Nurses’ Policy: Influence, Development, And Implementation University Essay Example

Policy and Politics

The case studies show that private initiatives can be crucial for changing existing policies for the better. For example, Margaret Sanger was a public health advocate whose contribution to healthcare was vital. To make changes in the existing system, she organized protests, demanded services for the poor, discussed the problem of sexual and reproductive freedom, built voluntary movements, and established family-planning movement in the country and abroad (Nickitas, Middaugh, & Aries, 2011).

The Arkansas State Legislature made a significant effort to address the healthcare needs of the state by appointing a task force that focused on the population’s well-being. In the other case, the implementation of a bedside medication verification system eliminated medical errors and allowed for the improvement in staff performance. These and other examples from the chapter prove that it is crucial to respond to the needs of the society to make change.

The policy change results in legislation with the expanding public attention to the problem. De Leeuw and Peters (2014) note that innovation in health care requires expertise in the field to develop alternative approaches to existing practices.

Boivin, Lehoux, Burgers, and Grol (2014) underline the significance of proper communication of internal beliefs to the improvement of public expertise. Internal and external advocacy skills are crucial for nurses that want to make a change; they include an ability to establish an active political position and understanding of factors influencing decision-making (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). I would advocate for making abortions free for individuals in all clinics to reduce the number of adverse outcomes of unplanned pregnancies and rape.

Nursing Strong Throughout Time

One of the notable nursing advocates is Florence Nightingale, who changed British hospitals’ sanitary conditions. Before her interventions, people had experienced the lack of hygiene in operation facilities, which resulted in severe health complications including cholera and typhus (Nightingale, 1992). The situation improved with Nightingale’s help because she stressed the significance of hygiene in medical environments.

By suggesting incorporation of sanitary methods to British military hospitals, she contributed to the decrease in patients’ mortality rate. Another nursing advocate is Mary Breckinridge (1927), who founded the Frontier Nursing Service which provided care to the underserved population for a low fee. The service caused the significant drop in neonatal and maternal mortality rates and drew attention to the needs of minorities. Finally, Margaret Sanger is a nurse advocate that made a significant contribution to the issue of planned parenthood. She addressed women’s rights and health, stressing the adverse outcomes of frequent and unwanted pregnancies and discussing contraceptive methods (Sanger, 1969). Due to her advocacy, birth control medications became available and legal in the US.

Several changes should be made for the profession of nursing advocates to be successful. For example, Williams et al. (2016) note that healthcare institutions should engage nurses in decision-making processes.

They also should improve the hierarchy that exists within hospitals and implement principles of shared governance. Other changes may include establishing rewards systems for nursing staff, which may have a positive impact on caregivers’ perspectives of their role and significance (Walker et al., 2015). Finally, both nurses and medical institutions should understand the caregivers’ role in protecting patients’ rights as their advocates (Yuliastuti, 2017). It may contribute to the establishment of healthcare policy reforms and increase the number of nurses that change the history.

The Affordable Care Act

There are several significant features of the Affordable Care Act (ACA) that have improved health conditions of America’s population. For example, the ACA requires insurance companies to cover preventive procedures for free (Office of the Legislative Counsel, 2010). Other features include the pre-existing condition insurance plan, extended coverage for young adults and elderly people, increased tax credits for the middle class, and lower annual coverage limits.

The ACA had a significant effect on providers and consumers as prevents the rise of healthcare costs, increases the number of patients with coverage, and reduces payments for physicians whose practices do not comply with the initiative. It also addresses cultural and ethnical minorities’ problems by allowing them to have free access to mental health and behavioral treatment. As many of them encounter challenging life situations, these features may be vital for the improvement of their living standards. The act has decreased the number of uninsured Americans as it provides Medicaid expansion, health insurance exchanges, dependent coverage, and other policies (French, Homer, Gumus, & Hickling, 2016).

