[Sharon]

How Health Care Decisions Get Made, The Policy Cycle and How Policies Get Made

Discussion starters:

What are some examples of the different types of policies that affect nursing in Canada? Would you consider yourself a “politically astute” nurse?  What are some ways in which nurses can become active in policy as advocates?

[Marilyn]

Hello Everyone,

As you can see, we’ve jumped straight into the course content. This course is designed to build on the foundational concepts introduced in the “Introduction to Leadership” course. If you haven’t taken that course, don’t worry. By drawing on your critical thinking skills and lived experiences, you will be able to successfully complete this course. Along the way, you will also have the opportunity to learn from your peers and contribute to the collective knowledge of the group.

Looking forward to great discussion!

Marilyn

[Jessica]

Nursing in Canada is influenced by policies at the federal, provincial, organizational and professional levels. Federal and provincial laws and regulations govern who can practice nursing, as well as outline standards regarding scope of practice. Healthcare organizations create policies and standard operating procedures to support compliance with best practices. All these policies help shape a Nurses’ responsibility and decision making.

I resonated with the Nursing Now article as my clinical background is in infection prevention and control and would consider myself on more of the upstream approach in terms of preventing infections. However, we do will experience downstream approaches, for example, when an outbreak is declared. Responses to both approaches are influenced by policies at all levels.

I am confident in my knowledge and understanding of Nursing in the specialty of infection prevention and control, however I recognize I may not know everything related to policies, legislation, and the decision-making processes. My organization has a variety of policies that were created with the health and safety of staff and Patients in mind and to ensure we are following the appropriate guidelines set out by the ministry and public health. This includes outbreak thresholds, communicable disease reporting, etc. While I stay informed about changes to infection prevention and control standards and organizational policies, I would benefit from gaining a deeper understanding of the policy-making process at provincial and federal levels.

Examples of things a Nurse could do to remain active in policy include, identifying gaps and recommending practice improvements (micro), serve on organizational committees, participate in quality improvement initiatives, and contribute to developing or revising organizational policies and procedures (meso), and join professional organizations, participate in advocacy campaigns, and meet with elected officials/writing to members of parliament (macro).

[Jamie]

Jessica,

I appreciate your comments. I agree with where policies come from and how they can be both upstream and down stream. I like you wish that there were more involvement of the staff that works in the area’s that they are writing the policies for could be more involved in the process. To fill the gap that seems to always be there. But as the articles we read say it is difficult to fix the issues for everyone. Thank you for sharing. I enjoyed your insight.

Jamie

[Marion Catherine]

Questions:
1. What are some examples of the different types of policies that affect nursing in Canada? 2. Would you consider yourself a “politically astute” nurse? 3. What are some ways in which nurses can become active in policy as advocates?
Answers:
1. Public policy, Public Health policy, Nursing Act, CNO standards of care and ethics
2. I do not consider myself to be a “politically astute” nurse. Why? The experiences of life with those who are politically active tended to be quite radical in their approach to change. I have backed away from this method of advocacy leaning toward an educational evidence-based approach with a calm assuredness. Saying that, I also tend to use theatre as a tool for education and getting poignant points across to general public. Hat and that I am really very new to the health care system and am learning more and more every day about the nuance of health care and its policy framework.
3. Continuing education in the social determinants of health, the health care system, CNO nursing standards, legal range for public health advocacy – pick an area – mine retirement homes and long-term care facilities. Engaging in creative expressions where meaning can be made clearer through entertainment. This is not to imply that this approach is taken less seriously than any other mainstream method of eliciting change, rather my approach may allow for a calmer presentation that permeates resistance.

[Mary Ann]

Hi Marion,

I appreciate your perspective. I agree that advocacy can take many forms, and using education and evidence-based approaches can be very effective. I can relate because I’m also still learning about healthcare policies. That’s one of the reasons I continue to upgrade my knowledge and skills through online nursing courses. As we gain more experience and knowledge, our understanding of policy and our confidence in advocating for patients will continue to grow.

[Jessica]

I agree Mary Ann. I believe it’s important to stay engaged and seek out opportunities for growth. I wish additional education was mandatory for all Nurses to improve accountability throughout the profession. As an infection control professional I am responsible for earning IPUs (Infection prevention units), for a total of 40 units in 5 years in order to renew my certification. I think Nurses would benefit from something similar to improve many things, including our knowledge about nursing policies, accountability and confidence to advocate effectively.

[Mary Ann]

What are some examples of the different types of policies that affect nursing in Canada?
Each policy affects nursing in Canada. My first example is the government health policies – these policies affect how much funds hospitals and healthcare services receive, that impacts the number of nurses hired, available apparatus / equipments, and the quality of care receive by the patients.

Second is professional regulations from nursing regulatory bodies like CNO standard guidelines and regulations referring to nurses’ scope of practice, licensing requirements, professional responsibilities, and ethical conduct to ensure safe patient care.

