InstructionsReaching out a SolutionThis assignment is designed to assist you in developing a thoughtful process for advocating about an issue as a nurse, from identifying a problem that needs to be solved through articulating a process for doing so.This assignment consists of answering each of the questions listed below from the “Political Analysis and Strategies” chapter of your course textbook. Write each question as a new topic area; then follow with a paragraph or two to answer the question. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources, if any used. This project should be no longer than 4 pages.Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet. Reflect on the following questions outlined in the “Political Analysis and Strategies” chapter:What is the issue?Is it my issue, and can I solve it?Is this the real issue or merely a symptom of a larger one?Does it need an immediate solution, or can it wait?Is it likely to go away by itself?Can I risk ignoring it?What are the possible solutions? Are there risks to these solutions?What steps would you need to take in order to solve the issue?Does anyone else at the school need to be involved in the solution?Where is the power leverage in the school to reach the preferred solution?Reaching a solution requires the use of power vested in the nurse. Review Box 9-1 (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.No Wikipedia, No Health.com, No .com for references. I like .gov, state boards of nursing and the American Nurses Association websites. I love academic/nursing journal articles. You can also use assigned readings and POLITICO Pulse and Kaiser Health News Morning Briefing.
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CHAPTER 9
Political Analysis and Strategies
Kathleen M. White
1
“The difficult can be done immediately, the impossible takes a little longer.”
Unknown author, Army Corps of Engineers motto, World War II
The knowledge and expertise of nurses regarding health and health care are critical to the political process and
the development of health policy. However, the word politics often evokes negative emotions and many nurses
may not feel inclined to get involved. Nonetheless, nurses have the skills to be active participants in the political
arena for a number of reasons. First, nurses are skilled at assessment, and being engaged in the political process
involves analysis of the relevant issues and their background and importance. Second, nurses understand people
and, in order to understand an issue, it is critical to know who is affected and who is involved in trying to solve
the problem. Finally, nurses are relationship builders and the political process involves the development of
partnerships and networks to solve problems. As skilled communicators, nurses have the ability to work with
other professionals, patients, families, and their communities to solve health care problems that affect their
patients and the health care system. Nurses have much to offer in the political process and need to develop skills
in political analysis and strategy to truly make a difference.
What is Political Analysis?
Political analysis is the process of examining an issue and understanding the key factors and people that might potentially
influence a policy goal. It involves the analysis of government and organizations, both public and private; people and their
behavior; and the social, political, historical, and economic factors surrounding the policy. It also includes the identification
and development of strategies to attain or defeat a policy goal. Political analysis involves nine components.
Identification of the Issue
The first step in conducting a political analysis is to identify and describe the issue or problem. Identifying and framing the
issue involves asking who, what, when, where, and how questions to gather sufficient information to lay the groundwork
for developing an appropriate response to the issue. Start with what you know about the issue:
• What is the issue?
• Is it my issue and can I solve it?
• When did the issue first occur, is it a new or old problem?
• Is this the real issue, or merely a symptom of a larger one?
• Does it need an immediate solution, or can it wait?
• Is it likely to go away by itself?
• Can I risk ignoring it?
Beware of issue rhetoric (Bardach, 2012) that is either too narrowly defining an issue in a technical way, or defining the
issue too broadly in a societal way. Decide what is missing from what you know about the issue and gather additional
information:
• Why does the problem exist?
• Who is causing the problem?
• Who is affected by the issue?
• How significant is the issue?
• What additional information is needed?
• What are the gaps in existing data?
Don’t cut corners or overlook the importance of this step in the political analysis, as a well-defined issue is important to
the whole process, as is identifying and defining the right issue. The way a problem is defined has considerable impact on
the number and type of proposed solutions (Fairclough, 2013). The challenge for those seeking to get policymakers to
address particular issues (e.g., poverty, the underinsured, or unacceptable working conditions) is to define the issue in ways
that will prompt decision makers to take action. This requires careful crafting of messages so that calls for solutions are
clearly justified. This is known as framing the issue. In the workplace, framing may entail linking the problem to one of the
institution’s priorities or to a potential threat to its reputation, public safety, or financial standing. For example, inadequate
nurse staffing could be linked to increases in rates of morbidity and mortality, outcomes that can increase costs and
jeopardize an institution’s reputation and future business.
It is important not to confuse symptoms, causes, or solutions with issues. Sometimes what appears to be an issue is not.
For example, proposed mandatory continuing-education for nurses is not an issue; rather, it is a possible solution to the
challenge of ensuring the competency of nurses. After an analysis of the issue of clinician competence, one might establish
a goal that includes legislating mandatory continuing-education. The danger of framing issues as solutions is that it can limit
creative thinking about the underlying issue and leave the best solutions uncovered.
Context of the Issue
The second part in the political analysis process is to do a situational analysis by examining the context of the problem. This
analysis should include, at a minimum, an examination of the social, cultural, ethical, political, historical, and economic
contexts of the problem. Several questions can guide you in analyzing the background of the issue:
• What are the social, cultural, ethical, political, historical, and economic factors that are creating or contributing to this
problem?
• What are the background and root causes of each of these factors?
• Are these factors constraining or facilitating a solution to the problem?
• Are there other environmental obstacles affecting this issue?
It is important to be as thorough as possible at this stage and to consider whether the source of the information is verifiable
and impartial. It is also important to understand any opposing views.
When assessing the political context, nurses need to clarify which level of government (federal, state, or local) or
organization is responsible for a particular issue. Scope of practice is a good example. Although typically defined by the
states, there are examples where the federal government has superseded the state’s authority, such as in the Veteran’s
Administration and the Indian Health Service. Nurses also need to know which branch of government (legislative, executive,
or judicial) has primary jurisdiction over the issue at a given time. Although there is often overlap among these branches,
nurses will find that a particular issue falls predominantly within one branch.
Knowledge of past history of an issue can provide insight into the positions of key public officials so that communications
with those individuals and strategies for advancing an issue can be developed accordingly. For example, if it is known that
a particular legislator has always questioned the ability of advanced practice registered nurses (APRNs) to practice
independently, then that individual may need stronger emphasis on the evidence about the quality and value of APRNs to
support legislation allowing direct billing of APRNs under Medicare.
This type of context analysis is also applicable to the workplace or community organization. Regardless of the setting,
assessing the history of the issue would include identifying who has responsibility for decision making for a particular issue;
which committees, boards, or panels have addressed the issue in the past; the organizational structure; and the chain of
command.
At an institutional level, once the relevant political forces in play have been identified, the formal and informal structures
and the functioning of those structures need to be analyzed. The formal dimensions of the entity can often be assessed
through documents related to the organization’s mission, goals, objectives, organizational structure, bylaws, annual reports
(including financial statement), long-range plans, governing body, committees, and individuals with jurisdiction. The
informal dimensions of the organization, such as personal relationships and personal communication networks that could be
positive or negative, are more difficult to analyze but need to be understood to get a full picture of the context of the issue.
One final example in the analysis of the context of the issue is worth mentioning. Does the entity use parliamentary
procedure? Parliamentary procedure provides a democratic process that carefully balances the rights of individuals,
subgroups within an organization, and the membership of an assembly. The basic rules are outlined in Robert’s Rules of
Order (www.rulesonline.com). Whether in a legislative session or the policymaking body of large organizations, one must
know parliamentary procedure to develop a political strategy to get an issue passed or rejected. There have been many issues
that have failed or passed because of insufficient knowledge of rule-making.
Political Feasibility
The third part of a political analysis is to analyze the political feasibility of solving an issue. There are several ways to
conduct a political feasibility analysis. A simple analysis is conducting a force field analysis (Lewin, 1951) to identify the
barriers and facilitators to making change to solve the issue. The force field analysis asks you to think critically about the
issue and the forces affecting it by creating a two-column chart. One column lists the restraining forces, or all of the reasons
that preserve the status quo and any reasons why the issue should stay the same. The second column lists the driving forces,
or forces that are pushing the issue to change. This exercise requires that the whole picture is considered and provides a list
of the important factors that surround the issue.
