the issue? • What additional information is needed? • What are the gaps in existing data? Don't cut corners or overlook the importance of this step in the political analysis, as a well-defined issue is important to the whole process, as is identifying and defining the right issue. The way a problem is defined has considerable impact on the number and type of proposed solutions (Fairclough, 2013). The challenge for those seeking to get policymakers to address particular issues (e.g., poverty, the underinsured, or unacceptable working conditions) is to define the issue in ways that will prompt decision makers to take action. This requires careful crafting of messages so that calls for solutions are clearly justified. This is known as framing the issue. In the workplace, framing may entail linking the problem to one of the institution's priorities or to a potential threat to its reputation, public safety, or financial standing. For example, inadequate nurse staffing could be linked to increases in rates of morbidity and mortality, outcomes that can increase costs and jeopardize an institution's reputation and future business. It is important not to confuse symptoms, causes, or solutions with issues. Sometimes what appears to be an issue is not. For example, proposed mandatory continuing-education for nurses is not an issue; rather, it is a possible solution to the challenge of ensuring the competency of nurses. After an analysis of the issue of clinician competence, one might establish a goal that includes legislating mandatory continuing-education. The danger of framing issues as solutions is that it can limit creative thinking about the underlying issue and leave the best solutions uncovered. Context of the Issue The second part in the political analysis process is to do a situational analysis by examining the context of the problem. This analysis should include, at a minimum, an examination of the social, cultural, ethical, political, historical, and economic contexts of the problem. Several questions can guide you in analyzing the background of the issue: • What are the social, cultural, ethical, political, historical, and economic factors that are creating or contributing to this problem? • What are the background and root causes of each of these factors? • Are these factors constraining or facilitating a solution to the problem? • Are there other environmental obstacles affecting this issue? It is important to be as thorough as possible at this stage and to consider whether the source of the information is verifiable and impartial. It is also important to understand any opposing views. When assessing the political context, nurses need to clarify which level of government (federal, state, or local) or organization is responsible for a particular issue. Scope of practice is a good example. Although typically defined by the states, there are examples where the federal government has superseded the state's authority, such as in the Veteran's Administration and the Indian Health Service. Nurses also need to know which branch of government (legislative, executive, or judicial) has primary jurisdiction over the issue at a given time. Although there is often overlap among these branches, nurses will find that a particular issue falls predominantly within one branch. Knowledge of past history of an issue can provide insight into the positions of key public officials so that communications with those individuals and strategies for advancing an issue can be developed accordingly. For example, if it is known that a particular legislator has always questioned the ability of advanced practice registered nurses (APRNs) to practice independently, then that individual may need stronger emphasis on the evidence about the quality and value of APRNs to support legislation allowing direct billing of APRNs under Medicare. This type of context analysis is also applicable to the workplace or community organization. Regardless of the setting, assessing the history of the issue would include identifying who has responsibility for decision making for a particular issue; which committees, boards, or panels have addressed the issue in the past; the organizational structure; and the chain of command. At an institutional level, once the relevant political forces in play have been identified, the formal and informal structures and the functioning of those structures need to be analyzed. The formal dimensions of the entity can often be assessed through documents related to the organization's mission, goals, objectives, organizational structure, bylaws, annual reports (including financial statement), long-range plans, governing body, committees, and individuals with jurisdiction. The informal dimensions of the organization, such as personal relationships and personal communication networks that could be positive or negative, are more difficult to analyze but need to be understood to get a full picture of the context of the issue. One final example in the analysis of the context of the issue is worth mentioning. Does the entity use parliamentary procedure? Parliamentary procedure provides a democratic process that carefully balances the rights of individuals, subgroups within an organization, and the membership of an assembly. The basic rules are outlined in Robert's Rules of Order (www.rulesonline.com). Whether in a legislative session or the policymaking body of large organizations, one must know parliamentary procedure to develop a political strategy to get an issue passed or rejected. There have been many issues that have failed or passed because of insufficient knowledge