CLASS ONE – NURSING HISTORY

 Demonstrates expert knowledge, skills, and attitudes in the practice of nursing  Administrative skills are based upon the AONE (American Organization of Nurse Executives) guidelines and ANA (American Nurses Association) standards of practice  One of these skill is policy expert

 What can you tell me about the evolution of nursing as explained by Milstead (2008)?

 What can you tell me about how the political role has been developing?

 What are the influencing forces affecting health care organizations today?  How has this affected your organization, or has it?

 Look at exhibit 1-2 on page 16 in Milstead  Give highlights of the changes.

 A term used to define both an entity and a process  Purpose: to direct problems to government and secure government’s response  Health policy directly addresses health problems and is our focus  What other kinds of policy areas are there?

 Standing decisions/formal documented directives of an organization, official government policies that reflect the beliefs of the administration in power and provide direction for the philosophy and mission of the government  Position statements such as those be MBON  Often refers to goals, programs, and proposals

 Agency policies, even procedure manuals  Laws  Judicial interpretation 1. Meaning of laws written broadly 2. Determine questions in which the law is unclear or controversial 3. Interpret the Constitution

 4 stages - Milio (1989) 1. Agenda setting 2. Legislation and regulation 3. Implementation 4. Evaluation It is important to note that the policy process is not necessarily logical or sequential (Milstead, 2008)

 5 stages - Anderson J.E. (1984) 1. Policy agenda 2. Policy formulation 3. Policy adoption 4. Policy implementation 5. Policy evaluation

 Agenda-the list of subjects or problems to which government officials, and people outside of government are paying some serious attention at any given time  We want to understand not only why the agenda is composed as it is at any one point in time, but how and why it changes

 Iron Triangle - legislators or their committees, interest groups, and administrative agencies  Stakeholders – policy actors, policy communities, and policy networks  Streams – Kingdon’s concept of the interaction of public problems, policies, and politics that couple and uncouple throughout the process of agenda setting

 Windows of opportunity – limited time frame for action  Contextual dimensions – studying issues in the real world, in the circumstances or settings of what is happening at the time

 Answers the questions of how issues get on the political agenda and how alternatives are devised  Identifies both participants and processes that explain the emergence of the agenda  Actors in the federal government are the administration (President and advisors), Congress and to a lesser degree, their staff

 Interest groups – most influential if it can convince government that it speaks for a majority in “one voice”…can also be powerful in blocking an issue  Administrative agencies – any governmental agency that will be instrumental in formulating or administering a policy

 Problem stream  Policy stream  Political stream

 Problem stream – dealing with the complexities in getting policy-makers to focus on one problem out of many facing the constituency such as the lack of access to care for the uninsured  Components of the problem definition include: problem causation, the nature of the problem, characteristics of the problem population, ends-means orientation, and the nature of the solution

 Problem causation – can be personal or impersonal, intended or accidental, blame allocated or avoided, and simple or complex  Nature of the problem – focuses on the severity, incidence, novelty, proximity (personally relevant or general), and crisis assessment

 Characteristics of the problem population – deserving or undeserving, worthy or unworthy, familiar or strange, sympathetic or threatening  Ends-means orientation – focus on instrumental or expressive options, such as distribution of needles to drug dependent populations to decrease spread of bloodbourne pathogens

 Nature of the solution – whether it is available or nonexistent, acceptable or objectionable, affordable or unaffordable

 Addresses policy goals and ideas of those in policy subsystems, such as researchers, congressional staff, agency officials, and interest groups  These ideas float around policy circles in search of problems

 Criteria that must be met for a policy to survive: 1. Technical feasibility 2. Value acceptability within the policy community 3. Tolerable cost 4. Anticipated public agreement 5. A reasonable chance for elected decision makers to be receptive to it

 Includes factors in the political environment that influence the policy agenda, such as an economic recession special interest media campaigns, or a pivotal election

 Complex interactions among the streams occur leading to couplings as they meet.  New combinations of streams for policy issues and changing public opinion may provide a window of opportunity for utilizing a policy idea or option that was developed