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Nurses on a Different Front Line

Miller, Jeannie MPH, BSN, RN; Blackstock, Sheila C. JD, MSM, BSN, RN

AJN, American Journal of Nursing: February 2016 - Volume 116 - Issue 2 - p 11
doi: 10.1097/01.NAJ.0000480476.12266.f9
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Helping to shape U.S. health care policy.

Jeannie Miller is the former deputy group director of the Clinical Standards Group, Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, MD, where Sheila C. Blackstock is a senior nurse consultant. Blackstock is also a retired captain in the U.S. Public Health Service. Contact author: Jeannie Miller, jeanmil21043@verizon.net. The authors have disclosed no potential conflicts of interest, financial or otherwise.

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The Institute of Medicine (IOM) Future of Nursing: Leading Change, Advancing Health report calls for nurses to be “full partners, with physicians and other health professionals, in redesigning health care in the United States.” It cites various settings, including hospitals and communities as well as schools and boards, in which RNs should assert this leadership.

Nurses also belong in the federal government. Their clinical experience, patient advocacy, and participation in interdisciplinary teams make them well-suited for health care policy development, enforcement, program management, and senior leadership positions. Nurses can make a significant contribution, not just at the highest levels of leadership, but also at the foundations of the process, where much of the research and policy development work is done.

Those of us working in health care policy are on the front lines, but not at the bedside. Our work impacts the nation's health care delivery system broadly rather than one patient at a time and is needed at many agencies within the federal government, including the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the Food and Drug Administration, as well as in congressional offices and subcommittees. There are opportunities to work on payment policy, quality improvement, information technology, health and safety, and measure development, among other topics.

Nurses have an array of relevant skills and ­experience—they are trained in listening, teaching, researching, assessing, collaborating, decision making, and consensus building. Their experience delivering care and interacting with patients gives them insight into the translation of policy into practice. This perspective is needed when, for example, nonclinicians are considering requirements or policies that a nurse knows will not work given the workflow of a nursing unit, operating room, or public health clinic. Nurses can give voice to the operational realities of delivering care and the impact on patients of certain care processes, ensuring that these considerations are incorporated into policy proposals. This input is critical if we are to ensure patients have access to high-quality, person-centered health care.

Health care policies are created and implemented by many professionals, including RNs, from a variety of backgrounds and practice settings. Most nurses working in health policy have a bachelor's degree and clinical experience, and many have a master's degree, either in nursing or in public health or management. They come from varied environments, including the military, hospitals, clinics, community health practices, and ­insurance companies. Some are drawn to policy work early in their ­careers, whereas others bring to it years of experience and education.

Policy development is often a team-based, iterative activity that brings together multiple viewpoints as well as varied research and operational considerations. It mirrors the interdisciplinary team approach needed to deliver high-quality patient care. Just as nurses are important members of these health care delivery teams, they are essential members of policy development teams, helping to ensure that regulatory bodies deliver well-developed policies—regarding infection control practices, for example—that improve the lives of millions.

Nurses can position themselves to work in government policy development in many ways. Becoming involved in state and national nursing organizations and with state boards of nursing will broaden an RN's chances of having a direct impact on health care policies—as will the networking opportunities afforded by nursing conferences and meetings.

The voices of nurses are welcome and needed in government. As the IOM report states, “Nurses must see policy as something they can shape rather than something that happens to them.”

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