Posted: August 15th, 2022

DQ Services within the broader health care system

DQ Services within the broader health care system

PSLO 4:Collaborate with inter-professional teams to provide services within the broader health care system.

PSLO 6:Promote ethical practice and research within the nursing discipline and organizational and political environments

CO 1: Integrate components of leadership, systems, and related nursing theories into professional

nursing practice.

CO 2: Evaluate healthcare issues within the context of policy, practice, and economic implications.

CO 6: Participate in political processes and grass roots legislative efforts to influence healthcare policy.

Competencies (4g, 4h, 4j, 6j, 6k, 6l)

4g) Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, including local, state and national healthcare trends impacting nursing care delivery. Show that you know the basics about healthcare policy, finances, and regulations, as well as local, state, and national healthcare trends that affect how nursing care is given.

4h) Explain how health care is organized and paid for, including the effects of business principles like cost factors for both patients and the system.

4j) Look at the ways that laws and rules affect the way healthcare is given. (5.4)

4h) Describe how health care is organized and financed, including the implications of business principles, such as patient and system cost factors.

4j) Examine legislative and regulatory processes relevant to the provision of healthcare. (5.4)

6j)Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety, and the scope of nursing and other health professionals’ practice.

6k) Participate as a nursing professional in political processes and grass roots legislative efforts to influence healthcare policy.

6l) Describe state and national statutes, rules, and regulations that authorize and define professional nursing practice that various populations.

