Out of the Classroom and into the Mix Active Learning About Health Policy and Politics

Karen Kelly, EdD, RN, NEA-BC Associate Professor & Coordinator, Continuing Education Southern Illinois University Edwardsville School of Nursing, Department of Primary Care and Health Systems Nursing

Objectives Examine the use of “political activities” as a learning methodology related to health policy and politics. Examine the use of “political activities” as a learning methodology related to health policy and politics. Discuss the feedback of graduate students related to their engagement in “political activities.” Discuss the feedback of graduate students related to their engagement in “political activities.”

Nurses and politics…. While nurses represent 1 in 50 voters, only a minority of nurses are political activists or even members of a single professional organization. While nurses represent 1 in 50 voters, only a minority of nurses are political activists or even members of a single professional organization.

Nurses and politics…. Say the word “politics” to a cross-section of nurses and their eyes will roll…. Say the word “politics” to a cross-section of nurses and their eyes will roll….

AACN’s “Essentials of Master’s Education….” “Most often, policy processes and system- level strategies yield the strongest influence on…broad determinants of health. Being accountable for improving the quality of healthcare delivery, nurses must understand the legal and political determinants of the system and have the requisite skills to partner for an improved system” (AACN, 2011, p. 20). “Most often, policy processes and system- level strategies yield the strongest influence on…broad determinants of health. Being accountable for improving the quality of healthcare delivery, nurses must understand the legal and political determinants of the system and have the requisite skills to partner for an improved system” (AACN, 2011, p. 20).

Why is health policy important? Nursing must be a visible player in shaping health policy: If you are not at the table, you are on the menu! at the table, you are on the menu!

At Southern Illinois University Edwardsville School of Nursing The faculty have chosen to present this content in a core course: HEALTH POLICY ADVANCED PRACTICE NURSING HEALTH POLICY AND ADVANCED PRACTICE NURSING 3 hour graduate course Also a 3 hour course in health policy & health care finance in new doctoral program.

Assumptions of the course Politics and policy are inseparable Politics and policy are inseparable –Policy is a plan to achieve a goal –Politics is a process, involving human interaction, by which policy is created and implemented and implemented –Health policy is a plan that uses the political process to address the health of a population: global, national, regional, state-wide, local

Assumptions of the course Nursing is engaged in two levels of politics: professional and legislative/ regulatory Nursing is engaged in two levels of politics: professional and legislative/ regulatory These two elements are intertwined: professional politics, as exercised through nursing organizations, is a force to shape legislative/regulatory politics These two elements are intertwined: professional politics, as exercised through nursing organizations, is a force to shape legislative/regulatory politics

Assumptions of the course Active participation in professional nursing organizations provides the most effective means for nurses to engage in shaping health policy through legislative and regulatory bodies Active participation in professional nursing organizations provides the most effective means for nurses to engage in shaping health policy through legislative and regulatory bodies

Assumptions of the course Governmental regulatory bodies are shaped by legislative processes (e.g., funding for state department of public health) Governmental regulatory bodies are shaped by legislative processes (e.g., funding for state department of public health) Nongovernmental regulatory bodies (e.g., the Joint Commission) are highly political Nongovernmental regulatory bodies (e.g., the Joint Commission) are highly political

Assumptions of the course Political and policy activism requires well informed activists. Political and policy activism requires well informed activists. The most effective & efficient way of gathering information related to health policy and politics is through active membership in professional nursing organizations. The most effective & efficient way of gathering information related to health policy and politics is through active membership in professional nursing organizations.

