Leadership & Management Triaxal of Actions Discussion

Leadership & Management Triaxal of Actions Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Leadership & Management Triaxal of Actions Discussion Read Chapter on Davis Plus: Discussion of Triaxial of action: Policy, Politics,and Nursing. Leadership & Management Triaxal of Actions Discussion 1- What is Policy? 2- Explain each of them: Public policy— Private policy— Health policy— Social policy— Organizational policy? 3- Who was Florence Nightingale, and what was her contribution to the Nursing Field? 4- Who was Lillian Wald? 5- Who was Margaret Sanger, and in what way she helped to the developments of Nursing Field? 6_ What is (ICN), and what they do? 7- What is s (NLCA) and they do? Jeanne Blum, RN, is a nurse on a LDRP unit. Recently, the policy and procedures manual for Jeanne’s unit included the premature rupturing of membranes of a laboring patient as a practice acceptable for nurses to perform. Jeanne and some of her coworkers shared their concern over lunch about this new responsibility.They felt uncomfortable with the possibility of cord prolapse and other potential medical complications resulting from this practice. Jeanne gathered data from her state and many others states and noted that her hospital was not in compliance with her professional organization practice standards. Jeanne shared this information with her coworkers. She volunteered to contact the state board of nursing on their behalf to request a declaratory statement on the nurse’s role in the initiation of premature rupturing of uterine membranes. Her state board’s clinical practice committee reviewed her request for a declaratory statement and gathered information from other states. A formal declaratory statement was drafted by the board and made it available on its Web site. A letter from the board was sent to Jeanne’s institution, informing it of the declaratory statement, which stated that the task nurses were requested to perform was beyond their scope of practice based on the Nurse Practice Act. 8- Which stage of the policy model does this scenario represent? attachment_1 2208_Ch02_019-046.qxd 6/23/09 11:28 AM Page 19 bonus chapter 2 Triaxial of Action: Policy, Politics, and Nursing OBJECTIVES After reading this chapter, the student should be able to: ? Provide fundamental information on how to shape policy in a political environment. ? Define key terms regarding policy. ? Review the values that are the foundation for health-care policies and political processes. ? Describe the influences that novice nurses must face related to policy issues. OUTLINE Defining Policy Defining Politics as It Relates to Policy History of Nursing Politics 19th Century—Florence Nightingale and Sojourner Truth Early 20th Century—Lillian Wald Mid-20th Century—Margaret Sanger Nursing’s Political Growth in the 21st Century Policy and Nursing Governance Regulatory Policy—International and National History of Nursing Licensure Professional Nursing Organizations: Where Regulation Stands Now NCLEX Testing Multi-State Licensure Compact State Boards of Nursing Organizations for Political Action American Nurses Association Nursing Organizations Alliance National League of Nursing Policy Models: A Guide Conceptual Model of Political Development Four Spheres of Political Influence Nursing and Political Action Novice Role: Nursing and Policy Nursing Values Policy Policy Position and Ethical Practice Nursing Policy Issues Nursing Shortage Mandatory Staffing Ratios Policy Affecting Nursing Cost-Containment Initiatives Quality Data Reporting Payment for Performance Report Cards—Transparency Growing Need for Policy Action Patient Advocacy Access to Care Trust in the System Conclusion 19 2208_Ch02_019-046.qxd 20 6/23/09 11:28 AM Page 20 bonus chapter 2 | Triaxial of Action: Policy, Politics, and Nursing In the nursing profession, there is an educational void with regard to information related to policy and politics and the nursing role. In 2009, it has become even more important that nursing students are exposed to policy and politics during their educational preparation. This preparation will lay the foundational understanding of the political process, assisting nursing students to understand that policy decisions are part of their environment and preparing graduate nurses to become involved and ultimately to drive the political process. Leadership & Management Triaxal of Actions Discussion Politics is a world that is continuously changing, and nurses have an opportunity to choose political action and thus become participants in policy changes. Defining Policy Policy comes from two different Greek roots, one meaning demonstration or proof and the other meaning citizenship (Chrichton, 1981). It is the citizenship root that we will be addressing. One definition of a policy is “a purposeful, overall plan of action or inaction developed to deal with a problem or a matter of concern in either the public or private sector” (Milstead, 2004, p. 195). Policy has also been defined as “the continuous chosen course of action/inaction directed toward some end” (Kalisch and Kalisch, 1982, p. 61) or simply as “authoritative decision making” (Stimpson and Hanley, 1991, p. 61). The following definitions of policy and process will provide a better understanding of these related terms: Public policy—Affects institutional and individual behaviors such as professional licensure or legislation. Public policy can address local, state, or federal issues. ? Private policy—Usually refers to