Please read each response to the questions below and respond to each of these discussion responses:
1. Discuss the relationship between policy and clinical practice? Can you think of an example of how this has impacted on Advanced Nursing Practice.
2. The book describes the addiction epidemic as a case study. List another example, more than one if you can, not listed in the book, where policy and clinical practice intersect?
3. Identify a healthcare bill using www.congress.gov website. What is the progress of the bill and what are the next steps to getting it passed.
Discussion 1: (Angelica)
1. According to Short (2022), policy is a consciously chosen course of action. Policy is a law, regulation, rule, procedure, administrative action, incentive or voluntary practice of governments and other institutions (Short, 2022). Clinical practice includes the activities performed on patients. There is a direct relationship between policy and clinical practice. Policy dictates clinical practice.
As relayed by Short (2022), “what we are allowed to do, required to perform, or prohibited from engaging in, is determined by public policy.” These actions make nursing practice a political activity. All parts of nursing practice and patient care are regulated by political bodies (Short, 2022). Furthermore, the statutes that govern nursing and the nursing scopes of practice are directly influenced by professional regulatory boards and state boards of nursing.
Advanced Nursing Practice has been greatly impacted by the relationship between policy and clinical practice. For instance, as per the New York State Education Department (2023), “New York State Law holds that nurse practitioners are independently responsible for the diagnosis and treatment of their patients and does not require the NP to practice under physician supervision.” Here, the advanced practice nurse can act independently, and their scope of practice is broad. However, in states such as Maryland, policies dictate that the NP must work under physician supervision. Furthermore, policies change the ways by which advanced practice nurses can use their license. In New York, the advanced practice nurse has more freedom and can work to their fullest potential. Conversely, in Maryland, the advanced practice nurse is restricted to work under a physician who may or may not agree with their intended diagnosis and treatment plan.
2. Example: Patients receiving methadone in the hospital.
Actual clinical scenario: Patient was an active cocaine and heroin user (last dose was 2 days prior to admission). Patient was taking Suboxone for withdrawal symptoms but threatened suicide if she did not also get her methadone.
Policy dictates that the patient has a right to receive the methadone even though he/she is an active drug user. However, as the RN, it is a difficult situation to be in knowing that the patient is getting treatment while also still actively using drugs. It becomes an internal struggle for the RN because no matter what you do, the patient is not actually getting proper help.
3. Healthcare bill: H.R. 2819- Good Samaritan Health Professionals Act of 2023
To amend the Public Health Service Act to limit liability of health care professionals who volunteer to provide health care services in response to a disaster.
Progress: Introduced into the House
House – 04/25/2023 Referred to the Committee on Energy and Commerce
Next steps: This bill has been introduced into the House. Once accepted and passed by the House, the bill will move on to the Senate. The Senate will either pass, deny, or amend the bill. If the bill is amended, it will go back to the House to be re-evaluated. Once passed, the bill will move on to the President, who ultimately decides if it becomes law.
Discussion 2: (Andrew)
1. Milstead and Short define policy as a consciously chosen course of action, which can be any law or voluntary practice set by an institution (2017). Clinical practice is all nursing work with patients, and is guided and regulated by policies. The relationship between policy and clinical practice can be framed in that all aspects of nursing work are regulated by policies, but both inform each other.
In advanced nursing practice, policies that govern the nurses’ scope of practice are defined, and vary by, each each state in the US. The professional regulatory boards in each state define scope of practice, including the ability to diagnose conditions and prescribe medications independently. For example, The regulatory board in New York State validates advanced nursing practice independent of a physician in New York state, unlike California, which is a restricted-practice authority state. Advance-practice nurses would be required to work under a physician. Federal Trade Commission (FTC) in 2014 appears to support independent practice of advanced practice nurses for “consumer choice.” While not education or health-care institution, the FTC’s support is may be informed demand for practitioners in states with less physicians; other full-practice authority states include mostly rural states like Utah, Wyoming, and Nebraska (Plemmons, et al. 2023).
2. A recent example in which policy and clinical practice intersect are New York City government’s policies which can contribute to “frequent flier” patients, as seen in a recent homeless patient with DKA, in my medical ICU. In March 2023, City government announced that $15 million fund for non-profits to build or rehabilitate homeless shelters. The social determinant of health of neighborhood and built environment supports the need for stable housing as a foundation for healthier living, and this has been supported by housing-first programs, as described by the US Interagency Council on Homelessness, not temporary shelters. Without funding or policies for stable housing, people experiencing homelessness will be far less likely to address their basic health needs. They will have to return to hospital emergency departments, for basic needs, and still likely have poor long term health outcomes.
3. HR 420, Language Access for Medicare Beneficiaries Act of 2023, as identified in the website, seeks to mandate the Centers for Medicare and Medicaid services translate the annual explanation of benefits for enrollees in multiple, most-frequently requested languages, along with the current Spanish and English (Gomez, 2023). It has only been introduced, and needs to be passed by the House, The Senate, and then to the Office of the President to become law. Considering the advanced practice nurse role core competencies in the domain of population health, this is supportive of culturally competent practice to increase health promotion for population care. In my own hospital, almost patient hand-outs and educational materials are available in the most common languages in the borough. This is a standard that will support all patients nationwide.
Discussion 3: (Samantha)
1. There is a relationship between policy and clinical practice. Policy is defined as “a consciously chosen course of action: a law, regulation, rule, procedure, administrative action, incentive, or voluntary practice of governments and other institutions,” (Short, 2022). Policies are developed to solve social problems. Professional associations such as Sigma Theta Tau International, create opportunities for nurses to become more involved in policy development and can expand the nurse’s perspective to a state, national, or global level, (Short, 2022). Nurses can play a role in policy making not only at a hospital level but also at a state or international level. “It is not unusual for a nurse to become the point person for a policymaker who is seeking information about a health problem,” (Short, 2022).
Advanced Nursing Practice has been impacted by policy and its role in clinical practice. Nurse Practitioners in the state of New York were greatly impacted by state policy in 2022. According to the American Association of Nurse Practitioners, legislation was passed in 2022, allowing Nurse Practitioners the ability to Full Practice Authority or FPA. This legislation provides New Yorkers with access to better quality care by allowing nurse practitioners to see patients without the barriers that were set in place prior to the passing of this legislation. “FPA is the authorization of NPs to evaluate patients; diagnose, order and interpret diagnostic tests; initiate and manage treatments; and prescribe medications, all under the exclusive licensure authority of the state board of nursing,” (AANP, 2022). This was a giant step forward for New York based Nurse Practitioners and all healthcare providers to help with providing care to the population of New York in a way that takes patients away from overcrowded hospitals. Nurse Practitioners can now work within their scope and not under it.
2. When thinking of another example where policy and clinical practice intersect, a clinical scenario came to mind. A 20-year-old Type 1 Diabetic patient recently joined our practice after being under the care of a pediatric endocrinologist for the past 16 years. The patient had put his girlfriend as his emergency contact and did not include his mother as an alternative contact. The patient’s mother would constantly call the office demanding results or having complaints about the patient’s blood sugar although the patient himself never voiced any concerns in between visits. It is our organization’s policy that we cannot provide patient information to anyone that is not authorized by the patient in writing. This has caused a lot of frustration for the patient’s mother and the RN trying to advocate for the patient and explain the policy to the patient’s mother in an empathetic way.
3. Health Care Bill: H.R.497 – Freedom for Health Care Workers Act. “This bill nullifies the rule titled Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination, which was issued by the Centers for Medicare & Medicaid Services on November 5, 2021, and prohibits the issuance of any substantially similar rule. The rule requires health care providers, as a condition of Medicare and Medicaid participation, to ensure that staff are fully vaccinated against COVID-19.”
Progress: 01/31/2023: Passed/agreed to in House: On passage passed by recorded vote: 227 – 203
Next Steps: Health Care Bill H.R. 497 was received by the Senate. Once passed by the Senate it will then go to the President where he will decide to whether the bill will be passed and then becomes a law.
Discussion 4: (Joanna)
1. There is an obvious relationship between policy and clinical practice. According to Milstead (2016) policy is defined as “a purposeful plan of action or inaction developed to deal with a problem or a matter of concern in either the public or private sector” (p.192). Policies communicate standards and expectations for clinical practice that are intended to optimize patient care by establishing guidelines/protocols to provide and/or improve quality care. This has a major impact on advanced nursing practice as APRN’s must be current on policy issues in order to advocate for change and shape the direction of healthcare delivery. APRN’s are in a position of “discovering and acknowledging health problems and health system problems that may demand intervention by public policymakers” (Milstead, 2016). Policies are used to govern practice as APRN’s are considered authorized providers of healthcare. However, there is variation between state statutes, rules, and regulations of how APRN’s can practice. Therefore, it is important that there is a clear understanding of how a APRN’s scope of practice is defined by those laws and regulations. For example, New York state allows for NP’s to work independently with the responsibility of treating and diagnosing patients without being under physician supervision whereas NP’s in Florida require “career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care” (AANP, 2022).
2. Data privacy & IT security- policies in data privacy and IT security regulate the usage, monitoring and management of data in an organization. Practitioners must follow the Health Insurance Portability and Accountability Act (HIPAA) to protect patient identifiable health information by avoiding data leaks and privacy breaches. As the use of technology increases in healthcare, it is important for practitioners to follow these policies to protect patient information like for example, obtaining patient consent before sharing health information, which gives patients the choice to whether or not they want certain health information to be disclosed.
3. H.R.3086: “Find it Early Act.” This bill—with its primary sponsors representative Rosa DeLauro & Brian Fitzpatrick—aims to “provide for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer.” This bill proposes, if passed, would require all insurance plans to cover mammograms, MRIs, and ultrasounds without additional cost to the patient. It was introduced to the house on May 5, 2023, and is still in its early stages of the legislation process. Although this bill is in its earliest phases, on 5/26/23, it was referred to the subcommittee on health by the committee on veterans’ affairs but action is still pending.
Discussion 5: (Ashley)
1. The relationship between policy and clinical practice is crucial for the delivery of effective healthcare. Public policy, as described by Short, refers to the consciously chosen courses of action, laws, regulations, and procedures implemented by governments and institutions (Short, 2017). These policies provide direction and guidelines for clinical practice and shape the overall healthcare system. Policies influence many aspects of clinical practice, including patient care standards, diversifying the healthcare professionals, and quality improvement initiatives. Short mentions that laws and regulations govern all facets of nursing practice and patient care. Policies not only define the parameters within which healthcare professionals operate but also serve as a framework for interprofessional cooperation and leadership (Short, 2017). Nurses, being the largest group of healthcare workers, play a leading role in identifying problems in daily practice and advocating for policy changes that address the needs of both nurses and patients. Thus, policies directly impact and shape the landscape of clinical practice, influencing the provision of safe, effective, and high quality care. The education, experience, and perspectives of nurses uniquely position them to contribute to the policy making process. This has impacted the advanced nursing practice because by leveraging their knowledge and skills, nurses have influenced policy design, advocated for changes that align with the needs of patients and the nursing profession, and addressed healthcare system challenges. Through engagement, political activism, and collaboration with legislators and agency directors, nurses have actively participated in shaping healthcare policies that support positive outcomes for individuals, families, and communities. The relationship between policy and clinical practice is dynamic and reciprocal, with policies providing the framework for clinical practice and nurses actively influencing the development of new policies, and the implementation in the health field.
