Jean B. Ivey, DSN, CRNP

Disclosures

Topics in Advanced Practice Nursing eJournal. 2008;8(4) 

Nurses in a practice doctorate program aim to become more than licensed independent practitioners. They will be leaders, advocates, and politically savvy nurse activists. It is essential for practice doctorate curricula to teach not only the meaning and importance of health policy and advocacy, but also the skills that doctor of nursing practice (DNP) graduates will need to advance their own practice and the welfare of the patients who they serve.

Master's-level nurse practitioner programs prepare students to function as beginning practitioners. Although students are encouraged to participate in professional organizations and to be active in supporting initiatives to improve advanced practice, most nurse practitioners are not prepared to develop health policy or influence the political process. The American Association of Colleges of Nursing (AACN) underscores the importance of education in health policy:

"Health care policy -- whether it is created through governmental actions, institutional decision making, or organizational standards -- creates a framework that can facilitate or impede the delivery of health care services or the ability of the provider to engage in practice to address health care needs. Thus, engagement in the process of policy development is central to creating a health care system that meets the needs of its constituents. [1"]

In support of this emphasis, the National Organization of Nurse Practitioner Faculties (NONPF) identifies 3 entry-level competencies for DNP graduates:

  • Analyzes ethical, legal, and social factors in policy development;

  • Influences health policy; and

  • Evaluates the impact of globalization on healthcare policy development.[2]

DNP program content focuses on the significance of healthcare policy on multiple (local, state, national, and international) levels and how that policy influences healthcare systems. Faculty members assist the student to envision how they can incorporate health policy and/or advocacy into their scholarly project proposal. The scholarly project is the student's opportunity to demonstrate synthesis of knowledge gained during the program and apply that knowledge to a significant health or health system problem. Scholarly projects that incorporate health policy issues frequently drive desired system changes.

Practice doctorate students enrolled in a health policy course often comment that although they know that they "should" be involved in changing nursing practice, they really don't understand how such actions relate to health policy. Despite personal difficulties with the process of obtaining reimbursement for their services, students often don't understand third-party reimbursement systems. Most students are reluctant to contact local and state legislators, believing that they will have little influence with these individuals.

The focus on globalization and healthcare policy also makes students more aware of how the healthcare policies of the United States compare with those of other nations. DNP students are often surprised to discover good outcomes in some foreign healthcare systems, and new methods of managing healthcare needs in others. International data allow students to infer the effects that health policy can have on the incidence and prevalence of healthcare problems. For example, a student reported that in Spain, where life expectancy for women is 83 years and for men is 76 years, local health clinics provide easy access to care and home visits, and the country's immunization program is ranked fifth in the world. Another student noted that in China, where 70% of the citizens are living in rural areas, only those living in urban settings have access to hospitals. These observations help students realize that problems can be many faceted and that solutions for health system problems are seldom as simple as they may appear.

In a field experience, the student is encouraged to contact an individual who may help bridge the gap between the literature and real-world experiences. Students may visit an elected official, spend time with an administrator, contact a community-based action group, or communicate via email or telephone with a national leader. These activities enable students to find mentors who are knowledgeable about health policy who can assist with the final design for their scholarly projects. Another type of mentor who is helpful in project development is the faculty person or healthcare leader who is actively involved in advanced nursing practice issues at various levels.

Students who participated in mentored field experiences felt empowered and encouraged by the interest expressed by mentors when students shared plans for their scholarly projects. Students were also surprised at how willing others were to help them and how enthusiastic leaders were about their ideas. In many cases, students found new resources and sources of support that might not otherwise have been available.

The AACN DNP Essentials and the NONPF DNP Competencies emphasize competency in understanding and acting to implement changes in healthcare policies.[1,2] DNP students value opportunities to apply newly gained knowledge about policy development and political involvement and will become the practice arena leaders needed by our profession. These leaders offer our healthcare system new vision, insight, and innovative approaches that will improve healthcare delivery worldwide.

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