1. Nursing Policy and the Ministry of Health and Long-Term Care Trent University Wednesday March 24, 2004 Sue Matthews Provincial Chief Nursing Officer

2. 2 Nursing Policy in Ontario Ministry of Health and Long-Term Care Administers the largest publicly funded health care system in North America. The annual expenditure for health care in Ontario is $28 billion dollars. Regulates hospitals, nursing homes and long term care facilities. Operates psychiatric hospitals and medical laboratories Co-ordinates emergency health services

3. 3 Role of the Nursing Secretariat Mission To provide leadership in the development, implementation and evaluation of nursing policies, research, and programs, and strategic advice on emerging nursing and health system issues and trends Role Advising on health & public policy from a nursing perspective Providing leadership and fostering collaboration Supporting implementation and monitoring of the provincial strategy for nurses Initiating and supporting strategies to strengthen the nursing profession

4. 4 The Nursing Secretariat Operational Support Joint Provincial Nursing Committee Ministry Divisions Policy Advisory Role Premier’s Office Minister’s Office / Deputy Minister MOHLTC Divisions / Other Ministries Intra-/Inter-ministerial committees Policy Development Provincial Nursing Strategy Platform Commitments Leadership and Collaboration Ministry Liaison to Nursing Stakeholders Federal, Provincial, Territorial Committees Employer Associations Professional Organizations Research Role of the Nursing Secretariat

5. 5 Policy Development Definition of Policy everything a government chooses to do or not to do (Dye, 1972) set of interrelated decisions taken by a political actor...concerning the selection of goals and the means of achieving them within a specified situation, where those decisions should, in principle, be within the power of those actors to achieve (Jenkins,1978)

6. 6 Policy Development Definition of Politics Study of power Conflicts and struggles over leadership, structure, policies Who gets what, when, how (Lasswell, 1958) Goal is power or influence Exists in most organizations

7. 7 Considerations in Policy Development Politics is about Policy Policy is about making or preventing change Politics is use of power for change Politics are the MEANS, Policy is the END Goals: Implementable and sustainable policies Balancing agendas

8. 8 Considerations in Policy Development Power consists of one's capacity to link his will with the purpose of others, to lead by reason and a gift of cooperation (Woodrow Wilson, 1913)

9. 9 Policy Options Formulation Decision-Making Program Design Policy Implementation Evaluation Agenda-Setting Stages of Policy Development Opportunities to Influence

10. 10 Policy Development in the MOHLTC Set Policy Agenda Establish Accountability Develop Policy Options / Recommendations Approved Product Legislation Policy Regulations Guidelines Consultation Document If Financial Implications Approvals Funding & Accountability Implementation Stakeholders, government policy/ program areas involved in identifying issues Provide information Environmental scans Strategic communication Step 1 Consultations Step 2 Develop submission to cabinet/cabinet committees POLICY IS CONFIDENTIAL POLICY IS MADE PUBLIC Cabinet Evaluation Program, Implementation, Communication Plan Management Board Secretariat POLICY WINDOW

11. 11 Influences on Policy Development Allocation of resources Changes in external climate Health care context Consumer values and expectations Electoral cycles  Changes in government or key decision-makers  Commitments made Continuing search for new ideas

12. 12 Influences on Policy Development Platform Commitments for Nursing: Hire 8,000 new nurses Create positive, rewarding working environments Create new nursing school spaces Recruit nurses who have left the profession or left the province 70% of nurses working full-time Fund more positions for nurse practitioners

13. 13 How Priorities are Operationalized National Priorities R omanow First Minister’s Health Accord National Nursing Strategy & the Canadian Nursing Advisory Committee Report Office of Nursing Policy, Health Canada Environmental Drivers Unpredictable Events (SARS) Determinants of Health Aging and Changing Populations Cost Pressures Public & Stakeholder Expectations / Demands Media & IT Nursing Secretariat Priorities Strengthening the Nursing Profession Through: Education, Career, Professional Practice, Leadership, Research MOHLTC Priority Issues Priority Nursing Issues Policy

14. 14 Priority Nursing Issues Priorities identified through reports and by stakeholders that impact on nursing include: Unemployment / underemployment Health and safety for Nurses (highlighted by SARS) Barriers to full scope of practice Supply of nurses: high rates of retirement, limited ability to recruit or retain, limited educational capacity Funding models for nursing services are efficiency based and challenge stability - e.g. sustainability/productivity vs. efficiency

15. 15 Nursing Secretariat’s Vision for Nursing Ontario’s nurses will be leaders in Ontario’s health system through: Making nursing a profession of choice Having the best, most current knowledge Creating effective and supportive professional environments Applying full scope of practice in all health care sectors

16. 16 Nursing Influencing Change Stakeholders & Interest Groups: Connect individuals to political system Articulate political demands yDefine the problem yTransform demands into public policy Seek support for demands Demonstrate leadership Influence choice of political personnel Influence processes of policy development Influence enforcement of policy

17. 17 Nurses Influencing Change One person with a belief is equal to a force of 99 who have only interests (John Stuart Mill, 1806-1873)

18. 18 Be Aware Knowledge of current issues and the policy process Be Involved - Spheres of political influence Workplace Professional Associations (RNAO, RPNAO, ONA, NPAO) Community Government (political and bureaucratic levels) Opposition Nurses Influencing Change

19. 19 Be Strategic Communication Collegiality Collectivity Capitalize on Policy Windows Nurses Influencing Change

20. 20 How to make a difference: Understand the bigger picture, process, and limitations Communicate effectively - facts and evidence Explain the importance Tell your story Participate - associations, research, surveys Build support, co-ordinate, collaborate Avoid tribalism Public criticism as last resort No surprises Nurses Influencing Change

21. 21 Our own success, to be real, must contribute to the success of others (Eleanor Roosevelt) Nursing involvement and influence in the development of policies will lead to improvements for nurses, impact and influence the health of Ontarians, and improve access and quality of care for those requiring health care Be involved! Nurses Influencing Change