Third is workplace policies that guide management / nurses daily operational work such as staffing, infection control protocol, patient safety protocol

Fourth is Retirement home and long-term care legislations – these laws establish standards care for seniors, outlining nurses’ responsibilities for resident safety including medication management and protecting residents’ rights (Residents’ Bill of Rights)

Lastly, public health policies like the immunization program for early disease prevention, health promotion, public education. Overall, all of these policies affect nursing because they serve as a guideline how nurses provide care, protect patient safety, define professional responsibilities, and influence the resources available to deliver quality healthcare.

2. Would you consider yourself a “politically astute” nurse?
No. I am still learning about healthcare policies and how government decisions affect nursing practice. I hope to improve my knowledge of health policy, advocacy, and leadership so I can better support my patients and the nursing profession.

3. How can nurses become active in policy as advocates?
Micro level: Advocate for patients, provide education, and suggest improvements to patient care.
Meso level: Join workplace committees
Macro level: Join nursing associations

[Marion Catherine]

Hi Mary Ann, The information presented in your response provides insights into the various policies and levels of authority that govern health care in Ontario. The style used to present this information is appreciated as it provides a succinct summary of those entities. I find this to be very helpful in distinguishing the nuance of each authority. Thank you!

[Samantha]

What are some examples of the different types of policies that affect nursing in Canada? Would you consider yourself a “politically astute” nurse? What are some ways in which nurses can become active in policy as advocates?

1.CNO, public health, private nursing organization policy
CNO guides RPNs on best standard of practice. Guides us on our scope.
Public Health- Guided us on infection control
Private nursing organizations have their own set of policies based on their values and beliefs, but CNO will always trump a private organization’s policy.

2.I do not consider myself to be a “politically astute” nurse. The reason for this is I don’t feel like I have a full understanding of what Nursing Policy/ political looks like. I have for the majority of my career been guided by the CNO, for me to follow what best standard of care is, what my scope and responsibility. I also worked in LTC for a great number of years where I was very much guided by public health (especially during covid and the ministry of LTC which took me several years to fully understand. I feel like policy can be very overwhelming and often not talked about or explained enough. The ministry of LTC protects the residents and lets Nurses know what their legal obligation is when caring for a resident ( giving medications, providing hands on care, and advocating for their many needs)

3.Some ways Nurses can become active as advocates are to be a part of RPNAO and other professional associations. I personally feel since joining RPNAO ,continuing my education and by attending in person events, it has opened up a door to learn. Nurses can also advocate for their clients front line, challenge the status quo, ask questions, educate themselves, be willing to be a lifelong learner/student. They can also start conversations with fellow nurses and keep the conversation open and ongoing.

[Alhasan]

Hi Samantha, I really liked your point about policy not always being explained well. I think a lot of nurses feel confident following standards and organizational policies but don’t always get the opportunity to learn how those policies are actually developed. I also agree that joining organizations like RPNAO and continuing our education are great ways to become more involved and build confidence in advocacy.

[Alhasan]

1. Nursing in Canada is influenced by policies at the federal, provincial, regulatory, and organizational levels. Federal and provincial legislation governs healthcare delivery and professional regulation, while organizations develop policies and procedures that guide day-to-day nursing practice. Professional standards established by regulatory bodies also influence scope of practice, documentation, medication administration, and ethical decision making. Together, these policies ensure safe, consistent, and evidence-informed care.

2. I would consider myself somewhat politically astute. In my current nursing leadership and program development role, I regularly work with organizational policies, quality improvement initiatives, and provincial standards to develop education and support safe practice. However, I would like to further develop my understanding of how healthcare policies are developed at the provincial and federal levels and how nurses can more effectively influence policy decisions through advocacy and professional engagement.

3. At the micro level, nurses can advocate by identifying patient needs, promoting safe care, and recommending improvements to everyday practice. At the meso level, they can participate in quality improvement projects, serve on committees, contribute to policy development, and support organizational change. At the macro level, nurses can become involved with professional associations, participate in advocacy campaigns, respond to government consultations, and communicate with elected officials to influence healthcare policy and improve health outcomes.

[Nathalia]

Hi Alhasan, I agree with you in that nurses can advocate for clients in a multi-level care approach. Nurses knowledge and involvement can be a great asset in policy implementation processes as well as first hand approach experiences that aid in investigative proof to be able to bring change. Overall the outcome is to provide a patient-centered approach and with the current gaps, sometimes the people making the changes are not familiar with the healthcare issues. Therefore, some of the solutions can be misaligned with the intended goal. By nurses becoming policy astute the different approaches you previously described would succeed at ensuring the nursing and client component are always considered.

.

[Jamie]

What are some examples of the different types of policies that affect nursing in Canada? Would you consider yourself a “politically astute” nurse? What are some ways in which nurses can become active in policy as advocates?

Policies influence nursing practice every day, but it can often feel like many of the decisions are made by people who are not directly involved in patient care. In my current position, the hospital has reduced the number of Personal Support Workers (PSWs). Instead of having one PSW assigned to each floor, there is now one PSW shared between two floors. This has increased the workload for the nursing staff and has made it more difficult to provide the level of personal care that patients deserve because nurses already have many responsibilities to manage.

The hospital has also implemented a Pyxis medication dispensing system on each unit. Instead of having medications delivered to the floor, nurses must now retrieve medications from the machine themselves. While I understand that this system may improve medication security and accountability, it also requires additional nursing time that could otherwise be spent providing direct patient care.

