CSI Policy and Clinical Practice Relationship Discussion Responses

Please read each response to the questions below and respond to each of these discussion responses:

1. Discuss the relationship between policy and clinical practice? Can you think of an example of how this has impacted on Advanced Nursing Practice.

2. The book describes the addiction epidemic as a case study. List another example, more than one if you can, not listed in the book, where policy and clinical practice intersect?

3. Identify a healthcare bill using www.congress.gov website. What is the progress of the bill and what are the next steps to getting it passed.

Discussion 1: (Angelica)

1. According to Short (2022), policy is a consciously chosen course of action. Policy is a law, regulation, rule, procedure, administrative action, incentive or voluntary practice of governments and other institutions (Short, 2022). Clinical practice includes the activities performed on patients. There is a direct relationship between policy and clinical practice. Policy dictates clinical practice.

As relayed by Short (2022), “what we are allowed to do, required to perform, or prohibited from engaging in, is determined by public policy.” These actions make nursing practice a political activity. All parts of nursing practice and patient care are regulated by political bodies (Short, 2022). Furthermore, the statutes that govern nursing and the nursing scopes of practice are directly influenced by professional regulatory boards and state boards of nursing.

Advanced Nursing Practice has been greatly impacted by the relationship between policy and clinical practice. For instance, as per the New York State Education Department (2023), “New York State Law holds that nurse practitioners are independently responsible for the diagnosis and treatment of their patients and does not require the NP to practice under physician supervision.” Here, the advanced practice nurse can act independently, and their scope of practice is broad. However, in states such as Maryland, policies dictate that the NP must work under physician supervision. Furthermore, policies change the ways by which advanced practice nurses can use their license. In New York, the advanced practice nurse has more freedom and can work to their fullest potential. Conversely, in Maryland, the advanced practice nurse is restricted to work under a physician who may or may not agree with their intended diagnosis and treatment plan.

2. Example: Patients receiving methadone in the hospital.

Actual clinical scenario: Patient was an active cocaine and heroin user (last dose was 2 days prior to admission). Patient was taking Suboxone for withdrawal symptoms but threatened suicide if she did not also get her methadone.

Policy dictates that the patient has a right to receive the methadone even though he/she is an active drug user.  However, as the RN, it is a difficult situation to be in knowing that the patient is getting treatment while also still actively using drugs. It becomes an internal struggle for the RN because no matter what you do, the patient is not actually getting proper help. 

3. Healthcare bill:  H.R. 2819- Good Samaritan Health Professionals Act of 2023

To amend the Public Health Service Act to limit liability of health care professionals who volunteer to provide health care services in response to a disaster.

Progress: Introduced into the House

House – 04/25/2023 Referred to the Committee on Energy and Commerce

Next steps: This bill has been introduced into the House. Once accepted and passed by the House, the bill will move on to the Senate. The Senate will either pass, deny, or amend the bill. If the bill is amended, it will go back to the House to be re-evaluated. Once passed, the bill will move on to the President, who ultimately decides if it becomes law.

Discussion 2: (Andrew)

1. Milstead and Short define policy as a consciously chosen course of action, which can be any law or voluntary practice set by an institution (2017). Clinical practice is all nursing work with patients, and is guided and regulated by policies. The relationship between policy and clinical practice can be framed in that all aspects of nursing work are regulated by policies, but both inform each other.

In advanced nursing practice, policies that govern the nurses’ scope of practice are defined, and vary by, each each state in the US. The professional regulatory boards in each state define scope of practice, including the ability to diagnose conditions and prescribe medications independently. For example, The regulatory board in New York State validates advanced nursing practice independent of a physician in New York state, unlike California, which is a restricted-practice authority state. Advance-practice nurses would be required to work under a physician. Federal Trade Commission (FTC) in 2014 appears to support independent practice of advanced practice nurses for “consumer choice.” While not education or health-care institution, the FTC’s support is may be informed demand for practitioners in states with less physicians; other full-practice authority states include mostly rural states like Utah, Wyoming, and Nebraska (Plemmons, et al. 2023).