agency or institutional rulings that address employment through policies, procedures, directives, and guidelines. ? Health policy—Refers to health-care reimbursement, resources, and/or services related to public or private health-care institutions. ? Social policy—Refers to addressing and promoting the public welfare. ? Institutional policy—Similar to public policy, but usually discusses how the institution complies with public policy. ? Organizational policy—Positions taken by nursing organizations such as specialty nursing associations like the American Organization of Registered Nurses (AORN) and national ? nursing organizations like the American Nurses Association (ANA). ? Policy analysis—Evaluation of the total effects of a policy as it relates to political, social, economic, legal, or ethical aspects of proposed or instituted policies. (Mason, Leavitt, and Chaffee, 2007) Defining Politics as It Relates to Policy When discussing policy, the subject of politics inevitably arises, as if these terms can be used interchangeably. Politics is an action or a behavior that is often used to drive the legislative process. The goal of political action is to influence the end product— policy. Politics, closely related to policy, opens the floodgates to many varied opinions. The term politics means the “influencing the allocation of scarce resources” (Talbott and Vance, 1982, p. 592). Opportunities exist to influence the outcomes of the political process. Health care deals with the allocation of scarce resources, dividing limited supplies and resources among members of society. Scarcity means there are limitations to available resources and therefore not everyone will have equal access. Nurses are affected by and direct the use of scarce health-care resources and dollars on a daily basis. They are impacted by the limitations and roadblocks in the health-care system as they try to obtain authorization from providers for patient-care services. However, the profession of nursing feels alienated from the political arena. Even though the profession is significantly impacted and directed by policy decisions, it has been slow to participate in the process. Nursing needs to be competent in health-care leadership dynamics if it is to have input into the workplace. Nurses respond inconsistently to political action. On the one hand, they traditionally have referred to the behavior of goal-oriented colleagues as “playing politics,” a description that is not meant in a positive way. However, when they need and want their nurse executive to be politically aware, they express opposite views. To benefit personally and professionally, nurses need a “go-to” person who is able to accomplish change. Whether one perceives politics as negative or positive depends largely on the following factors: ? ? Acknowledging individual biases Knowing how the “game” of politics is played 2208_Ch02_019-046.qxd 6/23/09 11:28 AM Page 21 bonus chapter 2 | Triaxial of Action: Policy, Politics, and Nursing Understanding the rules in which politics is operating ? Realizing whether the goals or ends are important ? Realizing when one is in a position to change the rules of the system (Mason, Leavitt, and Chaffey, 2007, p. 4) Leadership & Management Triaxal of Actions Discussion ? Policy and politics are important parts of the nursing profession. Nurses can either help create policy or will be required to respond to it. Politically astute nurse executives know that relationshipbuilding and networking are required for successful leadership. Relationships become valuable when issues require consensus and compromise. It is important for every new nurse to realize that relationship-building starts early and builds throughout their professional career. Relationshipbuilding cannot be put off until help is needed. Networking, starting as a personal acquaintance, builds to invaluable relationships that can be called upon in a time of need. History of Nursing Politics Nursing has had many visionaries and heroines who have addressed social, cultural, and health problems. These nurse laureates did not remain silent, but sought to use their voices to highlight the injustices affecting broad groups of citizens in the neighborhoods and across the world. It is important to celebrate those nurses who worked so diligently to shape policy in their eras and had the courage to make a difference. 19th Century—Florence Nightingale and Sojourner Truth The most famous nursing visionary, Florence Nightingale (1820–1910), was a statistician and politician who lobbied for safer health care. After the Crimean War, Nightingale was confined to bed for much of the time but used this time to send her message to nurses and politicians. She sent roses and held teas for new graduates, challenging the new nurses to use principles of infection control in their practice. Because of her training as a statistician, she valued collecting data that could support and influence people’s minds. Policy makers found the information fascinating and came to her bedside seeking useful information. Nightingale’s message was clear and her methods of lobbying for her 21 cause were successful: “She was a leader who knew how to garner the support of her followers, colleagues and policy makers and used her skills to change her environment” (Mason, Leavitt, Chaffee, 2007, p. 14). Sojourner Truth, originally named Isabella Van Wagner (1795–1883), who was born into slavery, provided nursing care to Union soldiers during the Civil War. Truth became politically active and