Virginia Trotter Betts, MSN, JD, RN, FAAN and Barbara Cherry, DNSc, MBA, RN, NEA-BC After studying this chapter, the reader will be able to: 1. Differentiate between policy and politics. 2. Discuss the roles of the legislative, administrative, and judicial levels of government. 3. Differentiate among federal, state, and local governments and their roles in governing and influencing health care and nursing. 4. Identify three policy issues of significant consequence to nurses and nursing. 5. Demonstrate knowledge needed to be a responsible and informed politically active nurse. 6. Use diverse technologic resources to obtain information about current health policy developments and political issues. A citizen who has the opportunity to vote for candidates in elections for representation at the local, state, and federal level. Constituent/State Nurses Association (C/SNA) The professional organizational unit member of the American Nurses Association that represents all professional nurses within a state or territory or other defined organizational entity or boundary—also known as the state nurses association (SNA). Personal advocacy by individual constituents—everyday citizens—in support of a problem/position/option related to a policy issue. A set course of action undertaken by governments or health care organizations that results in a course of action for a health outcome. Private health policy is made by health care organizations, such as hospitals, whereas public health policy refers to local, state, and federal legislation, regulation, and court rulings that govern health care within a certain arena. Health policy as used in this chapter most often refers to public policies directly related to the health care workforce, the structure of the health system, health service delivery, and/or reimbursement. The act of persuading or otherwise attempting to educate and/or convince policymakers to respond positively to a particular position on an issue or to follow a particular course of legislative or regulatory action. The statement of principles and policies of a political party, candidate, or elected official. A local, state, or federally elected or appointed official who can propose legislation, regulations, or programs that can become actualized. Rules used to implement legislation and translate concepts into actions that can be put into practice. Individuals, groups, or organizations who have a vested interest in and may be affected by policy decisions and actions being taken and thus may attempt to influence those decisions and actions. Additional resources are available online at: http://evolve.elsevier.com/Cherry/ Vignette Juan wonders what the issues are in filling the care team with BSN-prepared nurses. Juan seeks out the MICU nurse manager to try to better understand the reasons for the delay in hiring RNs, to voice his professional concerns, and to offer to assist in the recruiting process. He is both relieved and alarmed by what he hears. First, the hospital administrators clearly support his position that adequate numbers of well-educated RNs are required to provide high-quality, safe patient care, and they are actively seeking applicants who can provide care throughout the hospital’s rapidly evolving care models by giving a preference to nurses with a BSN or above. Second, an underlying issue for Juan’s state and region is that the numbers of nurses with the needed education and credentials simply are not adequate to meet the demand, and hiring is taking much longer than in the past. Questions to Consider While Reading This Chapter 1. What types of local, state, and federal health policies affect Juan’s nursing practice? 2. What are the major steps in health policy development that Juan must understand? 3. How can Juan apply the nursing process to develop an effective plan for policy development related to improved developments for the nursing workforce and his own professional career? Perhaps at no other time in the history of the nursing profession has there been such an imperative for strong, involved, informed nursing leadership. The challenges currently faced by the U.S. health care system—ongoing and serious patient safety issues; a shortage of appropriately educated and geographically dispersed nursing and other health professionals; complex, high-tech work environments; a fragmented delivery system; an aging population; and dramatic overall health care system changes in response to national health reform—confront the health and well-being of patients, families, and communities across the country. Nurses can no longer simply move forward and participate in the delivery of patient care without also addressing these larger issues that impact the whole of the health care system. Frequently these critical issues can be understood, addressed, and resolved only through the policy process. Without a doubt, legislation, regulation, and health policy directly affect how health care is delivered and how the health care system responds to the very real challenges and opportunities it faces. Nurses must get involved now in the policy process and provide strong leadership among the health care professions to ensure evolution to an efficient, effective health care system that promotes and protects the health and well-being of each person in our society. • State and federal governments play an increasingly important role in health care, especially as federal and state governments and multiple private players embark on implementation of The Patient Protection and Affordable Care Act (PPACA), which was signed into law in 2010. • Nursing practice is directly affected by health policy development which is, in turn, affected by the political action of citizens—nurses and many, many others. • Patient safety and quality; access to affordable health coverage and services; and costs, value, and outcomes of services have received national media attention and have become a major debate among policymakers, especially at the federal and state levels of government over the past few years. • National attention on nurses and nursing has intensified—our numbers, education, scope of practice, and overall value to the health care system. Federal health policies have played and continue to play a pivotal role in shaping nursing practice. The first federal policy to provide funding for nursing services was the Sheppard-Towner Act of 1921. This act, which was passed by Congress despite objections from the American Medical Association (AMA), provided states with matching funds to establish prenatal and child health centers staffed by public health nurses. The goal of the act was to reduce maternal and infant mortality rates by teaching women about personal hygiene and infant care. Eventually this highly successful program was discontinued when the AMA successfully persuaded Congress that physicians should perform these health activities (Starr, 1982), but these services were later reinstated (and continue today) within Title V of the Social Security Act of 1935. Another example of legislation that has significantly influenced the context of nursing practice over the past six decades was the Hill-Burton Act of 1950. This act provided funding to local communities that resulted in a boom in the construction of hospitals across the country. As the number of hospitals increased rapidly, so did the need for nurses to staff them. Thus, the nurse’s role shifted from community and public health settings to be predominately in hospital/acute care settings. Federal legislation has affected nursing practice through expanding Medicare and Medicaid reimbursement directly to advanced practice nurses and implementing policies and programs to expand the nursing supply through enhancing access to nursing education at all levels of nursing from BSN to DNP and PhD. Table 23-1 provides some historic examples of how health policy enacted at the federal level affected nursing practice and health care. Current policy issues affecting nursing practice and health care are addressed later in this chapter. TABLE 23-1 EXAMPLES OF HEALTH POLICIES THAT HAVE INFLUENCED PROFESSIONAL NURSING PRACTICE The development of health policy at the state or federal level is a complex, dynamic process that occurs in the following three ways (Chaffee et al, 2011): • Enactment of legislation and the accompanying rules and regulations that carry the weight of law • Administrative decisions/directives made by various governmental agencies of the executive branch • Judicial decisions that interpret statutes, regulations, and settle legal conflicts within society The development of health policy involves all three branches of government: executive, legislative, and judicial. A basic knowledge of the functions of the three branches of government is necessary to understand health policy development. Table 23-2 presents a brief review of the three branches of the federal government and their differing roles in health policy. Although most state governments parallel the structure and functions of the federal government, there are differences among states. Each nurse is encouraged to learn about the governmental structure of his or her state. In addition to understanding the branches of government, nurses also need to understand the influence of legislation and regulation on health policy as discussed in the following sections. TABLE 23-2 THE THREE BRANCHES OF THE FEDERAL GOVERNMENT
Health Policy and Politics
Get Involved!
