Shaping Health Policy: A Role for Nurse Scientists

Health policy grounded in sound evidence can serve as a powerful intervention for health related risks that occur at a population level. These include fewer smoking-related deaths, improved infant health through the widespread addition of folic acid into many foods, and reduced fatalities as a result of mandatory seat belt use.

Based on this compelling track record, the power of research to shape health policy for the good seems obvious.  So while attending a conference recently, I was surprised to learn that just a small percent of nursing PhD programs offer formal coursework in health policy. This means that only a tiny minority of our profession’s future researchers are adequately prepared with the investigative tools and skills needed to benefit entire populations of patients through effective policymaking.

Here at Columbia Nursing, all of our educational programs incorporate health policy into their curricula. In our Entry to Practice program, its importance is emphasized in virtually all coursework. Our Masters’ students study health policy for a full semester, and our PhD and DNP programs include evidence-based practice and policy courses, as well as health services research and comparative and cost-effectiveness research.

Comparative and cost effectiveness research (CER2), a relatively new research paradigm, holds particular promise for wide-ranging policy impact. This type of inquiry seeks to generate knowledge that improves quality and efficiency by informing everyday health decisions that confront clinicians, patients, purchasers, and policymakers. This is in contrast to efficacy research, where the question is, “Does the intervention work under a controlled environment?”

Columbia Nursing’s Center for Health Policy, under the direction of Patricia Stone, PhD, RN, FAAN, has been at the CER2 forefront with several research studies and a new training grant for our PhD students. For example, Stone has been working with colleagues at the CDC and the Association of State and Territorial Health Officials (ASTHO) to determine whether state-mandated reporting of health care-associated infections plays a system-wide role in reducing these preventable conditions and the costs they inflict.

Also in the area of infection-prevention, Stone and colleagues recently found lax compliance with evidence-based practice guidelines for eliminating health care-associated infection in almost 1,000 adult intensive care units. These guidelines were issued by The Joint Commission, the organization which oversees accreditation for US hospitals. Additionally, Stone is examining the cost-effectiveness of infection-prevention practices in nursing homes.

Evidence-based research as a basis for policy recommendations is highlighted in the activities surrounding the Affordable Care Act and the IOM Future of Nursing Report. Moving beyond clinical research, our Center for Health Policy, in partnership with the Office of Development and Alumni Relations, is sponsoring a panel discussion on April 8th, “The Changing Healthcare System and the Future of Nursing.” I will be joined by experts from RAND Corporation, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and The Future of Nursing New York State Action Coalition to examine how the Affordable Care Act and IOM Future of Nursing report are being implemented.

In developing the evidence for managing chronic illness, preventing or delaying disease and disability, and improving clinical-care settings, nursing offers a real opportunity for influencing future health policy decisions. And because nurses are especially attuned to the societal, behavioral, and environmental factors that affect health and health care, they’re playing a leading role in research on these individual and population-based determinants of health. And since many of these health care problems are complex, requiring an interdisciplinary approach, again, nurse researchers are especially proficient working in interprofessional teams.

Adding to this mix, several major national health policy directives, including Healthy People 2020: Understanding and Improving Heath (US Department of Health and Human Services), encourages nurse-scientists to develop research investigating increasing life expectancy, improving quality of life, and eliminating health disparities.

Columbia Nursing is proud to provide future nurse-scientists with the training and guidance to play an active role in shaping health policy throughout our nation. We invite our colleagues in other programs and institutions to join us in this vital undertaking.