LEADERSHIP AND HEALTH POLICY
APRNs provide excellent patient care; this is supported by multiple studies (Stanik-Hutt, 2013). They are comfortable advocating for their patients, but they may not see the connection between advocating for health policy and providing quality care. Without development of leadership competencies and influence at decision-making tables, clinical competence will not be enough to affect care. Leadership skills that are especially important in advocacy for health policy include vision, timing, risk taking, communication, and relationship building. Others have cited the legacy of Florence Nightingale and her response to the "moral imperative" as a model for leadership in health policy development today (Falk-Rafael, 2005, p. 213). Florence Nightingale's vision for change was informed by her practice on the battlefields in Crimea. APRNs also bring that practice experience to the policy tables. It is their stories that personalize for decision makers the impact of the policies they create.
The National Organization of Nurse Practitioner Faculties (NONPF) published updated Nurse Practitioner Core Competencies in 2012. At least four leadership competencies directly relate to leadership in health policy:
(1) Assumes complex and advanced leadership roles to initiate and guide change
(2) Provides leadership to foster collaboration with multiple stakeholders (e.g., patients, community, integrated health care teams, and policy makers) to improve health care
(4) Advocates for improved access, quality and cost-effective health care
(7) Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus (p. 2)
These competencies reflect NONPF's endorsement of the doctorate of nursing practice (DNP) as entry level for nurse practitioner practice. The Essentials of Doctoral Education for Advanced Nursing Practice (American Association of Colleges of Nursing [AACN], 2006) Essential II addresses leadership and includes the expectation that DNP graduates will engage in policy development to improve health care quality and access.
Why should APRNs care about becoming leaders in health policy? For many APRNs, moving from leadership in clinical practice to leadership in health policy is not an obvious choice. However, APRNs need to understand how the skills used in motivating patients to improve their health are the same skills that can move legislatures to pass laws and develop rules that will allow APRNs to practice to their full scope and remove the obstacles to providing quality care to their patients. Policy makers at the federal, state, and local levels influence what nursing professionals can do, how they do it, and what they are paid. Public policies dictate who has insurance and what insurance will pay. Public policies and how they are implemented shape the direction of health care delivery. They affect the experience of providers as they practice and the experience of consumers as they attempt to receive care in an increasingly complex and expensive system. APRNs need to have the resources to stay informed and respond to proposed changes to local, state, and national policies that will affect their practice and the care their patients receive.
PUBLIC POLICY: THE PROCESS
The U.S. Constitution was written by men of vision. Their ability to frame a document that not only addressed current issues but allowed for adaptation to challenges faced in the future has been cited as the reason the Constitution has remained relevant. The document set forth broad principles in general terms that allowed future interpretation based on the context at that time (Stone & Marshall, 2011). When laws contain specific language, adaptation to changes in the future environment may be stymied. Medicare Law PL. 89-97, passed in 1965, specified that authority for many actions was limited to physicians. Lawmakers did not envision future changes to a physician-dominated health care system because most of the advanced practice roles did not exist at that time. This limitation has resulted in a number of barriers to APRN practice and provided strong motivation to include provider-neutral language in laws and rulemaking. Inclusion of provider-neutral language is one of the key priorities of the APRN Health Affairs agenda today.
The Constitution describes three branches of government and delineates the responsibilities of each. The legislative branch, which includes the Senate and the House of Representatives, creates the laws, confirms presidential appointments, and has the power to declare war. The executive branch includes the president, the vice president, and the cabinet and is charged with carrying out and enforcing the laws, including the responsibility for rulemaking. The judicial branch includes the Supreme Court and other federal courts; it is responsible for settling conflicts that occur over the law, interpreting the law, and deciding whether a law is constitutional (USA.gov, 2014).