THE ROLE OF THE RN/APRN IN POLICY-MAKING

Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.

What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?

Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation.

RESOURCES

Be sure to review the Learning Resources before completing this activity.Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To Prepare:

• Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.
• Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

BY DAY 3 OF WEEK 8

Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.

 

• Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning.
  • Chapter 5, “Public Policy Design” (pp. 87–95 only)
  • Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137–146)
  • Chapter 9, “Interprofessional Practice” (pp. 152–160 only)
  • Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183–191 only)
• American Nurses Association (ANA). (n.d.). AdvocacyLinks to an external site.. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/
• Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementationLinks to an external site.. Retrieved from https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdf
• Congress.govLinks to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/
• Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementationLinks to an external site.. Academy of Management Review, 21(4), 1055–1080.
• Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patientLinks to an external site.. Journal of Evaluation in Clinical Practice, 21(6), 1014–1017.
• Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretionLinks to an external site.. Public Management Review, 16(4), 527–547.

Welcome to Week 8!  During this week, you will continue to explore the role of the APRN in policy formation.  There are two parts to this week’s assignments:  a discussion board and a written assignment.

Discussion:  For this discussion, you will be focusing on the APRN’s role in policy making.  How do nurses get involved in actually helping create policy? Cite two opportunities that nurses can use to become involved in policy making and discuss the barriers that often occur.  Then, discuss two strategies to overcome these barriers and advocate for nurses to have a more active role in policy making.

Assignment:  For the assignment, you will continue what you started last week.  You will identify a program in your workplace or practice area and describe the role of the nurse in the planning and implementation.  Choose something that is meaningful to you!  Please review the rubrics for each, but pay particular attention to the assignment in which you will prepare a transcript of an “interview” using the questions provided in the assignment guidelines.  If there are questions, let me know!

Suggested APA headings for the Week 8 post:

Two Opportunities for Nurses to Participate in Policy-making

Challenges 

Ways to Overcome the Challenges

Two Strategies to Advocate for these Opportunities

Hillary

Main Post: Week7: Discussion

Evidence base in design

Policy and background

Suicide prevention has been a major issue for emergency services decades, in 2005 SAMHSA launched the national suicide prevention hotline alleviating some on the burden on 911 services (Matthews et al., 2022). However, suicide rates and calls continue to rise, between 2000-2018 suicide rates rose 37%, followed by a slight dip between 2018 and 2020, rates were back at their height in 2021 (Centers for Disease Control and Prevention, 2023). In 2020 congress approved the national suicide prevention hotline to be granted a national number, 988, which became active in 2022 (Mathews et al., 2022). This change was made with hopes that it would catalyze a systematic change in mental health emergency services and continue to direct calls to the 988 number instead of 911.

Many states and localities have expanded on the hotline to provide more access to local resources, including deploying mobile crisis response teams that include mental health professionals (Matthewa et al., 2022).  However, these response teams are not commonplace, and the public continues to utilize 911 services over 988 services. Continued concerns over police being deployed to stop suicide or involuntarily committing users of the hotline began to spread on social media (Pattani, 2022). Many have argued that the mental health hotline does not fix the issue of lack of in person resources or fear of law enforcement. The proposed Bill, H.R. 1423 911 Community Crisis Responders Act of 2023, would “would authorize grants to dispatch unarmed, specialized health care or social service providers to respond to nonviolent emergency calls instead of law enforcement officers” (H.R. 1423- 118th Congress, 2023). In this way the Bill is working to use grants to staff and train personal to work with “with 9-1-1 dispatchers and 9-8-8 call centers to appropriately dispatch services in response to nonviolent emergency calls and connecting individuals with local health and social service providers” (H.R. 1423- 118th Congress, 2023).