of rule-making. Political Feasibility The third part of a political analysis is to analyze the political feasibility of solving an issue. There are several ways to conduct a political feasibility analysis. A simple analysis is conducting a force field analysis (Lewin, 1951) to identify the barriers and facilitators to making change to solve the issue. The force field analysis asks you to think critically about the issue and the forces affecting it by creating a two-column chart. One column lists the restraining forces, or all of the reasons that preserve the status quo and any reasons why the issue should stay the same. The second column lists the driving forces, or forces that are pushing the issue to change. This exercise requires that the whole picture is considered and provides a list of the important factors that surround the issue. A second option is to use John Kingdon's (2010) model of public policymaking (see Chapter 7). Kingdon proposes three streams or processes that affect whether an issue gets on the political agenda; the problem stream is where people agree on an issue or problem, collect data about the issue, and share the definition of problem; the policy stream is characterized by discussion and proposal of policy solutions for the issue; and the political stream is when public mood and political will exists to want to address the issue. Kingdon's model explains that an issue gets on the political agenda only when the three streams couple or converge and a window of opportunity is thereby created. This analysis provides consideration of what needs to happen for the issue to advance to the public policy agenda, including an analysis of the policy and political factors. The Stakeholders Stakeholders are those parties who have influence over the issue, are directly influenced by it, or could be mobilized to care about it. In some cases, the stakeholders are obvious. For example, nurses are stakeholders on issues such as staffing ratios. In other situations, one can develop potential stakeholders by helping them to see the connections between the issue and their interests. Other individuals and organizations can be stakeholders when it comes to staffing ratios. Among them are employers (i.e., hospitals, nursing homes), payers (i.e., insurance companies), legislators, other health care professionals, and consumers. The role of consumers cannot be underestimated. In the political arena, these are the constituents and therefore the voters, and they can wield tremendous power over an issue and its solution. In many cases, nurses are advocates and work on behalf of stakeholders such as the patients who are affected by the care they receive. Nursing has increasingly realized the potential of consumer power in moving forward nursing and health care issues. For example, a consumer advocacy organization such as AARP possesses significant lobbying power. When nurses wanted to advance the idea of a Medicare Graduate Nursing Education (GNE) benefit, similar to the Medicare Graduate Medical Education funding to hospitals for the clinical training of interns and residents, AARP championed the proposal because it views the nursing shortage as a threat to its members' ability to access health care. GNE was included in the ACA as a pilot project. In commencing a stakeholder analysis it is important to evaluate the relationships you, or others in your group, have with key stakeholders. Look at the connections with possible stakeholders throughout your organization, community, places of worship, or businesses. Consider the following when doing a stakeholder analysis: • Who are the stakeholders on this issue? • Which of these stakeholders are potential supporters or opponents? • Can any of the opponents be converted to supporters? • What are the values, priorities, and concerns of the stakeholders? • How can these be tapped in planning political strategy? • Do the supportive stakeholders reflect the constituency that will be affected by the issue? For example, as states expand coverage of health services through the state's Medicaid program, it is vital to have those who now qualify let their policymakers know how important the issue is for them and to share their personal stories of how this insurance coverage has made a difference. Yet stakeholders who are recipients of the services are too often not identified as vital for moving an issue forward. Nurses, as direct caregivers, have an important role in ensuring that recipients of services are included as stakeholders; especially when bringing issues to elected officials. Economics and Resources An effective political strategy must take into account the resources that will be needed to address an issue successfully. Resources include money, time, connections, and intangible resources, such as creative solutions. The most obvious resource is money, which must be considered when defining the issue and getting it recognized or on the public agenda. Thus, before launching an initiative to champion an issue, it is necessary to determine the resources that will be necessary, how much it will cost, who will bear those costs, the source of the money, and what value will be achieved from the outlay of the resources. It is critical to fully examine, despite the initial financial outlay, the potential for cost savings it may produce. It could be helpful to know how budgets are formulated for a given organization, professional group, or government agency. What is the budget process? How much money is allocated to a particular cost center or budget line? Who decides how the funds will be used? How is the