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Advanced Practice Nurses and Public Policy, Naturally © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 1 © Jones & BartlettAdvanced Learning, LLC Practice Nurses© Jones and& Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONPublic Policy, NaturallyNOT FOR SALE OR DISTRIBUTION Jeri A. Milstead © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION KEY© Jones TERMS & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Advanced practice registered nurse (APRN): A registered nurse with a master’s or doctoral degree in nursing who demonstrates expert knowledge, skills, and attitudes in the practice of nursing. An © Jones & BartlettAPRN is Learning, certified by LLCa nationally recognized professional© Jones organiza-& Bartlett Learning, LLC NOT FOR SALEtion. OR Four DISTRIBUTION types of APRNs are recognized by mostNOT nurse FOR regulatory SALE OR DISTRIBUTION boards: nurse practitioner (NP), clinical nurse specialist (CNS), certi- fied nurse midwife (CNM), and certified registered nurse anesthetist (CRNA). Client/patient: The recipient of health care; patient carries a “sick” © Jones & Bartlett Learning,connotation LLC whereas client may ©not. Jones The terms & Bartlett will be used Learning, inter- LLC NOT FOR SALE OR DISTRIBUTIONchangeably throughout this chapter.NOT FOR SALE OR DISTRIBUTION Healthcare providers (HCPs): Registered nurses, advanced practice registered nurses (APRNs), physicians, pharmacists, dentists, psychol- ogists, occupational and physical therapists, and physician’s assis- tants© Jones who are& Bartlettlicensed by Learning, a state or territory LLC to provide health care.© Jones & Bartlett Learning, LLC Nursing’sNOT FOR agenda SALE for OR health: DISTRIBUTION Policy expectations of a vision forNOT nurs- FOR SALE OR DISTRIBUTION ing practice that include prevention of illness, promotion of health, empowerment of individuals to assume responsibility for the state of their own health, expertise in the provision of direct nursing care, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1 © Jones & Bartlett Learning, LLC© Jones & Bartlett Learning, LLC.© NOTJones FOR SALE& Bartlett OR DISTRIBUTION. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284068245_CH01_PASS02.indd 1 30/08/14 4:26 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 ■ CHAPTER 1 Advanced Practice Nurses and Public Policy, Naturally © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTdelegation FOR and SALE supervision OR DISTRIBUTION of selected care to appropriate individu-NOT FOR SALE OR DISTRIBUTION als, and the political influence to accomplish these goals. Policy process: Bringing problems to government and obtaining a reply. The process includes agenda setting, design, government © Jones & Bartlettresponse, Learning, implementation, LLC and evaluation. © Jones & Bartlett Learning, LLC NOT FOR SALEPublic OR policy: DISTRIBUTION A program, law, regulation, or otherNOT legal FOR mandate SALE pro- OR DISTRIBUTION vided by governmental agents; also actual legal documents, such as opinions, directives, and briefs that record government decisions. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction This text originally was written to focus on the relevance of public policy to advanced© Jones practice & Bartlett registered Learning, nurses (AP LLCRNs). The Institute of Medicine’s© Jones & Bartlett Learning, LLC report,NOT The FOR Future SALE of Nursing: OR DISTRIBUTION Advancing Health, Leading Change (InstituteNOT FOR of SALE OR DISTRIBUTION Medicine [IOM], 2010), challenged nurses to work with other healthcare professionals in two ways: to learn from them and to help them learn from nurses. In this spirit of interprofessional cooperation and leadership, this text will incorporate a variety of healthcare providers (HCPs) into the dis- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC cussion of public policy, case studies, discussion points, and reader activi- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ties. Although APRNs are the major focus, the astute reader will realize that the process is the same for all HCPs; the theories and scenarios that are presented have relevance to all providers. The authors hope that readers will recognize the spirit of respect and cooperation that is intended and begin © Jones & Bartlett Learning,to “gather LLC at the table” together and© Jonesto make & decisions Bartlett that Learning, truly integrate LLC