Role of RN/APRN in Policy Evaluation Discussion

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Role of RN/APRN in Policy Evaluation Discussion

DISCUSSION RESPONSE: Suggest additional opportunities or recommendations for overcoming the challenges described by your colleagues.

Select an existing healthcare program or policy evaluation or choose one of interest to you.

Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described. Role of RN/APRN in Policy Evaluation Discussion

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MAIN DISCUSSION POST: Role of RN/APRN in Policy Evaluation

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Foundational to the skills and knowledge of nurses is the nursing process. It is the basis of how nurses deliver quality, patient-focused care, a process inculcated in the critical minds of nurses. The stages of the Policy Process (Milstead & Short, 2017, p. 88) are similar to the nursing process, from the Identification of the Problem (Assessment) to Policy Formulation/Adoption (Diagnosis/Planning)  to Implementation and Evaluation. Evaluation is a critical stage in which nurses determine the effectiveness (efficiency) of the care delivered if expected outcomes are met and modify it accordingly. These inherent skills and knowledge of the nursing process are bankable assets why nurses are in the best position to influence or impact the (Health) Policy Process. The IOM’s landmark report (Future of Nursing) 2010 espouses that nurses are essential/invaluable to transforming the US healthcare system (Milstead & Short, 2017, p. 117). Role of RN/APRN in Policy Evaluation Discussion

Policy evaluation is a critical stage of the policy process, through which (nurse) researchers can understand a policy’s merit, worth, and utility  (Centers for Disease Control and Prevention, 2013). It is a way to know if the policy worked and achieved the intended outcomes or impact (Milstead & Short, 2017, p. 119).  The Patient Protection and Affordable Care Act (ACA) was mandated in 2010 to address (at that time) the three main aims of healthcare reform efforts – Quality, Cost, and Population Health (Access). Through the expansion of Medicaid, the ACA reduced the uninsured by 20 million (addressing the SDOH of healthcare access, among other SDOH). Since more people were insured, including those with pre-existing conditions, payers (insurance carriers) have to drive up premium costs to remain ‘afloat’/solvent in the industry; the healthy segment of the population, those earning above a certain federal poverty level (FPL) as stipulated in the Act are obligated to pay more for their health insurance to help defray the costs of the increased number of the young, healthy and insured added in the population (enlarged and balanced risk pool [Milstead & Short, 2017, p. 176]). Last year, the administration signed the Inflation Reduction Act (The Biden White House, 2022) to extend premium subsidies through 2025, benefiting millions of Americans. This benevolent objective complicates the issue of sustainability and costs for the nation in the long term. Issues that sparked the debate of how to “repeal, replace, repair or starve” the ACA. Role of RN/APRN in Policy Evaluation Discussion

I am sure you will agree that the ACA’s astute scholar proponents or developers must have exhausted every evidence-based knowledge available (I am sure nurses were consulted). However, it still had its failures and pitfalls. As they say, in policy and politics, there is always a compromise; public policy fails because researchers are unable to predict public behavior and participation in the programs (Milstead & Short, 2017, p. 88). The ACA is, I believe, at the evaluation stage of the Policy Process – an ongoing evolution/transformation to improve implementation for the future. Glasgow et al. (2003) suggested that research designs should proceed logically and systematically, building on the previous body of evidence/knowledge to develop improved policies in or for the future; they have also warned that efficiency studies do not always translate to effectiveness once applied to the population. Hence, the debate over ACA is not yet over; still undergoing the steps in the CDC (policy) evaluation framework  (Centers for Disease Control and Prevention, 2013) of constant and continuous evaluation of all stages of the process, from problem identification to policy implementation (page 4). Role of RN/APRN in Policy Evaluation Discussion

References

Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), 573–576. https://doi.org/10.1370/afm.1713Links to an external site.

Bunis, D. (2022, August 15). Aca subsidies extended under new law. AARP. https://www.aarp.org/politics-society/advocacy/info-2022/affordable-care-act-subsidies-extended.htmlLinks to an external site.

Centers for Disease Control and Prevention. (2013). Brief 1: Overview of policy evaluation [PDF]. Retrieved October 23, 2023, from https://www.cdc.gov/injury/pdfs/policy/brief%201-a.pdfLinks to an external site.

Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93(8), 1261–1267. https://doi.org/10.2105/ajph.93.8.1261Links to an external site.

Milstead, J. A., & Short, N. M. (2017). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning.

The Biden White House. (2022, August 15). By the numbers: The inflation reduction act [Statement and Press Releases]. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/15/by-the-numbers-the-inflation-reduction-act/Links to an external site. Role of RN/APRN in Policy Evaluation Discussion