Running head: HEALTH CARE POLICY ANALYSIS 1

Health Care Policy Analysis

Gracie Hertel

Grand Canyon University: NSG-436

November 3, 2019
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Health Care Policy Analysis

Health care policy refers to the decisions, plans, and actions that are undertaken in order

to achieve specific goals within the health care system and society. A health care policy aims to

achieve several goals such as the defining of a vision for the future which helps to establish

targets and points of reference. They also help to outline priorities and the expected roles of

different groups within the health care system; it helps to build consensus (World Health

Organization, 2013). With the ever-changing health care system, there is a continuous update on

laws and regulations. However, with every law, there is always room for revision or

improvement to that law, even laws that have just been recently passed. The health care policy

that will be discussed within this paper is the Clinical Nurse Specialists; Prescribing Authority

bill. The purpose of this discussion is to summarize the chosen health care policy, identify its

major stakeholders and how they influence the policy, the positive and negative aspects of the

policy on individuals and communities, factors that impact nursing practice, and what possible

changes could be made or added to the policy.

Health Care Policy Summary

The Clinical Nurse Specialists; Prescribing Authority bill was a part of the remaining

compliance with the APRN Consensus Model. This model was developed for the guidance for

states to adopt a uniformity in the regulation of APRN roles. In other words, the states had been

creating their own guidelines for those who were considered to be APRNs, with knowing this,

this model came into place of creating uniform regulations for every state (National Council of

State Boards of Nursing, 2019). The prescribing authority is limited to clinical nurse specialists

who have had the same education and training as nurse practitioners and they are also limited to

prescribing in specific licensed health care institutions; as well as limitations to prescribing

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opioids (Arizona Nurses Association, 2019). By enacting this bill into law, it allows clinical

nurse specialists greater access to patient care and greater scope of practice.

Major Stakeholders and their Influence

Stakeholders are those who are integrally involved within the healthcare system and are

substantially affected be reforms to the system (Institute of Clinical Bioethics, 2011). These

major stakeholders include patients, physicians, insurance companies, pharmaceutical firms, and

the government, and they each have their own responsibilities. For this particular policy, the

major stakeholders are the government, physicians, and patients. When this bill was created, it

was sent to Arizona’s government, where it was then voted on and agreed to be acted on. From

there, the government is in charge of implementing and enforcing the bill into the health care

system. Physicians are more so affected by this policy. Depending on that Board of Nursing’s

rules and regulations, CNSs may have had to work under the supervision of physicians.

However, with this bill now passed, this will not be the case because CNSs will be able to work

independently. This allows physicians to focus more on the work they have to do and providing

care to their patients. Finally, patients are affecting by this policy by being able to receive a

wider range of care from multiple providers. They will also receive more patient-centered care,

especially since at one point CNSs used to be nurses at one point in their lives.

Positive and Negative Aspects of the Policy

The Clinical Nurse Specialists; Prescribing Authority policy has opened up a large

opportunity and has impacted these nurses in a positive aspect. Before this policy was put into

place, Arizona clinical nurse specialists were allowed to practice without a physician’s

supervision, but they had no prescribing authority (National Association of Clinical Nurse

Specialists, 2019). Now that Arizona has signed off on this bill, CNSs will be granted
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independent authority of prescribing medications. This is a positive impact on CNSs because it

allows them to work under their full scope of practice, especially since they have received the

same education as nurse practitioners. Another positive impact this policy has made is meeting

the requirements of the APRN Consensus Model, which allows CNSs to prescribe medications to

patients. This new policy also has a positive impact on patients. Clinical nurse specialists are

expert clinicians with advanced education and training in a certain area of nursing practice,

which allows patients with certain diseases to receive their care from a CNS. With CNSs having

advanced training and education in a specialized area, it potentially allows patients to receive

greater care and a better outcome due to the advanced knowledge of the CNS. In Flanders and

Foster’s article, “Challenges in Clinical Nurse Specialist Education and Practice, they identified

time management as a barrier for CNSs’ effectiveness. As a CNS, one has a lot that has to be

done within a day and adding the prescribing of medications is another thing on their to do list.