2. Management of patient falls: Policies and guidelines are developed at the organizational and national levels to address fall prevention in healthcare settings. These policies outline the standards and protocols for identifying patients at risk of falls, implementing preventive measures, and responding to fall incidents. These protocols may include risk assessment tools, safety protocols for patient mobility, guidelines for bed and furniture positioning, and requirements for staff education and training. Policies inform clinical practice by providing evidence based strategies and interventions to prevent falls. These may include implementing bed alarms, providing non-slip footwear, ensuring a well lit environment, promoting patient education on fall prevention, and facilitating the use of assistive devices. Nurses are responsible for incorporating these interventions into their daily care routines and documenting their implementation in patient care plans. When it concerns patient falls, policy mandates that you must follow protocols to prevent them. However clinical practice can sometimes result in falls that resulted due to carelessness of the patient or an outside party that is not the nurse.
3. The H.R.3733 bill is a bill introduced on May 25th, 2023 sponsored by representative Adam Smith. The committees representing this bill are House – Energy and Commerce; Ways and Means. The purpose of this bill is to address the barriers immigrants and refugees face when entering the health care workforce, and for other purposes. As of now the latest action there has been is that on the 25th the bill was introduced to the House of Representatives and then referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee. This bill spoke to me because it represents people like me, it made me feel heard/seen.
Expert Solution Preview
The relationship between policy and clinical practice is a crucial aspect of healthcare. Policies, which can be laws, regulations, rules, or procedures, guide and govern the activities performed in clinical practice. The decisions made in policy development impact the way healthcare is delivered and the scope of practice for healthcare professionals. This discussion will explore the relationship between policy and clinical practice, provide an example of how it has impacted advanced nursing practice, identify another example of how policy and clinical practice intersect, and identify a healthcare bill and its progress using the www.congress.gov website.
Discussion 1: (Angelica)
1. The relationship between policy and clinical practice is that policy dictates and regulates clinical practice. Policy decisions determine what healthcare professionals are allowed or required to do, as well as what they are prohibited from doing. Nursing practice, including the care provided to patients, is influenced and regulated by political bodies. The statutes that govern nursing and the scopes of practice for nurses are directly influenced by professional regulatory boards and state boards of nursing.
One example of how this relationship has impacted advanced nursing practice is the difference in scope of practice for nurse practitioners (NPs) in different states. In New York, NPs have independent responsibility for the diagnosis and treatment of their patients and are not required to practice under physician supervision. This policy allows NPs in New York to work to their fullest potential and provide patient care independently. On the other hand, in states like Maryland, NPs are required to work under physician supervision, limiting their autonomy and potentially impacting their ability to provide optimal care.
2. Another example of policy and clinical practice intersecting is the administration of methadone to patients in the hospital. Let’s say a patient is admitted, who is an active cocaine and heroin user and is taking Suboxone for withdrawal symptoms. The patient demands to receive their methadone as well, threatening suicide if they don’t receive it. Policy dictates that the patient has the right to receive the methadone, even though they are still actively using drugs. As a registered nurse, this situation creates a dilemma because administering methadone to an active drug user may not provide them with the proper help they need to overcome their addiction.
3. The healthcare bill I found on the www.congress.gov website is H.R. 2819, titled the “Good Samaritan Health Professionals Act of 2023.” The aim of this bill is to amend the Public Health Service Act to limit the liability of healthcare professionals who volunteer to provide healthcare services in response to a disaster. It was introduced into the House on April 25, 2023, and is currently referred to the Committee on Energy and Commerce. The next steps for this bill involve the Committee reviewing and potentially making amendments to the bill. If the bill is approved by the Committee, it will move on to the House for further consideration, and if passed, it will then proceed to the Senate. The Senate will have the option to pass, deny, or amend the bill. If there are any amendments made by the Senate, the bill will be sent back to the House for re-evaluation. Once both chambers of Congress pass the bill, it will be sent to the President, who will decide whether to sign it into law.
