Assignment: Reaching out a Solution

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 andwho is involved in trying to solve the problem. Finally, nurses are relationship builders and the political process involves the development of partnerships andnetworks 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 politicalanalysis and strategy to truly make a difference. Assignment: Reaching out a Solution

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. Assignment: Reaching out a Solution

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?

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• 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 anddefining 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 andjeopardize an institution’s reputation and future business. Assignment: Reaching out a Solution

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. Assignment: Reaching out a Solution

Knowledge of past history of an issue can provide insight into the positions of key public officials so that communications with those individuals and strategiesfor 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 82dimensions 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. Assignment: Reaching out a Solution

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 politicalwill 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.

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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. Assignment: Reaching out a Solution