How Health Care Decisions Get Made, The Policy Cycle and How Policies Get Made
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?
Two that come to mind currently would be the different vaccine policies that nurse are facing depending on their place of employment. As well as the current bill being reviewed by our Provincial Government in relation to LTC placements outside of patient/family location in an effort to offload the strain on our hospital systems and deal will ongoing waitlists.
I would say that I am ‘politically aware’ instead of ‘astute’ as I do listen to the news and generally keep up on current affairs. I could definitely increase my knowledge in how these policy decisions are made and implemented as well as reflect further on how this directly affects our patient base and our nurses on a day to day basis. Further to that I would like to increase my skill on taking that knowledge and putting in into practice as a way to advocate for improvements for both patients and staff in the process.
I think on a personal level we as nurses can all stay informed in both pollical and professional policies, asking questions and clarifying when appropriate. This increases our ability to advocate for our patients and for ourselves as professional. Participating in opportunities for advocacy groups and policy review in the workplace can help affect change on a larger level. Taking the opportunity to share our concerns with members of parliament and municipal leaders is a great next step for those wishing to add to their involvement. We as nurses have great insight to add to many discussion and need to trust that our contributions can affect change around us.
Policies that affect nursing in Canada would be the vaccine policy. Depending on which setting you work in you either have to have two vaccines or three. This policy has affected the nursing shortage in certain sectors. Certain sectors aren’t hiring nurses if they only have two vaccines instead of three.
I think nurses can become active in policies as advocates, to take the opportunity to learn about different policies. Learn about groups out there that help nurses such as WeRPN. If your place of employment happens to have a union, take the time to learn about what the union offers and how they can support you.
As nurses we advocate daily for our patients. Staying informed and seeking guidance from senior nurses is a way that I keep current in my practice.
Amanda I agree with you that the vaccine mandates have contributed to the shortages we are seeing across the board in our province. It is a complicated area when it comes to policy and I found at times difficult to see a consensus on even on a local level let alone a larger political one.
I agree with you that as nurses we have to stay informed of professional policies especially in the workplace. Also taking the time to advocate for our patients/clients and being informed of rights and regulations.
The integration of policy in nursing has assisted to maintain the standards of care and optimize healthcare within Canada. Types of nursing policy include public policy, substantive policy, horizontal policy, vertical policy, reactive policy and proactive policy.
Public policy assists to address issues that affect individuals in society. Examples of public policy include increasing health care access to the general population; improving health care quality through workforce development; and working towards sustainable health care through systems transformation. These directives have been put in place to increase the quality encompassing culturally sensitive care for future generations. When reviewing public policy, this translates into policies and procedures built within health care facilities, to ensure the proper and ethical procedures are carried out in the best interest to serve the largest potential and/or actual population access the facility. When looking at public policy, I can see how this translates into vertical and horizontal policy within my own workplace.
To further assist in creating a healthier population, the government’s initiative to retain nurses and expand the roles of nurses within Ontario has assisted to address the health demands within the current population. This translates into nurses advocating for different roles to assist with nursing care in a workplace, when unable to retain or address a shortage on a facility level. To further address the nursing shortage, the review of educational requirements, and different types of diploma/degree programs has been reviewed. This assists to increase the number of nurses who can participate in direct care services, teach and instruct future nurses, provide research and development for nursing professionals, promote workplace safety, increasing access to education to create a dynamic workforce.
Reactive policy exists to respond to crises including environmental disasters and health care emergencies. In society, we have observed reactive policy when implanting measures to respond to natural disasters and disease exposure. Canada’s Federal Emergency Response Plan (FEMA) has assisted with the response to disease/toxin exposure through unsafe water resources, exponential flooding due to storms, and implementation of essential lockdown procedures within Canada, as recently observed through the COVID-19. FEMA us used when there is a direct threat to public safety, security, health, welfare, or property. As a nurse, if obtaining the right knowledge and skills, it may be necessary to step outside his/her current role established within the workplace to provide direct health care services where needed.
Proactive policy looks at the prophylaxis of disease, injury and destruction of an essential resource, that is necessary to the well-being of individuals. Reviewing proactive policy assists in identifying the issue that has occurred, through careful research, while identifying the problem that has occurred to create this. Examples of proactive policy include the usage of personal protective equipment (PPE), the way in which individuals distance themselves to protect each other and the environment. This has been used as predictor for supply needed for disease management.
When reviewing my practice, I consider myself to be a nurse that acts in the best interest of the residents. I consider myself to be evolving into a politically astute nurse. Although I don’t see myself as having the ability to assess the situation accurately, due to the population of individuals I serve, I do see myself participating in aspects of the facility life within the long-term care home I work in that enhances the life of the residents. I see myself as a nurse, who can accurately assess some situations, possessing the ability to reflect after the occurrence of an event and assist in picking out the flaws within a process, to build on a procedure. The skills I’d like to possess to participate in a more forefront role, would be the ability to interpret the needs identified in response to a situation more accurately, differentiate between what is best for my co-workers and resident population at the time and going forward. I’d like to be able to document more factually, give more direct responses and complete time for focused hands-on skills. I often read about the practice of a skill but have not been able to carry it out.
