This paper explores a nurses role in health care, policies implemented, and the legislative process in which they operate. Nurses are not only advocates for themselves; they are also an advocate for their patients. Therefore, it is important for nurses to be active in lobbying for much needed policies that concern their healthcare and wellbeing. It sheds some light on various organizations set into place in which these nurses can come together and have a voice in which to enable the changes desired and needed for individual voices that may not have been heard otherwise. It explores a few specific healthcare policies that have had major influences on healthcare management as well as the nurses themselves. In addition, it outlines some of the legislative processes, budgetary and bill policies, as well as some of the programs not otherwise known to have been started through nurses rallying together to allow citizens better healthcare regardless of race, socio-economic status, or age. Nurses truly are the apex of healthcare policy and legislature.
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Legislature, by definition, is a powerful and intimidating body of officials that seem to do works above that of your everyday individual out in the workforce living pay check to paycheck. However, when closely examined, legislature starts with that very individual. It is said that it takes an entire village to raise a child; as is the case of health care policies and legislature. Health care is universal to everyone in the fact that everyone needs healthcare and is therefore, affected by its policies. Everyone has the power to make changes that can benefit them as an individual. These individuals bind with other like-minded individuals and form a united voice in which a platform is set for desired changes to be heard. Nurses are at the very apex of this voice as they are on the front-lines with these individuals giving the day to day care and have first-hand knowledge to help in health care policies and legislature.
Politics plays a key role in determining what health care policies are lobbied, passed and implemented. The American Nurses organization is extremely involved in the political side of healthcare by writing, lobbying and even visiting their representatives to advocate for patients as well as nurses issues needing to be addressed. A few topics being brought before the State Capitol by the Mississippi Nurses Association for the 2013 Congressional meeting are tax breaks for doctors with a practice in rural areas, making each state’s licensing board responsible for writing their own regulations for licensure, additional funding for nurses working in the public health system, and eliminating an insurance company’s ability to dictate what medications their patients could take based on cost (Dickson, 2012).
Political Action Committees (PACs or Special Interest Groups SICs) are established either by registering independently or becoming a PAC that arises out of an organization already established; such as the American Nurses Association. These committees begin a large percentage of the legislative issues being lobbied for today. PACs raise money to be spent on television campaigns, famous people to speak on their behalf, have literature printed, funds to hold events, and any other resource needed to help advocate on the special interest of the Committee. The American Nurses Association’s PAC raises money to support those federal candidates that hold the same beliefs and agenda as the American Nurses Association. The ANA/PAC is bipartisan and has a Board of Trustees to ensure there is no misappropriation of funds on their behalf (American Nurses Association, 2012).
Specific bills are required by Congress for the government to get the approval to spend money. These bills are known as Appropriation bills. Appropriation bills represent the spending of cabinet departments and all must be congressionally sanctioned and signed by the President of the United States and must be presented and approved for each fiscal year. Such bills are named for their specific need such as the Taxpayer Relief Act or the Homeland Security Act. There are some amendments added, known as “pet” programs, to get bills enacted and gain votes from certain members of Congress before they adjourn. These pet programs are added just before the close of the Congressional meeting because members know the President does not have line item veto authority and must either sign or veto the bill, and many times the public is not aware of certain disbursements until after they have been approved.
Health programs are divided into two categories based on how the budgets are controlled; Discretionary and Entitlements. While Discretionary programs are annually appropriated, they are considered controllable. Discretionary programs are primarily research services for communicable diseases, training and family planning. Entitlement programs are those that are not easily controlled due to the appropriation demographic being based on age, disabilities, prepayment, or socio-economic status. Those programs are known as Social Security, veteran’s pay, Medicare, Medicaid, and Children’s Health Insurance Programs. The only way to control appropriations is to change the eligibility requirements of the receiving parties. The United States Department of Health and Human Services has been implemented to oversee this massive operation and is established from the Secretary of Health’s office. This department is comprised of agencies representing all levels of the state and government; from the Surgeon General, the Food and Drug Administration, to the local interviewing office. (Creasia & Friberg 2011)
There are currently three problems in the nursing world. There are not enough nursing educators that are doctoral-prepared to meet the need, there needs to be more nurses with baccalaureate level or advanced practice nurses with masters-level preparation, and there is also an issue with competency-based education. It is suspected that there is a shortage of nursing educators that are doctoral-prepared due to a large number of nurses that retired in the early 2000’s. There have been a lot of new doctoral programs that have opened in the past few years however, there is still a shortage of educators. Health related businesses have come to encourage those seeking a nurse’s education to now obtain a baccalaureate or master’s in order to have a more holistic approach to nursing. Many candidates, however, opt for obtaining an associate’s degree instead due to the program requiring less time, money, and required courses.