use of funds evaluated? How might an individual or group influence the budget process? Money is not the only resource to evaluate. Sharing available resources, such as space, people, expertise, and in-kind services, may be best accomplished through a coalition. It may require a mechanism for each entity to contribute a specific amount or to tally their in-kind contributions such as office space for meetings; use of a photocopier, telephone or other equipment; and use of staff to assist with production of brochures and other communications. Other cost considerations include publicity efforts such as printing materials, paying for postage, and accessing electronic communications. Values Assessment Every political issue should prompt discussions about values. Values underlie the responsibility of public policymakers to be involved in the regulation of health care. In particular, calls for extending the reach of government in the regulation of health care facilities imply that one accepts this as a proper role for public officials, rather than as a role of market forces and the private sector. Thus, electoral politics affect the policies that may be implemented. An analysis that acknowledges how congruent nurses' values are with those of individuals in power can affect the success of advancing an issue. There are issues that would be considered morality issues−those that primarily revolve around ideology and values, rather than costs and distribution of resources. Among well-publicized morality issues are abortion, stem cell research, and immigration. However, most issues that are not classified as morality issues still require an assessment of the values of supporters and their opponents. Any call for government support of health care programs implies a certain prioritization of values: Is health more important than education, or jobs, or military action in the Middle East? Elected officials must always make choices among competing demands. And their choices reflect their values, the needs and interests of their constituents, and their financial supporters such as large corporations. Similarly, nurses' choice of issues on the political agenda reflects the profession's values, political priorities, and ways to improve health care. Although nurses may value a range of health and social programs, legislators review issues within the context of demands from all of their constituencies. When an issue is discussed, it is critical to link the issue to the problem it may solve. It is also important to make sure issues are framed to show how they will help the public at large and not just the nursing profession. For example, when a request for increased funding for nursing education is made, linking this request to the need to alleviate the nursing shortage or to increase the number of nurses necessary for successful implementation of health care reform would be important. Networks and/or Coalitions Although individuals develop political skill and expertise, it is the influence of networks and coalitions, or like-minded groups that wield power most effectively. It is critical to the political analysis process to evaluate what networks or coalitions exist that are involved with the issue. Too often nurses become concerned about a particular issue and try to change it without help from others. In the public arena particularly, an individual is rarely able to exert adequate influence to create long-term policy change. For instance, many advanced practice registered nurses (APRNs) have tried to change state Nurse Practice Acts to expand their authority. As well intentioned as the policy solutions may be, they will likely fail unless nurses can garner the support of other powerful stakeholders such as members of the state board of nursing, the state nurses association, physicians, and consumer advocacy groups. Such stakeholders often hold the power to either support or oppose the policy change. (See Chapter 75 for a discussion of building coalitions.) Power Effective political strategy requires an analysis of the power of proponents and opponents of a particular solution. Power is one of the most complex political and sociological concepts to define and measure. It is critical to be aware of the sources of power, regardless of setting or issue, to understand how influence happens and to build your own sources of power for leadership in the political process. Power can be a means to an end, or an end in itself. Power also can be actual or potential. Many in political circles depict the nursing profession as a potential political force considering the millions of nurses in this country and the power they could wield if more nurses participated in politics and policy formation. Any discussion of power and nursing must acknowledge the inherent issues of hierarchy and power imbalance that arise from the long-standing relationships between nurses and physicians. Some of nurses' discomfort with the concept of power may also arise from the inherent nature of “gender politics” within the profession. Male or female, gender affects every political scenario that involves nurses. Working in a predominantly female profession means that nurses are accustomed to certain norms of social interactions (Tanner, 2001). In contrast to nursing, the power and politics of public policymaking typically are male dominated, although women are steadily increasing their ranks as elected and appointed government officials. Moreover, many male and female public officials have stereotypic images of nurses as women who lack political savvy. This may limit officials' ability to view nurses