From the hospital’s perspective, these changes may reduce costs and improve efficiency. However, the impact on frontline staff and patient care must also be considered. Increased workloads can contribute to nurse fatigue, decreased job satisfaction, and less time available for meaningful patient interactions. Effective healthcare policies should balance financial sustainability with the resources needed to maintain safe, high-quality patient care. Including input from bedside nurses during the decision-making process could help organizations better understand the practical effects of these policy changes and develop solutions that support both patients and healthcare staff.

As an astute nurse, I can recognize how these changes will affect both my role and the quality of care I am able to provide. Advocacy is a fundamental part of nursing practice, and I advocate for my patients and their families by encouraging them to contact Patient Relations to share their concerns about how these changes may impact their care. I also have a responsibility to advocate for safe nursing practice by bringing my own concerns forward through workload reports and by working with my union to address staffing and workload issues. By speaking up through these established channels, I hope to contribute to positive changes that support safe, high-quality patient care while ensuring the concerns of frontline nurses are heard by hospital leadership.

[Heather]

Thank you for your post. I have to agree with you that in healthcare workplaces, often decisions and new policies seem to be made by those who are not directly involved in patient care. I think that reducing personal support workers is a great example of this and will likely be more costly in the long run, at the very least, there will be effects of patient wellness and overburdened nurses. I work in home care and see this more often that I would like. Often patients are do not get the amount of care that they need or the timing
of admissions and discharges in not amenable to quality care. I am hoping to learn from this course ways to be a better patient advocate.

[Heather]

Types of Policies that affect nurses in Canada: Nursing in Canada is guided by regulations and policies from the College of Nurses of Ontario and other Colleges in other provinces. Workplaces have their own policies on health and safety and practice standards. The provincial government sets policies for budgets which affect the services that are provided to the public and how these services will be delivered.

I am not well versed in politics and how decisions about policy are made at various levels of government. I am hoping to improve my knowledge and understanding of this by taking this course. I would like to learn how to be a more effective advocate for patients in the home care community.

I think that ways to become more involved in policy making are to join professional organizations like WeRpn, review health news to stay up to date on current issues, participate in advocacy campaigns, and grassroots campaigns often become forces to create change.

[Sara]

Hi Heather, I really appreciated the mention of workplace policy. I believe it really goes hand in hand with scope specifically for RPNs. I find that scopes appear to be facility-specific and it can be confusing when working in different areas

[Maame]

Hi Heather,

Joining WeRPN is a great way of staying informed of the state of nursing and anything regarding RPNs; also stay up to date with health news and joining adovoacy committees you for sure will be in tuned with everything that’s going on. Thanks for sharing.

[Nathalia]

What are some examples of the different types of policies that affect nursing in Canada? Would you consider yourself a “politically astute” nurse? What are some ways in which nurses can become active in policy as advocates?

Nursing in Canada is influenced by different policies based on the sector such as federal, provincial, organizational and professional level. Although i don’t consider myself a politically astute nurse at this point in time. I ensure to research and learn what i can when changes to policies need to be implemented or when new issues arise that require policy development. As nurses we can become active in policy as advocates by recognizing gaps in our system or within our company framework and elaborating a purpose for policy development in order to address the issue or gap. Taking part of the committee that discusses/revises policies can also assist in understanding the current implementation practices and will provide insight in the decision-making process for the current policies in place. This provides the nurse with new information regarding the processes and current priority items on the list. While doing so, as nurses we can take part in these discussions to provide a different perspective or evidence regarding the current issue, which can help to raise awareness or assist in discussing other issues that can arise considering all avenues. Over time, the more we expose ourselves to policies and becoming knowledgeable on the topics that require changes can help nurses advocate for clients health and well-being. Although changes are made by political parties, nurses can work as unit to push for implementation once all the information is gathered, investigations completed, appropriate submissions made and common cause is clearly stated; with sufficient support and quantifiable evidence, politicians then can reassess and plan.

[Sara]

The best example I can think of when it comes to policy is having a regulatory body like the CNO. They oversee all nurses in Ontario to ensure competency and public safety. Policies regarding education requirements, licensing exams, investogations and ethical obligations. These all foster safe healthcare in Ontario.

As a nursing student, I am still working on becoming a politically astute future nurse. I try to keep up with policies related to healthcare and advocate on a smaller scale within my school community. I joined the board of directors as a student member and was able to see firsthand the difference advocacy makes in the lives of nurses.

[Maame]

What are some examples of the different types of policies that affect nursing in Canada ?

Hello everyone,
Some examples of policies that affect nursing in Canada :
1. Healthcare policies- which includes funding ,access to healthcare and long-term care standards.
2. Professional practice policies – scope of practice , nurse licensing, documentation and standards of care.
3. Privacy policies- which protect patients’; their personal health information and confidentiality.

I would say I am a politically astute nurse due to the fact I’m a board member of WeRPN; myself and other board members use are voice to fight for the rights of RPNs across Ontario. My advice would be for nurses join a professional organizations or committees so you can advocate yourself and other nurses.

[Author]

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