Lec 1: Health Policy, Politics, and Advocacy

where must leadership happen

every level from bedside to boardroom

Why is nursing leadership important?

• gaps exist as result of accelerated turnover in leadership positions

• low satisfaction with leadership development in nursing

• essential for improving and sustaining outcomes at the pat, nurse, and organizational level

• shapes health policy

• drives innovation

what is policy def (they are everywhere)

set of statements of principles, values, and intent that guide decision-making and resource allocation

• are chief tools of governance for an institution

what is health policy def

strategies and activities across healthcare, public health, and social systems that promote population wellbeing

• include laws, regulations, actions, and decisions

what are the levels of policies in canadian healthcare

• federal = national principles & funding

• provincial = health care jurisdiction

• regional = policies for regional authorities

• organizational = guidelines in healthcare facilities

what are the 5 primary principles of the canadian health act

• public administration = non profit

• comprehensiveness = covers all services/insurance

• universality = no discrim/premiums, all insured entitled

• portability = 3 months of coverage between provinces

• accessibility = no financial barriers

Intersections of Policy pic

example Policy Issues pic, dont memorize

what are RNs fully registered with

passed the canadian registered nurse exam or the quebec examination + registered with their provincial regulatory body

• can specialize in many areas of care.

what do RPN, Registered Psychiatric Nurses do

• provide nursing care

• supportive counselling and life skills programming to pts in psychiatric hospitals, mental health clinics, long-term care and community-based settings

what do LPN, Licensed Practical Nurses do

provide nursing care usually under the direction of medical practitioners, RNs, or other health team members

what kind of care/profession is unregulated in canada

• assist in nursing care under guidance of regulated nursing personnel

• variation in kind and length of educational preparation

• ex nursing aides, HCAs, personal support workers

Why are Policies Useful?

• clarifies the values on which a policy is based;

• it defines a vision for the future = help establish objectives/priorities

• facilitates setting targets and milestones for the short/medium term = clarifies challenges to be faced

• consensus can then be strengthened + role clarity

Policy Development Process steps

• agenda setting

• formulation

• adoption

• implementation

• evaluation

Development of Health Policies process in detail, lots of info

• Problem Identification: A health-related issue is identified, usually as a problem.

  • Nurses can be especially effective in this stage by helping to frame the issue. Framing the issue means creating a particular perspective for the issue—for example, that assisted suicide is ethically justified because patients have a right to make their own health care decisions.

• Agenda Setting—Once defined and framed, an issue is refined through a political process that involves negotiation and debate as well as the mobilization of support from interested politicians and interest groups.

• Policy formulation—different policy interventions are proposed and considered.

• Policy adoption—a proposed intervention is selected.

• Policy implementation (carrying out the proposed intervention)

• Policy evaluation or determining if the policy achieved the desired policy goals

Policy Analysis def

process/technique for understanding the nature, intent and impact of a policy = assess the strengths/weakness of a policy

• What is the present policy? How, when and why did the policy come into being?

• Who are the policy makers? Which, if any, interest groups do they represent? What influenced policy-makers to adopt a particular course of action, what were the objectives of the policy? What interested groups, if any, have been consulted and what resources and kinds of advice have been obtained?

• What have been the stages and methods, including organizational arrangements and structures, used in the policy making process? Is the process of policy making that has been adopted the best we can hope for? How it might be improved?

• Is it a good policy? What has it achieved? Would a different policy be likely to yield better results? For whom? Does the present policy need to be changed? Is it feasible to change it and in what ways?

What is Politics? def

using power to influence, persuade, or change

• activity in which conflicting interests struggle for advantage or dominance in the making/using public policies

Why Politics Exist?

resources can be limited, and some people control more resources than others

• control of health care resources is spread among several vested interest groups = stakeholders

what do stakeholders do

exert political pressure on health policy makers to make the health care system work to their economic advantage

• at the municipal, provincial, or federal level

Why Does Policy Matter to Nurses?

• policy implementer

• policy advocate

• policy advisor/analyst

• policy maker

Why should nurses understand the relevance of policy and politics to health care outcomes and nursing practice?

shapes working conditions, clinical scope, and resource allocation

• enables patient advocacy and health equity

• empowers nurses to act as policy implementers, advocates, and leaders

• directly impacts care quality and health outcomes

• nurses know determinants/knowledge

Health Inequalities def

diffs in health status among population groups defined by specific characteristics

• can be due to biological factors & individual choice

Health Inequities def

diffs in health that could be avoided if reasonable action were taken =unfair and socially unjust

• d/t unequal distribution of the social and economic factors that influence health ex SDH

list the SDOH

• income and social status

• employment & working conditions

• education and literacy

• childhood experiences

• physical environment

• social supports & coping skills

• healthy behaviors

• access to health services

• biology and genetic endowment

• gender

• culture

• race/racism

social justice def

fair distribution of society benefits and responsibilities and their consequences

advocacy def

act of supporting or recommending a cause or course of action, undertaken on behalf of persons or issues

• involves engaging others, using your voice and using evidence to influence policy

what does political action involve doing

lobbying at the individual and federal levels

effective policy advocacy skills pic

Politically-Active Nurses: dont memorize

• Have a clear political strategy before taking political action, voicing concerns, making demands, or advocating for others.