“Health policies, or decisions regarding the health care system, are developed and implemented through several avenues. Congressional and state legislation; federal, state, and local rules and regulations for agencies; and appropriation decisions are methods to develop health policy.” (Creasia & Friberg 2011) This is the definition of health policies and who makes them. Health policies are usually only made through legislation but there are many parties who contribute to them. Public opinion, the economy, societal demographics, professional expertise, technology, and overall knowledge about health all contribute to making health policies.
There have been many different health policies, some in which have been very influential. The three most important policies before 1990 were Medicare, Medicaid, and the Social Security Act of 1935. The Social Security Act of 1935 established the Social Security Administration and the pension income. Medicare provides health coverage for the elderly and Medicaid provides care for the poor and needy citizens in America. These policies were created to ensure that everyone in America was ensured health coverage even if they couldn’t get it for themselves. A policy that was very influential for nurses and nursing school was the Nurse Training Act of 1964 and it was an initial federal act for professional nurse training.
In 1990, a very important policy was passed concerning hospitals. “With the Occupational Safety and Health Act of 1970, Congress created the Occupational Safety and Health Administration (OSHA) to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.” (“About OSHA”) OSHA was created to make rules for hospitals to follow that would help prevent the transmission of infections and diseases. With OSHA hospitals have to follow certain procedures for handling blood, bodily fluids, and biohazard wastes.
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In the 1990’s there were also a few really important acts. The Americans with Disabilities Act of 1990, Welfare Reform Act in 1996, and The Health Insurance Portability and Accountability Act of 1996. The Americans with Disabilities Act prohibited discrimination towards citizens with mental or physical disabilities and the Welfare Reform Act prohibited people from staying on Welfare longer than five years and it requires that they must have a job within two years. The Health Insurance Portability and Accountability Act’s purpose is so that citizens will have insurance when they are transferring in between jobs. It also contains rules for hospitals and institutions protecting patient’s health data.
From 2001 to the present, there has also been a lot of health policies passed. Three of the most common were The Nurse Reinvestment Act, Medicare Modernization Act, and the Children’s Health Insurance Program Reauthorization Act. The Nurse Reinvestment Act gives funding for recruitment, retention, and education of nurses. The Medicare Modernization Act created Part D and Part C drug benefits. The Children’s Health Insurance Program (CHIP) Reauthorization Act reauthorized CHIP’s until 2013.
The State Nurse Practice Acts defines the rules and regulations for nursing education and licensure. They require that all nurses graduate from a state board approved college and that students pass the NCLEX after graduating. The NCLEX is the National Council Licensure Examination and it is a test to ensure that nursing students learned everything they needed to learn in school before they are licensed to care for patients.
In the past few years nurses have really became active in health policy and politics. Nurses have even started serving as legislatures to help pass health policies! “As nurses become more informed, passionate, and committed about their leadership role in the policy arena, legislation at the state and federal levels will require input from nurses to advocate for patients, for the public, and for themselves. (Creasia & Friberg 2011)
President Obama signed in the Patient Protection and Affordable Care of 2010 on March 23, 2010. “The passage of the Affordable Care Act (ACA), the historic health reform legislation signed into law in 2010, promotes access to care and strengthens consumer protections. But by supporting the integration of clinical medicine with population-based prevention, the ACA also builds on and strengthens the foundation for prevention and wellness established by Healthy People, the nation’s health promotion and disease prevention aspirations for a healthier nation.” (Fielding, Teutsch, & Koh 2012) The main point of “Obamacare” is to reduce the number of uninsured Americans and to reduce the overall cost of health care.
Nurses play a vital role in health policy and planning. Nurses are advocates for both themselves and their patients. It is imperative that nurses play a role in health policy and planning to ensure quality health care and an effective practice environment.
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