Continuing professional education and development for advanced practice nurses Managerial issues related to advanced practice nursing. The focus is on strategic planning and policy development that supports advanced nursing practice.
Defining Strategy and Strategic Planning
This perspective can be viewed as emergent strategies where patterns are developed in the absence or despite intentions. Strategy defined as position and/or perspective can be compatible with strategy as plan/or pattern.
Policy and Policy Theory Defined
By providing different definitions of strategy, the author aims to broaden and expand the use of the term. By linking particular elements of theory to policy and policy-making, theory can help to understand some of the key issues, provide a useful frame of reference for drawing conclusions, and potentially lead to action (Minzberg et al. 2003).
Significance of a Strategic Approach
Benefits to a Strategic Approach
A good strategic plan acknowledges potential challenges and includes an approach to overcoming them. In addition, an effective strategic plan focuses and coordinates efforts involving problem solving when unforeseen bottlenecks or barriers may occur.
Limitations to a Strategic Approach
Despite the extensive literature supporting the value of the advanced practice nursing (APN) concept, the processes most conducive to the development and implementation of advanced practice nursing (APN) roles remain unclear (Delamaire and Lafortune 2010; DiCenso et al. . 2010; Horrocks et al. 2002; Sastre-Fullana et al. 2014; Schober 2016). This is followed by an introduction to various aspects of the policy process along with recommendations on how nurses can participate in the policy process.
Key Factors to Consider in Exploring the Possibilities
This chapter begins by suggesting key factors to consider when exploring the possibility of introducing an advanced nursing scheme. The concept of advanced nursing practice is facing a period of attention and excitement in seeing evidence of positive outcomes for nurses performing at an advanced level.
Defining the Policy Process
- Agenda Setting
- Policymakers and Their Networks
- Influencing Policy Decisions
- Nurses’ Participation in the Policy Process
In addition, the development of strategies includes knowing the different decision makers and their spheres of influence in order to identify possible ways to influence the policy process (refer to chapters 3.1 and 3.2 for further in-depth discussion of agenda setting). This increased visibility suggests that nurses must actively participate in policy making, the policy process and strategic planning discussions.
Frameworks for Implementation of Advanced Nursing Practice
- PEPPA Framework
- Schober Conceptual Policy Framework for Advanced
- Conceptual Policy Framework: Singapore Exemplar
- Additional Models/Frameworks for Advanced
Critical and pragmatic points to be considered emerged in the creation of the conceptual policy framework for advanced practice nursing (see Fig. 2.2). Ultimately, with this approach, developments in Singapore achieved all aspects of Cornerstone One and stabilized one aspect of the ANP initiative as depicted in the Conceptual Policy Framework for Advanced Practice Nursing (see Fig. 2.2).
Hall, Land, Parker, and Webb Agenda-Setting Framework
Legitimacy
Feasibility
Support
However, the ability to move forward was dependent on the action of three key decision makers with power and authority to influence the medical fraternity in particular. According to Hall et al. 1975), using these three conditions, governments and key decision makers assess whether an issue falls high or low on a continuum.
Kingdon’s “Windows of Opportunity”
A position of high legitimacy (a view that they have the right to intervene), high feasibility (sufficient resources and infrastructure), and high support (important interest groups are supportive or at least not opposed) suggests that the issue may to come on the policy agenda. In addition, Sabatier (2007) suggests that the metaphor of flows may be an incomplete description of policy making as it does not describe the policy process beyond the opening of windows of opportunity.
Lindblom’s Incrementalism and Disjointed Incrementalism
Disjointed Incrementalism
Although incrementalism and disjointed incrementalism were not conceptualized with nursing and health care policy in mind, the principles are useful in this context. 2.2.2, for the application of aspects of incrementalism and disjointed incrementalism in the construction of the framework.
Strengths and Limitations of Incrementalism
There are too many things at stake, too many possible alternatives, and too many potential consequences (expected and unexpected) to fully understand the full complexity of any situation.
Walt’s Framework for Policy Implementation
- Principles of the Walt Framework
- The Policy Process According to Walt
- Implementation: Do Those Who Implement
- Walt’s Strategy for Policy Implementation
In this way, all different parts of the political system that influence health policy are assessed, including direct and indirect participation in the process. What is clear to Walt (2006) in the analysis of policy is that most thinking is focused on the formulation of policy and related dialogue.
A Comparison of Theories of the Policy Process
The implication is that policymakers do not spend much time assessing the environment to determine whether the conditions for successful implementation exist. The implication is that to avoid this gap, policymakers should incorporate implementation strategies into the policy formulation process.
Commentary on the Relevance of Policy Theory for Nursing
This chapter suggests that there are several options for nurse participation in the policy process. This calls for a transformation in nursing to become more visible and active leaders in the policy process.
Reality: Is Evidence Used to Make Policy Decisions?
The concept of evidence-based policy decisions means that a rational, rigorous and systematic approach is used in making policy decisions (Birkland 2005; Zahariadis 2014). Support for this view suggests that policy decisions based on empirical evidence produce better results (Walt 2006).
Policy Agenda Setting and Policy Decisions
Key Decision-Makers: Power and Authority
In addition, their interpersonal and political networks influence which issues or topics reach the political agenda. At this level, government representatives have clear control over which topics make it onto the political agenda and can accept or reject specific topics.
Participation in the Policy Process: Direct and Indirect
Nevertheless, regardless of perceived limitations, there are opportunities for advanced practice nurses to engage at some level in the policy process. In: Blair KA, Jansen MP (eds) Advanced practice nursing: core concepts for professional role development, 5th ed.
