“Nurses must see policy as something they can shape rather than something that happens to them,” according to the landmark Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. But many nurse education programs, including those that confer doctoral degrees, fall short in educating nurses about public policy, leaving them unprepared to maximize their expertise in policy arenas. To help change that, the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico (UNM) hosted a conference in February that brought together some of the nation’s leading nurse educators, public policy experts, social scientists, and others. The goal was to identify and share effective ways to prepare students in doctoral (PhD and DNP) nursing programs to be health policy leaders who develop, analyze, implement, and research health policy.
“As the health professionals who spend the most time with patients and families, and who have a keen understanding of how policies can affect patients and the care they receive, nurses simply must contribute to health policy formation and implementation at the local, state, and national levels,” Sally S. Cohen, PhD, RN, FAAN, director of the Collaborative, said in kicking off the event. “For many nurses, having a voice on health policies isn’t something that comes easily. So we need to make it something they learn as part of getting their doctoral degrees.”
Cohen co-chaired the two-day conference along with Gabe Sanchez, PhD, interim executive director of the RWJF Center for Health Policy at the University of New Mexico. More than 100 people participated.
Understanding Public Policy
Nurses have vast expertise about the health care needs of both patients and communities, and should lead the way in setting health policy priorities, said keynote speaker Colleen Grogan, PhD, faculty chair of graduate programs in health administration and policy at the University of Chicago. She said nurses can be a force in shaping policies “not just about nursing, but about how to improve health in the United States and globally.”
Referring to John Kingdon’s well-known framework for agenda-setting, Grogan said change occurs in this country through “a problem stream, a policy stream, and a politics stream,” each of which moves independently and in fits and starts. Windows of opportunity open and legislation becomes possible, she said. “We think of ‘big bang’ legislation, such as the Affordable Care Act, Medicare, Medicaid, the New Deal. But that happens, maybe, every 30 or 40 years. Smaller windows of opportunity at all levels open much more often and they add up to change over time.”
Change comes not just from joining coalitions, but creating them, Grogan added. When you create a coalition, “you’re not fighting for a seat at the table. You’re at the head of the table, leading the way.” She urged nurse faculty to teach their doctoral students to build rather than simply join coalitions, frame effective messages, and pay attention to cost and value. “If you develop a policy and haven’t worked out the financing, when the window of opportunity opens, you will get nowhere,” she warned.
Linking Research and Policy
Nurse-led science and discovery can inform public policies, but many nurses have not been taught to translate their research into language that is easily understood. “Really good research changes the discourse,” Grogan said. “Even if you can’t get legislation now, there is still a need to gather stories, and develop evidence and research, so [you’re] ready when a window of opportunity opens. More than many other professionals, nurses are out there in the community, working with vulnerable populations. Nurses conduct research that documents a problem, what’s happening in the real world. ”
But talking to policy-makers does not come easily to many nurses, said Michael Bleich, PhD, RN, FAAN, the Maxine Clark and Bob Fox dean and professor of nursing at the Goldfarb School of Nursing at Barnes-Jewish College. Bleich recalled testifying before a Missouri state legislative committee about scope of practice restrictions on advance practice registered nurses. He prepared detailed evidence, he said, only to be interrupted by a legislator who said: “With all due respect, sir, we don’t care about your evidence. What do you think?”
Talking to lawmakers is “high-stakes communication,” Bleich added, and in some ways runs counter to how nurses are trained to communicate with patients and families.
Jacquelyn Campbell, PhD, RN, FAAN, shared her long-term work to promote policies that will prevent domestic and sexual violence and help victims. Provisions for screening for abuse were included in the Affordable Care Act—a major public policy victory on the issue. She and colleagues conducted research, found compelling stories, educated the public, built broad-based coalitions, developed and refined messages, generated policy changes at the local and state levels, educated lawmakers, and took advantage of windows of opportunity when they opened, she said. Campbell is professor and Anna D. Wolf Chair in the Department of Community Public Health at Johns Hopkins School of Nursing, and director of the RWJF Nurse Faculty Scholars program.
Glenn Flores, MD, professor of pediatrics, clinical sciences, and public health at the University of Texas Southwestern, explained his strategies for building a program of research that led him to become a nationally recognized expert in care for Latino children in the United States. He was eventually invited to testify before Congress. He explained that his work is typically team-based and includes collaboration with nurses.
The Road Ahead
In describing the value of nurses’ expertise, Bleich said: “Nurses speak for those who may not be able to speak for themselves.”
“We need to figure out an evidence-based way to teach policy in nursing programs,” said Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing. “We know firsthand at RWJF that we need more than research; we need great policies to support change in this country. We are learning that you need to translate your research and talk about how it affects patients and families when you talk to policy-makers.”
The Collaborative is implementing much of what experts at the conference recommended, supporting ten fellows who are working toward their PhD degrees in nursing with a health policy concentration. All 10 attended the conference and one fellow, Laura Brennaman, MSN, RN, CEN, spoke on a panel. “Connecting nursing with health policy is not a new idea,” she said, noting that Sojourner Truth, Lillian Wald, and Margaret Sanger were all nurses who challenged or changed health policy.
Read more about the RWJF Nursing and Health Policy Collaborative at UNM.
Read a profile of Nancy Ridenour, PhD, APRN, FAAN, dean and professor at the UNM College of Nursing, who is urging nurses to advocate for public policies that will improve health and health care.