NURS 6226 Week 11 Reflection Example

Reflection: Finding the Earlier Table in the Policy Process

Student Name

College of Nursing, Walden University

NURS 6226: Introduction to Healthcare Policy

Instructor Name

Month Day, Year

Reflection: Finding the Earlier Table in the Policy Process

What

In Week 4, tracing the composite state's workplace violence bill through committee, I compared the introduced bill with the committee substitute and found that nearly all the substitute's language had been settled before the committee hearing. Two weeks before the hearing, according to the bill history, the chair had convened the interested parties, where the nurses and hospital associations sat with defense lawyers, disability advocates and health department staff. The felony section was dropped and the prevention mandate written there. I learned about that meeting only from a single line in the bill history. The hearing I had pictured as the decisive moment, with nurses testifying about being assaulted, took place after the deal was done.

My first reaction was frustration, as if I had been reading the wrong part of the story all term. My second, more useful reaction was curiosity about who had been in that room and how they got there.

So What

What that moment showed me is that hearings often ratify more than they decide. Testimony matters: it creates a public record, persuades undecided members and signals that nurses are paying attention. But the entry point nurses are most often taught, testifying at a hearing, arrives late in the process, after committee counsel and a small group of organized stakeholders have agreed on the text. By then the choices have narrowed to yes or no on a package others assembled.

Mason et al. (2016) describe four spheres in which nurses can act politically: the workplace, government, professional organizations and the community. My earlier picture of advocacy lived almost entirely in the government sphere, as an individual nurse speaking to legislators. The stakeholder meeting sits in the organizations sphere. Committee chairs invite associations, not individual nurses, because associations can speak for members and can commit to a negotiated result. That is the realistic route for a nurse like me to reach the earlier table.

It also changes how I understand timing. Drafting happens in the months before a session and in the weeks before markup, periods when legislators are least visible and the public is least engaged. A policy agenda can shift in those quieter periods when the right people are in the room (Kingdon, 2011).

Now What

I will take one step. Before the next legislative session, I will apply to join the state nurses association's legislative committee, which reviews draft bills before they are filed and represents the association at stakeholder meetings. I will tell the committee chair about my emergency department experience with workplace violence and ask to attend the next interim stakeholder session on the prevention rule's implementation, as an observer if not as a speaker.

What I still do not know is how those invitations are decided, whether the association chooses its representatives by expertise, seniority or availability, and how much a newer member can contribute. I will ask. The reflective framework of Driscoll (2007) ends with what will be done differently, and what I will do differently is look for the meeting before the hearing.

References

Driscoll, J. (2007). Practising clinical supervision: A reflective approach for healthcare professionals (2nd ed.). Baillière Tindall Elsevier.

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (Updated 2nd ed.). Longman.

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (Eds.). (2016). Policy & politics in nursing and health care (7th ed.). Elsevier.