Influencing the Policy Process as Nursing Practice

Many opportunities exist for nurses to become involved in the policy process. Involvement in health policy is a natural extension of the role as advocate. Nurses who seek elective office have chosen to take on the role of policymaker as their primary practice. In this case, nurses in elected office are practicing the highest form of civil service that a professional nurse can engage in to advance the public’s health. If running for elected office is not feasible or desired, the less difficult form of civic engagement is to participate in the electoral process. This includes a large menu of activities including, at the least, being informed of candidates’ positions regarding health care, but also potentially supporting financially candidates who advocate sound health policy reforms as well as working on campaigns, hosting fundraisers, and/or serving as policy advisors to candidates.

In addition to elective office, nurses serve in policy research roles; as policy analysts within professional nursing or patient advocacy organizations and health care institutions and within state or federal agencies; and as staff to policymakers. Nursing leaders have had considerable impact on policy from their leadership positions in organizations such as the AARP, the Institute of Medicine (IOM), the Health Services and Resources Administration (HRSA), and the Centers for Disease Control and Prevention (CDC).


Atul Gawande (2009) has emphasized that it is the leaders within health care who will implement policies on health reform. Nurses should be active in all policy arenas to assure that solutions improve the health of people. Mahlin (2010)asserts that nursing organizations must do more than advocate for patients, for there are many in the United States who require care yet have inadequate or nonexistent access. This author suggests it is a worthwhile goal for nurses to engage and participate more fully in the wider health policy realm because those who are outside the system cannot adequately address systematic problems and also asserts that professional nursing associations ought to extend the reach of nurses to include significant input into the debate regarding the widespread access issues for the disenfranchised. This includes nurses getting elected to Congress, becoming involved in policymaking, and serving on influential advisory and corporate boards.

The health care policy environment is rapidly changing and incremental reforms will be undertaken continuously. All nurses must see how the policy process is core to their role as nurses, advocating for patients on an increasingly broad level. The very first step in engaging effectively in the policy process is for nurses to understand how that process works. Nurses must also be knowledgeable of the current and emerging issues that are relevant to nursing practice and must develop the political competence to effectively shape health policy.

Discussion Questions

  1. Identify a problem you face regularly in your clinical setting. Next, identify how this problem could be framed as a policy issue.
  2. The Longest and the Kingdon models help us interpret how policy works. Select one model and apply it to a policy issue you care about.
  3. What do you think yourself and your peers can do to strengthen nursing’s influence in the policy process?


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Online Resources

American Association of State Colleges and Universities: The American Democracy Project.

Campaign to Promote Civic Education.

The Commonwealth Fund.

Health Affairs.

Kaiser Family Foundation.

Health Policy Brief

Improving Care Transitions

Rachel Burton

An example of a well-written policy brief is presented here. It was developed by Health Affairs and the Robert Wood Johnson Foundation. Website resource: policybriefs/brief.php?brief_id=76.

Improving Care Transitions: Better Coordination of Patient Transfers among Care Sites and the Community Could Save Money and Improve the Quality of Care1

What’s the Issue?

The term care transition describes a continuous process in which a patient’s care shifts from being provided in one setting of care to another, such as from a hospital to a patient’s home or to a skilled nursing facility and sometimes back to the hospital. Poorly managed transitions can diminish health and increase costs. Researchers have estimated that inadequate care coordination, including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions.

Several new federal initiatives aim to encourage more effective care transitions. In addition, debate continues over how to restructure fee-for-service payments to motivate providers across care settings to work as a team to make transitions smoother.

This brief examines the factors contributing to poor care transitions, describes the elements of effective approaches to improving patient and family experience with transitions, and explores policy issues surrounding payment reforms designed to address the problem.