Policy and Politics
The case studies show that private initiatives can be crucial for changing existing policies for the better. For example, Margaret Sanger was a public health advocate whose contribution to healthcare was vital. To make changes in the existing system, she organized protests, demanded services for the poor, discussed the problem of sexual and reproductive freedom, built voluntary movements, and established family-planning movement in the country and abroad (Nickitas, Middaugh, & Aries, 2011).
The Arkansas State Legislature made a significant effort to address the healthcare needs of the state by appointing a task force that focused on the population’s well-being. In the other case, the implementation of a bedside medication verification system eliminated medical errors and allowed for the improvement in staff performance. These and other examples from the chapter prove that it is crucial to respond to the needs of the society to make change.
The policy change results in legislation with the expanding public attention to the problem. De Leeuw and Peters (2014) note that innovation in health care requires expertise in the field to develop alternative approaches to existing practices.
Boivin, Lehoux, Burgers, and Grol (2014) underline the significance of proper communication of internal beliefs to the improvement of public expertise. Internal and external advocacy skills are crucial for nurses that want to make a change; they include an ability to establish an active political position and understanding of factors influencing decision-making (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). I would advocate for making abortions free for individuals in all clinics to reduce the number of adverse outcomes of unplanned pregnancies and rape.
Nursing Strong Throughout Time
One of the notable nursing advocates is Florence Nightingale, who changed British hospitals’ sanitary conditions. Before her interventions, people had experienced the lack of hygiene in operation facilities, which resulted in severe health complications including cholera and typhus (Nightingale, 1992). The situation improved with Nightingale’s help because she stressed the significance of hygiene in medical environments.
By suggesting incorporation of sanitary methods to British military hospitals, she contributed to the decrease in patients’ mortality rate. Another nursing advocate is Mary Breckinridge (1927), who founded the Frontier Nursing Service which provided care to the underserved population for a low fee. The service caused the significant drop in neonatal and maternal mortality rates and drew attention to the needs of minorities. Finally, Margaret Sanger is a nurse advocate that made a significant contribution to the issue of planned parenthood. She addressed women’s rights and health, stressing the adverse outcomes of frequent and unwanted pregnancies and discussing contraceptive methods (Sanger, 1969). Due to her advocacy, birth control medications became available and legal in the US.
Several changes should be made for the profession of nursing advocates to be successful. For example, Williams et al. (2016) note that healthcare institutions should engage nurses in decision-making processes.
They also should improve the hierarchy that exists within hospitals and implement principles of shared governance. Other changes may include establishing rewards systems for nursing staff, which may have a positive impact on caregivers’ perspectives of their role and significance (Walker et al., 2015). Finally, both nurses and medical institutions should understand the caregivers’ role in protecting patients’ rights as their advocates (Yuliastuti, 2017). It may contribute to the establishment of healthcare policy reforms and increase the number of nurses that change the history.
The Affordable Care Act
There are several significant features of the Affordable Care Act (ACA) that have improved health conditions of America’s population. For example, the ACA requires insurance companies to cover preventive procedures for free (Office of the Legislative Counsel, 2010). Other features include the pre-existing condition insurance plan, extended coverage for young adults and elderly people, increased tax credits for the middle class, and lower annual coverage limits.
The ACA had a significant effect on providers and consumers as prevents the rise of healthcare costs, increases the number of patients with coverage, and reduces payments for physicians whose practices do not comply with the initiative. It also addresses cultural and ethnical minorities’ problems by allowing them to have free access to mental health and behavioral treatment. As many of them encounter challenging life situations, these features may be vital for the improvement of their living standards. The act has decreased the number of uninsured Americans as it provides Medicaid expansion, health insurance exchanges, dependent coverage, and other policies (French, Homer, Gumus, & Hickling, 2016).
The primary limit of the Act is the taxing of uninsured individuals. As an advanced practice nurse, I believe that such feature of the policy is underdeveloped, as it does not consider a large group of population. Moreover, the ACA does not provide coverage options to immigrants (Oberlander, 2016). To provide health coverage for those who remain uninsured, I would suggest that the hospitals develop internal programs covering procedures that can play a crucial role in patients’ state of health. They may include doctor’s visits for acute pain or in the case of emergency.
The Role of the Advanced Practice Nurse in a Changing Healthcare Environment
The roles of the advanced practice nurse (APN) have expanded with the change in the current healthcare system. McDonnell et al. (2015) state that their primary goal is to improve patients’ health conditions and experiences in the hospitals using cost-effective and timely methods. The areas of APNs’ work include leadership and management in population health, patient guidance and coaching, improving the quality of care and enhancing access to it, and research (Bryant‐Lukosius et al., 2016). The expanded role of the advanced practice nurses will augment physicians’ practice as well. For example, the Transitional Care Model, a nurse-led approach to care, is now utilized by clinicians, which adjusts their treatment methods to the needs of the population and allows for collaboration at the workplace.
