1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 23 Nursing, Policy, and Politics: Understanding the Connection and Importance of Getting Involved

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions Policy –Government programs –Relationship of citizens to one another –Manifestations of ideology or belief systems about how the world should work –Public policy = government actions (foreign, economic, and social)

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Federal Policy Policy making at federal level Health care policy in all three areas –Health-related defense policy: military health care; weapons of mass destruction –Health-related domestic policy: payment for children’s vaccinations; Medicare services –Health-related foreign policy: assistance to nations to prevent HIV/AIDS; family planning/nutrition assistance to developing countries

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Policies and Values Policy: goal and priority setting by a society or organization Decisions about how and what resources used to achieve goals Policies reflective of values, beliefs of leaders making them Female policy makers promote policies addressing social issues Policies by nurses showing strong belief in assisting people to care for self

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Policies and Values (cont.) Caring: value central to nursing, women –Not a value receiving much attention by institutions, government policy makers Nursing involvement necessary for change

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Politics Government of the city-state Actions of a government, politician, or political party Process by which communities make decisions and govern Managing of a state or government Process of influencing allocation of scarce resources required for policy goal achievement Power and influence, significant investment in social capital necessary Who gets to decide what will be done and when

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following would be an example of a health- related domestic policy? A. Military health benefits B. Use of weapons of mass destruction C. Medicare services D. HIV prevention in other countries

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Examples of health-related domestic policies might include payment for children’s vaccinations and Medicare services. Military health care benefits and use of weapons of mass destruction are examples of health-related defense policies. Assistance to other countries for HIV prevention would be an example of a health-related foreign policy.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Politics (cont.) Political skill –Ability to understand another’s values and position –Use that understanding to influence others to act –4 essential components Social astuteness Interpersonal influences Networking ability Apparent sincerity

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Models for Policy and Policy Development Kingdon’s Streams of Policy Development (see Box 23.1) –Problem stream (problems, indicators, social construction; see Box 23.2) –Policy stream (potential policy solutions; feasibility, value acceptability) –Political stream (benefits vs. costs; external pressure for action; interest groups) –Convergence of three streams necessary

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Models for Policy and Policy Development (cont.) Systems-based model –Asses, plan, implement, evaluate, assess again –Critics’ arguments: rarely reflective of consensus; omission of interest-group influence

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Policy Making and Politics Engagement in process necessary for changes –Continuum from no engagement to extreme activism –Nurse as citizen->nurse as activist->nurse as politician –Spectator activities, transitional activities, gladiatorial activities –People who make things happen; people who watch what’s happening; people who wonder what’s happened

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Benefits and costs are elements of the policy stream.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. The policy stream involves feasibility and value acceptability. Benefits and costs are part of the political stream.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Toolkit for Political Advocacy Get involved Use voice, experience, and expertise Participate Stay informed Embrace and act

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Political Action Committees Nurses Coalition for Action in Politics (precursor to ANA PAC); “1 in 44” ANA lobbying to extend Nurse Training Act Growth of ANA-PAC

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Political Parties and Politics Need to pick a political party that reflects nurses views and become involved Democrats: public systems with taxpayers funding access to health services with a guaranteed benefit package and price controls Republicans: market strategy with consumers making choices based on cost and quality within private systems; market choices keeping prices down Tea Party Movement

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Beyond the Bedside Need for nurses to move to board room or at least be represented at tables of influence Need to balance care of patients with concerns of health care policy Involvement in professional organization as a way to increase influence Involvement in elections, being informed (see Box 23.4) Letters to legislative representatives (see Box 23.5) Lobbying on issues of concern

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Leaders: Policy Pioneers Lavinia Dock: nurses for social awareness Lillian Wald: public health, child welfare (Henry Street Settlement; Outdoor Recreation League; Children’s Bureau; National Organization for Public Health Nursing) Margaret Sanger: birth control (National Committee on Federal Legislation for Birth Control; American Birth Control League [Planned Parenthood Federation of America]) Martha Minerva Franklin: segregation, discrimination (National Association of Colored Graduate Nurses; National Black Nurses Association)

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Lillian Wald was an early public-policy pioneer, championing for child welfare and public health.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Lillian Wald exemplified involvement in social change, community leadership, and politics. She advocated for public health and child welfare.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurses and Social Change Outlawing child labor Protection of women abandoned by husbands Civil rights movement, elimination of segregation Women’s movement of 1970s Equal rights amendment Strikes for equal wages (1980 and beyond)

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 21st-Century Nursing Leaders Mary Wakefield: Nation’s Health—administrator of the Health Resources and Services Administration (HRSA) Loretta Ford: first Pediatric Nurse Practitioner model of advanced practice Gayle Douglas: Nurse Managed Center

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Insurance: Then & Now National Health Insurance, recognition of nursing’s impact –Proposal for national health care: first by T. Roosevelt, then F. D. Roosevelt, then Truman –Emphasis lost during 1950s; resurgence again in 1974 –1992/1994: development of Health Security Act—did not pass Congress –Patient Protection and Affordable Care Act (2010)

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? National health care was first proposed during the Clinton administration.

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. The concept of national health care was first proposed by Theodore Roosevelt but was unsuccessful.

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation