Health Policy and Politics SG PDF

**Health Policy and Politics SG** **Pt 1** Health care delivery - Nurses one role is to advocate Health Policy - Sets of courts of action taken by the government or health care organizations to obtain positive outcomes - Private health policies- is made by health care organizatio...

**Health Policy and Politics SG** **Pt 1** Health care delivery - Nurses one role is to advocate Health Policy - Sets of courts of action taken by the government or health care organizations to obtain positive outcomes - Private health policies- is made by health care organizations such as hospitals and managed care\ organization - Public health polices- are developed by judicial or legislative branch of government - In legislative branch health care policies, it can be made local, state or federal - Health policy issues: - Cost - Barriers to access health care - Quality and safety - Disparities - How is it made? - By legislative, executive, and judicial branch - The legislative branch originates major policy initiatives. - The executive branch supports the initiative or vetoes it and causes it to go back for revision in the legislative chamber - The judicial branch is to make sure that the bill or law is constitutional. - Elected officials & governmental agency officials - Experts in the related area - Stakeholders such as corporate representatives - Representatives from special interest groups Legislation of Health Policy - Moves public problem to a viable problem - The process: - Introduction, committee action, House and/or Senate action, and Presidential action - Once a bill becomes law, implementation falls under jurisdiction of one of the departments of the executive branch - Implementation of new legislation often can be very different from what was intended when the bill was passed by Congress Regulation Connection VS Health Policy - Regulations- [written set of rules] issued by the gov agency that is responsible for admin the new law - It carries the force of the law - Interval between interim rules and final rules are critical for assessing effect of the policy. - Health policy- is a [broad set of guidelines] that are developed by legislators to achieve a specific goal. - If a health policy or legislation is passed, the gov department that is appropriate writes the set of rules for implementation, which is known as the regulations. Examples of Federal Health Policy - Federal Policies that shape Nursing Practice Sheppard-Towner Act (1921) - Hill-Burton Act (1950) - Medicare program (1965) - Renal disease program (1972) - Diagnosis-related groups (DRGs) (1983)- DRGs are a payment method. - How does DRG pricing work? - Medicare or private insurers pay a predetermined amount based on your diagnostic-related group. - The DRG system was set up to make sure that your bill isn\'t full of unnecessary charges. - Patient Protection and Affordable Care Act (2010) Examples of state and local health policy - Local health policy: Free or reduced-rate, immunizations, Tobacco-free public buildings, Provision of an emergency medical system - State health policy: Governs nursing through nurse practice act, regulates healthcare facilities, pays for healthcare services through Medicaid State level policy - Developed by state senators and house of representatives - Regulations are created/enforced by AHCA (agency for healthcare administration) and FDOH. - FDOH regulates counties public health departments that provide services to lower income citizens - FBON governs nursing through nurse practice act AHCA (agency of healthcare administration) - [Approves licensing of healthcare facilities in the state] - Need a license for hospital to practice medicine - Inspects/visits/surveys the facilities every 3yrs - If doesn't meet standards/rules they can be fined, probation or license revoked - Determines where federal funds go - Accredits healthcare facilities at regular intervals - Develops and enforces rules for the state Medicaid program and the state children's health insurance program (SCHIP) - Medicaid- health insurance program for those individuals and families that earn below a certain income level (can't afford insurance), disabilities, and dialysis. - Partially funded by the federal gov and state gov, but the rules for the Medicaid program are developed by [each state legislative] branch - If Medicaid in one state cannot use it in another only home state - In the state of Florida, the Medicaid program is controlled by ACHA. - Medicare is federal (for individuals 65+) -- can use in any state National regulatory bodies - The Joint commission (TJC) - OSHA- ensure safety in workplace for HCP and researchers - Nursing education accreditation bodies: ACEN, CCNE, CNEA The Joint Commission (TJC) - Nonprofit [non-government] private organization - Reports to ACHA if notices an issue- work together - Accredits health care organizations and programs - State and federal gov recognize TJC as golden standard for accreditations - Do not need TJC accreditation but it makes it look better - Focuses on pt safety and quality care Professional Nursing Organizations - Helps unify the profession- gives the profession say in policies & regulations that affect the profession on the whole. - The professional environment/practice can be controlled more through unity. - It is not mandatory to belong to a professional nursing organization. - Provide opportunities to network with other nurses - Most serve as political voice for nurses - Most fund political initiatives - May disseminate research and provide other sources of education relevant to current\ practice - May provide a service to the community ANA (American Nursing Association) - The major national nursing organization that represents nurses at a federal level. - It is concerned: - broad scope of practice issues - standards of practice - scope of practice - ethics, legal, & employment - a federation of state nurses associations - Benefits to ANA membership - Publishes the nursing code of ethics - Discounts on certain services provided by national