Healthcare policy is a crucial concept in nursing, as it impacts the provision of medical care on the state level. Healthcare policy is a set of rules and regulations affecting a particular area of medical care. For instance, healthcare policy can regulate payment and service delivery models, state insurance coverage, reinsurance conditions, and other issues in healthcare (Appold, 2017). Healthcare policy impacts the conditions on which medical care is provided to individuals and communities, thus affecting the nursing profession, too. For example, changes in payment schemes can result in financial losses for care providers, whereas insurance coverage has an impact on patients’ overall health state and demand for medical services.
Advocacy is generally understood as “a series of actions, behaviors and/or practices for preserving and safeguarding the rights, values, wellbeing and best interests of patients in the healthcare system” (Choi, 2015). Advocacy has a significant role in improving healthcare policy issues, as nurses can draw the attention of legislators towards problems affecting patient care. For instance, Choi (2015) states that advocacy is often needed in healthcare issues, such as the end of life care, provider-patient conflicts, information sharing, patient autonomy, medical errors, healthcare reimbursement, and more.
Advance practice nurses spend more time with patients more than any other medical professionals. They are often responsible for decision-making during diagnostics and treatment and can influence patients’ choices by providing information, advice, or experience. Choi (2015) explains that nurses have the capacity to protect patients from the impact of healthcare policy issues by empowering them. Finally, nurses constitute a significant share of the workforce in healthcare and tend to more patients than other medical specialists, thus also having more experience with healthcare policy issues. Therefore, the role of advocacy is consistent with the responsibilities of an advance practice nurse.
Selected Healthcare Policy Concern
The selected healthcare policy concern is the relatively low rate of childhood vaccinations in Florida. Veiga, Alcantara, and Dapena (2015) comment on the issue, stating that half of Florida counties do not meet the goal for 95% immunization rate among kindergartners. The 95% immunization rate is considered to be essential for creating “herd immunity”, which can prevent a disease outbreak even if a small share of the population remains unvaccinated.
Failure to meet state vaccination goals, therefore, poses a threat of disease outbreak and can influence the overall health of children in Florida. One of the key reasons for such results in vaccination rates is the state laws allowing exemptions for religious reasons. Throughout Florida, the number of religious exemptions has grown from 0.3% in 2001 to 1.7% in 2013 (Veiga et al., 2015). Notably, religious exemptions can be claimed by parents of any religious background based on their negative beliefs about vaccinations.
The population group that is affected by the selected healthcare policy issue consists of children that are enrolled in schools or kindergartens. These spaces create a significant risk of a disease outbreak, as children may pass the infection is vaccination rates remain lower than required. Moreover, in areas where adult immunization rate is low, too, the disease can spread to entire communities, thus creating a risk of an epidemic. The risk is not one-time or recurring, but rather constant, which means that consistent legislative action is required to address the issue.
Non-medical exemptions from vaccinations are the main reason for low vaccination rates, as they allow parents who are hesitant or misinformed about immunization to exempt their children from obtaining required vaccinations.
Therefore, there are two main issues to address. First of all, it is important to restrict legislative grounds to refusing vaccinations. For instance, the state could follow the example of California, which prohibited exemptions based on religious and philosophical beliefs in 2015 (Mello, Studdert, & Pamet, 2015). Secondly, it is critical to spread awareness about vaccinations to address the myths and fears about them. Higher awareness about the usefulness of immunization would affect the cause of the problem by eliminating false beliefs about vaccines in the community. The main positive outcome of such a comprehensive solution would be improved vaccination rates among children, as well as increased overall vaccination rates throughout the community.
Changes to Target Population and the Community
In order to foster implementation in the community, it would be critical to ensure cooperation from schools, kindergartens, and parents. Negative attitudes towards vaccinations are often caused by the lack of knowledge about their benefits or false information about the risks of immunization. This causes parents to refuse to vaccinate their children and educational institutions to agree with them. Ideally, the change process discussed above would improve the awareness about vaccines, thus fostering successful implementation of the solution.
In addition, it is important to note the required changes in the target population group. Children often fear vaccinations and may refuse to proceed with them, even if encouraged by parents and teachers. Therefore, it would be critical to reduce the fear of vaccinations in children by providing them with information and making the process of obtaining shots more child-friendly. For instance, nurses administering vaccinations could try to offer toys or explain the process in order to comfort the child afraid of immunization.
If the solution were implemented, a growth in vaccination rates would be the key determinant of success. The current situation in Florida is that 16 counties have childhood vaccination rates of 87-92% (Veiga et al., 2015). If the solution is implemented, the number of counties with low immunization rates will decrease steeply, and the vast majority of the states would be in the healthy range of 95-100% immunization. Data on vaccination rates is collected regularly using patients’ medical records and school or kindergarten reports. Another measurable action demonstrating a positive outcome would be the parental acceptance of vaccinations. As a significant part of the solution is aimed at improving attitudes to and awareness about vaccinations, it would be useful to collect data from population surveys to determine the growth in vaccination acceptance.