2. A recent example in which policy and clinical practice intersect are New York City government’s policies which can contribute to “frequent flier” patients, as seen in a recent homeless patient with DKA, in my medical ICU. In March 2023, City government announced that $15 million fund for non-profits to build or rehabilitate homeless shelters. The social determinant of health of neighborhood and built environment supports the need for stable housing as a foundation for healthier living, and this has been supported by housing-first programs, as described by the US Interagency Council on Homelessness, not temporary shelters. Without funding or policies for stable housing, people experiencing homelessness will be far less likely to address their basic health needs. They will have to return to hospital emergency departments, for basic needs, and still likely have poor long term health outcomes.

3. HR 420, Language Access for Medicare Beneficiaries Act of 2023, as identified in the website, seeks to mandate the Centers for Medicare and Medicaid services translate the annual explanation of benefits for enrollees in multiple, most-frequently requested languages, along with the current Spanish and English (Gomez, 2023). It has only been introduced, and needs to be passed by the House, The Senate, and then to the Office of the President to become law. Considering the advanced practice nurse role core competencies in the domain of population health, this is supportive of culturally competent practice to increase health promotion for population care. In my own hospital, almost patient hand-outs and educational materials are available in the most common languages in the borough. This is a standard that will support all patients nationwide.

Discussion 3: (Samantha)

1. There is a relationship between policy and clinical practice. Policy is defined as “a consciously chosen course of action: a law, regulation, rule, procedure, administrative action, incentive, or voluntary practice of governments and other institutions,” (Short, 2022).  Policies are developed to solve social problems. Professional associations such as Sigma Theta Tau International, create opportunities for nurses to become more involved in policy development and can expand the nurse’s perspective to a state, national, or global level, (Short, 2022). Nurses can play a role in policy making not only at a hospital level but also at a state or international level. “It is not unusual for a nurse to become the point person for a policymaker who is seeking information about a health problem,” (Short, 2022).

Advanced Nursing Practice has been impacted by policy and its role in clinical practice. Nurse Practitioners in the state of New York were greatly impacted by state policy in 2022. According to the American Association of Nurse Practitioners, legislation was passed in 2022, allowing Nurse Practitioners the ability to Full Practice Authority or FPA. This legislation provides New Yorkers with access to better quality care by allowing nurse practitioners to see patients without the barriers that were set in place prior to the passing of this legislation. “FPA is the authorization of NPs to evaluate patients; diagnose, order and interpret diagnostic tests; initiate and manage treatments; and prescribe medications, all under the exclusive licensure authority of the state board of nursing,” (AANP, 2022). This was a giant step forward for New York based Nurse Practitioners and all healthcare providers to help with providing care to the population of New York in a way that takes patients away from overcrowded hospitals. Nurse Practitioners can now work within their scope and not under it.

2. When thinking of another example where policy and clinical practice intersect, a clinical scenario came to mind. A 20-year-old Type 1 Diabetic patient recently joined our practice after being under the care of a pediatric endocrinologist for the past 16 years. The patient had put his girlfriend as his emergency contact and did not include his mother as an alternative contact. The patient’s mother would constantly call the office demanding results or having complaints about the patient’s blood sugar although the patient himself never voiced any concerns in between visits. It is our organization’s policy that we cannot provide patient information to anyone that is not authorized by the patient in writing. This has caused a lot of frustration for the patient’s mother and the RN trying to advocate for the patient and explain the policy to the patient’s mother in an empathetic way.  

3. Health Care Bill: H.R.497 – Freedom for Health Care Workers Act. “This bill nullifies the rule titled Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination, which was issued by the Centers for Medicare & Medicaid Services on November 5, 2021, and prohibits the issuance of any substantially similar rule. The rule requires health care providers, as a condition of Medicare and Medicaid participation, to ensure that staff are fully vaccinated against COVID-19.”

Progress: 01/31/2023: Passed/agreed to in House: On passage passed by recorded vote: 227 – 203

Next Steps: Health Care Bill H.R. 497 was received by the Senate. Once passed by the Senate it will then go to the President where he will decide to whether the bill will be passed and then becomes a law.