Nurses’ Stages of Political Engagement
Knowing how the policy process works and identifying ways to participate allows APNs to engage in policymaking at numerous levels (Duffy 2015). The opportunity to participate in the political process can stimulate a nurse to consider political involvement.
Acquiring the Necessary Skills
Leadership Competencies
In Hamric A, Hanson CM, Tracy MF, O'Grady ET (eds) Advanced practice nursing: An integrative approach, 5th edn, Elsevier Saunders, St. In: Hamric AB, Hanson CM, Tracy MF, O'Grady ET (eds ) Advanced practice nursing: an integrative approach, 5th ed.
Assessment of the Healthcare Environment
Scanning the Environment
In this case, it is a way to assess the interest and opportunities for the ANP concept and/or the health care needs of the country or health care sector. The processed form approach collects information from internal and external sources, and the information is used after processing and analysis based on the requirements and criteria of the investigation.
SWOT (Strengths, Weaknesses, Opportunities, Threats)
The information and trends discovered during the environmental scan are also the basis for confirming the findings of the SWOT analysis. It is useful to identify the contrasts between an environmental scan and a SWOT analysis to determine whether one or both will be useful.
Stakeholder Analysis
Environmental scanning collects information and data, particularly on trends, to understand the context, eg, the healthcare environment. Although the techniques can be used independently, aspects of the findings from both when used together can help assess the readiness of a country, institution or agency for the PNA concept (Schober 2016).
Regulation
SSPP Model (Scope, Standards, Policies,
In the SSPP model (Fig. 6.1), practice goals, professional standards, policies and procedures are linked in a logical approach, with one component as a building block for another. In the SSPP model, setting standards involves establishing procedures and policies that provide the basis for professional accountability and autonomy.
Non-medical Prescribing in the United Kingdom (UK)
The Department of Health (2001) built on the prescribing experience of registered nurse (DN) and registered nurse (HV) nurses when developing a non-medical prescribing programme. Need – Non-medical prescribers may only prescribe medication to a patient if there is a genuine need.
Nurse Prescribing: A Global Role Analysis
For example, advanced level nursing is practiced in the United Kingdom in the capacity of basic registration or in the post-professional arena (East et al. 2014). However, there are only two countries in the world that currently only prescribe nurses at the advanced practice level, the United States and Montserrat in the Caribbean (Ladd et al. 2016).
Introducing Advanced Practice Nurses: A Process
- The Nurse Practitioner in New Zealand
- Transition Experiences of Nurse Practitioners
- Advanced Nursing Practice Strategy and
- The Netherlands: Process, Legislation, and Evaluation
These issues need to be addressed and considered a matter of urgency so that the sustainability of the NP role in Australia is not jeopardized (MacLellan et al. 2016a) 6.3.2.2 The importance of intraprofessional support. Other healthcare facilities, not just hospitals, also became interested in the development of NP.
Influencing the Process: Beneficial Debate and Discussion
This is beneficial for the growth of the number of nurse specialists and, with their growing number, beneficial for their effectiveness. It is still confusing, but it was the only way to quickly legalize a function that has a proven right to exist within healthcare in the Netherlands.
Research and Evaluation
Dissemination of Empirical Findings and Information
There is controversy about the extent to which research and empirical evidence informs policy and decision-making; therefore, the importance of evaluation, research and information dissemination is discussed. Political decisions can be influenced in many ways; however, the extent of the evidence's impact may not be directly apparent.
SWOT Analysis Matrix Template
SWOT Analysis Matrix Illustration
Global Nurse Prescribing by Role Descriptor
Process and Models
- Policy Analysis Models
The context in which a problem arises or policy exists is assessed in the process of policy analysis through interpretive analysis of the policy and an evaluation of the historical context of the policy. The policy feedback theory proposed by Mettler and Sorelle (2014) adds another dimension to the concept of policy analysis.
Indicators and Outcomes
This model of policy analysis aims to directly engage citizens of the country or locality in the policy-making and analysis processes (Smith and Larimer 2009). The presentation of policy analysis models aims to suggest the variety of approaches that can be considered if policy analysis is desired when developing strategies for a PNA initiative.
Evaluation and Adaptation: Population Indicators
Ideally, indicators should inform decision-making by helping to understand a problem and establishing a direct relationship between indicators and decision-making outcomes. Defining, selecting and advancing knowledge in policymaking are highly variable processes that involve not only rational debate and decision-making, but also power and politics. 2012) note that understanding the prevailing political context and navigating the many choices and conflicting perspectives on an issue provides insight and entry points to engage in the process.
Determining the Correct Path to Follow
The definition, selection and promotion of knowledge relevant to the political process and strategic thinking are highly variable, based as much on issues of politics and power as on rational discussion and problem solving. Birkland TA (2005) An Introduction to the Policy Process: Theories, Concepts and Models of Public Policy Making, 2nd edn.
Policy-Making: A Rational Process
The rational approach to decision making is compared to the theory of incremental or incremental decision making. Assumptions of the rational model imply that the outcome of this process is a rational decision that most effectively reaches an expected conclusion.
Incrementalism and Policy Decisions
A Debate: Rational Change Versus Disjointed
- Assumptions of the Rational Decision-Making Model
- Incrementalism and Disjointed Incrementalism
Similar to the rational approach, policy formulation is also dependent on a policy agenda, culture of the political environment and the policy issue under consideration (Porche 2012). Strategic thinking regarding the initiation or refinement of an advanced nursing practice plan requires knowledge of the policy process and policy making.