The primary limit of the Act is the taxing of uninsured individuals. As an advanced practice nurse, I believe that such feature of the policy is underdeveloped, as it does not consider a large group of population. Moreover, the ACA does not provide coverage options to immigrants (Oberlander, 2016). To provide health coverage for those who remain uninsured, I would suggest that the hospitals develop internal programs covering procedures that can play a crucial role in patients’ state of health. They may include doctor’s visits for acute pain or in the case of emergency.

The Role of the Advanced Practice Nurse in a Changing Healthcare Environment

The roles of the advanced practice nurse (APN) have expanded with the change in the current healthcare system. McDonnell et al. (2015) state that their primary goal is to improve patients’ health conditions and experiences in the hospitals using cost-effective and timely methods. The areas of APNs’ work include leadership and management in population health, patient guidance and coaching, improving the quality of care and enhancing access to it, and research (Bryant‐Lukosius et al., 2016). The expanded role of the advanced practice nurses will augment physicians’ practice as well. For example, the Transitional Care Model, a nurse-led approach to care, is now utilized by clinicians, which adjusts their treatment methods to the needs of the population and allows for collaboration at the workplace.

The ACA presents an opportunity for growth for the advanced practice nurses as it allows them to improve preventive services and take a leadership role in offering high-quality primary care (Lathrop & Hodnicki, 2014). Moreover, it provides funding for nursing education, nurse-managed healthcare centers, and increases payment for primary care services. With the ACA, caregivers have an opportunity to support cost-effective services and establish a partnership with patients in achieving positive health outcomes.

Global Nursing Shortage

The global nursing shortage has become a serious challenge for the healthcare industry as it results in the lack of the workforce, the decreased quality of care, and personnel’s burnout. The problem creates pressure for nurses and prevents them from spending an adequate amount of time with patients; it has negatively affected the United Nation’s Millennium Development Goals as well. The objectives of the World Health Organization (2018) include reducing child mortality and improving maternal health. With nursing shortages, these goals cannot be achieved fully as it is impossible to provide high-quality care if there are few people working in pregnancy and acute care units (MacLean et al., 2014).

Mendes and Ventura (2017) note that the nursing shortage presents the opportunity to transform care by making reforms in educational programs that will allow for progressive recruitment of the future generation nurses. If caregivers advocate for their values, stating that it is crucial to increase the number of professionals that provide care to improve patient outcomes, the problem of shortages may be eliminated. Policy can dictate treatment options when it is established by a hospital or a national or state law.


Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research, 19(3), 315-322.

Boivin, A., Lehoux, P., Burgers, J., & Grol, R. (2014). What are the key ingredients for effective public involvement in health care improvement and policy decisions? A randomized trial process evaluation. The Milbank Quarterly, 92(2), 319-350.

Breckinridge, M. (1927). The nurse-midwife—A pioneer. American Journal of Public Health, 17(11), 1147-1151.

Bryant‐Lukosius, D., Spichiger, E., Martin, J., Stoll, H., Kellerhals, S. D., Fliedner, M.,… & De Geest, S. (2016). Framework for evaluating the impact of advanced practice nursing roles. Journal of Nursing Scholarship, 48(2), 201-209.

De Leeuw, E., & Peters, D. (2014). Nine questions to guide development and implementation of Health in All Policies. Health Promotion International, 30(4), 987-997.

French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the patient protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771.

Lathrop, B., & Hodnicki, D. R. (2014). The Affordable Care Act: Primary care and the doctor of nursing practice nurse. Online Journal of Issues in Nursing, 19.

MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., & Fairman, J. (2014). Scale, causes, and implications of the primary care nursing shortage. Annual Review of Public Health, 35, 443-457.

McDonnell, A., Goodwin, E., Kennedy, F., Hawley, K., Gerrish, K., & Smith, C. (2015). An evaluation of the implementation of advanced nurse practitioner (ANP) roles in an acute hospital setting. Journal of Advanced Nursing, 71(4), 789-799.