Chapter Overview
Nurses’ Involvement in Health Policy and Political Action
What is health policy?
Health Policy at the Local, State, and Federal Level
Federal Health Policy
LEGISLATION
INFLUENCE ON PROFESSIONAL NURSING PRACTICE
Nurse practice acts and registration of nurses were established (1910).
Established scope of practice and minimal educational requirements for nurses; implemented by most states.
Sheppard-Towner Act (1921) funded prenatal and child health centers staffed by public health nurses.
First federal policy to provide funding for nursing services.
Hill-Burton Act (1950), also known as the Hospital Survey and Construction Act, provided federal funding for hospital construction.
Caused a boom in hospital construction, shifting nurses’ primary employment setting from public health to hospitals.
Nurse Training Act (1964) Public Law 88-581 (78 Stat. 908) provided enhanced funding for collegiate nursing programs.
Expanded university education for nurses, and laid the groundwork for the development of APRNs.
Medicare program (1965) provided funding for health care services for older adults and the disabled.
Led to an increased number of hospitalized older adults and an increased need for nurses in acute care settings.
Renal Disease Program (1972) provided funding for dialysis treatments and renal transplants for patients with kidney failure.
Led to the development of a new area of nursing practice that is now a recognized specialty—nephrology nursing.
Diagnosis-related groups (DRGs) (1983) changed Medicare reimbursement to hospitals from a fee-for-service method to a fixed-fee method.
Forced hospitals to reduce patients’ lengths of stay, cut costs, and initially reduce staff, including nurses; led to the development of new nursing roles—nursing case management and utilization review.
Balanced Budget Amendment (1997) Title 42 Sect 4511 CFR 410.75 and 410.76 provided for direct reimbursement of nurse practitioners and nurse clinical specialists, regardless of geographic location following state NPAs requirements for scope and practice.
Expanded the practice opportunities for advanced practice registered nurses (APRNs), and further increased the importance of political action at the state level to remove barriers to APRN practice such as medical supervision or other unwarranted limitations on scope and independence.
Medicare Modernization Act (Medicare Part D) (2003) PL 108-173 117 Stat 2066 added a prescription drug benefit for Medicare enrollees.
Provides needed access to medications for Medicare enrollees, and calls attention to cost-and-effectiveness outcome from policymakers, requiring nurses to stay alert to proposed legislation and to advocate for appropriate benefits for the nation’s older adults.
Mental Health Parity and Addictions Equity Act (MHPAEA) 2008 PL 110-343 Sect 511 removed discrimination in insurance coverage and benefits for mental illnesses and substance abuse disorders.
Greatly increases access to a continuum of mental health/substance abuse services, and puts pressure on developing a nursing workforce with sufficient numbers and knowledge to address these illnesses as integrated with other chronic illnesses and as specialty services.
How is health policy developed?
EXECUTIVE
LEGISLATIVE
JUDICIAL
Composition
Office of the President and 15 executive departments (State, Treasury, Defense, Agriculture, Energy, Housing and Urban Development, Justice, Commerce, Education, Health and Human Services, Interior, Labor, Transportation, Veterans Affairs, and Department of Homeland Security)
Senate and House of Representatives known collectively as Congress with 535 elected members
U.S. Supreme Court, federal district courts, and U.S. circuit courts of appeals
Role in health policy
Recommends legislation and promotes major policy initiatives
Possesses the sole federal power to enact legislation and to tax citizens and allocate federal spending
Judicial interpretations of the Constitution or various laws may have a policy effect
Implements laws and manages programs after they have been passed by Congress through regulation, oversight, and presidential funding priorities
Able to originate and promote major policy initiatives
Resolves questions regarding agency regulations that may affect policy
Writes regulations that interpret statutes (laws)
Power to override a presidential veto
Has the power to veto legislation passed by Congress
Restrictions to power
Unable to enact a law without the approval of Congress (legislative branch)
U.S. Supreme Court may invalidate legislation as unconstitutional
Unable to recommend or promote legislative initiatives Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree