The Role of the RN/APRN in Policy-Making.

Posted: December 16th, 2022

The Role of the RN/APRN in Policy-Making.


Discussion 1: Evidence Base in Design and Discussion 2: The Role of the RN/APRN in Policy-Making
When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.The Role of the RN/APRN in Policy-Making.


In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy. (I page with 3 refrences.)

To Prepare:

Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.
Review the health policy you identified and reflect on the background and development of this health policy.
By Day 3 of Week 7
Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.
Add Refernces used for disscussion1 in 1 seperate page.
Discussion 2: The Role of the RN/APRN in Policy-Making
Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role. (1 separate page from discussion 1 and with references)The Role of the RN/APRN in Policy-Making.

What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?

Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation.

To Prepare:

Revisit the website provided in the Resources and consider the role of RNs and APRNs in policy-making.
Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.
By Day 3 of Week 8
Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.The Role of the RN/APRN in Policy-Making.

Add 3 reference to 2nd discussion.

Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 5, “Public Policy Design” (pp. 87–95 only)
Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137–146)
Chapter 9, “Interprofessional Practice” (pp. 152–160 only)
Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183–191 only)
American Nurses Association (ANA). (n.d.). Advocacy. Retrieved September 20, 2018, from

Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementation. Retrieved from (n.d.). Retrieved September 20, 2018, from

Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055–1080. doi:10.5465/AMR.1996.9704071863

Note: You will access this article from the Walden Library databases.

Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice, 21(6), 1014–1017. doi:10.1111/jep.12350

Note: You will access this article from the Walden Library databases.

Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretion. Public Management Review, 16(4), 527–547. doi:10.1080/14719037.2013.841978.

Note: You will access this article from the Walden Library databases.

Required Media
Laureate Education (Producer). (2018). Getting your Program Designed and Implemented [Video file]. Baltimore, MD: Author.
video transcript
Getting Your Program Designed and Implemented
Program Transcript
FEMALE SPEAKER: It’s most important to start with your own elected officials
and to try and identify within that group who might be most receptive to your
message. It’s also important to know, what level of government is this issue most
appropriate to engage in? And in some cases, that will be state government. In
other cases, it’ll be the federal government.
So having a little bit of a sense of where the issue is playing out and what the
environment is that it can best be served, you need to know that in advance so
that you’re bringing forward issues that actually are relevant to the work of a
member of Congress. That way, you don’t waste your time. You’re not wasting
their time either.The Role of the RN/APRN in Policy-Making.
FEMALE SPEAKER: If I had opposition to a program, I would ask for
recommendations from the person who was opposing it. I would go to my staff
and say, what else can we do differently? I would go to stakeholders like
veterans service organizations, women’s group, congressional members, the
Women’s Congressional Policy Institute. Ask them– this is the issue– how do
you think we should [? present ?] this? What else is missing on there? What can
we do to get this policy passed?
FEMALE SPEAKER: When we think about policy implementation and we’re
trying to help influence that process, it can be beneficial for us to build
relationships not just with the policy makers themselves, but also build
relationships with the media. Just as you’re leaving information with members of
Congress or state legislators, so too you can leave information and get
information in front of the media, hoping that they will bring lift to that topic and
inform the public.
Then also partnering with other outside organizations who are willing to engage
with policymakers right alongside of you. Those can be consumer groups. They
might be businesses. They could be school teachers who share your concern, for
example, about children getting vaccinated. So it’s looking both within the nursing
community, but outside it as well, as you’re working to shape the policies that are
being implemented.
Getting Your Program Designed and Implemented
© 2018 Laureate Education, Inc. 2
Getting Your Program Designed and Implemented
Additional Content Attribution
Trowell‐Harris, I. (n.d.). Various Photographs [Photograph]. Used with permission
of Irene Trowell-Harris.
Wakefield, M. (n.d.). [Photograph]. Used with permission og Mary

