Sally S. Cohen

Stages of nursing's political development: Where we've been and where we ought to go

How has nursing evolved as a body politic? A framework that conceptualizes the political development of the nursing profession in four stages is useful for analyzing previous accomplishments and planning future actions that will enhance the political involvement of nursing as it seeks to improve the health care delivery system.

Women’s Experience of Group Prenatal Care

Group prenatal care (GPNC) is an innovative alternative to individual prenatal care. In this longitudinal study we used ethnographic methods to explore African American and Hispanic women’s experiences of receiving GPNC in two urban clinics. Methods included individual, in-depth, semistructured interviews of women and group leaders in GPNC, participant observation of GPNC sessions, and medical record review. GPNC offered positive experiences and met many of women’s expressed preferences regarding prenatal care. Six themes were identified, which represented separate aspects of women’s experiences: investment, collaborative venture, a social gathering, relationships with boundaries, learning in the group, and changing self. Taken together, the themes conveyed the overall experience of GPNC. Women were especially enthusiastic about learning in groups, about their relationships with group leaders, and about having their pregnancy-related changes and fears normalized; however, there were also important boundaries on relationships between participants, and some women wished for greater privacy during physical examinations.

Advancing health policy in nursing education through service learning.

Knowledge of health policy is an increasingly important aspect of nursing practice and education, especially as nurses strive to improve the rapidly changing health care delivery system. At the same time, many educators, researchers, foundations, and government officials are touting the benefits of service learning. In particular, service learning offers ways to enhance partnerships between academia and community agencies and to extend learning beyond the traditional classroom. We present a model for educating nurses as advanced practice nurses in health policy that links service learning with a framework for the political development of nurses. Under the rubric of service learning, the curriculum is based on the overlap among health policy, the role of the nurse as consultant, and community-based care. After discussing the importance of health policy for graduate nursing education and reviewing the essentials of service learning, we describe a three-semester graduate sequence in health policy service learning. The focus is on the clinical and classroom components of both individual and group practica and their relationship to stages of nursings political development. The article concludes with evaluation considerations and the implications of our work for nursing theory, research, practice, and education.

Nursing Testimony Before Congress, 1993-2011

This article describes nurses’ testimony before congressional committees between1993 and 2011. We address three questions: (a) How have trends in nurses’ testimony changed over time? (b) What do data reveal about nursing’s engagement with health policy issues on the congressional agenda? (c) How might the findings be useful in implementation of health care reform and the Institute of Medicine report on the Future of Nursing. Using LexisNexis® Congressional online database, we identified 434 nursing testimonies presented at congressional hearings. Descriptive statistics were used to examine characteristics of the nurse expert witnesses and the testimonies topics on which they testified. Nurses most frequently testified on workforce issues (36%), followed by access and coverage (14%). The majority of the nurse witnesses had graduate degrees 65% and lived and worked in fewer than 10 states. Nurses appeared before House or Senate appropriations committees 38% more often than before any other congressional committees. Our findings point to the need for additional research, especially given the crescendo of calls for nursing to step up to the political table. The article concludes with implications for future research and policy action.

Rooms without Rules: Shaping Policies for Assisted Living Facilities

A burgeoning aging population, the desire of elders to “age in place,” and changes in family structure that leave elders with limited family supports have generated great interest in assisted living. Many baby boomers have the means to afford assisted living either for themselves or their aging family members. Additionally, in an effort to contain skyrocketing Medicaid expenditures, policy makers are interested in alternatives to nursing home care. As the number of assisted living facilities soars, calls for regulation are growing. Nurses have much to contribute to the formation of federal, state, and local assisted living policies. In particular, knowledge of regulatory issues and the agenda-setting process can enhance nursing’s influence in assisted living policy making. This article describes the issues surrounding policy making for assisted living with an eye toward promoting the role of nurses in this important policy area.

Nurse practitioners' experiences with managed care organizations in New York and Connecticut

In a study of nurse practitioners in New York and Connecticut, more than half reported they had never applied to be credentialed by a managed care organization. The majority of nurse practioners reported that their offices billed for their services under the name of the collaborating physician and at the physician rate.

MANAGED CARE AND REPRODUCTIVE HEALTH

Managed care poses special challenges to midwives providing reproductive health care. This is owing to the sensitive nature of issues surrounding reproductive health and aspects of managed care that may impede a womans ability to obtain continuous, confidential, and comprehensive care from the provider of her choice. Variations across payers (ie, Medicare, Medicaid, and commercial insurers) regarding covered benefits and reimbursement of midwifery services also may create obstacles. Furthermore, some physicians and managed care organizations are embracing policies that threaten the ability of midwives to function as primary health care providers for women. Despite these hurdles, midwives have the potential to remain competitive in the new marketplace. This article underscores the importance of being knowledgeable about legislation and policy issues surrounding the financing of midwifery services, quality performance measurement for HMOs as they pertain to reproductive health, and discussions regarding which clinicians should be defined as primary care providers.

Nurses Improve Their Communities’ Health Where They Live, Learn, Work, and Play:

Nurses are often recognized for their volunteer efforts following disasters and international humanitarian crises. However, little attention is paid to the activities of nurses who promote a culture of health in their communities through local volunteer work. In this article, we describe nurses’ perceptions of how they promote health in their communities through formal and informal volunteer work. Using 315 written responses to an open-ended question included in a 2016 survey of the career patterns of nurses in the U.S., we utilized conventional content analysis methods to code and thematically synthesize responses. Two broad categories of nurse involvement in volunteer activities arose from the participants’ responses to the open-ended question, “Please tell us what you have done in the past year to improve the health of your community”: 17% identified job-related activities, and 74% identified non-job-related activities. 9% of respondents indicated they do not participate in volunteer work. Job-related activities included patient education, educating colleagues, and “other” job-related activities. Non-job-related activities included health-related community volunteering, volunteering related to a specific population or disease, family-related volunteering, church activities, health fairs, raising or donating money, and travelling abroad for volunteer work. Nurses are committed to promoting a culture of health in their communities both at work and in their daily lives. Leveraging nurses’ interest in volunteer work could improve the way nurses engage with their communities, expand the role of nurses as public health professionals, and foster the social desirability of healthful living.

State policies regarding nursing delegation and medication administration in child care settings: a case study.

Medication administration is an essential component of quality child care, and nurses play a central role in assuring high-quality training of child care providers. Through key informant interviews and review of public documents, this case study explored the development of state statutes and regulations for medication administration training of child care providers in the state of Connecticut, nursing liability issues related to the definition of this activity, and the role of the Connecticut State Board of Examiners for Nursing. This article also examines the interpretation of the nursing role within this context as delegation versus professional activity and the impact of such designation on nursing practice, child care providers’ access to medication administration training by nurses, and children’s health status in child care settings. As a result of this case study, the Connecticut State Board of Examiners for Nursing revised its policies, demonstrating an exemplar linkage among research, practice, and policy.

Dietary Supplements: Policy and Research Implications for Nurses

Millions of Americans use dietary supplements without full knowledge of their effects. Given the serious safety issues surrounding dietary supplements and the potential for nurses to play pivotal roles as patient educators and policy advocates, this article describes laws and regulations pertaining to dietary supplements, relevant research, the role of organized interests in policy making for dietary supplements, and how other countries regulate dietary supplements. We offer recommendations for policy change and identify implications of this issue for nursing practice.