How can you use evidence-based research to demonstrate the relationship of nursing practice to outcomes in mandatory nurse-to-patient staffing ratio?

Consider mandatory nurse-to-patient staffing ratio policy priority. How can you use evidence-based research to demonstrate the relationship of nursing practice to outcomes in mandatory nurse-to-patient staffing ratio?

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Determining Healthcare Policy Priorities
Introduction | Coalitions: One Very Powerful Approach | The Importance of Research |
Conflict Management | Special Interest Groups | Nursing Action and Nursing Specialty
Associations | Summary

Introduction
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This week, we will discuss the various elements impacting policy priorities, plans for implementation
of those policies, the relevant stakeholders, and evaluation of results once the policy is implemented.
Coalitions will be examined in terms of their functions and purposes, as well as the power of special
interest groups. The value of research and its application to the political process will be explored.
Conflict management and working effectively in the context of nursing specialty associations will also
be discussed.

Coalitions: One Very Powerful Approach
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Coalitions are powerful entities when they have solid leadership and good organization. At times of
crisis, needs are identified and resources are mobilized to tackle the problem. The power inherent in
a coalition lies in the diversity of its membership, clarity of purpose and goals, leadership,
organization, resources, and a little luck!
Have you ever been a member of a coalition? If so, what were the strengths? What were the
weaknesses? Was the coalition’s mission based on specific objectives or an ongoing mission?
Consider the success of the ongoing civil rights Rainbow Coalition or the various state nurse
workforce coalitions. Coalitions can be made up of members of different groups coming together for
a singular purpose, or they can be (as in the case of the state nurse workforce coalitions) subtypes
within the same group, unifying for a singular purpose.
Another component of an effective coalition is the use of scenario planning in order to consider all
approaches and the possible consequences involved in meeting their goal. Scenario planning is a
sort of “what-if” strategy. This technique allows for flexibility with various trends that may arise out of
a given issue. The coalition brainstorms all possible approaches in meeting their goal and designs
various contingency plans for dealing with issues that may arise.
Coalitions are groups of diverse people, and therefore, operate using a group process. It is important
that strong leadership and a carefully organized structure be in place in order to maximize
productivity and minimize conflict. It’s also critical to consider funding and promotion issues; money
and visibility are so important! Both formative and summative evaluations of the coalition’s progress
assist with keeping it on track and measuring effectiveness.

Pitfalls involved in coalitions result from a failure in tending to the elements that can make them
highly effective. Ineffective leadership, lack of a clearly articulated goal and plan, lack of structure
and organization, lack of resources, and having membership that just fails to click can all lead to a
lack of overall success. Being proactive in meeting these challenges head-on greatly increases the
coalition’s chances of meeting its goal.
Your textbook lists several web resources for coalition-building and maintenance. As you progress in
your professional development, consider getting involved in a coalition or building one of your own.
The best place to begin, as with most things, is with education. By taking this course and getting
directly involved in the political process, you are learning about and interacting with healthcare policy
issues of your choice and passion. Building networks by active involvement is what coalitions are all
about.

The Importance of Research
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Research is important in policy. Many think that powerful and conclusive research would greatly
influence politics and policy making; unfortunately, that is not always the case. It is important to
understand that most legislators are lay persons. Even when powerful, evidence-based research is
clearly presented, it can be perceived as dry and muddy. Oftentimes, policymakers require some
teaching about research and what comprises significant and accurate research results versus weak
and inconclusive results. Research can be accurate and very significant, but if it represents
information about subject matter that is not of interest (or counter to the interest) of the policymaker,
it will be of little use. The very nature of the political process lends itself to manipulation, self-interest,
and even deceit. Flawed studies have been promoted by individuals (both lobbyists and
policymakers) with a specific political agenda. Consider these issues when studying policy and
politics throughout this course.
Nurses can have a significant impact on policy by using research in a meaningful way, especially if
research reinforces a true passion for a policy. Most often, nurses develop their passions out of
experience; therefore, they have considerable knowledge not only about the issue but also the
underlying politics involved. Nurses can use an issue to advocate for funding for research to support
their issue, or they can use sound research data to recommend a course of action regarding their
issue. For example, consider two health-related issues involving research that made an impact on
the general public. The first issue involves the research done on Sudden Infant Death Syndrome
(SIDS). Even though the research study had not yet been concluded, the preliminary results were
significant enough to garner funding for a campaign to remind parents and caregivers to place
infants on their backs while sleeping. That simple strategy proved to be so effective and easy to
implement that the campaign was considered hugely successful.
The second research-related issue involves monthly breast self-exams. Funding for this campaign
disappeared because research on the effectiveness of the campaign itself showed that the costs
outweighed the efficacy of monthly breast self-exams. The assessment of the efficacy was based on
research on breast self-exams, which revealed that a good number of tumors are in dense breast
tissue and difficult to palpate.

