1. CLASS ONE – NURSING HISTORY

2.  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

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

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

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

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

7.  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?

8.  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

9.  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

10.  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)

11.  5 stages - Anderson J.E. (1984) 1. Policy agenda 2. Policy formulation 3. Policy adoption 4. Policy implementation 5. Policy evaluation

12.  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

13.  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

14.  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

15.  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

16.  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

17.  Problem stream  Policy stream  Political stream

18.  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

19.  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

20.  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

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

22.  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

23.  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

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

25.  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