Review of the Literature: APRNs impact population health through health policy because they have the understanding and the insight into the population they serve. However, APRN students have little exposure to health policy creation and advocacy in their academic plan of study (Garcia, Hernandez, & Mata, 2015). Many schools rely on PowerPoint lecture and assignments such as letters to the editor, preparing an elevator speech, or writing a letter to their state or federal legislator to educate students on health policy and advocacy. Since they may not have exposure to legislators, students feel intimidated to speak to state and federal representatives about issues affecting their state or profession (Dobson, Voyer, Hubinette, & Regehr, 2015). Students tend to see health policy as something they are unable to advocate for because they are not yet certified. When these students graduate, they rely on experienced APRNs to teach them health policy skills (Marquez, Pell, Forster-Cox, Garcia, Ornelas, Bandstra, & Mata, 2017). They are unprepared for the expectation of their profession to create, adopt, or advocate for health policy influencing population health. Newly graduated APRNs feel unprepared to contribute to health policy, and many do not understand the difference between health policy and politics (Kung & Rudner Lugo, 2015). This leads to apathy in the health policy arena or learning skills through a process of trial and error. As a result, there is an urgent need to enhance APRN health policy at the academic level to prepare students for future practice (Martin, Hum, Han, & Whitehead, 2013).
Summary: Two independent schools in neighboring states collaborated to strengthen health policy education for APRN students. Faculty from the schools are active in health policy, which allowed for enhanced education and infusion of new ideas into the APRN curriculum. Using previous faculty experiences, assignments were created to focus on various aspects of health policy from creation to advocacy. For health policy, students were provided a presentation and discussion session to dialogue about health policy. The presentation outlined the difference between health promotion, health policy, and politics. Working in small groups, faculty provided students with a community scenario in which there were several health promotion and health policy needs. Each group researched and developed a new evidence-based health policy for the community to improve health. Students identified costs of the policy, needed grant funding, stakeholders, opponents, and short and long-term goals. Students also developed advocacy strategies through talking points and key people to approach. Students were able to relate this to the DNP Projects they are completing, which strengthened the feeling of knowledge and ability to impact health outcomes through health policy. For advocacy education, students identified a topic pertinent to the state’s population. Students recorded a time limited elevator speech including an “ask” for the legislator they were addressing. Students at one school attended a breakfast hosted by the state APRN association to discuss with current state representatives legislative bills that influenced health outcomes. Results of the collaboration showed significant learning in health policy creation and advocacy. Students carried the learning forth to subsequent semesters when discussing legislation and health policy. More students were involved in the legislative session advocating for legislation to improve population health than in previous years. Students had an overall positive experience with health policy and indicated a desire to continue this work into the future.
Discussion: APRNs should be aware and comfortable with health policy creation and advocacy. Lack of knowledge, skills, and confidence leads to APRNs being inactive in the area of health policy. The belief from students that they are not knowledgeable or the best advocate to speak for an issue leads to a silent voice (Taylor, 2016). Many times APRNs are providing care to the rural and underserved population. Health disparities are increased in these populations, and the need for health policy to enhance health outcomes is evident. APRNs have a duty to patients to understand and advocate for the care needed to achieve health outcomes (Kostas-Polston, Thanavaro, Arvidson, & Taub, 2015). Once APRNs experience the health policy process, they are less apprehensive in the future. It is crucial that schools provide this experience for students (Blenner, Lang, & Prelip, 2017). Increasing knowledge and confidence in the academic setting translates to advocacy and health policy effort as APRN providers. This will lead to better outcomes for the state, nation, and the world (Long, Chaiyachati, Khan, Siddharthan, Meyer, & Brienza, 2014).