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Health Policy: What's Your Role?

NPs and PAs are adept patient advocates in the clinical setting, but they must utilize these advocacy skills in the policy arena as well. This requires developing awareness of issues, laws and health policy.1 NPs and PAs should apply their skills to develop polices as well as to engage patients in policy making.2

Policy Development

NPs and PAs can have a variety of roles in policy development. Utilizing knowledge of evidence-based practice, we can work with employers to develop policies that affect patient care. NPs and PAs can also draft and develop policies.

Another role is in organizational or team policy agenda setting. For example, when developing a policy for urinary catheter care, NPs and PAs have the knowledge to review and critique the literature and determine the best data to utilize for an evidence-based guideline.

Professional organizations are another avenue to affect policy change. NPs and PAs have leadership and organizational skills valuable to professional organizations. NPs and PAs can become involved in these organizations' political action committees as well as other leadership positions that set policy agenda.

Serving as a healthcare expert for elected officials is another area where NPs and PAs can affect policy development. NPs and PAs can become familiar with these officials through communications about legislation. NPs and PAs possess expert knowledge that can be presented to legislators when assisting with legislation development.

Policy Implementation

In the rulemaking phase of policy implementation, regulations and rules of operation are established.3 NPs and PAs can aid in the creation of these requirements. When a new policy is developed, NPs and PAs have the leadership and quality improvement abilities to work with employers and employees on regulations.

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A major component of policy implementation is management.3 NPs and PAs are well equipped to work within an agency or corporation to manage policies. With their background in understanding the challenges presented to staff members, as well as their possession of advanced skills in leadership, management and quality improvement, NPs and PAs can be effective in policy implementation.

Policy Modification

Once a policy is implemented, it will be modified over time to correct flawed regulations and adapt with, and to, changing environments.3 A common example of a frequently modified policy is the Medicare benefit.

Every year minor and major modifications are made to adapt to a changing healthcare environment. NPs and PAs can advocate for adaptations to the Medicare law necessary to provide better care for Medicare beneficiaries.

Policies in agencies are also frequently modified. One example is an organizational policy that outlines the frequency of medication reconciliation. This is periodically reviewed to determine if the frequency of reconciliation in the electronic health record should be adjusted.

NPs and PAs within the organization can see the entire picture of what this change affects, including corporate needs, how the change will affect the NP and PA role, and most importantly, patient care.

NPs and PAs also have a responsibility to teach other members of the healthcare team about the importance of policy development.

Evidence demonstrates that public policy learning activities increase awareness of the policy-making process.4

Nurse practitioners and physician assistants are well positioned to improve the current state of healthcare advocacy. We should utilize our skills to elevate the healthcare profession.


1. Boswell C, et al. Nurses' political involvement: responsibility versus privilege. J Prof Nurs. 2005;21(1):5-8.

2. Byrd M, et al. Political astuteness of baccalaureate nursing students following an active learning experience in health policy. Public Health Nurs. 2012;29(5):433-443.

3. Longest B. Policy Formulation: Development of Legislation. In: Health Policymaking in the United States. 5th ed. Chicago, IL: Health Administration Press; 2010: 81-100.

4. Price B. Practical evidence on improving local healthcare policies and practices. Nursing Standard. 2010;25(7):39-46.

Katherine Abraham Evans is a family and gerontologic nurse practitioner at Optum Health/Evercare Georgia and a member of the adjunct faculty at Emory Nell Hodgson Woodruff School of Nursing in Atlanta.

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