• A political strategy helps nurses persuade the people supporting an issue, formulating a policy, or taking action.

  • Being aware of the position of other involved groups regarding any relevant political issue.

  • Listen to other policy perspectives and understand as many facets of the issue as possible when making health policy proposals (have a clear rationale)

  • Clearly articulate what nurses do and why.

Developing Political Skills dont memorize

• Build a relationship with a legislator.

• Be an active member of an organization.

• Run for office.

• Develop expertise in shaping policy.

• Seek appointed positions.

• Become an active member of selected nursing organizations, especially your provincial nurses’ association and a specialty organization (e.g., special role organization or clinical specialty organization).

• Develop a powerful personal/professional self-image.

• Invest in your nursing career by continuing your education.

• Make nursing your career, not just a job.

• Develop networking skills.

• Be visible and competent in the organizations in which you work and network

The Nurse as A Political Activist & Advocate dont memorize

• Studying and defining issues;

• Voting;

• Directly contacting policy makers;

• Joining professional organizations; and

• Actively participating to ensure collective voice.

• Speaking out against inequity and inequality

• Participating directly and indirectly in political processes and acknowledge the importance of evidence, power and politics in advancing policy options

how does the college/university play a role in Influencing Policy

protecting the public through nursing regulation

how does the professional association play a role in Influencing Policy

advancing the profession and influencing nursing, health, and public policy

how does the union play a role in Influencing Policy

improving nurses socio-economic welfare

what is the core focus of regulatory bodies

public protection & governance

what is the primary role of regulatory bodies (big word)

MANDATE

• set entry-to-practice standards

• grant nursing licenses

• enforce codes of ethics

• manage disciplinary processes to ensure safe care

what is the role of regulatory bodies at the provincial level

regulates the profession directly within their jurisdiction ex CRNA

what is the role of regulatory bodies at the national level

coordinates standards across jurisdictions to facilitate labor mobility and national exam consistency

what is the role of regulatory bodies at the international level

promotes global regulatory convergence and standards for safety and mobility

what is the core focus of nursing unions

socioeconomic welfare & workplace conditions

what is the primary role of unions

BARGAINING

• engage in collective bargaining to negotiate wages, benefits, staffing ratios, and safe working conditions

• handle workplace grievances

what is the role of unions at the provincial level

acts as the certified bargaining agent for nurses employed in healthcare facilities across the province

what is the role of unions at the national level

represents member unions across canada to lobby the fed gov on national labor issues, health worker retention, and public healthcare funding

what is the role of unions at the international level

partners with global trade union federations to advocate for workers rights, safe work environments, and fair labor practices internationally

what is the core focus of specialty associations

• domain-specific knowledge

• best practices

• research

what is the primary role of specialty associations (big word)

EXPERTISE

• support nurses practicing within a specific clinical area ex ICU by creating clinical guidelines, offering specialized certifications, and creating focused research

what is the role of specialty associations at the provincial level

regional chapters or specialized sub-groups that host local educational workshops and networking

what is the role of specialty associations at the national level

develops

• national specialty competencies

• clinical resources

• certification support

what is the role of specialty associations at the international level

connects global experts in specific domains to share international clinical practice guidelines and research

what is the core focus of professional associations

advocacy for the profession + practice advancement

what is the primary role of professional associations

• represent collective voice of nurses

• advocate for evidence-informed health policy

• promote leadership

• offer professional development opportunities

what is the role of professional associations at the provincial level

advocates for local health policy, professional growth, and nursing issues within the province

what is the role of professional associations at the national level

represents canadian nurses on

• federal health policy

• national public advocacy

• national clinical initiatives

what is the role of professional associations at the international level

unites nursing association to shape international health policy and human rights in care

What are Policy Briefs? def

a concise summary of a specific issue, the policy options to address it, and some recommendations for action

• often based on a larger evidence synthesis or research study which provides more technical details

• target an informed, non-specialist audience

what are position statements def

a form of health policy

• are developed to increase public awareness and knowledge, to promote a unified approach on an issue among stakeholders, and to encourage new directions in health care outcomes

What is a fact sheet? def

brief document, usually one page long, that provides data about an organization, product/service, or idea

• display key info in a visual manner to be easily read