Research, healthcare, and politics are a powerful combination, especially when the media is
involved. For instance, in the past several years, pharmaceutical companies have been permitted to
advertise on television. Pharmaceutical companies are especially powerful special interest groups.
Consider the conflict of interest involved when healthcare practitioners and researchers for
pharmaceutical companies are also involved, both directly and indirectly, with the Food and Drug
Administration (FDA). When power, money, and influence are at stake, corruption can result. Who is
funding the research? What are their ties to the regulating agency? Is it a case of the fox guarding
the henhouse? How has the research data been presented to the general public? Keep in mind that
most new research is not replicated and may prove troublesome in the future until further studies are
conducted. It is a lot more difficult to correct public misconception and misperception (or remove a
drug from the market) than it is to spark attention for a new and provocative study or drug. Often, the
news media will hype interesting news on page one, but if a retraction later becomes necessary, it is
deeply embedded in fine print somewhere in the back of the section.
Health services research is a category of research that deals with how care or service is practiced
and how service is related to outcomes. Nothing is more powerful than research that demonstrates
the difference that nurses make in promoting health and wellness. We share basic things in common
with our legislators: they too have children and aging parents; and they and their loved ones get sick
or injured. Chances are that they also have friends and loved ones whose lives have been impacted
by health-related issues. Personal anecdotes are engaging and very powerful. Nurses would greatly
benefit from educating the general public, as well as policymakers, about nursing. Nurses both
conduct and utilize research, and thus have a unique perspective on both sides of the issue. Sadly, it
is one of the best-kept public secrets.
Using research to look at nursing where the work happens demonstrates the relationship of nursing
practice to outcomes. Ask yourself, where is the evidence to support this idea? How strong is the
evidence? How can I use this evidence to get the importance of my policy-priority issue across to lay
persons? This approach will shed more light on the use of best evidence in caring for patients at all
levels of prevention. Packaging research in a policy context and the ability to convey it in a
meaningful and compelling way will greatly advance the agenda of nursing.

Conflict Management
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Conflict is a perceived threat to a social position, power, values, or resources. Conflict is expected in
policy and politics and is a natural part of human interaction. Politics and conflict go hand-in-hand!
Although dealing with conflict is never pleasant, it is a necessary part of productively interacting with
others, especially when it comes to policy making issues. There are basically four types of conflict.
Intrapersonal (within oneself)
Interpersonal (between two persons)
Intergroup (between two or more groups)
Organizational (within an organization: between individuals or groups)
Roll your cursor over each item to view the type of conflict involved.

Conflict resolution involves negotiating toward a mutually acceptable agreement that can result in
win-lose solutions (one person or group gets more of what they want), or preferably, win-win (both
are satisfied). When it comes to policy and policy making, two win-win strategies that are especially
effective are principled negotiation and collaboration.
At the root of both of these approaches lies the ability of participants to focus on problem solving.
Each participant must also separate the issue from the other individual involved to demonstrate
mutual respect and valuing of the other person, along with empathetic understanding of a differing
viewpoint and the desire to come to a deeper understanding of the issue. Finding common ground in
a conflict tends to help the resolution process by uniting the participants, as does finding mutual
benefits. It is essential to explore conflict and avoid toxic behaviors that will hinder the process of
policy. Brainstorming alternatives is also important, as is the use of objective criteria. In this way,
egos and positions are removed from the equation. When one considers working in coalitions,
conflict resolution skills are essential.
It is important to understand that effective conflict management and resolution is a lifelong process.
As with any useful skill, it must be practiced regularly. The payoff for becoming adept at this skill is
huge for a nurse policymaker. Proper management of conflict is essential to advance policy agenda.

Special Interest Groups
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Interest groups in the United States today number in the thousands and represent both for-profit
sector and nonprofit groups. They are classified according to structure, focus, type of benefit, and
goals and mission, although some types fall into more than one category. Often, the development of
one type of special interest group (American Cancer Society) spawns the creation of an opposing
group (Tobacco Research Council) and thus strikes a balance between the two. Some of the
strongest political alliances formed are also the oldest. These powerful alliances are made up of
three entities: a congressional committee or subcommittee, the special interest group, and a federal
agency. In this way, all three support and benefit from each other. Can you think of an example in the
area of healthcare?
Interest groups exist because people come together for

solidarity (strength in numbers);

purposive benefits; and

material benefits.

The strategy of interest groups involves direct lobbying or political action committee (PAC)
contributions (direct strategies), or it can also include indirect or outside strategies, such as those
that target public opinion. In the information age, the Internet has proven an invaluable (and initially
underestimated by some politicians) tool in the hands of some special interest groups. Take a look at
examples of interest groups listed in your textbook. Are you surprised to learn that you are a member
of a special interest group? We, as nurses, are all represented by the American Nurses Association
(ANA), whether or not we are members.

The strength and power of interest groups lie in information; information is what allows the various
types of interest groups to lobby and influence lawmakers and public opinion. Interest groups collect
information to support their agendas, structure the data to enhance their agenda, and ensure that
the policymakers (and the general public via media) are exposed to that information. No matter the
amount of money contributed to a given campaign, the evidence shows that the access to the
candidate and the visibility provided by contributions prove the most valuable. In other words, the
key factor is that your group contributes enough money to get you in the door. Now you have the ear
of the lawmaker and can tell your story and make your proposals to influence policy making.
Interest groups vary in form, mission, structure, and type. Interest groups are unpredictable because
they use varying strategies at different times and are especially active between election cycles,
because political parties are active during elections. Do you feel that interest groups are positive or
negative forces in the political process? Are they really representative of the average person in
society, or are they elitist? How do you feel about your own interest group? Are you knowledgeable
about the ANA, its focus, and how contributions are spent? How does that money help you, your
practice, and your clients? Attempts have been made in recent years to monitor and regulate political
contributions made by special interest groups. Both hard money (donations made directly to the
candidate) and soft money (party-building activities) are regulated in terms of amount allowed by
campaign finance laws. Still, as mentioned previously, the world of politics involves competition for
scarce resources, which opens the door for corruption. Monies coming from contributors outside the
United States have added a new layer of problems regarding enforcement of regulations on political
campaign finance.

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