The ACA presents an opportunity for growth for the advanced practice nurses as it allows them to improve preventive services and take a leadership role in offering high-quality primary care (Lathrop & Hodnicki, 2014). Moreover, it provides funding for nursing education, nurse-managed healthcare centers, and increases payment for primary care services. With the ACA, caregivers have an opportunity to support cost-effective services and establish a partnership with patients in achieving positive health outcomes.
Global Nursing Shortage
The global nursing shortage has become a serious challenge for the healthcare industry as it results in the lack of the workforce, the decreased quality of care, and personnel’s burnout. The problem creates pressure for nurses and prevents them from spending an adequate amount of time with patients; it has negatively affected the United Nation’s Millennium Development Goals as well. The objectives of the World Health Organization (2018) include reducing child mortality and improving maternal health. With nursing shortages, these goals cannot be achieved fully as it is impossible to provide high-quality care if there are few people working in pregnancy and acute care units (MacLean et al., 2014).
Mendes and Ventura (2017) note that the nursing shortage presents the opportunity to transform care by making reforms in educational programs that will allow for progressive recruitment of the future generation nurses. If caregivers advocate for their values, stating that it is crucial to increase the number of professionals that provide care to improve patient outcomes, the problem of shortages may be eliminated. Policy can dictate treatment options when it is established by a hospital or a national or state law.
References
Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research, 19(3), 315-322.
Boivin, A., Lehoux, P., Burgers, J., & Grol, R. (2014). What are the key ingredients for effective public involvement in health care improvement and policy decisions? A randomized trial process evaluation. The Milbank Quarterly, 92(2), 319-350.
Breckinridge, M. (1927). The nurse-midwife—A pioneer. American Journal of Public Health, 17(11), 1147-1151.
Bryant‐Lukosius, D., Spichiger, E., Martin, J., Stoll, H., Kellerhals, S. D., Fliedner, M.,… & De Geest, S. (2016). Framework for evaluating the impact of advanced practice nursing roles. Journal of Nursing Scholarship, 48(2), 201-209.
De Leeuw, E., & Peters, D. (2014). Nine questions to guide development and implementation of Health in All Policies. Health Promotion International, 30(4), 987-997.
French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the patient protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771.
Lathrop, B., & Hodnicki, D. R. (2014). The Affordable Care Act: Primary care and the doctor of nursing practice nurse. Online Journal of Issues in Nursing, 19.
MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., & Fairman, J. (2014). Scale, causes, and implications of the primary care nursing shortage. Annual Review of Public Health, 35, 443-457.
McDonnell, A., Goodwin, E., Kennedy, F., Hawley, K., Gerrish, K., & Smith, C. (2015). An evaluation of the implementation of advanced nurse practitioner (ANP) roles in an acute hospital setting. Journal of Advanced Nursing, 71(4), 789-799.
Mendes, I. A. C., & Ventura, C. A. A. (2017). Nursing Protagonism in the UN Goals for the people’s health. Revista Latino-Americana de Enfermagem, 25.
Nickitas, D., Middaugh, D. J., & Aries, N. (Eds.). (2011). Policy and politics for nurses and other health professionals. Sudbury, MA: Jones & Bartlett Learning.
Nightingale, F. (1992). Notes on nursing: What it is, and what it is not. Philadelphia, PA: Lippincott Williams & Wilkins.
Oberlander, J. (2016). Implementing the Affordable Care Act: The promise and limits of health care reform. Journal of Health Politics, Policy and Law, 41(4), 803-826.
Office of the Legislative Counsel (2010). Compilation of patient protection and Affordable Care Act.
Sanger, M. (1969). The pivot of civilization. New York, NY: Pergamon Press.
Walker, D. K., Barton-Burke, M., Saria, M. G., Gosselin, T., Ireland, A., Norton, V., & Newton, S. (2015). Everyday advocates: Nursing advocacy is a full-time job. The American Journal of Nursing, 115(8), 66-70.
Williams, T. E., Baker, K., Evans, L., Lucatorto, M. A., Moss, E., O’Sullivan, A.,… & Zittel, B. (2016). Registered nurses as professionals, advocates, innovators, and collaborative leaders: Executive summary. The Online Journal of Issues in Nursing, 21.
World Health Organization (2018). Millennium Development Goals (MDGs).
Yuliastuti, R. A. (2017). The role of nurses as advocates and communicators in the implementation of informed consent preoperative in Cempaka room Dr. Iskak Hospital Tulungagung. Web.