Nursing Healthcare Wk5/PROJECT The Nurse as Advocate

Nursing Healthcare Wk5/PROJECT The Nurse as Advocate

Nursing Healthcare Wk5/PROJECT The Nurse as Advocate

Whether nurses are advocating for their patients, health care, and/or policies that improve people’s lives, the advocacy processes have commonalities that transcend the subject of their advocacy. There are also differences, although these differences may be more nuanced than obvious.

Write a 5-page brief to answer the following questions. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.Read the following chapters from your course textbook:(((SEE ATTACHED DOCUMENTS /CHAPTER 76-80)))))

Taking Action: Nurse, Educator, and Legislator: My Journey to the Delaware Senate
Taking Action: A Nurse in the Board Room
Answer the below questions:

Describe what you believe to be the drivers for each of the individuals? What factors led them to become advocates?
Discuss the challenges that each of them identified in their writings.
Analyze these drivers and challenges and compare them with your own experience to date as an advocate. In what ways do you believe that you can expand your advocacy skills within the next five years?
Submission Details:
Submit your response in a 5-page Microsoft Word document.
Cite sources in the APA format on a separate page.


Advocacy is a dish best served unified. No matter the issue, if more than one player in the process supports or opposes it, there is an increased potential that the final action will result in their favor. Although there are multiple factors that may impact this (i.e., the reputation of the players, their influence, or the political dynamics), the general rule is power in numbers. Legislators anticipate that their staff will thoughtfully investigate both sides of an issue and present them with sound options on how to proceed. The support of constituents, opinions of national or state organizations (depending on the legislative body), historical positions of the office, coalitions, and, of course, influence are major factors in the decision-making process. Of these, coalitions certainly make a sizable impression. If likeminded groups, particularly from diverse fields of expertise, join together for a common cause, it is noticed. There are many forms of coalitions, some more formal than others, but the question becomes, what makes a coalition effective? And, more importantly, why have they become increasingly necessary? Nursing Healthcare Wk5/PROJECT The Nurse as Advocate

The Necessity of Coalitions

Competition often necessitates coalition formation when political pressure to win is intense. Competition, in other words, is defined as the scenario when multiple parties have differing interests at stake, and the outcome of a particular policy favors one group’s interests over another’s ( Holyoke, 2009 ). For example, in today’s health care system, multiple parties, including health care professionals, hold interests and positions that do not always align and competition intensifies when the stakes are high. Essentially, the battle to advance a policy position focuses on who has the most presence on an issue, both the type that goes noticed and that which does not.

Consider any issue nurses would be passionate to promote. Does the profession have the resources to tip the odds in their favor (i.e., time, financial infrastructure, individual advocates)? The public assumes policy is formed on the basis of evidence, and this assumption is absolutely true. However, the wise citizen knows that evidence alone is not always the deciding factor. Take, for example, advanced practice registered nurses (APRNs) being able to practice to the full extent of their education and training. There are decades and mountains of evidence to show that APRNs are effective clinicians who can provide cost-effective, high-quality care. If evidence is all it took to create policy, then why is there not full practice authority for APRNs in all 50 states? There is much more to policy than evidence; there is politics. And politics is driven by competition. If competition is driven by those with the most resources to win, what are nursing’s odds?

Time and time again we see advances made at the state level to amend practice acts that would allow APRNs to serve their patients to the level they were educated. Nursing organizations at the state level have made tremendous strides to find legislative champions, allies in the community, and partnerships among their associations, but when push 615comes to shove, the odds do not end up in their favor. It would appear that a perfect campaign was run, but the effort fell short. Ask any nurse who has endured this encounter and they will say their competition was intense.

Take, for example, a 2014 case in Nebraska. The efforts of the nurses in the state to pass Legislative Bill 916 were formidable. This bill would have eliminated the requirement that nurse practitioners must have a practice agreement with a collaborating physician. It passed the state legislature. However, when the bill was sent to the Governor’s office, he notified the members of the legislature that he would not sign it, expressing the concern that the bill “goes too far too quickly” (, 2014 , para 3), despite the fact that the legislation included a transition period in which new graduate nurse practitioners would have a 2-year transition into practice with a collaborating physician. In the Governor’s official letter that vetoed the bill, he states,

… the Chief Medical Officer expressed concern that the “total independent practice for nurses practitioners … without identifying an alternative means by which nurse practitioner can be included in viable practitioner referral networks creates potential safety issues for patients.” The Chief Medical Officer also stated that “recent graduates of nurse practitioner programs … lack sufficient clinical experience to practice independently”… (, 2014 , para 4)

The Governor’s letter does not mention the body of evidence supporting the APRN full practice authority or the Federal Trade Commission’s (FTC) recent position that:

As explained herein and in prior FTC staff APRN advocacy comments, mandatory physician supervision and collaborative practice agreement requirements are likely to impede competition among health care providers and restrict APRNs’ ability to practice independently, leading to decreased access to health care services, higher health care costs, reduced quality of care, and less innovation in health care delivery. For these reasons, we suggest that state legislators view APRN supervision requirements carefully. Empirical research and on-the-ground experience demonstrate that APRNs provide safe and effective care within the scope of their training, certification, and licensure. ( Federal Trade Commission, 2014 , p. 38)

One of the glaring issues in this debate is always education and clinical hours, not necessarily the outcomes. In a letter written by the American Association of Colleges of Nursing, the rigor of APRN education was presented ( American Association of Colleges of Nursing, 2014 ). Moreover, some health care disciplines are moving to a competency-based educational system over a prescriptive number of clinical hours. There are a host of factors that could have played a role in the Governor’s decision, but he only cited one opinion in his veto letter: that of the Chief Medical Officer. One thing can be said in this case: there is competition in who helps inform the ultimate decision. Even the Institute of Medicine’s (IOM’s) The Future of Nursing report calls for nurses to assume more highly influential policy positions, stating, “Public, private, and governmental health care decision makers at every level should include representation from nursing on boards, on executive management teams, and in other key leadership positions” ( IOM, 2011 , p. 5).Nursing Healthcare Wk5/PROJECT The Nurse as Advocate

In a competitive environment, as the number of players involved grows, the spectrum of positions becomes wider and the pot of resources needed to win becomes larger. Even within a larger group representing smaller, but similar interests, it is difficult to imagine that the positions and preferences of these smaller subgroups would be exactly the same ( Moe, 1980 ). For example, the nursing profession is represented by more than 100 national organizations. Conceivably, one could assume that there are at least 100 policy positions that represent a segment of the nursing profession. Realistically, many of these nursing organizations have similar policy interests. Finding middle ground that appeals broadly helps to build the case for taking unified action ( Holyoke, 2009 ). When multiple groups can convene around their common interests, the collective action of these groups helps promote competition and secure an outcome in their favor.