Discussion 2: (Andrew)
1. The relationship between policy and clinical practice can be described as a mutual influence between the two. Policy, which encompasses laws and voluntary practices established by institutions, guides and regulates clinical practice. In turn, clinical practice informs policy decisions by highlighting the needs and challenges faced by healthcare providers. All aspects of nursing work, including patient care, are regulated by policies, making nursing practice a political activity.
The impact of policy on advanced nursing practice can be seen in the variations of scope of practice for nurse practitioners (NPs) across different states. Each state in the U.S. has its own professional regulatory boards that define the scope of practice for NPs. For example, in New York State, nurse practitioners have independent responsibility for diagnosing and treating their patients, without the need for physician supervision. This broad scope of practice allows NPs in New York to provide care independently. On the other hand, some states, like California, have policies that require NPs to work under physician supervision, limiting their autonomy.
2. An example of policy and clinical practice intersecting can be observed in the policies of the New York City government regarding homeless shelters. The government recently announced a $15 million fund for non-profits to build or rehabilitate homeless shelters. This intersects with clinical practice as stable housing is a social determinant of health. Policies and funding that support stable housing have been shown to improve health outcomes. Without policies and funding for stable housing, individuals experiencing homelessness are more likely to seek basic health needs in emergency departments, leading to poor long-term health outcomes.
3. The healthcare bill identified on the www.congress.gov website is H.R. 420, known as the “Language Access for Medicare Beneficiaries Act of 2023.” This bill aims to mandate the translation of annual explanation of benefits for Medicare beneficiaries in multiple languages, in addition to English and Spanish. As of now, the bill has only been introduced and referred to the Committee on Energy and Commerce. The next steps for this bill involve the Committee reviewing and potentially making amendments to the bill. If the bill is approved by the Committee, it will move forward for consideration in the House and then the Senate. Finally, the bill will be sent to the Office of the President to become law if it receives approval.
Discussion 3: (Samantha)
1. Policy and clinical practice have a significant relationship. Policy refers to consciously chosen courses of action, such as laws, regulations, rules, and procedures, implemented by governments and institutions. Clinical practice, on the other hand, encompasses the actual activities performed in healthcare, including nursing work with patients. Policies are developed to address social problems, and nursing professionals can play a role in policy development at various levels, including hospitals, states, and even internationally.
Advanced nursing practice has been impacted by the relationship between policy and clinical practice. A notable example is the legislation passed in New York in 2022, granting nurse practitioners full practice authority (FPA). This legislation allows nurse practitioners in New York to evaluate patients, diagnose conditions, interpret diagnostic tests, initiate and manage treatments, and prescribe medications under the exclusive licensure authority of the state board of nursing. By removing barriers and expanding the scope of practice for nurse practitioners, this policy change improves access to quality care for patients.
2. An example of policy and clinical practice intersecting is the provision of culturally competent healthcare to diverse patient populations. Policies can mandate the availability of healthcare materials, handouts, and educational resources in multiple languages. This ensures that patients from different language backgrounds can receive crucial information about their health. In my own hospital, patient handouts and educational materials are available in the most common languages in the local community. This policy supports culturally competent practice and enhances communication and understanding between healthcare providers and patients.
3. The healthcare bill I found on the www.congress.gov website is H.R. 420, the “Language Access for Medicare Beneficiaries Act of 2023.” This bill aims to mandate the translation of annual explanation of benefits for Medicare beneficiaries into multiple languages, in addition to English and Spanish. As of now, the bill has been introduced but has not made significant progress. The next steps involve the bill being reviewed and debated in the House and Senate. If it receives approval from both chambers, it will be sent to the President to be signed into law. This bill supports the provision of healthcare information in languages that are more accessible and culturally appropriate for Medicare beneficiaries, promoting equitable access to healthcare services.