1. Competency Model for Professional Rehabilitation Nursing Behavioral Scenario for Competency 3.3: Impact Health Policy for Persons with Disability and/or Chronic Illness Christine Cave, RN, MSN, CRRN, HFS Copyright©2015, Association of Rehabilitation Nurses

2. Competency 3.3: Impact Health Policy for Persons with Disability and/or Chronic Illness Description/Scope: Effectively champions the healthcare policy process in the legislative arena locally, regionally, or nationally. Presents ethical strategies for effective action. Identifies names and purposes of standard regulatory and accrediting agencies, such as CARF, JC, CMS, and Magnet Demonstrates an awareness of the power of health policy in the provision of care to clients and families living with disability and/or chronic illness Beginner Proficiency Level Descriptors Copyright©2015, Association of Rehabilitation Nurses

3. Behavioral Scenario A nurse from the acute rehabilitation unit is attending a national conference. A speaker addresses the need for all rehabilitation nurses to advocate for the special needs stroke survivors. The speaker describes the special challenges faced by many stroke survivors. She specifically addresses the difficulty with obtaining quality durable medical equipment such as bedside commodes, walkers, reachers and sock-aids. The speaker goes on to describe how expensive some equipment is, despite how necessary it is for these patients. The nurse hears the charge to advocate for the unique needs of stroke patients and contemplates what actions could be taken to respond. Copyright©2015, Association of Rehabilitation Nurses

4. Path 1 – Not Proficient The nurse thinks about the stroke patients she has cared for in her rehabilitation unit. She knows that these patients have unique needs when they go home. But once these patients leave her care, she doesn’t really feel responsible for them anymore. The nurse is aware of support groups for stroke survivors in the community, and figures that that must be what the conference speaker is referring to. Copyright©2015, Association of Rehabilitation Nurses

5. Path 1 – Not Proficient Observations & Outcomes 1.The nurse recognizes that stroke is a disabling condition that can lead to social isolation and depression, but relies on some other mode of support to take care of the people in her care once they are discharged from the hospital. 2.What are the impacts/consequences of not being proficient? Rehabilitation nurses possess the unique skills of advocating for those who cannot advocate for themselves. Rehabilitation nurses can do this for their patients in every aspect of their patients’ recoveries. 3.The nurse should recognize how hospital and agency regulations limit access to supplies that can assist stroke patients to function as independently as possible in their own homes. Copyright©2015, Association of Rehabilitation Nurses

6. Path 2 - Proficient The nurse hears the challenges to all rehabilitation nurses to speak up and advocate for the unique needs of stroke patients. After all, rehabilitation nurses are advocates for patients living with disability and chronic illness through their lifespan. The nurse decides to take action. She returns to her unit after the conference and brings the message to act to her department nursing council. The council together researches the issue and determines the best approach to make an impact. Together, they write letters to their local officials and to a large governing agency to address concerns about access for stroke patients in need of affordable equipment. The rehab nurses decide to put together a DME awareness poster that displays the average costs of various equipment often needed by stroke patients. The rehab nurses form a coalition with other hospitals to advocate for cost reduction of DME for stroke patients in their community. Copyright©2015, Association of Rehabilitation Nurses

7. Path 2 – Proficient Observations & Outcomes 1.The nurse responded to a call to act on behalf of patients commonly served by rehabilitation nurses. Instead of feeling helpless as one, the nurse felt empowered and took action. The nurse recognized that one person can ignite a movement! 2.The nurse and her hospital nursing council researched the issues of DME access and explored the costs related to the types of equipment commonly needed by stroke survivors. They recognized the problem and took action by communicating to their hospital and local community leaders. They wrote letters to government officials and even addressed the issue with the larger regulating agency that sets limits on access to DME. 3.To increase proficiency, the nurse can meet with local DME providers and coordinate efforts to reduce costs and access to the needed DME by stroke patients. Copyright©2015, Association of Rehabilitation Nurses

8. What Did You Observe? How did the outcomes of this scenario differ? Proficient Nurse - Responds to a call to advocate for patients served in rehabilitation environments. - Collaborated with other nurses to spread the message of advocacy. -Wrote letters to community leaders and regulatory agencies to raise awareness of challenges commonly faced by stroke survivors. Non-Proficient Nurse - Did not act despite being challenged to do something - Did not see herself as an advocate for patients she serves - Believed someone else in the community could do the work of advocacy Copyright©2015, Association of Rehabilitation Nurses

9. Takeaways 1.A rehabilitation nurse embraces the role of advocate. The rehabilitation nurse recognizes that patients go on to live lives outside of hospitals, but can still benefit from nurses advocating for their needs in the community. 2.The nurse recruits support to advocate for patient needs. Communicating to other nurses about issues faced by patients is another aspect of advocacy. Raising nurse-awareness about the expensive equipment needed by stroke survivors may change how nurses educate patients about successful living in their home. 3.The nurses took their message to their hospital and used their role as advocates to teach other nurses outside of their specialty. Rehabilitation nurses can make an impact on other nurses outside of their specialty. Copyright©2015, Association of Rehabilitation Nurses