A second option is to use John Kingdon’s (2010) model of public policymaking (see Chapter 7). Kingdon proposes three
streams or processes that affect whether an issue gets on the political agenda; the problem stream is where people agree on
an issue or problem, collect data about the issue, and share the definition of problem; the policy stream is characterized by
discussion and proposal of policy solutions for the issue; and the political stream is when public mood and political will
exists to want to address the issue. Kingdon’s model explains that an issue gets on the political agenda only when the three
streams couple or converge and a window of opportunity is thereby created. This analysis provides consideration of what
needs to happen for the issue to advance to the public policy agenda, including an analysis of the policy and political factors.
The Stakeholders
Stakeholders are those parties who have influence over the issue, are directly influenced by it, or could be mobilized to care
about it. In some cases, the stakeholders are obvious. For example, nurses are stakeholders on issues such as staffing ratios.
In other situations, one can develop potential stakeholders by helping them to see the connections between the issue and
their interests. Other individuals and organizations can be stakeholders when it comes to staffing ratios. Among them are
employers (i.e., hospitals, nursing homes), payers (i.e., insurance companies), legislators, other health care professionals,
and consumers.
The role of consumers cannot be underestimated. In the political arena, these are the constituents and therefore the voters,
and they can wield tremendous power over an issue and its solution. In many cases, nurses are advocates and work on behalf
of stakeholders such as the patients who are affected by the care they receive. Nursing has increasingly realized the potential
of consumer power in moving forward nursing and health care issues. For example, a consumer advocacy organization such
as AARP possesses significant lobbying power. When nurses wanted to advance the idea of a Medicare Graduate Nursing
Education (GNE) benefit, similar to the Medicare Graduate Medical Education funding to hospitals for the clinical training
of interns and residents, AARP championed the proposal because it views the nursing shortage as a threat to its members’
ability to access health care. GNE was included in the ACA as a pilot project.
In commencing a stakeholder analysis it is important to evaluate the relationships you, or others in your group, have with
key stakeholders. Look at the connections with possible stakeholders throughout your organization, community, places of
worship, or businesses. Consider the following when doing a stakeholder analysis:
• Who are the stakeholders on this issue?
• Which of these stakeholders are potential supporters or opponents?
• Can any of the opponents be converted to supporters?
• What are the values, priorities, and concerns of the stakeholders?
• How can these be tapped in planning political strategy?
• Do the supportive stakeholders reflect the constituency that will be affected by the issue?
For example, as states expand coverage of health services through the state’s Medicaid program, it is vital to have those
who now qualify let their policymakers know how important the issue is for them and to share their personal stories of how
this insurance coverage has made a difference. Yet stakeholders who are recipients of the services are too often not identified
as vital for moving an issue forward. Nurses, as direct caregivers, have an important role in ensuring that recipients of
services are included as stakeholders; especially when bringing issues to elected officials.
Economics and Resources
An effective political strategy must take into account the resources that will be needed to address an issue successfully.
Resources include money, time, connections, and intangible resources, such as creative solutions. The most obvious resource
is money, which must be considered when defining the issue and getting it recognized or on the public agenda. Thus, before
launching an initiative to champion an issue, it is necessary to determine the resources that will be necessary, how much it
will cost, who will bear those costs, the source of the money, and what value will be achieved from the outlay of the
resources. It is critical to fully examine, despite the initial financial outlay, the potential for cost savings it may produce. It
could be helpful to know how budgets are formulated for a given organization, professional group, or government agency.
What is the budget process? How much money is allocated to a particular cost center or budget line? Who decides how the
funds will be used? How is the use of funds evaluated? How might an individual or group influence the budget process?