Health policy course Required of all students in the graduate program in nursing Required of all students in the graduate program in nursing Content is offered & discussion is conducted both in classroom and online: hybrid course meets in class 4- 6 times each semester; summer course is online Content is offered & discussion is conducted both in classroom and online: hybrid course meets in class 4- 6 times each semester; summer course is online

Health policy course Students complete a self-assessment at the start of the course. Students complete a self-assessment at the start of the course. Political Astuteness Inventory adapted from a 1990 book by Goldwater & Zusy Political Astuteness Inventory adapted from a 1990 book by Goldwater & Zusy Reprinted in chapter by Kelly in Yoder- Wise text Reprinted in chapter by Kelly in Yoder- Wise text

Sample items from inventory 1. I am registered to vote. 2. I know where my voting precinct is located. 3. I voted in the last general election. 4. I voted in the last two elections. 5. I recognized the names of the majority of candidates on the ballot and was acquainted with the majority of issues in the last election. 6. I stay abreast of current health issues.

Health policy course Early discussions focus on the “why” and “what” of health policy? Early discussions focus on the “why” and “what” of health policy? Exploration of role of professional nursing organizations in shaping health policy through efforts of members/citizen lobbyists & professional lobbyists Exploration of role of professional nursing organizations in shaping health policy through efforts of members/citizen lobbyists & professional lobbyists

Engaging in political activities Students choose from a menu of activities, which vary by time of year and by political cycles (election year vs. not an election year). These activities require structured reports. Activities are awarded point values that count toward students’ grades. Students choose from a menu of activities, which vary by time of year and by political cycles (election year vs. not an election year). These activities require structured reports. Activities are awarded point values that count toward students’ grades.

Engaging in political activities Students are encouraged to attend one activity with the instructor: local nursing association/SON legislative night, nurse political action day, selected nursing organization meetings. Students are encouraged to attend one activity with the instructor: local nursing association/SON legislative night, nurse political action day, selected nursing organization meetings.

Activities include… Nursing organization meetings where health policy or legislative matters are discussed (excludes nursing unions) Nursing organization meetings where health policy or legislative matters are discussed (excludes nursing unions) Legislative body meetings: state legislature, county board, city council Legislative body meetings: state legislature, county board, city council

Activities include… Regulatory bodies (usually state level): state board of nursing, Illinois Center for Nursing (state government body), county board of health Regulatory bodies (usually state level): state board of nursing, Illinois Center for Nursing (state government body), county board of health Candidate campaigns during election cycles Candidate campaigns during election cycles National political party conventions National political party conventions

Activities include… Interviews with legislators, state senator or state representative or members of Congress, health care leaders Interviews with legislators, state senator or state representative or members of Congress, health care leaders Letters to the editors of local newspapers, national news magazines Letters to the editors of local newspapers, national news magazines Others opportunities that present themselves during the semester Others opportunities that present themselves during the semester

Activities result in… Brief reports that summarize event and offer a reflection of what was learned and any emotional or cognitive responses to the event (the “aha!” moment) Brief reports that summarize event and offer a reflection of what was learned and any emotional or cognitive responses to the event (the “aha!” moment) Instructor preview of letters to the editor for editing/accuracy Instructor preview of letters to the editor for editing/accuracy

Outcomes…. Typical range of scores on first assessment using the Political Astuteness Inventory: 4-15 Typical range of scores on first assessment using the Political Astuteness Inventory: 4-15 Typical range of scores on second assessment using the Political Astuteness Inventory: Typical range of scores on second assessment using the Political Astuteness Inventory: Possible scores: 0-40 Possible scores: 0-40

Outcomes…. “Medicare and Medicaid: I learned so much about [this]!” “Medicare and Medicaid: I learned so much about [this]!” “This has been quite eye-opening.” “This has been quite eye-opening.” “This class made me realize how important it is to become part of the policy making process.” “This class made me realize how important it is to become part of the policy making process.” “This class opened my eyes….I have also been educating my friends, family, & co- workers.” “This class opened my eyes….I have also been educating my friends, family, & co- workers.”

Conclusions Students perceive themselves as having greater understanding of health policy concepts. Students perceive themselves as having greater understanding of health policy concepts. Students assess their knowledge of political/policy basics as greater at the end of the semester. Students assess their knowledge of political/policy basics as greater at the end of the semester % of each class plan to join a nursing organization to “get active.” 25-50% of each class plan to join a nursing organization to “get active.”

QUESTIONS?????