Mendes, I. A. C., & Ventura, C. A. A. (2017). Nursing Protagonism in the UN Goals for the people’s health. Revista Latino-Americana de Enfermagem, 25.

Nickitas, D., Middaugh, D. J., & Aries, N. (Eds.). (2011). Policy and politics for nurses and other health professionals. Sudbury, MA: Jones & Bartlett Learning.

Nightingale, F. (1992). Notes on nursing: What it is, and what it is not. Philadelphia, PA: Lippincott Williams & Wilkins.

Oberlander, J. (2016). Implementing the Affordable Care Act: The promise and limits of health care reform. Journal of Health Politics, Policy and Law, 41(4), 803-826.

Office of the Legislative Counsel (2010). Compilation of patient protection and Affordable Care Act

Sanger, M. (1969). The pivot of civilization. New York, NY: Pergamon Press.

Walker, D. K., Barton-Burke, M., Saria, M. G., Gosselin, T., Ireland, A., Norton, V., & Newton, S. (2015). Everyday advocates: Nursing advocacy is a full-time job. The American Journal of Nursing, 115(8), 66-70.

Williams, T. E., Baker, K., Evans, L., Lucatorto, M. A., Moss, E., O’Sullivan, A.,… & Zittel, B. (2016). Registered nurses as professionals, advocates, innovators, and collaborative leaders: Executive summary. The Online Journal of Issues in Nursing, 21.

World Health Organization (2018). Millennium Development Goals (MDGs).

Yuliastuti, R. A. (2017). The role of nurses as advocates and communicators in the implementation of informed consent preoperative in Cempaka room Dr. Iskak Hospital Tulungagung. Web.

Management In Organizations: Financial Issues

Creating the environment in which the staff delivers the performance of the finest quality is a necessity for managers in the contemporary business environment (Groebner, Shannon, Fru, & Smith, 2014a). However, managing the staff and maintaining high motivation rates among the employees is a challenging task that requires a detailed analysis of the current situation and a good understanding of the needs of the company members.

First, a more detailed overview of the number of defects occurring in the course of the production process among the staff members will have to be carried out so that the further steps for defining the problems, enhancing the enthusiasm rates, and encouraging initiative could be outlined. Since the information regarding the number and the percentage of the defects in batches is provided on a regular basis, it can be used successfully to pinpoint the current performance of the staff and locate the emergent problems (Knell, 2014). To analyze the data, one should consider using the correlation plot, thus, connecting the number of incentives retrieved by the staff members with the number of defective items produced.

Table 1. Number of Defective Items Produced in Each Unit.

Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10
101 89 26 50 33 11 18 43 77 36

Table 2. Incentives Retrieved by the Employees in Each Unit (Average).

Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10
92 75 4 31 16 1 12 24 51 27

Scatter Plot: Correlation between the Defects and Incentives.
Figure 1. Scatter Plot: Correlation between the Defects and Incentives (Including Appraisals)

As the example provided above shows, the information retrieved in the course of the staff’s performance analysis allows locating the problems in their performance and, therefore, identifying the issues that cause a significant drop in the enthusiasm levels. As a result, a more detailed analysis of the subject matter will lead to the isolation of the factors that are likely to affect the employees in question positively. Particularly, the distribution of rewards and incentives provided to the staff members will be reconsidered and improved according to the data offered above.

The choice of the tools mentioned and applied above is quite obvious. The correlation analysis helps identify the connection between two factors and, thus, deliver the necessary information. One might argue that the application of the ANOVA test could be more beneficial to the outcomes of the analysis. Indeed, by definition, ANOVA allows dealing with non-numerical data, such as public appraisals, which are also considered as a type of reward. However, in the case in point, even non-numerical data was quantified. Therefore, there was no obvious need to include an overly complicated test instead of a more basic one (Groebner, Shannon, Fru, & Smith, 2014b).