2nd video transcript
Politics and Policy
Program Transcript
FEMALE SPEAKER: Government policies have an enormous impact on how
healthcare organizations can operate. Healthcare administrators must take a key
role in identifying the need for new policies and successfully advocating for them.The Role of the RN/APRN in Policy-Making.
In this program Doctor Jeffrey Levi reviews the challenges and opportunities
administrators have in reforming health care policies. Doctor Mary Wakefield
describes the steps in the policy making process. And Todd Linden explains how
administrators can best influence the development of health care policies.
JEFFREY LEVI: Health care policy making is so complicated because we have a
very complex system. Not only do we have multiple players, whether it’s the
multiple insurance companies, Medicare, Medicaid, and all the different payers,
and, of course, the multiple providers that we have. But also that we’ve chosen
as a society, and this is how the United States is structured, that some of it is
regulated at the federal level, some of it is regulated at the state level, some is
regulated at the local level.
And creating a rational response to complex problems when even the level of
regulation and who’s responsible and who pays is so fragmented, makes making
health policy very, very complicated. It’s also important to recognize that it’s not
just governments that make policy. Health plans make policy. Individual
administrators in an individual institution are making policy.
A decision to adopt a program that will reduce medical errors, a decision that is
designed to change the patient experience in a health care setting, that’s making
policy. And so, on the one hand, you can look at this incredibly fragmented
system and say, oh my god, how do we make policy. We’ll never create
rationality here. That’s one way of looking at it.
The other can be, because we are such a diverse and diffused system, the
opportunity to influence change, in least in a local setting, is great. And so
individual policies one by one by one then can create a groundswell that then
bubbles up. In fact, real decision making about health care is something of a
pyramid, with what government does being the very smallest part of the tip of
the– certainly, what the federal government does is sort of at the tip.
Towards the bottom is what purchasers decide. And the very base are the
providers and the individuals who are running the health care system, who on a
day to day basis really are making policy.
I think one of the challenges we faced in thinking more systemically about health
care reform or how our system is developed is that we have so many different
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©2018 Laureate Education, Inc 2
interests. And because we aren’t all in the same plan, except perhaps the elderly
and Medicare, we don’t always have common interests and we don’t always have
common issues. And in fact, we’ve tended in this country not to organize
politically or even respond politically on a population level, but rather disease by
disease by disease.
And so our identity is less around gee, how good a health care system could we
have for all Americans, and more how can I as a person with cancer or a person
with HIV or a person with whatever or heart disease, how can I make sure that
I’m getting the benefits and the best services possible. And so we end up then
responding on a disease by disease or body part by body part basis, and that
doesn’t create a terribly rational system.
But more importantly it makes it harder then to create broad based health care
policy. In fact, some of the fundamental issues, whether you have cancer,
whether you have heart disease, whether you have HIV– whatever your
condition– are pretty much cross cutting.
And it’s only been recently that disease advocacy groups have come to
recognize that, actually, this broader level reform is what we need to be focusing
on. The fact that the American Cancer Society has decided that the issue about
insurance is the most important issue in fighting cancer I think is a major
breakthrough. That they’re not looking for a specific answer around cancer, but
are looking more systemically. And I think that is going to make a big difference.
But until recently we’ve really been thinking of it in such a segmented way, even
among the providers– there’s fighting between the specialists, and the
generalists, and people in the hospitals and the clinics– everyone’s fighting one
another for a tiny sliver of the pie, rather than thinking about how do we make it
work for everyone.
I think the challenges we’ve faced around HIV and AIDS is a good example of
how hard it is to make rational policy. If you’re a person living with HIV, the best
interventions are those that happen early in your disease progression. And yet,
our safety net health care system was really– in Medicaid– is really designed for
you to be disabled before you become eligible.
So what happens? Because it’s so hard to get onto the core safety net programs,
we created a separate program– the Ryan White program– for people living with
HIV to provide them health care services, pay for pharmaceuticals, and provide
support services.
Why should we have a disease specific program along these lines? Shouldn’t
anyone with a catastrophic condition have those kinds of services? The answer
is probably yes, but the politics of how we do health in the United States gets
people organized disease by disease. You know, people with cancer have very
Politics and Policy
©2018 Laureate Education, Inc 3
similar needs to people with HIV. They sometimes have the same problems
accessing Medicaid.
Why do we have a Ryan White program for HIV? I think it’s a really good
program, but we should also it for people with cancer. Why don’t we have safety
net programs for people with dementia, another perfect example? You don’t
become eligible for Medicaid that could pay for home and community based
services that might prevent you from becoming institutionalized. Medicaid will pay
for that, but not until you are disabled.
Well, once I’m disabled I’m probably less likely to be able to stay in my home and
take advantage of those community based services. So do we create a Ryan
White program for dementia? Or do we expand Medicaid? I don’t know what the
answer is.
But because we look at these issues disease by disease– because we don’t
think systematically about what people need to keep them as well as possible
and as independent as possible– we’d rather have these rigid guidelines for who
can be in what program.
The work that Trust for America’s Health is doing now around promoting
community level prevention– it’s certainly my hope by making that economic
case, by showing to policymakers and to the American people that we actually
can save money by doing more community level prevention.
But that means as we’re doing health care reform, that public health part of the
health system, as opposed to health care system, will be adequately financed
and will be a constant presence as we think about what a true health system
looks like.
MARY WAKEFIELD: The challenges that we see health policy designed to
address are challenges of access to health care services. Health policies are
designed to address concerns around cost of health care or financing health care
services. And health policies are also crafted to help improve quality of health
care. Or, put another way, health policies are crafted to address concerns about
compromises in the quality of health care that the American public receives.
So let’s think about that public policy maker who is trying to fashion a solution to
one of those challenges of cost, access, or quality. What is it that determines
what the solution is that gets put on the table and how that solution moves
through the policy making process?
It’s not just about good research or what I might view as an obvious solution to a
particular problem associated with quality of health care. In fact, there are a
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number of factors that influence what solution gets put on the agenda, how that
solution moves through the policy making process, and whether, in fact, it even
survives through to the end of that policy making process.
Health policy can be influenced by crises. Media can influence what gets put on
the policy making agenda, or how it’s treated once it gets there. Political ideology,
personal experiences of members of Congress can influence how they respond
to a particular health care challenge. Research findings also can be influential.
Special interest groups can exert a lot of influence on what gets put on the health
policy agenda. Constituents, like each of you, who might draw the attention of
your policy maker, the member of your congressional delegation.
The policy making process has three major areas of activity to it. The first area, is
on the front end of policy making, is policy formulation. That is agenda setting. It’s
the part of the policy making process where decisions are made about what gets
put on the agenda, what the political implications of that issue might be, how
important this issue is to the American public or a particular special interest
group, for example.
Believe it or not, at least based on my experience, a lot of ideas that were
eventually incorporated into legislation came from constituents– came from
physicians, dentists, nurses– who identified in the field a problem maybe for an
HIV/AIDS population, maybe for a geriatric population, maybe it had something
to do with the use of restraints in nursing homes, for example, and they didn’t like
what they saw. And so they wanted to do something about it.
Institutional policies weren’t sensitive enough, public policy seemed to be the
vehicle for them to move on, and so they engaged their public policy maker at the
state or federal level with the identification of a problem as well as, typically,
identifying a potential solution. And that’s the agenda part– getting an issue on
the agenda, having policymakers paying attention to it, attracting their attention,
and initiating that policy formulation process.
The back end of that is actually the development of the legislation done in
Congress, incorporating those new ideas by members of Congress and their
staffs to capture at least a part of a solution to a particular problem. So there’s
the policy formulation piece.
So we move from the policy formulation piece to the policy implementation piece.
And between those two pieces we see enactment of the legislation. It’s the old
how a bill becomes law basic civics 101. The piece of legislation is enacted into
law. It’s signed by the president or it’s signed by the governor. And it moves over
into the executive branch– out of the legislative branch into the executive branch-
– where rules to implement that new piece of legislation are devised.
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So policy implementation, then, typically occurs inside public programs, federal
programs, within the US Department of Health and Human Services– i.e. Within
the Executive Branch of government. It’s here that some of the nuances of how
that particular idea is actually going to be operationalized are crafted.
Historically, a lot of us have thought about only influencing the policy making
process on the front end. So it’s really important to keep your eye on not just
whether or not a bill is enacted– that might be great, good news from your
perspective– but also how that bill is implemented are operationalized inside the
Executive Branch.
If you’re talking about the Executive Branch of your local state government, for
example, or you’re talking about the Executive Branch of the federal government,
because what comes out of that is the actual program, regulation, new policy
enacted to fulfill the requirements of that initial bill that was introduced by either
the state legislature, for example, or by the US Congress.
And then what you start to see is the third and last component of the policy
making process, which is policy modification. Probably to put this most directly–