Nurses become active in policy as advocates on the micro (unit level/individual), meso (workplace/organization) and macro (government) level. Nurses advocate on a unit or individual level through carrying out bedside care. This includes providing effective pain management through orders received, making suggestions for change towards the PSWs, RCAs and MD/NPs through use of pharmacological and non-pharmacological interventions. Other ways include, providing therapeutic interventions relatable to resources outside of the facility, such as counselling family and/or non-familial individuals or caretakers who have been highly involved in the individual’s care; advocating through discussion with the team providing direct care services to the individual to enhance life and create a referral process that is streamlined to the needs of the resident.
On a meso level, nurses become advocates through identification of areas of strength and faults, to improve on care for a similar individual within a different area requiring improved or reduced services. This can involve a better verbal communication amongst the interdisciplinary team, providing care support to the workers through use of physical and mental health well-being programs, involvement of residents from different home areas in programs such as a counsel; end-of-life discussions and services; hand hygiene programs for both residents and the staff.
Nurses become advocates addressing issues in government on a macro level, when the issue within a workplace has become a crises or situation outside of a facility. This can be through identifying political issues requiring action, such as participation in government elections, within a courtroom, participation in direct political actions, including but not limited to legal protests, use of media and completion of writings to address a problem. This is usually in response to lack of or reduced use of resources within a cohort of health care facilities or resident population within a larger geographical area, that often leads to identification of a cause to elicit a response.
Amanda and Katie – I agree with both of you that the vaccine policy is probably having the most significant aspect on nursing in healthcare today. When I was working in LTC during the pandemic the policy not only resulted in staff shortages but also conflict with families of residents. Some families were pro-vaccine and upset that others could visit who were not vaccinated (still requiring a rapid swab) while others who were anti-vaccine did not appreciate the pressures being imposed on them to get vaccinated. As the RPN I was the listening ear to frustrations from both sides and it could be exhausting at times for sure.
In my experience in LTC and MINT Memory Clinics, our government has many reactive policies however we are lacking in proactive policies. We have funding to support those in need moving to LTC however we do not have the staffing or beds available to support the overwhelming waitlist (or even those currently residing in LTC). The funding to maintain health through early detection programs and prevention programs is minimal yet these programs save millions in the long run. For each person living with dementia supported by the MINT clinics, we save $30,000 annually of Ontario’s health care budget yet there is no funding for this program. By enhancing access to consistent in-home supports we could significantly reduce caregiver burnout and have those who want to live at home do so and reduce the cost of LTC placement.
I would say up until the pandemic I was not politically astute. I have always found politics to be intimidating and tended to shy away from enhancing my knowledge. During the pandemic I began paying more attention to the policies being made by our governing bodies and while my political knowledge has improved I have plenty of room for growth.
Through the MINT Memory Clinics, we have been advocating for funding for dementia care including early detection and prevention. We are creating public support by having those we have helped and their loved ones speak out about our services both in paper and video media. We have various disciplines including pharmacy, nursing, OT, physicians, geriatricians and social work being interviewed for further media coverage.
I feel nurses (including myself) can make a bigger impact on nursing policy by enhancing our knowledge base of politics affecting healthcare through programs such as this, connecting with unions we may be part of and trying to get involved with decision makers within our organizations.
I have always had an interest in proactive policies or if not policy then procedure. I put great emphasis and effort towards this in school, but I found prior to the pandemic it wasn’t looked at as important by my co-workers. My co-workers were great at the “clean up” and reactive policies that I am paying more attention to, since the measures have changed so much over the past few years. Although participating in them, as needed to maintain my job, I find myself more engaged and aware than before. I do hope that in future, as you discussed more funding is available, for better or smoother transition, looking at prophylaxis measures as importance, within LTC facilities, other health care facilities and reflected towards those in the public. Although resistance is needed with the chain of infection, I’m glad to see you’ve been advocating for people with dementia. They’ve been through a lot! With joining a new union during this, a different way of observing things is very evident, even within the same area. Something that I am paying closer attention to. –
Thanks for sharing
Great first week everyone!
Just in the way of introduction, my name is Norma Tomlin and I am the director of professional practice here at WeRPN, and with JP Munro, here in our professional practice department, we will be providing feedback throughout the course on the discussion post.
We are off to a great start and I could not agree more with you Katie that as nurses we have insight that can add value to the conversation when it comes to the development of policies within the healthcare system. As mentioned by both you and Amanda, the vaccine policy has certainly had an impact on nurses and hiring practices. This is complicated as you mentioned Katie and one that perhaps will continue to evolve in time.
Eve thanks for your post and in-depth coverage of the integrated role that policies play within nursing. Again, the insight that you have within your sector of practice is valuable at both the micro, meso, and macro levels.
Jen very interesting perspective from the family’s views on the vaccine policies of those for and against it. I am sure again, nurses beard the bunt of all who were frustrated with changes that unfolded at times on a daily bases. I agree with your view on the lack of proactive policies and to your point, if more was proactively in place to enhance the access within homecare there certainly would be a cost saving to the system.
As was mentioned here, the pandemic has certainly forced us all to consider policies in our day-to-day practice like never before. Nurses must understand and provide valuable insight whenever possible into the development of policies that have an impact on their patients and the overall healthcare system. Decisions on policies often involve a wide variety of stakeholders to provide perspectives to identify solutions that are usually supported by evidence.
As noted in the reading this week; “At the end of the day, the formulation of public policy involves a process of making good decisions – for the public good”. (Torjman, 2005)
Keep up the great work everyone, looking forward to seeing next week’s posts!