Another argument concerning the use of correlation and the subsequent application of the scatter plot concerns their forecasting properties. The trend line incorporated into the graph permits a clear overview of the current tendency and, therefore, serves as the premise for designing a future forecast. While admittedly isolated from the rest of the factors, including external ones, the scatter plot provided above makes it quite clear that there is a strong need in reconsidering the current approach toward the distribution of financial incentives as well as the policy of public appraisals (Boyhan, 2013).

Improving the quality of the staff’s performance is the primary task of the manager. Seeing that the identified characteristic is related closely to the use of both financial and social rewards, it is strongly suggested that a combination of both should be offered to the staff members. The correlation analysis carried out above, as well as the, scatter plot, make a very solid statement concerning the necessity of applying the specified measures in the target environment.

Reference List

Boyhan, G. (2013). Agricultural statistical data analysis using STATA. Chicago, IL: CRC Press.

Groebner, D. F., Shannon, P. W., Fru, P. C., & Smith, K. D. (2014a). Graphs, charts, and tables – describing your data. In Business statistics (9th ed.) (pp. 31-84). Upper Saddle River NJ: Prentice Hall.

Groebner, D. F., Shannon, P. W., Fru, P. C., & Smith, K. D. (2014b). Describing data using numerical measures. In Business statistics (9th ed.) (pp. 85-138). Upper Saddle River NJ: Prentice Hall.

Knell, R. (2014). Introductory R: A beginner’s guide to data visualisation, Statistical analysis and programming in R. New York, NY: Robert Knell.

Patient Experiences Of Caring And Person-Centredness

The title of this article represents a quite accurate description of the article. It pointed to the aims and the results of the study, and also it contained most keywords that facilitate searching for the study and recognizing it. This title is considered as a statement of the declarative type, which is meant to state the findings of the study. It is also described as a single-unit title (Nagano, 2015). Even though it associated the two factors of the study, it did not determine whether this association is of positive or negative nature.

The abstract is representative of the study. It is characterized by being clear, organized, with clear objectives, well-structured methodology and significant results. It possesses all of the sections of an ideal abstract (Alguire, n.d.).

The introduction clarifies the importance of the topic and provides the rationale for conducting this study. It provides an explanation for some concepts related to the study such as nursing care quality, measurement of patient experiences and self-reported patient experiences. Also, it mentioned previous studies linked to different aspects of the problem discussed.

The problem of the research has been illuminated in an organized way. At the start, the indicators of the quality of health care were mentioned, with the importance of defining standards of indicators so as to assess the performance and improve the service as a cyclical process. Then, the significance of caring as a fundamental aspect of nursing care quality was declared. Finally, it illustrated that caring has not driven much attention as other quality indicators such as issues related to safety and prevention of adverse events, and the impact of caring on self-reported patient experiences and quality of nursing care is largely unknown.

The purpose of conducting this study was clearly explained, as it focused on studying the association between caring and person-centredness and the nursing care quality. In addition, two research questions were put to explore the association between the studied factors. According to FINER criteria, these questions can be considered fairly good questions. FINER criteria stand for Feasible, Interesting, Novel, Ethical and Relevant (Hulley, et al., 2013). However, these questions could be more clarified.

The theoretical framework has been discussed through explaining the definition of quality of care by the Australian Commission for Safety and Quality in Health Care. This definition depends on linking quality and safety by using three core principles. The ability of this accreditation to improve hospital care has been debated, as it is not linked to patient recommendation rates of institutions.

The literature review is well organized, logically sequenced and structured, relevant to the topic of the study, defining and explaining many concepts, and depending on multiple sources that are recent and research based (Boland, Cherry, & Dickson, 2013).