Discussion 4: (Joanna)

1. There is an obvious relationship between policy and clinical practice. According to Milstead (2016) policy is defined as “a purposeful plan of action or inaction developed to deal with a problem or a matter of concern in either the public or private sector” (p.192). Policies communicate standards and expectations  for clinical practice that are intended to optimize patient care by establishing guidelines/protocols to provide and/or improve quality care. This has a major impact on advanced nursing practice as APRN’s must be current on policy issues in order to advocate for change and shape the direction of healthcare delivery. APRN’s are in a position of “discovering and acknowledging health problems and health system problems that may demand intervention by public policymakers” (Milstead, 2016). Policies are used to govern practice as APRN’s are considered authorized providers of healthcare. However, there is variation between state statutes, rules, and regulations of how APRN’s can practice. Therefore, it is important that there is a clear understanding of how a APRN’s scope of practice is defined by those laws and regulations. For example, New York state allows for NP’s to work independently with the responsibility of treating and diagnosing patients without being under physician supervision whereas NP’s in Florida require “career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care” (AANP, 2022).

2. Data privacy & IT security- policies in data privacy and IT security regulate the usage, monitoring and management of data in an organization. Practitioners must follow the Health Insurance Portability and Accountability Act (HIPAA) to protect patient identifiable health information by avoiding data leaks and privacy breaches. As the use of technology increases in healthcare, it is important for practitioners to follow these policies to protect patient information like for example, obtaining patient consent before sharing health information, which gives patients the choice to whether or not they want certain health information to be disclosed.

3. H.R.3086: “Find it Early Act.” This bill—with its primary sponsors representative Rosa DeLauro & Brian Fitzpatrick—aims to “provide for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer.” This bill proposes, if passed, would require all insurance plans to cover mammograms, MRIs, and ultrasounds without additional cost to the patient. It was introduced to the house on May 5, 2023, and is still in its early stages of the legislation process. Although this bill is in its earliest phases, on 5/26/23, it was referred to the subcommittee on health by the committee on veterans’ affairs but action is still pending.  

Discussion 5: (Ashley)

1. The relationship between policy and clinical practice is crucial for the delivery of effective healthcare. Public policy, as described by Short, refers to the consciously chosen courses of action, laws, regulations, and procedures implemented by governments and institutions (Short, 2017). These policies provide direction and guidelines for clinical practice and shape the overall healthcare system. Policies influence many aspects of clinical practice, including patient care standards, diversifying the healthcare professionals, and quality improvement initiatives. Short mentions that laws and regulations govern all facets of nursing practice and patient care. Policies not only define the parameters within which healthcare professionals operate but also serve as a framework for interprofessional cooperation and leadership (Short, 2017). Nurses, being the largest group of healthcare workers, play a leading role in identifying problems in daily practice and advocating for policy changes that address the needs of both nurses and patients. Thus, policies directly impact and shape the landscape of clinical practice, influencing the provision of safe, effective, and high quality care. The education, experience, and perspectives of nurses uniquely position them to contribute to the policy making process. This has impacted the advanced nursing practice because by leveraging their knowledge and skills, nurses have influenced policy design, advocated for changes that align with the needs of patients and the nursing profession, and addressed healthcare system challenges. Through engagement, political activism, and collaboration with legislators and agency directors, nurses have actively participated in shaping healthcare policies that support positive outcomes for individuals, families, and communities. The relationship between policy and clinical practice is dynamic and reciprocal, with policies providing the framework for clinical practice and nurses actively influencing the development of new policies, and the implementation in the health field. 

2. Management of patient falls: Policies and guidelines are developed at the organizational and national levels to address fall prevention in healthcare settings. These policies outline the standards and protocols for identifying patients at risk of falls, implementing preventive measures, and responding to fall incidents. These protocols may include risk assessment tools, safety protocols for patient mobility, guidelines for bed and furniture positioning, and requirements for staff education and training. Policies inform clinical practice by providing evidence based strategies and interventions to prevent falls. These may include implementing bed alarms, providing non-slip footwear, ensuring a well lit environment, promoting patient education on fall prevention, and facilitating the use of assistive devices. Nurses are responsible for incorporating these interventions into their daily care routines and documenting their implementation in patient care plans. When it concerns patient falls, policy mandates that you must follow protocols to prevent them. However clinical practice can sometimes result in falls that resulted due to carelessness of the patient or an outside party that is not the nurse. 

3. The H.R.3733 bill is a bill introduced on May 25th, 2023 sponsored by representative Adam Smith. The committees representing this bill are House – Energy and Commerce; Ways and Means. The purpose of this bill is to address the barriers immigrants and refugees face when entering the health care workforce, and for other purposes. As of now the latest action there has been is that on the 25th the bill was introduced to the House of Representatives and then referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee. This bill spoke to me because it represents people like me, it made me feel heard/seen.