Consider your topic of interest and the purpose for exploring this topic.

My topic of interest is how to avoid unnecessary urinary catheter use and effectively implement safe catheter care with chlorhexidine gluconate wipes to prevent Catheter-Associated Urinary Tract Infection (CAUTI) in Long Term Acute Care patients. CAUTI has been a menace to the healthcare settings. Inappropriate and prolonged use of indwelling urinary catheter is a major risk factor for CAUTI, as the IUC poses a “daily bacteriuria risk of about 3-7 percent which rises to 25 percent in one week, and quadruple to 100 percent if the IUC stays inserted” (Gesmundo, 2016). Additionally, the financial burden for treating CAUTI is huge on the healthcare facilities compare to the cost of prevention. Treatment is “approximately $1000 and Medicare has declined to reimbursed hospital for the cost” (Hollenbeak and Schilling, 2018). Thus, preventing CAUTI should be the goal.

Nurses occupy an important position in the prevention of CAUTI, as “they deliver a huge part of daily catheter cares” (Gesmundo, 2016).  It is therefore essential that nurses are equipped with the necessary knowledge to critically assess patients, in all health care settings for therapeutic indications of IUC, and implement scientifically proven evidence-based catheter management care. This will change the current perception and culture of IUC, thereby enhancing safe catheter use and care.

What outcomes would you like to see emerge from this?

From this study, it would be expected that nurses have increased understanding of CDC recommendation and guidelines for appropriate use of an indwelling urinary catheter (IUC) by critically assessing patients for the therapeutic indication for IUC, perform efficient catheter care with CHG wipes during insertion and after, as well as ensure timely discontinuation of use to prevents CAUTI.

How would you measure these outcomes?

Aiken et. al (2016) submitted that outcomes can be measured using “patient mortality, patient ratings of care, care quality, patient safety, adverse events, and nurse burnout and job dissatisfaction”. For my study, the incidence of CAUTI after hospital admission, mortality, and morbidity due to CAUTI would be used in measuring the outcomes. Center of Diseases Control and Prevention (2020) submits that “15-25% of the hospitalized patient gets a urinary catheter inserted during their hospital stay and approximately 75% of Urinary Tract Infections (UTIs) acquired in the hospital is due to a urinary catheter”. Also, “more than 560,000 patients develop CAUTI each year, leading to extended hospital stays increased health care costs, patient morbidity, and mortality” (American Nurse Association, n.d). While measuring the outcomes, patients will be closely monitored, rate/prevalence of CAUTI, and morbidity and mortality associated with CAUTI  documented. Nurses must ensure optimal care for hospitalized patients by preventing CAUTI thereby meeting the “US Department of Health and Human Services’ goals of reducing healthcare-associated infections” (Krein, Kowalski, Harrod, Forman, and Saint, 2013).

Role of RNs and APRNs in policy-making.

It has been reported despite the percentage of nurses that serve on hospital board is very low, and legislative efforts to give APRN full autonomy fail year after year in California and other states (Houskova, 2018). Despite the societal trust and respect for Nurses (Gallup 2017), its collective voice remains unheard by decision-makers and legislators

As health systems evolve over time, Nurses, as a part of this system, require to evolve along (Cohen & Milone-Nuzzo, 2001), requiring nurses to influence the formulation of health policies rather than just implementation of them.

Nurses also require to very much involved in the development of health policies so that they will be able to be in charge of their practice. By implications, nurses require to acquire policy-making and advocacy skills that will meet their values and professional ethics.

Another role of Nurses is identification of critical issues and ways of advancing health care policies. Nurses also need to know the levels of power and those who control health resources (Ferguson, 2001). In short, nurses are expected to be involved in policies that could affect them, their  patients, families and the entire health care system (Taft & Nanna, 2008). This is to promote patient safety, quality of care, and access to care(Ferguson, 2001) .

Methods of Involvement

RN and APRN can influence policies through professional organizations. These professional organizations are in specialty areas, education-related organizations and leadership-related organization such as the American Nurse Association, the National League of Nursing. Many professional organizations employ lobbyists who have the responsibility of carrying issues of concern to lawmakers. These organizations provide massive repertoire of knowledge in policy issues from where RN and APRN may learn and being knowledgeable build confidence when required to help legislators interpret issues (Milstead, n.d.). Nurses also serve as custodian of knowledge     about health policy issues that are relevant to policymakers (Schaeffer, 2019).

The APRNs of the third millennium are also policy analyst by virtue of his/her critical thinking and decision model also shares his vision with policy makers (Milstead, n.d.).

Opportunities That Exist for RNs And APRNs to Actively Participate in Policy-Making  

The first opportunity for RNs and APRNs to actively participate in policymaking is by being active members of professional organization. Professional nursing associations are important platforms for individual nurses and the nursing profession to exercise power and influence policy (Matthews, 2012). Another means by which nurses may influence policy is by being political office bearers. For example,  nurses’ presence, role, and influence in health policy development  has been advancing based on an increasing number of nurses elected as political office bearers and/or appointed to national and international boards (Ferguson, 2001).

Other factors that influence nurses’ ability to be active in policy development include finding needed time and possessing relevant knowledge and interest about how political issues affect health care and the nursing profession (Shariff, 2014). 

Challenges That These Opportunities May Present and Solution

Challenges that nurses may encounter with this opportunity include lack of adequate understanding of the legislative process. A method of overcoming this challenge may be seeking adequate education about nursing, policy and legislative process (Rowley, 2020).

As mentioned earlier, joining a professional nursing organization such as the American Nursing Association is a method of engaging in policy. However, a major challenge is that serving or active members could be drafted into boards or committees, requiring additional time to function effectively (Rowley, 2020). A method of addressing this issue

Other challenges include a lack of support, resources and time for nurses to do so in their workplaces. Sometimes there are real bureaucratic walls which act as barriers to nurses being denied opportunities to openly voice their policy concerns, for example because they are government employees. And too often nurses lack confidence and skills in policymaking and do not understand the differences or connections between policy and politics (Turale & Kunaviktikul, 2019). 

 Overcoming These Challenges

In addition to specific methods of addressing specific challenges, the solution is for improved education on Nurses and Health Policies. This can be achieved by calling on national nursing associations, other nursing professional organizations, nurse regulatory bodies, nurse leaders and educators to form a common force in developing strategize about how nursing policy training can be incorporated and supported in each state in the US. country. This includes reviewing and modifying curricula so that policy is included in all programs to varying degrees (Turale & Kunaviktikul, 2019).