Regarding the methods used in this study, it was based on a descriptive non-experimental correlation design, which is appropriate for the nature of the study and its aims. The sample consisted of inpatients at the Australian acute hospital, which is suitable to conduct such a study, as they could rate the quality of the service provided during their admission periods. The sample size was sufficient to obtain reliable data and to avoid type II statistical error. The collection of data was done by using a questionnaire that included demographic data and 11 study-specific variables. These variables depended on four measurement tools, which documented reliability and validity in previous studies and publications. Moreover, two of these measurement tools were approved to have satisfactory psychometric properties.

The analytical approach is consistent with the study design. A descriptive statistical analysis was used to summarize the available data and analyze the structure and distribution of this data. A regression analysis in the form of hierarchical linear modeling was conducted to explore the effect of total score continuous variables “caring” on continuous dependent variable “quality of nursing care”. Also, correlation coefficient was calculated and estimated P-values of ˃ 0.5 were considered highly significant (Katsanidou, Horton & Jensen, 2016).

The results are clearly explained in the form of text and tables, but no figures. Additionally, the statistics are obviously clarified in the form of the Pearson product moment correlation coefficient, which is used to measure the strength of associations between nursing care quality, caring and person-centredness (Katsanidou, et al., 2016). The results showed significant association between these variables.

The discussion is described by being exemplary. The problem of the study is properly stated and supported by previous relevant studies. The methodology is discussed to reveal its validity and reliability. The findings are correlated to the theoretical framework and the questions of the study. Moreover, the results prove that caring is located in the environmental meta-paradigm of nursing. In other words, this study helps to confirm the previous theoretical conceptualizations of caring as being regarded the inter-personal quality indicator of nursing care. Additionally, it reveals the fact that caring contributes to the expert nursing practice and the creation of intimate relationships.

The limitations of the study in the method of sampling and the method of data collection are presented, and their effects on the results of the research are clarified. Furthermore, the factors that may have affected the patients’ perception of nursing care quality are mentioned. The conclusion included recommendations for nursing practice and policymakers to pay more attention to the effect of environmental and experiential domains on nursing care quality in nursing education and practice. Also, recommendations for including patient experiences of care quality in policy conceptualizations of nursing care quality were mentioned. Besides, the conclusion included recommendations for conducting future studies, so that evidence can be accumulated.

According to the Johns Hopkins nursing evidence-based practice (JHNEBP) Evidence Rating Scales, this study is at the level III for its nature as being a non-experimental study. Regarding assessment of the quality of the evidence, the study can be rated as B, which would be of a good quality. Factors included in the assessment of quality are research, summative reviews, organizational and expert opinion. Assessment of the research in the rate B is based on having fairly comprehensive literature review, sufficient sample size, some control, reasonably consistent results and reasonably consistent recommendations. The summative reviews in the rate B are characterized by having reasonably thorough and appropriate search. The organizational evaluation is based on the well-defined methods, reasonably consistent results and the use of reliable and valid measures. Finally, the expert opinion in this rate is demonstrated as that expertise appears to be credible (Dang & Dearholt, 2017).

This study is applicable in practice, as the results and recommendations could be used. Modifying the nursing education to meet the recommendations of the study, as well as modifying the policy conceptualizations of nursing care quality to include the patient experiences of care quality could be achieved.


Alguire, P. (n.d.) American College of Physicians. Web.

Boland, A., Cherry, M. G., & Dickson, R. (Eds.). (2013). Doing a systematic review: A student’s guide. London, UK: Sage Publications Ltd.

Dang, D. & Dearholt, S. L. (2017). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (3rd ed.). Indianapolis, IN: Sigma Theta Tau International.

Hulley, S. B. et al. (2013). Designing clinical research (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Katsanidou, A., Horton, L. & Jensen, U. (2016). Data Policies, Data Management, and the Quality of Academic Writing. International Studies Perspectives, 17(4), 379-391.

Nagano, R. (2015). Research article titles and disciplinary conventions: A corpus study of eight disciplines. Journa of Academic Writing, 5(1), 133-144.

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