as potential political partners. Therefore nurses need to be sensitive to gender issues that may affect, but certainly not prevent, their political success. Any power analysis must include reflection on one's own power base. Power can be obtained through a variety of sources such as those listed in Box 9-1(French & Raven, 1959; Benner, 1984). An analysis of the extent of one's power using these sources can provide direction on how to enhance that power. Although the individual may hold expert power, it will be limited if one attempts to go it alone. An individual nurse may not have sufficient power to champion an issue through the legislative or regulatory process, but a network, coalition, or alliance of nurses or nursing organizations can wield significant power to move an issue to the public agenda and to successfully solve it. Box 9-1 Sources of Power 1. Legitimate (or positional) power is derived from a belief that one has the right to power, to make decisions and to expect others to follow them. It is power obtained by virtue of an organizational position rather than personal qualities, whether from a person's role as the chief nurse officer or the state's governor. 2. Reward power is based on the ability to compensate another and is the perception of the potential for rewards or favors as a result of honoring the wishes of a powerful person. A clear example is the supervisor who has the power to determine promotions and pay increases. 3. Expert power is based on knowledge, skills, or special abilities, in contrast to positional power. Benner (1984) argues that nurses can tap this power source as they move from novice to expert practitioner. It is a power source that nurses must recognize is available to them. Policymakers are seldom experts in health care; nurses are. 4. Referent power is based in identification or association with a leader or someone in a position of power who is able to influence others and commands a high level of respect and admiration. Referent power is used when a nurse selects a mentor who is a powerful person, such as the chief nurse officer of the organization or the head of the state's dominant political party. It can also emerge when a nursing organization enlists a highly regarded public personality as an advocate for an issue it is championing. 5. Coercive power is based on the ability to punish others and is rooted in real or perceived fear of one person by another. For example, the supervisor who threatens to fire those nurses who speak out is relying on coercive power, as is a state commissioner of health who threatens to develop regulations requiring physician supervision of nurse practitioners. 6. Information power results when one individual has (or is perceived to have) special information that another individual needs or desires. For example, this source of power can come from having access to data or other information that would be necessary to push a political agenda forward. This power source underscores the need for nurses to stay abreast of information on a variety of levels: in one's personal and professional networks, immediate work situation, community, and the public sector, as well as in society. Use of information power requires strategic consideration of how and with whom to share the information. 7. Connection power is granted to those perceived to have important and sometimes extensive connections with individuals or organizations that can be mobilized. For example, the nurse who attends the same church or synagogue as the president of the home health care agency, knows the appointments secretary for the mayor, or is a member of the hospital credentialing committee will be accorded power by those who want access to these individuals or groups. 8. Persuasion power is based in the ability to influence or convince others to agree with your opinion or agenda. It involves leading others to your viewpoint with data, facts, and presentation skills. For example, a nurse is able to persuade the nursing organization to sponsor legislation or regulation that would benefit the health care needs of her specialty population. It may be the right thing to do, but the nurse uses her skills of persuasion for her own personal or professional agenda. 9. Empowerment arises from any or all of these types of power, shared among the group. Nurses need to share power and recognize that they can build the power of colleagues or others by sharing authority and decision making. Empowerment can happen when the nurse manager on a unit uses consensus building when possible instead of issuing authoritative directives to staff, or when a coalition is formed and adopts consensus building and shared decision making to guide its process. Consider the nursing organization that is seeking to secure legislative support for a key piece of legislation. It can develop a strategy to enhance its power by finding a highly regarded, high-profile individual to be its spokesperson with the media (referent power), by making it known to legislators that their vote on this issue will be a major consideration in the next election's endorsement decisions (reward or coercive power), or by having nurses tell the media stories that highlight the problem the legislation addresses (expert power). A longer-range power-building strategy would be for the nursing organizations to extend their connections with other organizations by signing onto coalitions that address broader health care issues and expanding connections with policymakers by attending fundraisers for key legislators (connection power); getting nurses into policymaking positions (legitimate power); hiring a government affairs director to help inform the group about the nuances of the legislature (information power); using consensus building within the organization to enhance nurses' participation and activities (empowerment), or, finally, by identifying a legislative champion for the issue who could garner the use of several power bases at once. Goals and Proposed Solutions Typically, there is more than one solution to an issue and each option differs with regard to cost, practicality, and duration. These are the policy options. The political analysis of the issue involves the context of the issue, stakeholders, values, power, and what is politically feasible. By identifying the goal, and developing and analyzing possible solutions, nurses will acquire further understanding of the issue and what is possible for an organization, workplace, government agency, or professional organization to undertake. There needs to be a full understanding of the big picture and where the issue fits into that vision. For example, if nurses want the federal government to provide substantial support for nursing education, they need to understand the constraints of federal budgets and the demands to invest in other programs, including programs that benefit nurses and other health care professionals. Moreover, support for nursing education can take the form of scholarships, loans, tax credits, aid to nursing schools, or incentives for building partnerships between nursing schools and health care delivery systems. Each option presents different types of support, and nurses would need to understand the implications of the alternatives before asking for federal intervention. The amount of money and time needed to address a particular issue also needs to be taken into account. Are there shortterm and long-term alternatives that nurses want to pursue simultaneously? Is there a way to start off with a pilot or demonstration program with clear paths to expansion? How might one prioritize various solutions? What are the tradeoffs that nurses are willing to make to obtain the stated political goals? Such questions need to be considered in developing a political strategy. Political Strategies Once a political analysis is completed, it is necessary to develop a plan that identifies activities and strategies to achieve the policy goals. The development and implementation of a political strategy to solve an issue requires that there is a tightly framed message, an aligned common purpose or goal, and a well-defined target audience. Messaging is critical to the development of a political strategy. Nurses need to be able to communicate with policymakers, other health care leaders, and the public, and may sometimes use social media for messaging to advise on institutional and public policy. Look at the Big Picture It is human nature to view the world from a personal standpoint, focusing on the people and events that influence one's daily life. However, developing a political strategy requires looking at the larger environment. This can provide a more objective perspective and increase nurses' credibility as broad-minded visionaries, looking beyond personal needs. In the heat of legislative battles and negotiations, it is easy to get distracted. However, the successful advocate is the one who does not lose sight of the big picture and is willing to compromise for the larger goal. It is critical for nurses to frame their policy work in terms of improving the health of patients and the broader health delivery system, rather than a singular focus on the profession. Do Your Homework We can never have all the information about an issue, but we need to be sufficiently prepared before we advocate. Usually it is unlikely to know beforehand when a particular policy will be acted on; nonetheless, it is not sufficient to claim ignorance when confronted with questions that should be answered. However, if one has done everything possible to prepare and is asked to supply information that is not anticipated, it is reasonable and preferable to indicate that one does not know the answer. The information should then be obtained as soon as possible and distributed to the policymaker who requested it. Remember not to let perfection be the enemy of good; gather the requested information, and present it as clearly and simply as possible. Some of the ways to be adequately prepared are provided in Box 9-2. Box 9-2 Being Prepared for Political Advocacy Here are some ways to ensure that you're prepared for advocacy around a specific issue. Conducting a full political analysis will inform your preparation strategy. • Clarify your position on the problem, your goal in pursuing the issue, and possible solutions. • Gather information and data, and search the clinical and policy literature. • Prepare documents to describe and support the issue. • Assess the power dynamics of the stakeholders. • Assess your own power base and ability to maneuver in the political arena. • Plan a strategy, and assess its strengths and weaknesses. • Prepare for the opposition. • Line up support. Read between the Lines It is as important to be aware of the way one conveys information as it is to provide the facts. When legislators say they think your issue is important, it does not necessarily mean that they will vote to support it. A direct question such as, Will you vote in support of our bill? needs to be asked of policymakers to know their position. Communication theory notes that the overt message is not always the real message (Gerston, 2010). Some people say a lot by what they choose not to