Once the problems and solutions have been clearly identified and described, the appropriate political arenas for influencing the issue need to be analyzed. Usually this begins by identifying the entities with jurisdiction over the problem. Is the issue primarily within the public domain, or does it also entail the private sector? Many issues require a mix of public and private sector players, but responsibility for decision-making will ultimately rest with one sector more than the other. For example, nurses interested in improving workplace conditions would first turn to their employers and other local stakeholders. It is seldom prudent to turn to public officials until other efforts in the private sector have failed. Additionally, making a change in one arena, such as Medicare in the public arena, affects other sectors such as private payers.
With regard to public policy, nurses need to clarify which level of government (federal, state, or local) is responsible for a particular issue. When one communicates with legislators and develops strategies, it is critical to understand the level of government responsible for a particular issue and how the levels interrelate. 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 Although typically defined by the states, there are examples where the federal government has superseded the state’s authority—such as in the Veteran’s Administration and the Indian Health Service. (See Chapter 64 for a full discussion of how government works.)
In addition to the level of government, nurses 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 (see Chapter 65 on the legislative and regulatory processes).
If the issue is in the problem definition and policy formation stage, then nurses will focus on the legislative branch. If an issue entails the implementation of a program, including promulgating regulations, then nurses will focus on the executive branch while maintaining an eye toward the legislative role in oversight. Issues that are within the courts call for knowledge of the judicial system.
Nurses can also apply a political analysis to the workplace or community organization. Regardless of the setting, nurses will want to identify 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 arenas are identified, the formal and informal structures and functioning of that arena 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, constitution and bylaws, annual report (including financial statement), long-range plans, governing body, committees, departments, and individuals with jurisdiction.
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, such as the American Nurses Association (ANA) House of Delegates, one must know parliamentary procedure as a political strategy to get an issue passed or rejected. Countless issues have failed or passed because of insufficient knowledge of rule making.
It is also vital to know the informal processes and methods of communication. A well-known example of the power of informal processes and communication is the case of the business lunch or the golf game that in the past excluded women.