Money is not the only resource to evaluate. Sharing available resources, such as space, people, expertise, and in-kind
services, may be best accomplished through a coalition. It may require a mechanism for each entity to contribute a specific
amount or to tally their in-kind contributions such as office space for meetings; use of a photocopier, telephone or other
equipment; and use of staff to assist with production of brochures and other communications. Other cost considerations
include publicity efforts such as printing materials, paying for postage, and accessing electronic communications.
Values Assessment
Every political issue should prompt discussions about values. Values underlie the responsibility of public policymakers to
be involved in the regulation of health care. In particular, calls for extending the reach of government in the regulation of
health care facilities imply that one accepts this as a proper role for public officials, rather than as a role of market forces
and the private sector. Thus, electoral politics affect the policies that may be implemented. An analysis that acknowledges
how congruent nurses’ values are with those of individuals in power can affect the success of advancing an issue. There are
issues that would be considered morality issues−those that primarily revolve around ideology and values, rather than costs
and distribution of resources. Among well-publicized morality issues are abortion, stem cell research, and immigration.
However, most issues that are not classified as morality issues still require an assessment of the values of supporters and
their opponents.
Any call for government support of health care programs implies a certain prioritization of values: Is health more
important than education, or jobs, or military action in the Middle East? Elected officials must always make choices among
competing demands. And their choices reflect their values, the needs and interests of their constituents, and their financial
supporters such as large corporations. Similarly, nurses’ choice of issues on the political agenda reflects the profession’s
values, political priorities, and ways to improve health care.
Although nurses may value a range of health and social programs, legislators review issues within the context of demands
from all of their constituencies. When an issue is discussed, it is critical to link the issue to the problem it may solve. It is
also important to make sure issues are framed to show how they will help the public at large and not just the nursing
profession. For example, when a request for increased funding for nursing education is made, linking this request to the need
to alleviate the nursing shortage or to increase the number of nurses necessary for successful implementation of health care
reform would be important.
Networks and/or Coalitions
Although individuals develop political skill and expertise, it is the influence of networks and coalitions, or like-minded
groups that wield power most effectively. It is critical to the political analysis process to evaluate what networks or coalitions
exist that are involved with the issue.
Too often nurses become concerned about a particular issue and try to change it without help from others. In the public
arena particularly, an individual is rarely able to exert adequate influence to create long-term policy change. For instance,
many advanced practice registered nurses (APRNs) have tried to change state Nurse Practice Acts to expand their authority.
As well intentioned as the policy solutions may be, they will likely fail unless nurses can garner the support of other powerful
stakeholders such as members of the state board of nursing, the state nurses association, physicians, and consumer advocacy
groups. Such stakeholders often hold the power to either support or oppose the policy change. (See Chapter 75 for a
discussion of building coalitions.)
Power
Effective political strategy requires an analysis of the power of proponents and opponents of a particular solution. Power is
one of the most complex political and sociological concepts to define and measure. It is critical to be aware of the sources
of power, regardless of setting or issue, to understand how influence happens and to build your own sources of power for
leadership in the political process.
Power can be a means to an end, or an end in itself. Power also can be actual or potential. Many in political circles depict
the nursing profession as a potential political force considering the millions of nurses in this country and the power they
could wield if more nurses participated in politics and policy formation. Any discussion of power and nursing must
acknowledge the inherent issues of hierarchy and power imbalance that arise from the long-standing relationships between
nurses and physicians. Some of nurses’ discomfort with the concept of power may also arise from the inherent nature of
“gender politics” within the profession. Male or female, gender affects every political scenario that involves nurses. Working
in a predominantly female profession means that nurses are accustomed to certain norms of social interactions (Tanner,
2001). In contrast to nursing, the power and politics of public policymaking typically are male dominated, although women
are steadily increasing their ranks as elected and appointed government officials. Moreover, many male and female public
officials have stereotypic images of nurses as women who lack political savvy. This may limit officials’ ability to view nurses
as potential political partners. Therefore …
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