disclose. What is not being said? Are there hidden agendas that the stakeholders are concerned about? When framing the issue, know the hidden agendas and covert messages. Be careful to make the issue as clear as possible and test it on others to be certain that reading between the lines conveys the same message as the overt rhetoric. In God We Trust, All Others Bring Data This quote is attributed to W. Edwards Deming (Hastie, Tibshirani, & Friedman, 2011) who developed principles for managers to transform business effectiveness through the application of statistical methods. He suggested that by presenting data to workers, they can see the outcomes or intended results of their work and make improvements to meet goals. This quote resonates in today's current heath care environment in that it requires measurement and data reporting by most health care organizations, by many health care professionals, and at all levels of practice, including the institutional, local, state and national. Data are important to the political analysis process and again during strategy development to move an issue through the policy process. Decision makers are often dissatisfied with their ability to get or understand the data needed to make good policy decisions. They need an interpretation of the data in a form that is understandable and useable for their purposes. Nurses are skilled are interpreting and reporting data in the clinical setting and as researchers and consumers of clinical research. A nurse can make himself or herself valuable to a policymaker by preparing a report of the important points on an issue under consideration that translates data into concise information. Money Talks Follow the money and understand the flow of funds within a private health care organization/system or the public sector. Money is important in both the public and private sectors, and the more money you have, the more powerful you appear to others, whether the money is revenue, profits, or donations. In the political arena, special interest groups, such as professional organizations (for example, the American Nurses Association), solicit money from their members and spend it to maintain a presence in Washington, DC, and 50 state capitals through political action committees (PACs). Other organizations, such as labor unions, trade associations, and some large corporations, also make donations to influence the agenda in Washington and the state capitals. One other type of influential group is the “527 committees” that get their name from the IRS code section that governs their existence. These 527 committees are advocacy issue groups that are outside the mainstream of special interest groups and corporate America. They may have ties to some of the other groups, but they have less stringent rules to follow on the use of money and how it influences the political process. These advocacy groups hire professional advocates or lobbyists to monitor the policy and political environments and influence elected and appointed officials on issues of importance to their special interest group. Even though money is important to have and can be very influential, the problem with money in politics is who is spending the money, what they are asking for in return, and how that affects the allocation of public resources. Communication is 20% What You Say and 80% How You Say It and to Whom Using the power that results from personal connections can be an important strategy in moving a critical issue forward. In the example of APRN reimbursement, the original legislation that gave some APRNs Medicare reimbursement was greatly facilitated by the fact that the chief of staff for the Senate Majority Leader was a nurse. Or consider the nurse who is the neighbor and friend of the secretary to the chief executive officer (CEO) in the medical center. This nurse is more likely to gain access to the CEO than will someone who is unknown to either the secretary or the CEO. Building relationships and partnerships and networking are important long-term strategies for increasing influence but can also be short-term strategies. Equally important is the way the message is framed and conveyed to stakeholders. We have often been told, it's not what you say but how you say it. When delivering the message, learn to use strong, affirmative language to describe nursing practice. Use the rhetoric that incorporates lawmakers' lingo and the buzz words of key proponents. This requires having a sense of the values of the target audiences, whether they are legislators, regulators, hospital administrators, community leaders, or the consumer public. Stakeholders appreciate a succinct and framed message that is responsive to the values and concerns of your supporters or opponents. For example, during health reform discussions, APRNs framed their issue in terms of quality of care and cost savings. Since the nation continues to be concerned about the amount of money spent on health care, the message of reducing costs without compromising quality resonated with the Administration, Members of Congress, insurers, employers, and the public alike. How you convey your message involves developing rhetoric or catchy phrases that the media might pick up on and perpetuate. Nurses need to develop their effectiveness in accessing and using the media, an essential component of getting the issue on the public's agenda. Learn and use good communication techniques; in particular, the use of a persuasive and assertive communication style that focuses on the facts and the data, and limits any emotional appeals to stories that illustrate the human impact of