NOT FOR SALE OR DISTRIBUTIONhealth care that benefits the client/patientNOT FOR. SALE OR DISTRIBUTION Why “Naturally”? The© policy Jones process & Bartlett is a broad Learning, range of decisionLLC points, strategies, activities,© Jones & Bartlett Learning, LLC andNOT outcomes FOR thatSALE involve OR elected DISTRIBUTION and appointed government officialsNOT and FOR SALE OR DISTRIBUTION their staffs, bureaucratic agencies, private citizens, and interest groups. The process is dynamic, convoluted, and ongoing, not static, linear, or concise. The idea of “messy” may be uncomfortable to nurses who are known to © Jones & expectBartlett action Learning, immediately, LLC but the political arena© requiresJones &patience, Bartlett tact, Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC© Jones & Bartlett Learning, LLC.© NOTJones FOR SALE& Bartlett OR DISTRIBUTION. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284068245_CH01_PASS02.indd 2 30/08/14 4:26 pm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Why “Naturally”? ■ 3 diplomacy,© Jones and & Bartlettpersistence. Learning, Knowledgeable LLC nurses in advanced© practice Jones & Bartlett Learning, LLC mustNOT demonstrate FOR SALE their OR commitment DISTRIBUTION to action by being a part ofNOT relevant FOR SALE OR DISTRIBUTION decisions that will ensure the delivery of quality health care by appropri- ate providers in a cost-effective manner. So why would anyone suggest that working at the policy level is “natural” to the nursing profession? This © Jones & authorBartlett proposes Learning, that involvement LLC in policy decisions© Jones and the & political Bartlett pro Learning,- LLC NOT FOR SALEcess is anOR integral DISTRIBUTION part of the role because of ourNOT history, FOR practice, SALE educa OR- DISTRIBUTION tion, and professional organizations. History © Jones & Bartlett Learning,Florence LLC Nightingale is regarded as© theJones mother & Bartlett of nursing Learning, being a profes LLC- NOT FOR SALE OR DISTRIBUTIONsion that requires education and practice.NOT FOR Although SALE reared OR in DISTRIBUTION an upper-class family, she viewed the service that nurses provided as worthy of respect, a standing generally not accorded to nurses at the time. She founded edu- cational programs (known as nurse’s training programs) and began the work© Jonesof creating & Bartlett standards Learning, of care. She LLCused her influence with her© family’s Jones & Bartlett Learning, LLC businessNOT FORand professional SALE OR colleagues DISTRIBUTION to obtain funding to send aNOT cadre FOR of SALE OR DISTRIBUTION trained nurses to the Crimea to care for soldiers during a war. The nurses focused on improving sanitary conditions and food in addition to attend- ing to personal and medical care such as using clean dressings and linen. When she returned to England, she developed education programs that © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC trained women in what became the principles of nursing. These schools NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION raised the reputation of nurses and increased their credibility and visibility in the public’s eye. Nightingale’s political influence became legendary. Over the years, other nurses have taken on health issues at various times and in various ways. Mary Mahoney was the first African American nurse © Jones & Bartlett Learning,in the United LLC States (1879). She was© aJones major advocate& Bartlett for Learning,equal opportuni- LLC NOT FOR SALE OR DISTRIBUTIONties for minorities. Nurses who exertedNOT FORtheir considerableSALE OR DISTRIBUTION political influ- ence in the early 20th century included Clara Barton, who founded the Red Cross; Margaret Sanger, whose leadership for Planned Parenthood resulted in arrest and conviction; and Lillian Wald, who worked diligently with the poor© throughJones &neighborhood Bartlett Learning, settlement LLC houses, helped President Theodore© Jones & Bartlett Learning, LLC RooseveltNOT FOR create SALE the Federal OR DISTRIBUTION Children’s Bureau, and suggested a NOTnational FOR SALE OR DISTRIBUTION health insurance plan. Jessie Scott, DSc, RN, testified frequently before Congress in her position as director of nursing for the U.S. Public Health Service and was instrumental in passing the 1964 Nurse Training Act, leg- © Jones & islationBartlett that Learning, provided LLC funding for nurse education© Jones (especially
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