sought federal funds to train nurses and physicians. In her speeches, she actively opposed slavery and advocated for women’s rights. She became famous in 1851 at the Women’s Rights Convention in Akron, Ohio, where she challenged the audience to advocate for the rights of black women in her speech “Ain’t I a Women.” She was largely responsible for transforming the gender and racist policies of that era with regard to health care, women, and African Americans. Early 20th Century—Lillian Wald The modern nursing movement tells the story of women seeking to provide better health care for their society. They saw the nurse as needed “not only for bedside care of the sick, but to help in seeking out the deep-lying basic causes of illness and misery, that in the future there may be less sickness to nurse and cure” (Buhler-Wilkerson, 2001, p. 98). Between 1900 and 1930, nurses sought first to obtain access to health care for patients and then authority to control the practice of nursing. In the 1920s, when society paid nurses directly for private duty services, Lillian Wald (1867–1940) was instrumental in the acquisition of funding for private duty nursing. Wald, one example of nurse leaders at this time, created the Henry Street Settlement and a school nursing program and initiated the concept of public health nursing. Looking back, the accomplishments of the Henry Street nurses were remarkable, especially in light of the fact that these efforts were successful socially, economically, and politically even though women did not gain the right to vote until 1920. Current models of public health nursing are based on the work of these pioneers. Leadership & Management Triaxal of Actions Discussion They provided “community prevention activities, advocacy for political change, and services to those who would otherwise not receive care” (Chang, Price, and Pfoutz, 2001, p. 219). Lillian Wald saw a health-care system that needed change and set out to create policy to improve societal conditions. 2208_Ch02_019-046.qxd 22 6/23/09 11:28 AM Page 22 bonus chapter 2 | Triaxial of Action: Policy, Politics, and Nursing Scenario 1 May Parker trained at Bellevue Hospital in New York City in 1910 and upon graduation was hired to work for the Henry Street Settlement. Her daily responsibilities included visiting 10 families in a tenement dwelling. These tenements primarily housed immigrant families whose main source of income was from factory work. May noted the high incidence of child truancy from school due to child and family illnesses. She also noticed that the family shared the bathroom with six other tenement families. She observed the bathroom was not cleaned regularly and that the family members had not been instructed in the importance of hand washing. May organized a general meeting of all the tenements and created a schedule with assigned responsibilities to clean the bathroom and instructed the families on the importance of washing their hands. May noticed a reduction in the number of child illnesses in the tenement following the procedural changes. Did May create a policy action and implement policy change in this apartment building in New York City? What impact could May have had in New York City if her actions had been required of all tenements in New York City? In later years, the Health Department did require this policy—and May gained the right to vote. ? Mid-20th Century—Margaret Sanger Medicaid budget, the third-largest governmental budget; Virginia Trotter Betts, former ANA president under President Clinton’s administration, was appointed Senior Health Advisor to the U.S. Department of Health and Human Services; also in Clinton’s administration, Dr. Beverly Malone became the Deputy Assistant Secretary for Health and Human Services. The visions of all these leaders were grounded in values that reflected a connection between social issues and health. Their passions were not always welcomed by policy makers, yet they continued to network with those in power to gain a voice in the health-care system. Margaret Sanger (1879–1966) was responsible for changing our nation’s acceptance of family planning. Even though she struggled with the possibility of jail and received death threats, she continued to distribute literature that educated women on the prevention of unplanned pregnancies. Her articles “The Woman Radical” (1914) and “Family Limitations” (1915) brought her under federal indictment and forced her exile to Europe. When she returned to the United States, her proactive stance and educational programs reduced the maternal infections and deaths due to unlicensed individuals performing illegal abortions. She opened the first birth control clinic in the United States but, after 9 days, the police closed the clinic as crowds gathered to seek information and counseling on birth control. Because she distributed birth control information, Sanger was arrested for obscenity and she served 30 days in jail; however, these efforts culminated in bringing the need for policy change before the public eye. Sanger died at age 87, a few months after the 1965 Supreme Court decision that made birth control legal for married couples. Leadership & Management Triaxal of Actions Discussion It took 50 years of nurses’ efforts to gain legislative support for this at-risk female population. Policy and Nursing Governance Nursing has always been an active voice in support of patient safety, protection of the public, professional and ethical behaviors, competency, and standardization in education and scope