the problem. As discussed above, it is important to develop a message that is important to your target audience. And finally, don't be afraid to toot your own horn. Don't assume that your good work will be recognized or valued by others. If nursing is leading an initiative or has generated the research evidence to support the issue, present the evidence to the policymakers and let them know what has been studied or found to be effective and inform them that nurses led the work. You Scratch My Back and I'll Scratch Yours Developing networks involves keeping track of what you have done for others and not being afraid to ask a favor in return. Often known as quid pro quo (literally, something for something), it is the way political arenas work in both public and private sectors. Leaders expect to be asked for help and know the favor will be returned. Because nurses interface with the public all the time, they are in excellent positions to assist, facilitate, or otherwise do favors for people. Too often, nurses forget to ask for help from those whom they have helped and who would be more than willing to return a favor. Consider the lobbyist for a state nurses' association who knew that the chair of the Senate public health and welfare committee had a grandson who was critically injured in a car accident. She visited the child several times in the hospital, spoke with the nurses on the unit, and kept the legislator informed about his grandson's progress and assured him that the boy was well cared for. When the boy recovered, the legislator was grateful and asked the lobbyist what he could do to move her issue. Interchanges like this occur every day and create the basis for quid pro quo. Strike While the Iron is Hot The timing of an issue will often make a difference in terms of a successful outcome. A well-planned strategy may fail because the timing is not good. An issue may languish for some period because of a mismatch in values, concerns, or resources but then something may change to make an issue ripe for consideration. The passage of the ACA is a good example. President Obama knew from studying the history of legislation in this country that the best chance of passing sweeping legislation was in the early years of a presidential term. Once elected, with both the U.S. House of Representatives and the U.S. Senate under the control of the Democratic Party, the President knew that the only hope of passing comprehensive health care reform would be if it became his priority within his first year. United We Stand, Divided We Fall The achievement of policy goals can be accomplished only if supporters demonstrate a united front. Collective action is almost always more effective than individual action. Collaboration through networking, alliances, and coalition building can demonstrate broad support for an issue. A 2010 Gallup poll of health care leaders found that the lack of a united front by national nursing organizations was viewed as a major reason why nursing's influence on health care reform would not be significant. To maximize nursing's political potential, we must look for opportunities to reach consensus or remain silent in the public arena on an issue that is not of paramount concern. Sometimes diverse groups can work together on an issue of mutual interest, even though they are opponents on other issues. Public and private interest groups that identify with nursing's issues can be invaluable resources for nurses. They often have influential supporters or may have research information that can help nurses move an issue forward. The Best Defense is a Good Offense A successful political strategy is one that tries to accommodate the concerns of the opposition. It requires disassociating from the emotional context of working with opponents and is the first step in principled negotiating. A person who is skillful at managing conflict will be successful in politics. The saying that politics makes strange bedfellows arose out of the recognition that long-standing opponents can sometimes come together around issues of mutual concern, but it often requires creative thinking and a commitment to fairness to develop an acceptable approach to resolving an issue. It is also important to anticipate problems and areas for disagreement and be prepared to counter them. When the opposition is gaining momentum and support, it can be helpful to develop a strategy that can distract attention from the opposition's issue or that can delay action. For example, one state nurses' association continually battles the state medical society's efforts to amend the Nurse Practice Act in ways that would restrict nurses' practice and provide for physician supervision. Nurses have become concerned about the possibility of passage during a year when the medical society's influence with the legislature was high. A key strategy to deal with this specific example is to develop coalitions and alliances to work with other health provider organizations engaged in similar battles with the physicians (e.g., optometrists, pharmacists) to monitor the current environment and be vigilant if changes arise. With this type of strategy in place, the physician groups will know that there would be a large coalition to deal with if any changes are proposed. In developing a good defense, arm yourself with data and information about the issue. Be sure to understand how the issue fits in to either the organization's current priorities or other important public agenda items. Know the supporters and opponents of the issue. Many groups maintain voting records of legislators on their key legislative