Encouraging advanced practice nurses to participate in the world of policy and politics warrants clarification of terminology in reference to the health policy process. Policy usually refers to decisions resulting in a law or regulation. Politics most often refers to power relationships and to the process used to influence individuals who are making health policy decisions. Advocacy and lobbying can be seen as activities by groups such as the collective voice of APNs to influence policy decision-makers and in turn influence public policy (O’Grady and Johnson 2014).

Envisioning strategic thinking and policy development in healthcare environments is a task of unprecedented complexity for APNs, administrators, and policymakers (Tracy and Hanson 2014). The participation of nurses in the policy process offers an option for progress, opening access to opportunity for political action. However, “healthcare practitioners have a tendency to allow policy to happen around them not through them. To truly be an effective advocate, [knowledge of] policy must become a tool used to sharpen…practice” (Stewart 2014, p. 3). It is essential that APNs strengthen their leadership skills to become policy leaders based on an understanding of advocacy, policy, and politics. As healthcare professionals, policy for APNs may arise as professional regulatory mandates that directly impact practice and can be seen as part of everyday practice. However, the tedious nature of policymaking and/or political terminology at times serves to disengage the healthcare providers who need to understand and implement policy directives.

Knowing how the policy process works and identifying ways to participate allows APNs to engage in policymaking at numerous levels (Duffy 2015). To guide an understanding of the political process, Anderson (2011) proposes that there are five stages of policymaking: (1) the policy agenda, (2) policy formulation, (3) policy adoption, (4) policy implementation, and (5) policy evaluation. Easton’s (1965) system model of the policy process is similar with the view of policymaking taking place in stages (see Fig. 5.1).

This is a simple linear approach to begin to think about policymaking. However, a critique of this view implies that policymaking takes place in stages with a clearly defined beginning and end. While this viewpoint is currently less commonly supported in the policy literature, the concepts and terminology that were originally developed continue to be used as a reference point (Birkland 2005). Refer to Chap. 3 for additional discussion of theories on social policy and factors that influence decision-making including the policy agenda and agenda setting.

The author proposes that nurses must be involved in policy development and emphasizes that without the participation of nursing in the policy process, decision-makers will formulate and enact policy that impacts the profession with limited knowledge of nursing and the advanced levels of practice. Four stages that characterize the political development of nursing are identified in Table 5.1. The proposed stages provide a reference point to consider as nurses in different countries and varied healthcare settings proceed to a level of maturity and leadership in the arena of politics and policymaking.

The knowledge and experience that are specific to ANP and APNs place them in a unique position to influence policymaking. As a researcher, they can provide data and evidence. As a member of a special interest group, they can be instrumental in organizing members to focus on specific policy issues and lobby to influence policymakers. As an advocate supportive of an issue, APNs can collaborate with policymakers to gather support and influence policy development. Their expertise reinforces relevance to the policy issues (Porche 2012).

However, the ability of APNs to engage in political activities and policymaking is influenced by their resources and motivation to be involved in the process. The motivation to become involved is linked to political interest, view of personal effectiveness, and strong views on an issue. The opportunity to participate in the policy process can stimulate a nurse to consider political engagement. Resources that influence participation include nonwork-related time, available financial resources, and acquired skills (Porche 2012). The next section identifies the skills APNs should acquire to facilitate engagement in policymaking.