generally speaking, there’s no one right fix, no one a magic bullet, that’s going to
take care of a particular problem. So if what I’m concerned about is access to
health care services for rural populations, it’s pretty likely that telemedicine is not
going to be the only solution to ensuring access to all services for that population.
So policy modification is the third and last part of the process where you see
policymakers beginning to think about how well that program is working, how well
a new regulation is working, and whether or not it needs to be tinkered with a
little bit– changed, altered, modified. Which then drives that policy right back into
consideration before state legislatures.
What gets put back on the agenda will depend on how well a regulation might be
perceived as working, how well a new program is working, whether or not it’s
accomplishing what it was designed to address as a problem. So this is a circular
process. There’s no one piece of legislation that provides all solutions to
concerns around access, or cost, or quality.
It might be that you’ll draw the attention of your congressional delegation to a
particular problem that you’re seeing. Your own voice is an extremely important
one. So don’t dismiss out of hand the impact that you can have as a factor, if you
will, in influencing what gets put on the policy making table, and how it’s treated
once it’s there.
TODD LINDEN: One of the changes that I’ve seen over my career has been the
impact and role that health care leaders need to play and are now playing in the
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©2018 Laureate Education, Inc 6
health care politics. I Used to be a pretty internal focus– managing this hospital,
managing this physician practice, managing this nursing home. Now we
recognize the impact that politicians have on the work we do, truly impacts our
ability to care for our patients.
I would say that often I end up spending a third of my time dealing on the health
care politics and the impact it has. The reality is most politicians don’t know much
about it, and so part of my responsibility is to help educate them. Part of my
responsibility is to be nonpartisan and to simply be a resource of good
information so that, as a politician is debating and thinking about new public
policy– whether it’s payment policy or access issues or regulatory issues– that
they at least think about what impact is that going to actually have on the folks
that deliver the care– the physicians, the nurses, the hospital, and for that matter,
the insurance companies and the other continuum of care providers.
Hospital leaders have an opportunity to really interact with politicians in a couple
different ways. One of the ways is to offer information– to be experts and give
information. And another way is to help bring color to the whole process. So we
work with our board members, our trustees. They’re great advocates. They’re
unpaid volunteers. They’re simply trying to make sure their community hospital is
meeting the needs of the community. And they can be great advocates.
So part of my role is to help put trustees in a position to interact. Same thing with
physicians. Physicians can be great advocates. Frankly, patients can be great
advocates. When you find a patient that’s articulate and has been impacted by a
political decision at one point– a policy or a payment issue– they can be
wonderful advocates. So part of my role is to help look for those advocates, put
them in a position so they can have some impact on the political process.
One of the ways that hospitals or physicians can really have an impact on the
political process is through associations, national associations. Clearly it’s a big
part of American politics today. So whether it’s the Iowa Hospital Association, or
the American Hospital Association, or it’s the American Medical Association,
these organizations do exert influence in the political process. And they get their
information from their members.
So hospitals being strong members of these associations, engaging in the
political process, making their voices heard, making sure their community is
aware of the issues, giving them opportunities to interact in the processes, is
really an important activity.
And recently we’ve been working on an issue of improved payment– not an
uncommon issue for hospitals when they think about the Medicare and Medicaid
systems. And what we’ve tried to do is just develop a good relationship with our
Congressman and with our Senators. And the effort there is to a, make sure they
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©2018 Laureate Education, Inc 7
understand what the issue is, and b, try to help them really personalize and
understand the impact that they can have on a community.
So recently we went out to Washington with a group of our trustees. Again, these
are community members who are unpaid who simply are advocating on behalf of
their community hospital and the impact it has on the community. One of the
trustees was really able to talk about not only the access to care– and if there’s
underfunding, it may cripple the ability for the institution to meet the needs of the
community or the patients– but also reminding the politician of how vital an
economic engine the hospital is in the community.
If there’s not a viable hospital in this community, it impacts other employers
thinking about coming or staying in our community. This is very serious stuff and
it’s stuff that takes folks leading health care institutions to engage in, to be part of
those discussions, to help think about and brainstorm where we’re going to go
with this.
I don’t know how government’s going to fund health care costs in the future for
Medicare and Medicaid. But clearly those questions and how that evolves is
going to drive a lot of what we do as health care administrators. And so paying
attention to that, being involved with that, is going to be critically important.
JEFFREY LEVI: Health care administrators have a vital role to play in educating
policymakers about what works, what doesn’t work, what’s going right, what isn’t