agenda priorities. Finally, learning as much as you can about current public agenda items and organizational priorities is critical to being an informed health care professional. Visit your professional organization websites, including NursingWorld.org, the online home of the American Nurses Association. Also, the websites of specialty nursing organizations can provide valuable up-to-date information on the key issues facing the profession and health care in general. Don't Make Enemies and Don't Burn Bridges To burn one's bridges is to cut off any potential future support or collaboration with a person or organization. Because nursing or even health care is such a small world, it is critically important not to burn bridges, no matter how tempted you might be! Building bridges rather than burning them is a much smarter option for the future. It is critical to handle tricky political maneuvers with care and finesse. Everyone has experienced a sound defeat at some stage and the person who can congratulate the winner and move on to learn from the experience will thrive. Rome Was Not Built in a Day It is important to remember that it takes a long time to do important work, to create something long lasting and sustainable. This is very true when referring to influence in the political process, whether it is governmental or organizational. It is often reported that it feels like the arguments have been going on for years, but policy successes will not happen immediately. It will take the involvement of many workers or volunteers and countless meetings, going through the political analysis of an issue and pursuing a political strategy to find a policy solution. It is critical not to overestimate the importance of that building process nor underestimate the importance of adding another brick. Discussion Questions 1. When you are attempting to undertake a political analysis of an issue, one of the key questions to continually ask during the process is: “In this political [or social or economic] climate, can we get this done?” How would you evaluate the barriers that arise from climate or context or timing on a specific issue of interest? 2. For the same issue, who are the stakeholders and how could they be used in a political analysis that might be different from their use in political advocacy? 3. What are the political strategies that could leverage facilitators and constraints into political momentum to move the issue forward? References Bardach E. A practical guide for policy analysis. 4th ed. CQ Press: Washington, DC; 2012. Benner P. From novice to expert. Addison-Wesley: Menlo Park, CA; 1984. Fairclough N. Critical discourse analysis: The critical study of language. Routledge Press: New York; 2013. French J, Raven B. The basis of social power. Cartwright D. Studies in social power. University of Michigan Press: Ann Arbor, MI; 1959:150–167. Gallup. Nursing leadership from bedside to boardroom: Opinion leaders’ perception. [Retrieved from] newcareersinnursing.org/sites/default/files/file-attachments/Top%20Line%20Report.pdf; 2010. Gerston LN. Public policy making: Process and principles. M.E. Sharpe: Armonk, NY; 2010. Hastie T, Tibshirani R, Friedman J. The elements of statistical learning. 2nd ed. Springer: New York; 2011. Kingdon J. Agendas, alternatives and public policies. 2nd ed. Pearson: New York; 2010 [(Longman Classics in Political Science)]. Lewin K. Field theory in social science. Harper and Row: New York; 1951. Tanner D. Talking from 9 to 5: Women and men at work. [(reprint ed.)] William Morrow Paperbacks: New York; 2001. Online Resources American Nurses Association's Take Action. www.rnaction.org/site/PageServer?pagename=nstat_take_action_home. American Association of Colleges of Nursing. www.aacn.nche.edu/government-affairs/AACNPolicyHandbook_2010.pdf. National League for Nursing. www.nln.org/publicpolicy. American Organization of Nurse Executives. advocacy.aone.org. . 1 This chapter is an updated adaptation of the chapter developed in prior editions by Susan Talbott, Diana Mason, Judy Leavitt, Sally Cohen, and EllenMarie Whelan.
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Advocacy in Nursing


Advocacy in Nursing

Sudden cardiac arrest is considered as one of the leading causes of death among athletes
in school environments. Rose et al. (2016) explain that student athletes in the United States
participate in over 7 million sport seasons in every school year. The researchers explain that
there are tendencies that mandatory cardiovascular screening in a wide range of athletics settings
may not adequately detect the presence of sudden cardiac arrest. However, schools are obliged to
consider the endeavors of incorporating secondary processes of minimizing sudden deaths in
sports. The adoption of early defibrillation techniques with the use of automated external
defibrillators is considered as one of the prior treatments for sudden cardiac arrest for the general
The Issue
I work as a nurse in one of the local high schools. The institution held an athletic event
about 2 weeks ago. However, the coach of the home team did not find an automatic emergency
defibrillator in the institution’s infirmary when one of the commentators was caught with a
cardiac arrest.in the meantime, the spectator was rescued by an emergency squad. I learned of the
absence of the automatic emergency defibrillator on Monday morning only to realize that it had
been locked in the custodian’s closet.
The case study above considers the medical response plans put...

Really great stuff, couldn't ask for more.


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