Social determinants

The social determinants, as defined by healthy people 2030, economic stability, education, healthcare access, environment and social context all affect this bill (U.S. Department of Health and Human Services, n.d.). The most obvious is social context or population (mental health, rural areas and minority groups). Over reliance on 911 emergency services for decades, along with the variable training and competencies have led to over policing, unnecessary uses of force, criminal legal system involvement, and other negative outcomes which are disproportionally affecting people of color and the mental health community (Pope & Compton, 2022; Matthews et al., 2023). While many still do not know about 988, some states have purposefully kept from publicizing the number for fear of flooding the unprepared centers, so 911 remains to go to emergency number (Sholtis, 2022). However, those who need help have reason to be wary of 911 services, “in 2015, one in four individuals fatally shot by a police officer had a mental health condition” (Matthews et al., 2023). The need for unarmed mobile crisis response teams is clear to decrease negative outcomes and to increase service utilization.

Evidence based support

When 988 went live as the new National suicide prevention hotline number Matthews et al. Conducted a survey of jurisdictions covering over 120 million people and found most reported being severely unprepared with Hispanic communities being least likely to report preparedness (2023a). Although 85% of the jurisdictions contacted reported having hotlines less than half were confirmed as being connected to the lifeline network, which means they would have significantly fewer local resources available (Matthews et al., 2023a). Although 988 hotlines are available in many rural areas many of them do not have the in-person resources to respond to those in crisis, which means 911 ends up responding when hotlines are unable to deescalate patients (Bolton, 2022). This can be dangerous as most police are untrained in mental health de-escalation and can end up making the situation more difficult on the patient, or even end in violence and death (Matthew et al., 2023; Bolton, 2022).

Nurse involvement

Nurses could become a part of the mobile response units, lessening the load on law enforcement, and increasing the medically sound care of people experiencing mental distress. Mental health nurses could also work to train and support law enforcement who are likely to respond to these types of calls. We can advocate for these opportunities by contacting our senators and asking for support in funding mobile relief units. Nurses can also raise awareness by talking to local law enforcement, writing opinion pieces for the local newspaper, or contacting nursing and mental health care associations to start an initiative.

 

References

Bolton, A. (2022, August 29). 988 mental health hotline doesn’t fix the lack of in-person resources in rural areas. All Things Considered. NPR. 988 mental health hotline doesn’t fix the lack of in-person resources in rural areas : NPRLinks to an external site.

Centers for Disease Control and Prevention. (2023, November). Suicide date and statistics. Centers for Disease Control and Prevention. Suicide Data and Statistics | Suicide Prevention | CDCLinks to an external site.

H.R.1423 – 118th Congress (2023-2024): 911 Community Crisis Responders Act of 2023. (2023, March 17). https://www.congress.gov/bill/118th-congress/house-bill/1423Links to an external site.

Matthews, S., Cantor, J. H., Holliday, S. B., Eberhart, N. K., Breslau, J., Bialas, A., & McBain, R. K. (2023). Mental health emergency hotlines in the United States: A scoping review (2012–2021). Psychiatric Services, 74(5), 513–522. https://doi.org/10.1176/appi.ps.20220128Links to an external site.

Matthews, S., Cantor, J. H., Brooks Holliday, S., Bialas, A., Eberhart, N. K., Breslau, J., & McBain, R. K. (2023a). National preparedness for 988-the new mental health emergency hotline in the United States. Preventive Medicine Reports, 33, 102208. https://doi.org/10.1016/j.pmedr.2023.102208Links to an external site.

Pattani, A. (2022, August 25). Social media posts warn people not to call 988. Here’s what you need to know. NPR. Social media posts warn not to call 988. What you need to know : Shots – Health News : NPRLinks to an external site.

Pope, L. G., & Compton, M. T. (2022). “If This Is an Emergency, Hang up and Dial 911” in the Era of 988. Psychiatric Services, 73(10), 1179–1181. https://doi.org/10.1176/appi.ps.20220261Links to an external site.

Sholtis, B. (2022, August 22). The National 988 hotline is up and running but local centers need workers, funding. Morning Edition. NPR. The national 988 hotline is up and running but local centers need workers, funding : NPRLinks to an external site.

The U.S. Department of Health and Human Serivces. (n.d.). Social Determinants of Health. Healthy People 2030. Social Determinants of Health – Healthy People 2030 | health.govLinks to an external site.