Political strategies include the methods and processes to influence policy goals (Porche 2012). Policy decision-making can be viewed as a process where hope and desire for an identified outcome are ongoing. The future is uncertain as decision-makers progress through unpredictable and divergent scenarios related to policy decisions. In contrast, there is a perception that the policy process is a matter of political certainty and that policy decisions are coordinated efforts forming the basis of policy choices. Pawson (2006) suggests that the policy process is a balancing act between “hierarchical privilege, economic power, ideological standpoints and democratic mandates” (p. 2).

In some countries, key stakeholders and decision-makers are less inclined to develop professional views and make decisions based on trust and more often expect to be shown supporting evidence. In addition, the growth of knowledge management systems contributes to an expectation that information and evidence is available. Knowledge provides a perceived advantage for decision-making in an age of information systems and data banks. However, evidence-based policymaking uses hierarchies of evidence to evaluate potential interventions and to determine the strength of the evidence (Porche 2012).

The PEW-MacArthur Charitable Trust (2014) identified lack of a comprehensive guideline to provide clear direction for evidence-based policy decisions as a problem. Recognition of this gap led to the development of a framework by the PEW-MacArthur Results First Initiatives research project. Based on the literature and in-depth interviews of government officials, practitioners, and academic experts, the framework identifies the following five steps (PEW 2014, p. 1):

The emphasis in this framework favors budgetary decisions with a focus on reduction of wasteful spending along with strengthened accountability and a somewhat inflexible view of progress toward expansion of innovative programs. This perspective is consistent with the concept of the New Public Management trend that suggests approaches used in the private sector can be successively applied in the public sector (Barzelay 2001). The identification of the PEW five-point path supportive of evidence-based policy seems appealing. However, the human and financial resources required of this type of rational approach would seem overwhelming and unobtainable within some country contexts (see Chap. 8 – Rational Policy Decision Making: Idealism Versus Realism – for further discussion on policymaking as a rational process).

There is an obvious point to be made that evidence should ideally and perhaps realistically inform policy decisions. In addition, it seems logical to think that research and empirical evidence should precede policy decisions (Pawson 2006). This view counters the perspective of an evaluation that occurs after program design and implementation more specifically measuring outcomes.

Systematic reviews are proposed as a bridge to fully utilize research of anticipatory outcomes and evaluation research therefore taking a look at the evidence before making decisions that impact policy and practice. There is also an implication that the use of both evidence and implementation research requires a continuous feedback loop from past to present synthesizing findings for policy development (see Chap. 2, A Conceptual Policy Framework for Advanced Practice Nursing, for an example of this). Thus, the concept of evidence-based policy from this point of view can be seen as based on a cumulative and progressive body of knowledge.

In addition, the premise of selection bias in gaining attention for an issue or strategy suggests that the structure of policy networks includes manipulation strategies and skills of policymakers (Zahariadis 2014). If the reality of making decisions includes levels of political manipulation, there is a mandate that APNs learn how to penetrate this context effectively. With this in mind, the next section discusses the concept of a policy agenda and how this relates to policy decisions.

A policy agenda is a set of issues, problems, or topics that obtain the attention of or are viewed as significant by individuals involved in making policy decisions (e.g., legislators, government officials, key policy stakeholders). The concept of a policy agenda and agenda setting is first introduced in Chap. 2 – Section 2.​2.​1. This section continues the discussion of this topic.

In addressing the importance for APNs to participate in the policy process, Stewart (2014) emphasizes the need for healthcare professionals to understand the political process and policy directives in order to implement policy in practice. Suggesting that policy is born out of collective action within advocacy and lobbying groups or organizations, Stewart (2014) refers to the policy agenda as Stage 1 of five stages of policymaking as proposed by Anderson (2011). In this stage, the focus is on the issues that require the attention of public or governmental officials. Understanding the concept of a policy agenda provides APNs knowledge to use when identifying options to introduce proposed policy. Gaining the attention of policymakers and reaching priority status on the policy agenda can determine the success or failure of progressing to further stages of policy development (Hall et al. 1975; Kingdon 2003; Walt 2006).