This chapter discusses opportunities for nurses to engage in the policy process that are not as widely known or as visible. These include actively participating in professional association memberships, contributing to political action committees, writing letters, sitting on local community boards, registering to vote and voting, engaging in the development of proposed legislation, testifying, writing comments on federal or state regulatory rule making, working on campaigns, and vetting local politicians for endorsement by organizations. The chapter examines the details of these activities, discusses the key features of governmental processes because understanding these processes is vital to accepting policy opportunities. Much of the focus of this chapter is on the processes at the federal level, recognizing that there are similarities, but diversity in structure and processes, at the state and local levels. Equally important is appreciating the long view of policy; creation and implementation can take years, with many different stakeholders.

Capital can be developed in intellectual, social, political, and financial forms. It is critical to understand not only how important it is to build capital, but also how to amplify the resources necessary to do so. Therefore, this chapter explores the individual nurse’s role in developing personal capital, as well as how the individual nurse supports the growth of the profession’s resources. It explores the four types of capital (i.e., intellectual, social, political, and financial), their interdependency, and ways that they can be maximized to advance healthcare policy. The introductory Policy Challenge and subsequent Policy Solution demonstrate how gaining political capital can accumulate from experience and challenging ourself to take opportunities when they arise. The chapter compares and contrasts the types of capital used in policy and advocacy. It helps the reader to understand the impact of capital on policy outcomes.

This chapter provides an overview of the concept of advocacy, the nurse’s advocacy roles, and expectations of society and the profession regarding advocacy. The American Nurses Association’s Code of Ethics for Nurses is used as a framework to describe the application of advocacy. In addition, the chapter identifies competencies for advocacy, resources for becoming an advocate, and advocacy arenas. It uses advocacy exemplars to illustrate the various possible outcomes of nurses’ advocacy efforts. Investigate advocacy as a means to improve the safety and quality of healthcare delivery. The chapter demonstrates the competencies needed to be an advocate in different healthcare settings and describes the relationship of social justice and ethics to the work of advocacy. It then discusses the public’s view of nursing in healthcare advocacy and identifies the barriers that can impact the success or failure of advocacy.

This chapter focuses on tracking outcomes for ongoing monitoring and evaluation of policies and expands on the centrality of the use of evidence. It examines assessing anticipated and unanticipated outcomes of enacted policies using a structure, process, and outcome framework. Evaluation data can form the basis for discontinuing, amending, or expanding policy or assist in advocating for greater investments for a strategy or wider uptake of a specific initiative. The evaluation process is fundamental in the policy making cycle, no matter whether one is involved in high-level or local service delivery policy. Documenting the contribution of nursing services to the public’s well-being is a challenging but worthwhile pursuit. Economic analyses of policies and programs are becoming more common, and an awareness of concepts such as sustainability and unintended consequences is certainly key to using evaluation data for policies.

Nurses are an essential part of healthcare delivery, and as such, they have an integral leadership role and responsibility in the development of health policy. Nurses have myriad opportunities to be involved in health policy on the continuum from providing direct care to the boardroom, with the formulation and implementation of policy at the top echelons of complex organizations. Some forces influencing nursing practice and healthcare include access to care, workplace and workforce needs, well-being, and the environment. Being a nurse means being a leader, being a leader means being involved in policy. Policy work is every nurse's work. It involves multiple areas and alignment of multiple forces and stakeholders to achieve a common goal in advancing health. Addressing a policy in one arena very often leads to new issues and new policy directions. Nurses are well positioned to lead the way in policy, from the bedside to the boardroom.

Harnessing evidence implies finding evidence and coupling it at the right times and places in the policy-making process. The literature and some organizations, including the World Health Organization, use the term evidence informed policy to reflect the need to consider different types of evidence and use the best available evidence when dealing with everyday problems and issues in the healthcare environment. Research and nonresearch evidence both play an important role in the translation of evidence to practice and policy. This chapter presents the importance of context as critical to translation. When new evidence is generated or discovered, it is essential that not only the new evidence is evaluated on the quality and strength of that evidence, but also an organization must consider the “fit and feasibility” of the uptake and adoption of that evidence in that environment (organizational, professional, local, state, and national).

Numerous strides have been made in policy when nurses are involved, but the reality is that to keep pace with the numerous changes in healthcare, it is imperative that all nurses across all settings be involved in policy. Nurses in all settings, including those in leadership roles, APRNs, nurse managers, administrators, educators, and researchers have tremendous opportunities and responsibilities to influence future generations of nurses. Widespread involvement requires a paradigm shift to nurses' active widespread involvement in policy. This chapter closely examines the creation of a paradigm shift to nurses’ greater involvement in policy, creating the structures and processes to facilitate such involvement. It presents a Policy Challenge that illustrates how the commitment to policy can unfold and grow. Increasing nurses’ engagement in policy is vital to advancing policy for the profession and the health of the public.

This chapter is organized around three steps in identifying and analyzing a policy problem or issue. First, it discusses the need for clear identification of a problem, including specificity in defining it, quantifying the problem and its impact with data, and determining the cost. Next, the chapter describes the importance of understanding the context of a policy problem, as the intrinsic and extrinsic factors related to the problem can sometimes be confounders to policy solutions. Finally, it discusses the importance of identifying and engaging stakeholders in both the policy problem identification and development of an advocacy strategy, including the consideration of political stakeholders. The chapter provides several policy analysis tools for use in both big “P” and little “p” policy problems. It should be noted that though this chapter outlines these steps individually, policy analysis is rarely a linear process.

Implementing a plan is a pivotal step in the policy process. Having a plan and giving careful thought to the phases of the plan, as well as to who the key stakeholders will be at each phase, are integral to the success of the plan. The plan and the details depend on the particular policy issue and the environment for bringing that policy issue forward in either the big “P” or the little “p” arena. This chapter helps one develop the knowledge and competencies necessary to successfully activate an advocacy plan. It discusses leadership strategies for implementing the plan, evaluation, and handling unexpected events, and adjustment and sustainability of the plan. This policy challenge is focused on addressing health equity by doing. Understanding the environment, assessing resources, and being strategic and systematic in the rollout are all critical to an advocacy plan's success.

The weight of nursing’s voice and the growing evidence on nursing’s influence to shape policy, are transforming care and health, including the definition of health. But how do we continue to reform healthcare and advance global population health? The immediate answer: individually and collectively. This chapter provides an overview of policy, politics, and the interconnected barriers, challenges, and opportunities that exist to assuage the geopolitical determinants of health. The power to shape policy is present in every role in nursing from providers in the community and at the bedside, to advanced practice providers, researchers, academia, boards, political action committees, and professional organizations. The chapter’s Policy Challenge describes the policy journey of an individual new to nursing. Nursing’s power to shape policy is essential to all facets of health. The chapter highlights selected examples of the diversity of roles that nurses hold that often are overlooked when advocacy and politics are discussed.