going right, what kinds of changes are needed. And it doesn’t have to be sitting
down across the table from the President of the United States in the White House
to have some influence. Trade associations can do that for you.
But just as importantly, members of state legislatures, members of city councils,
members of county boards, and members of Congress are far more open, I think,
than people recognize to hearing from individual constituents.
State legislatures have a huge influence over what happens in the health care
system. And most state legislators don’t even have staff to advise them and to
provide the expertise, that perhaps a member of Congress may have, around
health care issues. When you don’t have a staff who have expertise, then
constituents become a tremendously important resource. So there are lots of
opportunities to create relationships with local officials.
Just as importantly, creating a relationship with the local health department as
you become the senior administrator, and engaging in sitting on boards, sitting
on committees, sitting on commissions, can take a lot of time. But it’s important in
establishing a dialogue, so that what’s happening on the ground is understood by
policymakers as they’re moving forward.
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One thing I think administrators may be fearful of is engaging in the political
process and talking to policymakers– talking particularly to elected officials– and
whether that will make them appear to be partisan, and maybe even threaten
their charitable status, if they work for a 501(c)(3) organization.
The truth of the matter is that our system is built on and encourages individuals
as experts to be educating their legislators– educating public officials. You don’t
have to be lobbying for a particular bill. You don’t have to be lobbying for a
particular reimbursement rate, if that may be the issue.
But if you want to talk about your personal experience as an administrator, the
challenges that you are facing, that falls under the rubric of education. And that’s
a critical and vital role for administrators to play. no one else is going to do it for
you. And so you have to be that voice.
Politics and Policy
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Health Policy and the Role of Nurse Practitioners (NPs) and Advanced Practice Registered Nurses (APRNs) in Policy Making
Health policy formulation is a critical function of elected representatives in any jurisdiction. However, not every elected representative has a medical or nursing background to appreciate the depth and length to which this kind of policy needs to go. This is why the input of health professionals is needed when these policy initiatives are put in place (, n.d.). And this is where the registered nurse (RN) comes in. The registered nurse has an important role in influencing and giving direction to new health policies touching on the public. Apart from being involved in initiating the health policies, RN input is also crucial in the successful implementation of the policies (CDC, n.d.; Tummers & Bekkers, 2014).The Role of the RN/APRN in Policy-Making.
Recent Healthcare Policies
Two most recent healthcare policies that can be mentioned are the Patient Protection and Affordable Care Act 2010 “repeal and replace”, and prescription drug pricing policy. The Affordable Care Act (ACA) “repeal a d replace” policy by President Donald Trump’s Republican Party aimed at removing the provision for individual mandate. This involved contributing a certain amount to the coverage, failure to which there was a penalty or fine outlined in the ACA. The GOP under President Trump gave this “repeal and replace” promise during their campaigns (Mody & Blackwood, 2018). The other recent policy involved the pricing of prescription drugs. This is another policy that the Trump administration undertook to implement. The underlying aim was to lower the soaring cost of prescription medications, in spite of the ACA (Mody & Blackwood, 2018).
Opportunities for Policy Making for Registered Nurses
Registered nurses, as has been seen above, are important players when it comes to healthcare policy formulation and implementation. However, the nurses themselves must first recognize where the opportunities for policy making exist for them. Normally, registered nurses and other nurse leaders generally have to lobby Congressional lawmakers – who themselves do not have any medical background in most cases – to incorporate their views in healthcare legislation. A good example is the need for all states to allow for full practice authority (FPA) for all APRNs. Restricted and reduced practice requiring supervision by a physician has stifled APRN practice in many states for long. Unfortunately, lobbying from the outside alone is not sufficient to influence policy adequately. Therefore two opportunities that exist for nurses to influence policy from the inside are (i) running for a Congressional seat in either the House of Representatives or the Senate. Here, the nurse will have an insider’s advantage at articulating the issues from a professional’s point of view; (ii) running for a local state or county position. This will place the nurse in a good position to influence local politics and policies, including healthcare policies.The Role of the RN/APRN in Policy-Making.
The strategies that might be employed to better sensitise nurses of these opportunities for influencing policy include presentations at conferences and continuing education (CE) platforms. Many nurses are not aware of the immense opportunities they have to influence change. What they think is that all they are expected to do is to care for the patients. They are not primed to think that they have a part to play in the hard politics of policy change and implementation. This can be traced to the training that nurses undergo. And this is why the two strategies mentioned above are apt in sensitising the RNs of these available opportunities for changing health policy (Laureate Education, 2018; Milstead & Short, 2019).