of practice. Historically, however, nurse leaders have been polarized, struggling to gain a voice for nursing but unable to reach consensus on professional direction. In order to be regarded as a profession, standardization and regulation were necessary. Nursing’s Political Growth in the 21st Century Regulatory Policy—International and National In the 1990s and over the last decade, many nurses have made their mark in the political arena. Khristine Gebbie, RN, served as the AIDS czar; Sheila Burke, RN, was chief of staff to Senate Majority Leader Bob Dole; Carolyn Davis became the head of the Health Care Financing Agency and was responsible for shaping the Medicare and The International Council of Nurses (ICN) is a federation of national nursing associations, representing more than 120 countries. This group is operated by nurses who work to ensure quality patient care, sound global health policies, the advancement of nursing knowledge, and worldwide respect for the nursing profession. ICN’s code of 2208_Ch02_019-046.qxd 6/23/09 11:28 AM Page 23 bonus chapter 2 | Triaxial of Action: Policy, Politics, and Nursing 23 ethics is the foundation for nursing practice throughout the world. The National Council of State Boards of Nursing (NCSBN) was established in 1978. This not-for-profit organization’s membership is comprised of the boards of nursing in the 50 states, the District of Columbia, and the 5 United States territories (American Samoa, Guam, Northern Marina Islands, Puerto Rico and the Virgin Islands). This organization’s main purposes are to advance regulatory excellence for the protection of the public, which includes NCLEX testing, policy analysis, research, oversight of the uniformity of regulations for nursing practice, and the collection of data related to nursing licensure (NCSBN, 2008b). NCSBN’s values of integrity, accountability, quality, vision, and collaboration support its goals for public health, safety, and welfare. society made up of differing cultures and languages. Health-care delivery became a societal issue. History of Nursing Licensure Competence of All Practitioners Regulated by the Board of Nursing ? Nursing regulation is responsible for upholding licensure requirements for competence in the various levels of nursing practice. ? Competence is assessed at initial licensure/entry and during the career life of all practitioners. To define the role of the nurse in all nations, a campaign began in 19th-century England to support the identification of graduate nurses through licensure, but there was strong opposition to allowing nursing organizations to participate in nursing licensure. This conflict delayed the enactment of laws to govern the profession. Isabel Hampton Robb, the first American Nurses Association president, commented on the need for nursing regulation: “in the absence of educational and professional standards, I am sadly forced to admit that the term ‘trained nurse’ means anything, everything and next to nothing” (University of North Carolina Television, 2002, par 3). New Zealand became in 1901 the first country to license nurses. In 1903, North Carolina became the first state to enact a nursing registration law. New Jersey, New York, and Virginia followed in that same year. These early laws recognized nursing as a profession, provided title protection, and established standards of practice to protect the public. The laws were controversial, however, and there were inconsistencies from state to state. The ultimate purpose of regulation is to protect the public. Leadership & Management Triaxal of Actions Discussion A noted example of the need for this protection was demonstrated as a result of the rise of industrialization in the United States. At this time, a mass migration of people to the major cities occurred, which stressed the cities’ infrastructure and resources. These transplanted consumers of health care were now in a new environment, in a Professional Nursing Organizations: Where Regulation Stands Now Today’s state nursing regulations provide guidelines for protecting the public and advancing the profession of nursing, principles to assist the nurse with decision-making, and standards for safe and effective care. The NCSBN, as the national nursing regulatory body, provides guiding principles for nursing regulations and governance to all states and territories (NCSBN, 2008a). Protection of the Public Nursing regulation exists to protect the health, safety, and welfare of the public in their receipt of nursing services. Due Process and Ethical Decision-Making ? Nursing regulation is conducted in a manner to provide fair, reasoned and consistent decisions and due process. ? Boards of nursing hold nurses accountable for ethical decision-making and professional responsibility. Shared Accountability Nursing regulation requires shared accountability for distinguishing individual versus system errors and potential for error. Strategic Collaboration Nursing regulation requires collaboration with multiple strategic individuals and agencies in the interest of public protection, patient safety, and the education of nurses. Evidenced-Based Regulation Nursing regulation uses evidenced-based standards of practice, advances in technology, and demographic and social research in its mission to protect the public. 2208_Ch02_019-046.qxd 24 6/23/09 11:28 AM Page 24 bonus chapter 2 | Triaxial of Action: Policy, Politics, and Nursing … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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