corporations, - Access to various insurance companies who provide professional liability coverage - Political representation - Discounted continued education - Subscription to nursing journal Florida Nursing Association (FNA) - State nursing association supports education and advocacy for nurses - Main purpose: - Foster high standards of nursing practice - Promote professional and educational advancement of nurses - Promote the welfare of nurses - Part of ANA- if have FNA membership you are automatically an ANA member) Politics - Process by which the decisions of others are influenced and control over situations and events is exerted - Influence is the common denominator in any definition of politics - Political influence: money, knowledge, relationships, info, talent, and control over large groups of votes - Through effective political action, nurses can positively influence legislative decisions and health policies Grass root political strategies - As nurses you see an issue that needs to be addresses and act on it - Registering - Joining (a professional organization) - Working (in a candidate's campaign) - Attending (town hall meetings, meet the candidates) - Visiting (with policymakers or staff) - Communicating (with the policymaker's email fax phone) Institute of Medicine (IOM) - Nonprofit, nongovernmental organization - Purpose: provide national advice on issues relating to biomedical science, medicine, and health - Mission: serve as an advisor to the nation to improve health - Relies on volunteer workforce and operates under formal peer review system - Specific issues they address: - Improving access to care - Transforming nursing education - Promoting nursing leadership (including more nurses serving on Boards) - Increasing diversity in nursing - Collecting workforce data - Fostering interprofessional collaboration - Building healthier communities Health Care Reform - General term used to refer to health policy initiatives to effect significant changes in how health is promoted, and health care is accessed, delivered, and paid for in the US. - Robert Wood Johnson Foundation: Recognizes health as inextricably linked to all aspects of a person's and community's life Nursing involvement - Nursing policies are made with or without us - Nursing practice is directly affected by health policy development - PAC (political action committee): a division established to persuade policymakers to support certain policies and or to ensure the election or reelection of policymakers who support the organization's goals. - The aides have multiple duties, one of which is to answer emails and to tally up and keep a record of the feedback that the representatives\' constituents are providing. - A constituent: a person who resides in the district in which the policymaker (representative) represents in the legislative branch. **Pt 2** Workforce Advocacy Nursing Responsibility - Preventing hospital readmissions -- payment and reimbursement - Ex: if a pt comes into the hospital with CHF discharged and is readmitted within 30 days of their discharge with this DX. Medicare will not cover the second hospitalization. Bc of this pat education is crucial in preventing hospital readmissions. - RN's decrease adverse events and pts have shorter length of hospital stays. - \$ issue bc of DRG's and how hospitals are reimbursed for care based on averages of other pts stay with similar diagnostic groupings. - RN also are key in decreasing overall patient mortality (death) - The power the nurse can call on to resolve conflict and improve care is called "workforce advocacy" Nursing Shortage - Nursing School Enrollment, recruitment, and faculty shortages. - Efforts to recruit more students into nursing have been successful. - Unfortunately, most schools have serious shortage of nursing faculty. - Educational Preparedness - Shortages in the past have led to employers hiring nurses regardless of their degree preparation. - There is an increase need for BSN prepared nurses. - Emerging Workforce Recruitment and Retention - Health care challenged to become the employer of choice for the younger generation - Expectations of the 20-something generation: Recognition is a key motivation - Opportunities to gain advanced training, education, and certification - Ongoing coaching and feedback about performance - Manager to take a personal interest in them - Stability and flexible work schedules - Comfortable with technology and excel at multitasking - Nurse Retention - The key to retention is primarily the creation of a work environment conducive to professional autonomy. - The ANA has a credentialing Center or the ANCC and based on study findings the ANCC created the magnet recognition program - Nurses in magnet hospitals have higher levels of autonomy, greater control over the practice setting, and better relationships with physicians - Pathway to Excellence is another model to improve retention in smaller organization - Aging Workforce and Retention - Strategies for retaining the older, expert nurse: - Provide better ergonomics and health care design to decrease physical demands - Allow for greater participation in decision making - Flexible work schedules - Programs to pair experienced nurses and newer nurses to promote knowledge transfer - Retention and turnover - Inadequate orientation for new RNs - Floating between patient care units - Sprains, strains, and back injuries - Work-family conflict - Team cohesion - Insufficient supply of qualified managers & experienced staff - Inappropriate staffing - Healthy Work Environment - Collaborative practice culture - Communication-rich culture - Culture of accountability - Presence of adequate numbers of qualified nurses - Presence of expert, competent, credible, and visible leadership - Shared decision making at all levels - Encouragement of professional practice and continued growth/development - Recognition of the value of nursing's contribution Safe Staffing - Quantifying appropriate staffing - Federal regulations require hospitals to have adequate numbers of RNs and