However, by learning effective techniques for time management, this negative impact on the

policy can be greatly reduced. One final potential negative that could potentially occur with this

policy is the fact that CNSs are not typically considered to be direct patient care staffing

(Flanders and Foster, 2014) Therefore, this puts their positions at risk, especially when budgets

are tight, and cutbacks may be necessary. Even though this policy gives authority to CNSs to

administer medications, they are still at risk for losing their jobs for not being considered direct

patient care staffing.

Legislative, Regulatory, and Financial Factors

Within the health care system, there are many factors that impact nursing practice and the

effectiveness and equitable delivery of care. One factor that impacts nursing practice and the

effectiveness of the delivery of care if the legislative arena. This is where most advocates
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concentrate their efforts on making their point of a particular issue. However, before doing this,

it is important learn how to effectively play a part in the legislative arena by influencing policy

that is designed to have a positive impact on patients and the nursing profession. The legislative

arena helps to enact laws, creates and funds health programs, and balances health policy. For

example, Karen Daley, a nurse, who suffered a needle stick injury at work, went to the legislative

arena to advocate for Safe Needle Protection policy (Abood, 2007). This was passed and greatly

impacted nursing practice and the delivery of care within the health care system. Therefore, the

legislative arena is one of the biggest factors that impacts nursing practice. Another factor that

impacts nursing and delivery of care is finances. Financially, health care is very expensive, but it

is due to the advances of health care, including advances in technology, quality and safety of

care, diagnostics and tests, and surgical equipment. These advances have led to better delivery of

care, greater safety and protection of patients, quicker recovery times, and enhancement in

nursing practice. One final factor that impacts nursing practice and delivery and care includes

regulation. Regulations are rules or directives that are made and maintained by authority. The

regulations of nursing are typically defined by the Nurse Practice Act and governed by the Board

of Nursing (American Nurses Association, 2019). These rules and regulations impact nursing

practice by helping to define the scope of nursing, what is allowed and not allowed, and the

regulations of patient safety.

Proposing a Change

This policy, I believe, will be very effective and create positive client outcomes.

However, like every health policy, there are always changes that can be made. I believe my

change is the value the CNSs’ bring to the health care organization. CNS positions may fall into

the categories of “indirect caregiver,” because they typically are not included in direct patient
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care staffing (Flanders and Foster, 2014). Therefore, I believe what needs to be added to this

health policy is a more defined description of what clinical nurse specialists role is and how they

specifically contribute to the health care team. I believe there needs to be more of an

understanding of what their scope of practice is, especially since they are now allowed to

prescribe medications without the supervision of a physician. By providing this information,

CNSs’ will be more valued in the health care system and they will be given a more defined role

and scope of practice.

Conclusion

The Clinical Nurse Specialist; Prescribing Authority policy now allows CNSs the ability

to prescribe medications as long as they have had the same amount of education as a nurse

practitioner. This policy will greatly impact nursing practices and further enhance delivery of

care. By approving this policy, it will further enhance the health care system and what employers

can do within the system.

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References

Abood, S. (2007). Influencing health care in the legislative arena. Retrieved from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJI

N/TableofContents/Volume122007/No1Jan07/tpc32_216091.html

American Nurses Association. (2019). State law and regulation. Retrieved from

https://www.nursingworld.org/practice-policy/state-law-and-regulation/

Arizona Nurses Association (2019). 2019 Legislative summary report. Retrieved from

https://cdn.ymaws.com/www.aznurse.org/resource/resmgr/2019_Leg_Report_AzNA_.pdf

Flanders, S., & Foster, J. (2014). Challenges in clinical nurse specialist education and practice.

Retrieved from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJI

N/TableofContents/Vol-19-2014/No2-May-2014/Challenges-in-CNS-Education-and-

Practice.html

Institute of Clinical Bioethics. (2011). Health care reform: Duties and responsibilities of the

stakeholders. Retrieved from https://sites.sju.edu/icb/health-care-reform-duties-and-

responsibilities-of-the-stakeholders/

National Association of Clinical Nurse Specialists. (2019). CNS scope of practice and

prescribing authority. Retrieved from http://nacns.org/wp-

content/uploads/2016/11/PractPrescAuthority1605.pdf
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National Council of State Board of Nursing (2019). APRN consensus model. Retrieved from

https://www.ncsbn.org/aprn-consensus.htm

World Health Organization. (2013). Health policy. Retrieved from

https://www.who.int/topics/health_policy/en/