DNP Essentials: Nurse Advocacy and Healthcare Policy Leadership

The Nurse's Unique Role in Healthcare

The nurse is in a unique position in that they can see the effects of national and community-scale policies in a real-world setting (Abood, 2007). They are placed to witness firsthand the effects of rising healthcare costs, declines in access, and quality issues that directly affect patient outcomes (Abood, 2007). The nurse has a responsibility to take action and find opportunities to bring about system-wide changes that will positively affect the patients they care for on a daily basis. Gaining a deeper understanding of this role as a bridge between healthcare policy and real patients is a responsibility that goes beyond the basic daily needs of the patient.

One of the first actions that must be taken in regard to this role is to educate oneself on the major issues that affect patient care. The rising costs of medical care are a key concern in the current consumer-driven system. Insurance companies have been held responsible for many of these rising costs, as they have insulated patients from sensitivity to the costs and effectiveness of treatments and procedures (Jost and Hall, 2005). Consumer-driven healthcare advocates believe that making the patient more responsible for a larger portion of the cost will make them more selective in the services they choose to utilize (Jost and Hall, 2005).

From a macro perspective, it is easy to see how this would seem to be a logical solution to the problem. However, the nurse has a unique perspective: they can observe the patient who does not receive care because they cannot afford their portion of the bill. The nurse can also see the results when a patient does not seek treatment for an illness in its early stages — such as cancer — but waits until treatment is costlier, more involved, and less likely to result in a positive outcome. The nurse practitioner must utilize this unique position to advocate for solutions that will better serve the healthcare industry as a whole and the needs of individual patients.

In accordance with DNP Essential No. 1, this means taking active measures to stay informed about proposed changes in healthcare policies at the provider, community, regional, and national levels. This may involve subscribing to, or at least regularly reading, information about upcoming legislative changes and developing a thorough understanding of their implications. Another approach is to join professional nursing organizations that keep their members up-to-date on upcoming policy changes.

Developing leadership in this area involves staying current on changes and taking action to ensure that the voice of the nurse — who is in continual contact with real-world patients — is represented in policy discussions. Participating in committees, boards, and task forces at multiple levels of the system is another way to influence policy in a manner that advocates for improved patient outcomes. The nurse leader can serve as the voice of others in this capacity by gathering the experiences of colleagues within the profession, allowing their perspectives to inform policy advocacy even when those colleagues are unable to participate directly.

Nursing Care and Consensus

The consensus model plays a significant role in professional development and advocacy. Organizations have reached an overall consensus about what is required for licensure, accreditation, certification, and education of advanced practice registered nurses under the acronym LACE (Yoder-Wise, 2010). Reaching consensus among professional groups is one way to assure consistency in the care that patients receive, regardless of region or healthcare facility. However, reaching a national consensus is often more difficult in practice than in theory. For instance, various facilities allow nurses with differing certifications and licenses to teach, with some requiring an advanced degree and others not (Yoder-Wise, 2010).

This inconsistency makes it difficult to assure that nurses are receiving at least a minimal, standardized level of knowledge. Differences in training result in differences in patient care that could significantly affect patient outcomes. Developing a national consensus is another area where the nurse practitioner can advocate and have meaningful influence — shaping effective education and professional development standards that provide patients with greater assurance of consistency in the care they receive, regardless of region or facility.

References

Abood, S. (January 31, 2007). Influencing health care in the legislative arena. OJIN: The Online Journal of Issues in Nursing, 12(1): 2.

American Association of Colleges of Nursing [AACN]. (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC: Author.

Jost, T. and Hall, M. (2005). The role of state regulation in consumer-driven healthcare. American Journal of Law & Medicine, 31(4): 395–415.

Yoder-Wise, P. (2010). LACE: The consensus model and implications beyond advanced practice. Journal of Continuing Education in Nursing, 41(7): 291.