Nurse Policy Entrepreneurship: A Multiple Streams Approach to Influence Traffic Safety in a Rural Community

Monday, 30 October 2017

Judy Lynn Gregg, DNP
School of Nursing and Health Sciences, Mount Vernon Nazarene University, MT Vernon, OH, USA
Julie E. Miller, MSN
Knox County Health Department, Mount Vernon, OH, USA
Kathleen Tennant, PhD
Nursing, Carlow University, Pittsburgh, PA, USA

Objective: The purpose of this project was to implement and examine the role of a Nurse Policy Entrepreneur to reduce Motor Vehicle Crashes (MVC) in a rural community.

Background: Unintentional injuries are the leading cause of death in people under 44 years of age, and is the fifth foremost cause of death overall in the United States. Although motor vehicle traffic–related death rates have decreased over the past decade, MVC continues to be the leading cause of unintentional injury death among children under the age of 19. Literature states stronger policies are needed to reduce MVC.

Although policy making and agenda setting may be a novel role, nurses are well positioned to become policy entrepreneurs to assist in creating a policy window of opportunity to discuss this problem. A policy entrepreneur is able to help define the issue, understand the political climate, build teams and to provide leadership to address the issues such as motor vehicle crashes. Traffic fatalities are not unavoidable tragedies and need to be addressed as a preventable occurrence.

Local Problem: Even though motor vehicle mortality rates were higher than state and national benchmarks, motor vehicle crashes (MVC) were only considered a minor to moderate issue in the most recent Community Health Assessment Report in the focus county. MVC were currently only addressed in this rural community through limited, isolated initiatives. Deliberate actions were needed to raise awareness and help set the policy agenda related to MVC in the focus county.

Design: Applying the Multiple Streams Approach, the action research study concentrated on the role of a Nurse Policy Entrepreneur to gather data exploring specific local contributing factors and issues related to motor vehicle crashes; review current policies and best practices; meet with decision makers to open a policy window leading to a local policy change to reduce injury and fatalities from MVC.

Measurements: The Nurse Policy Entrepreneur analyzed a public MVC data to identify local priority issues. Teen injury crash prevention was selected as the priority issue. Policy analysis included comparison with peer counties and current literature to identify best practice. Top preforming peer counties all utilized a common policy/program for juvenile traffic offenders.

Results: Briefings with stakeholders created an open policy window through sharing a framed message to support the new policy/program. At the conclusion of the stakeholder alliance, in addition to verbal support, a modified Organizational Change Recipient’s Belief Scale tool was used for assessment. Results revealed that teen injury MVC’s in the county was an important issue (discrepancy), the proposed program was the appropriate solution (appropriateness), along with principle support for the project. However, neutral results were found for both efficacy (personal influence to impact the issue) and personal gain/impact from the change. With community support for ongoing program oversight, the Nurse Policy Entrepreneur gained judicial approval for the policy change for teen driver offenders, signifying success by the Nurse Policy Entrepreneur to effect policy.

Conclusions: The application of the Multiple Streams Approach is a valuable tool for all nurses regardless of setting and needs to continue to be explored along with the further development of the role of a Nurse Policy Entrepreneur. The Multiple Streams Framework can successfully guide nurses to change policy in healthcare at any level of policy change and in any setting. Through intentionally and thoroughly assessing the problem, policy and political streams, a Nurse Policy Entrepreneur is able to merge the three currents with a framed message which can open a policy window for change to improve health.