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Demonstrating Competencies in Healthcare Policy and Political Advocacy”:
Introduction
As healthcare professionals, nurses play an important role in advocating for patients and shaping healthcare policy. This paper will explore several competencies related to healthcare policy, finance, regulations, and political advocacy. It will provide context on how healthcare is organized and financed in the United States and examine the roles of regulatory agencies. Finally, it will discuss strategies for nurses to participate in the political process and grassroots efforts to influence healthcare policy.
Healthcare Organization and Financing in the United States
The United States healthcare system is largely private and employer-based. Around 55% of Americans receive health insurance through their employer, while others obtain coverage directly through private insurers or public programs like Medicare and Medicaid (KFF, 2022). Healthcare costs are shared between patients, employers, and insurers through premiums, deductibles, copays, and other out-of-pocket expenses. However, rising costs have made healthcare increasingly unaffordable for many Americans (Squires & Anderson, 2015).
The Affordable Care Act of 2010 was a major reform aimed at expanding coverage and reducing costs. Key provisions included prohibiting insurers from denying coverage due to preexisting conditions, allowing children to stay on their parents’ plans until age 26, establishing health insurance marketplaces, and expanding Medicaid eligibility (Obama, 2016). However, the law continues facing political and legal challenges that threaten coverage gains. Ongoing debates around “Medicare for All” proposals also illustrate the lack of consensus around how best to achieve universal coverage (Oberlander, 2020).
Business principles like cost-effectiveness strongly influence the U.S. healthcare system. Insurers and providers focus on reducing unnecessary utilization to control premiums and costs. Payment models are also shifting from fee-for-service to value-based arrangements like accountable care organizations and bundled payments (Porter & Lee, 2013). These changes aim to incentivize quality over quantity of care. However, some argue they may also limit access or disproportionately impact vulnerable groups (Frakt, 2016). Overall, navigating the complex financing structure presents ongoing challenges for both patients and providers.
Regulatory Agencies and Their Impact
Several government agencies play key roles in regulating healthcare and protecting public health:
The Centers for Medicare and Medicaid Services (CMS) oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplaces. CMS sets coverage and payment policies that strongly influence the entire industry (CMS, n.d.).
The Food and Drug Administration (FDA) ensures the safety and efficacy of drugs, medical devices, and other health products. New products must undergo rigorous review and approval processes overseen by the FDA (FDA, n.d.).
The Centers for Disease Control and Prevention (CDC) works to protect public health through prevention and control of diseases. The CDC conducts surveillance, research, and provides guidance to healthcare professionals and the public (CDC, n.d.).
These agencies establish standards that providers must meet around issues like clinical quality, safety, privacy/security, and scope of practice. Their rules and oversight aim to balance innovation, access, and consumer protection. However, the regulatory burden is also a common source of frustration among some providers (Barnes & Burke, 2006). Overall, understanding these agencies’ roles is important for navigating the healthcare system and advocating for patients.
Nursing Practice and Scope Regulations
At the state level, boards of nursing establish rules and regulations that define the scope and standards of professional nursing practice. For example, they determine which nursing interventions require supervision versus independent performance and delineate appropriate delegation of tasks. State statutes also protect the title of “registered nurse” and define unauthorized practice (NCSBN, 2019).
While regulations aim to ensure safe, high-quality care; they can also unintentionally limit innovation or the full use of nurses’ clinical skills. Many argue the scope of practice for advanced practice registered nurses (APRNs) like nurse practitioners (NPs) should be expanded (Xue et al., 2018). APRNs with appropriate training could help address provider shortages, especially in underserved areas. Scope laws vary significantly between states, creating barriers for telehealth, telemonitoring, and mobility of the nursing workforce across state lines. Overall, understanding both the intent and limitations of one’s scope of practice is important for ethical and compliant nursing care.
Political Advocacy and Influencing Healthcare Policy
As the largest healthcare profession, nurses are well-positioned to advocate for patients and influence policy change. Some strategies for political advocacy include:
Contacting legislators to voice support or concerns for pending bills. Nurses can share how policies would impact patient care from their clinical perspective.
Participating in lobby days where groups meet with representatives in person to discuss key issues. Having face-to-face interactions helps build relationships.
Joining professional organizations that monitor policy and mobilize members for calls to action. For example, the American Nurses Association actively lobbies on issues like nurse staffing ratios and full practice authority.
Running for local or state political office. Having nurses serve as representatives helps ensure healthcare perspectives are considered in policymaking.
Educating the public and rallying grassroots support for issues. When constituents contact their representatives en masse, it demonstrates the salience of an issue.
Partnering with other professions through interprofessional coalitions. Collaborating amplifies the voice for change and builds understanding across disciplines.
Overall, political will and public support are needed to reform complex systems like healthcare. Nurses play a vital role in cultivating both through relationship-building, education, and mobilizing collective action. Advocating respectfully within their scope and expertise allows nurses to fulfill their duty to patients and improve population health.
Conclusion
In summary, demonstrating competencies in healthcare policy, financing, regulations, and political advocacy is an important part of nursing practice. Nurses must understand how the U.S. system is organized and the roles of key agencies to provide effective, compliant care and advocate for patients. While regulations aim to ensure safety, they can also unintentionally limit innovation or full use of nurses’ skills. Political participation through relationship-building, grassroots efforts, and interprofessional collaboration allows nurses to influence policy change from an informed clinical perspective. Overall, applying these competencies empowers nurses to fulfill their professional responsibilities and shape a more equitable, accessible healthcare system for all.
References
Barnes, A. J., & Burke, T. F. (2006). The diffusion of innovation model: A framework for implementing change in intensive care units. Critical care clinics, 22(3), 507-516.
Centers for Disease Control and Prevention. (n.d.). About CDC 24-7. Centers for Disease Control and Prevention research essay writing service. https://www.cdc.gov/about/default.htm
Centers for Medicare & Medicaid Services. (n.d.). What is CMS? Centers for Medicare & Medicaid Services study bay. https://www.cms.gov/About-CMS/About-CMS
Frakt, A. B. (2016). How much do hospitals cost shift? A review of the evidence. Milbank Quarterly, 89(1), 90-130.
Food and Drug Administration. (n.d.). What does FDA regulate? Food and Drug Administration. https://www.fda.gov/about-fda/what-we-do
Kaiser Family Foundation. (2022, March 30). Health Insurance Coverage of the Total Population. KFF. https://www.kff.org/other/state-indicator/total-population/
National Council of State Boards of Nursing study bay. (2019). NCSBN Model Nursing Practice Act. https://www.ncsbn.org/14730.htm
Oberlander, J. (2020). The future of single-payer health care in the United States. New England Journal of Medicine, 382(18), 1677-1679.
Obama, B. (2016). United States health care reform: progress to date and next steps. JAMA, 316(5), 525-532.
Porter, M. E., & Lee, T. H. (2013). The strategy that will fix health care. Harvard business review, 91(10), 50-70.
Squires, D., & Anderson, C. (2015). US health care from a global perspective: spending, use of services, prices, and health in 13 countries. Issue brief  study (Commonwealth Fund), 15, 1-15.
Xue, Y., Ye, Z., Brewer, C., & Spetz, J. (2018). Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing Outlook, 66(1), 71-85.

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