Making the Process of Policy Making Transparent

Healthcare policy development in the United States is a patchwork quilt of complex issues complicated by legislative, regulatory and judicial activities.  Over the last twenty-five years healthcare policy has been challenged to address the impact of mandatory spending for healthcare and social security on the federal and state budgets.  Changes in healthcare have reverberated from the national, regional, to the state and local levels.  Yet, those directly affected by these changes fail to understand and engage in influencing the new structures, processes and payment models. Mistaken assumptions about how the healthcare policy process works, including the major drivers in formulating, reviewing and adopting changes in healthcare laws and regulation, are “missed opportunities” that leave nurses outside of the process.

Over the last several decades nurses have recognized the importance of advocacy and expanded their efforts and focused lobbying by professional organizations including the American Nurses Association, American Association of Colleges of Nursing, American Organization of Nurse Executives and the National League of Nursing.   Working together these four major organizations have been a strong and united voice “as advocates for nursing and patients.”   

During the Clinton administration’s health reform effort, nurses were involved in meaningful ways.  That experience helped nurses to realize that the visibility and access to policy makers was worthwhile, and it helped to lay the groundwork for the future.   Leaders of nursing organizations were asked to prepare white papers on specific aspects of health care reform legislation and major nursing and other health related organizations were active at the national, regional and local levels, participating in focus groups to identify and describe what were key components needed to make the legislation work.  Nurses served on major task forces to address such issues as access, cost, quality and safety, in addition to the new and expanded role of nursing in increasing access to primary care.  Major health care reform legislation did not pass during the Clinton administration but nursing’s substantial contribution to the debate has borne fruit over the years culminating in the enactment of the Patient Protection and Affordable Health Care Act under President Obama.  

Nurses are positioned to assume their roles in addressing the challenges of twenty-first century healthcare.  Appreciating the complexity and understanding the need for their ongoing involvement have given nurses the voice to advocate for change, including state scope of practice laws, promoting and funding graduate education, and the need for genuine collaboration and partnership with physicians and other inter-professional colleagues to achieve care coordination.