other staff but not specific - *States are addressing appropriate staffing* through legislation on three different models: - Require a nurse-driven staffing committee to create staffing plans that reflect the needs of the patient population and match the skills and experience of the staff - Require facilities to disclose staffing levels to the public and/or a regulatory body - Mandate specific nurse-to-patient ratio - Questions to ask BEFORE accepting employment - How are overtime, on-call time, and cancellation of regularly scheduled shifts handled? - What are the content and length of orientation for new nurses to your organization? - What is the turnover rate, and what is the average longevity of staff nurses in your organization? - Does the organization mandate overtime? - Resources for Decision Making, - Questions to Ask in the making the decision to accept a staffing assignment - What is the Assignment? - What are the characteristics of the patients being assigned? - Do I have the expertise to care for the patients? - [Do I have the experience and knowledge to manage the patients for whom I am being assigned? ] - First question to ask yourself esp. when floating - What is the geography of the assignment? - It is your responsibility to articulate your limitations and get the adjustments to the assignment - [Good Faith:] accepting the assignment after you have spoken up about your concerns to your supervisor/manager and believe that a different pattern of care or policy should be considered. - You acknowledge the difference of opinion on this matter and are willing to take the assignment and await the judgment of other peers and supervisors as your concerns are being reviewed and considered. - Floating and mandatory overtime - Nurses are concerned about employers' ability to mandate last-minute overtime\ or floating rather than finding safer, more appropriate staffing - Growing research on overtime and errors has caused many facilities to drop their\ use of mandatory overtime and even limit hours of voluntary overtime - Mandatory overtime = nursing burnout Patient Advocacy - Promoting pt safety - The National Database for Nursing Quality Indicators - Stopping preventable medical errors - Indicators that are measured are such things as patient falls, physical restraint use, nosocomial infections and nursing care hours provided per patient per day, and RN satisfactions surveys - QSEN - Whistleblower protection - Protects nurses who speak out about unsafe situations from being fired or subjected to other disciplinary actions by their employers - Nurses want to be able to speak up for their pts w/out fear of retaliation - Advocated for at the federal level and has passed in some states - Consult with your state nurses association or legal counsel before taking action to determine how best to document your concerns. - You are not protected in a whistleblower situation from retaliation by your employer until you blow the whistle. - TJC does not protect you against whistle blowing (report to state or national regulator) - Document all interactions relating to whistleblowing situation Workplace safety - Hazards to workplace: - Exposure to bloodborne pathogens - Ergonomic injuries - Workplace violence - Fatigue - OSHA instituted to wear gloves for all healthcare activities - Needlestick safety and prevention act- need a safe device to place used needles - Employer must log all sharp injuries (situation of incidence and area it occurred) - Barriers to reporting workplace injuries - Fear of repercussions such as disciplinary action - Stigmatization as a complainer - Harassment by supervisors and coworkers - Denial of opportunities for promotion - Termination of employment - Workplace violence and incivility - Nurses must proactively advocate for safe workplaces - Organizational assessment to identify high-risk environments, psychological conditions, and populations that threaten workplace safety. - Zero tolerance policy for workplace violence, verbal and nonverbal threats, and related actions - No employee who reports workplace violence faces reprisals. - Develop plans for maintaining security in the workplace. - Staff education to proactively address identification of and response to high-risk behaviors that can lead to violence - Fatigue - Nursing can be physically and emotionally taxing with 24/7 scheduling, shift work, and long and variable hours - Restorative sleep is critical t - Inadequate sleep negatively impacts performance, increases risk-taking behavior, impairs communication skills, and causes deficits in short-term and working memory. - Fatigue leads to an increased risk for work-related errors and negatively impacts the nurse's health - Advocating for safer workplace - ANA advocate for healthcare worker health and safety - Advocate for admin controls- shared governance, volunteer to be a part of nursing councils or taskforces in your workplace. - Keep current on EBP. - Stay current with nursing literature and join ANA and other professional nursing organizations. - Adequate staffing - Health and safety committees - Engineering controls---ventilation and safer needlestick devices - Personal protective equipment---respirators and synthetic glove - Opportunities for Workforce Advocacy - Identify mechanisms that provide opportunities for RNs to affect policies - Develop Conflict Resolution Models that address RNs concerns - Seek Legislative Solutions - Lobbying, grassroot lobbying, going to a PAC (political action committee) - Develop legal Centers to help with decision --making - Provide RNs with self and patient advocacy information. - How to advocate for professional nursing practice environment - Promote occupational safety and health of nurses - Use the nurse practice act and other legislative and regulatory protections. - Use the political process to influence legislative and regulatory agencies for the protection of nurses and patients - Participate in committee structures to ensure a nursing voice: nursing shortage, safe staffing, patient advocacy and workplace safety