Challenges to Implementation
Although examples of other states banning non-medical exemptions appear to be positive, it is still likely that such a major legislative change would create challenges to implementation. There are two key challenges that could arise due to the implementation of the proposed solution. Firstly, it is possible that the change will cause public outrage among parents who use religious exemptions to avoid immunizing their children. Secondly, there could be an organizational challenge of ensuring that schools and kindergartens are aware of the legislative change and refuse non-medical vaccination exemptions.
Public disapproval of legislative change is a common problem in the United States, especially when the change affects people’s choice with regards to certain actions. Many parents consider that the decision of whether or not to immunize their children should not be influenced by the government’s interference. Therefore, any efforts limiting the parents’ right to choose medical procedures performed on their children could result in a negative public response.
Nevertheless, as shown by Volokh (2014), religious exemptions are not part of the Free Excercise Clause, and thus the decision to allow them was not required by the Supreme court when such cases arose. Also, the second part of the solution could help to reduce the complaints from the public by informing people about the positive consequences of the new regulation.
The second challenge is that a small share of schools will not comply with new legal requirements and will continue to grant non-medical exemptions. This can occur due to misinformation or be part of an intentional effort to show disagreement with the change. The solution to this challenge depends on the share of incompliant schools. On the one hand, if the share of violations is rather small and only a few are detected in the first three months after the implementation, no subsequent action will be required, as a small share of violations would not affect the positive outcome of the change itself.
On the other hand, if there are significant, regular violations of the new law, and the vaccination rates in certain counties are not improving, the legislators would need to take action. Firstly, it would be essential to establish controls to enhance reporting of violations and results. For instance, nurses that are involved in vaccinations could keep records of student names, which could then be compared with school or kindergarten enrollment. Secondly, penalties for violations would need to be determined and imposed. For example, the law could require a fine for schools that accept non-medical vaccination exemptions. This action could reduce the rate of violations while also contributing to the results of the initiative.
Selection of an Elected Official
Frederica Wilson is a Democrat Representative in the 24th District of Florida. She has been a Representative since 2013 and would be a useful point of contact for the selected cause. There are several reasons as to why this particular official was selected. First of all, the search for officials was focused mainly on Representatives, as they are easier to reach and well-known to the local public. Secondly, Frederica Wilson’s District occupies a share of the Miami-Dade County, which is among the counties with lowest immunization rates (92% vaccinated with 7.8% exemption rate), according to Veiga et al. (2015).
As the issue affects her particular District, Frederica Wilson will also be more likely to take action than Representatives from other areas of the state. Moreover, Frederica Wilson is a Representative of the Democratic Party, which is considered to be generally supportive of sensible healthcare legislation. Finally, the Representative had already tried to address the issue of vaccination exemptions in 2015, when she voiced her support of a law mandating vaccinations for all public school students (Man, 2015). Overall, Frederica Wilson’s position, political alignment, and past history of involvement in the issue would make her a suitable point of contact.
Overall, advocacy is an important part of advanced nursing practice. Nurses have more experience with healthcare policy issues that affect patients and can influence medical decision-making, empowering patients to take action. Low childhood vaccination rates are an important issue affecting many states in the U.S., including Florida. Low vaccination rates make it impossible for the state to achieve population health goals and create herd immunity. The main reason for low vaccination rates is vaccination exemptions, granted to parents based on their religious beliefs. Recommended action for addressing the issue would involve banning religious exemptions and providing education on the benefits of immunization in order to improve community attitudes. This change can be achieved using the help of Frederica Wilson, a Democrat Representative who will be in favor of the proposed legislation.
Appold, K. (2017). Four healthcare policy changes to watch in 2018. Managed Healthcare Executive. Web.
Choi, P. P. (2015). Patient advocacy: The role of the nurse. Nursing Standard, 29(41), 52-58.
Man, A. (2015). South Florida congresswoman wants law forcing vaccinations for all public school students. Sun Sentinel. Web.
Mello, M. M., Studdert, D. M., & Parmet, W. E. (2015). Shifting vaccination politics—The end of personal-belief exemptions in California. New England Journal of Medicine, 373(9), 785-787.
Veiga, C., Alcantara, C., & Dapena, K. (2015). Half of Florida counties meet state’s vaccination goal. Miami Herald. Web.
Volokh, E. (2014). Religious exemptions — A guide for the confused. The Washington Post. Web.