Introduction and Background:
It is imperative that nursing graduates understand, and can collaboratively advocate for health policy that benefits patients, families, and communities. Evidence suggests a historical disparity between health care providers’ attitudes and experiences with health policy advocacy. Physicians’ perceptions of the importance of their role in political advocacy indicates that though 91.6% specified that political involvement was important, only 25% were politically active (Gruen, Campbell, & Blumenthal, 2006). Among nutritionists only seven percent reported being highly active in the policymaking process, while 44% declared no involvement (Boardley, Fox, & Robinson, 1999).
Nurses also exhibited poor enthusiasm and understanding regarding the political health policymaking process (Boswell, Cannon, & Miller, 2005). Salvador’s (2010) study of 347 Registered Nurses indicated that while 73.5% had participated in up to two health policy-related activities, 26.5 % reported no participation at all. More importantly, 68.8% reported receiving no health policy education. Of those Registered Nurses who had received health policy education, 66.7% rated it as poor (Salvador, 2010). Primomo’s (2007) definition of political astuteness is an “awareness and understanding of legislative and policy processes, and political skills” (p. 260). To quantify graduate students’ political astuteness, an adapted Clark’s (1984) Political Astuteness Inventory (PAI) was employed in a health policy course, as well as among students attending a state legislative day. Both studies found significant improvement in political astuteness scores following experiential learning events focused on health policy advocacy (Primomo, 2007; Primomo & Bjorling, 2013).
Capitol Hill Experiential Learning:
In August, 2016, five James Madison University Doctor of Nursing Practice (DNP) students attended the School of Nursing’s first Health Policy Institute (HPI) in Washington D. C., and in May, 2017, seven DNP students attended the second HPI on Capitol Hill, spending one intensive interprofessional week living and working on Capitol Hill as part of their practicum experience. They were each assigned a mentor at the federal policymaking level. Students worked for Senator Kaine’s office, completed assignments for Congresswoman Comstock’s office, worked with the American Nurses Association, the American Association of Colleges of Nursing, the Institute for Public Health Innovation, the National Alliance to End Homelessness, and American Association of Home Health and Hospice public policy divisions. The second HPI occurred during a historical week with students witnessing the passage of the House Health Care Repeal/Replace Plan (American Health Care Act, AHCA), Sally Yates’ testimony, and FBI Director Comey’s firing.
During both HPIs students met essential health policy components for their doctoral education and provided reflective narratives linked to DNP policy focused American Association of College of Nursing (AACN) Essentials. During the 2016 HPI One student assigned to work with the American Association of Colleges of Nursing (AACN) on Title VIII funding reported, “I personally was amazed at the level of recognition and respect that the AACN receives on Capitol Hill. I realize that this is the result of years of hard work and policy promotion, but they have been able to prove through evidence that these workforce development programs have paid off. The public has supported nursing efforts even through budget cuts and other services requesting appropriations.” Another student expressed, “this was the most beneficial and life changing experience….the highlight of my entire DNP program”. One 2017 HPI student really summed up the experience, “I feel through my work and experiences here at the Health Policy Institute, I have become competent in the process of health care policy and advocating for healthcare on a federal level. I came into this experience feeling intimidated and unsure, but I am leaving with confidence and the motivation to do more as a nurse to advocate health policy, not only in my local community, but for all Americans”. All participating students self-reported an increase in knowledge and comfort level related to healthcare political advocacy. Additionally, policymaker feedback related to the students' level of participation was positive.
Meeting AACN Essentials (AACN, 2006):
Analyze the environment and process of policy making at the federal level within the context of health policy.
Critically analyze health policy proposals, health policies, and related issues from the perspective of consumers, nursing, other health professions, and other stakeholders in policy and public forums.
Influence policy makers through active participation at the federal level to improve health care delivery and outcomes.
Educate others, including policy makers at all levels, regarding nursing, health policy, and patient care outcomes
Conclusion and Implications:
Health care professionals have often lacked the knowledge, experience, and /or underestimated their ability to educate legislators on the value of healthcare, health care professionals, and healthcare-based need for policy change. Implementing interprofessional experiential experiences to improve political astuteness may prove to enhance health care professional’s likelihood of influencing policy change in the future.