Health Policy and the Role of Nurse Practitioners (NPs) and Advanced Practice Registered Nurses (APRNs) in Policy Making
Health policy formulation is a critical function of elected representatives in any jurisdiction. However, not every elected representative has a medical or nursing background to appreciate the depth and length to which this kind of policy needs to go. And this is where the registered nurse (RN) comes in. The registered nurse has an important role in influencing and giving direction to new health policies touching on the public. Apart from being involved in initiating the health policies, RN input is also crucial in the successful implementation of the policies (CDC, n.d.; Tummers & Bekkers, 2014).
Discussion 1: Evidence Base in Program Design
The recent healthcare policy selected and that can be mentioned in this discussion is the Patient Protection and Affordable Care Act 2010 “repeal and replace” policy. The Affordable Care Act (ACA) “repeal and replace” policy by President Donald Trump’s Republican Party was aimed at removing the provision for what is known as individual mandate. This involves the requirement that every American citizen covered by the ACA contributes a certain amount of money to the coverage. In the event that they fail to do so, there is a penalty or fine outlined in the ACA. This is what the Republican Party of the current President set out to repeal. The GOP under President Trump gave this “repeal and replace” promise during their campaigns (Mody & Blackwood, 2018).
As far as the availability of evidence for this policy is concerned, statistical evidence appears to lend some credence to the Republican Party’s assertion that this provision is counterproductive. This is information from data that is available from Medicare and Medicaid (Sacristán & Dilla, 2015). For example, there have been cases where individual American citizens who have not been able to honor the individual mandate have had to renounce the coverage because they found the penalty for defaulting punitive.The Role of the RN/APRN in Policy-Making.

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