Strategic Planning for Advanced Nursing Practice (eBook)

Madrean Schober, PhD, MSN,  ANP, FAANP is a nurse practitioner, educator, mentor, writer, lecturer and consultant with expertise in the development of advanced practice nursing roles, healthcare policy, curriculum design and programme development. She has been an international consultant with expertise in role development for 15 years, past-Chair of the ICN International Nurse Practitioner/Advanced Practice Nursing Network as well as International Relations Liaison for the American Academy of Nurse Practitioners. With a background in family health, family nursing and community healthcare, she has an aim to provide healthcare services to diverse populations along with strategic planning for improved access to all. These services include the promotion of advanced nursing practice in the provision of healthcare services. 

Preface 6
Contents 8
1: Introduction 11
1.1 Defining Strategy and Strategic Planning 11
1.2 Policy and Policy Theory Defined 13
1.3 Significance of a Strategic Approach 14
1.3.1 Benefits to a Strategic Approach 15
1.3.2 Limitations to a Strategic Approach 15
References 16
2: Strategic Planning for Advanced Nursing Practice 18
2.1 Key Factors to Consider in Exploring the Possibilities for an Advanced Nursing Practice Initiative 18
2.2 Defining the Policy Process 19
2.2.1 Agenda Setting 20
2.2.2 Policymakers and Their Networks 21
2.2.3 Influencing Policy Decisions 22
2.2.4 Nurses’ Participation in the Policy Process 22
2.3 Frameworks for Implementation of Advanced Nursing Practice 24
2.3.1 PEPPA Framework 24
2.3.1.1 PEPPA Framework Steps 25
2.3.2 Schober Conceptual Policy Framework for Advanced Practice Nursing 27
2.3.2.1 Literature Review Leading to Framework Development 27
2.3.2.2 Framework Development 29
2.3.2.3 Intended Use of the Conceptual Policy Framework 30
2.3.2.4 Critical Points of the Conceptual Policy Framework 30
2.3.2.5 Discussion of Critical Points 31
2.3.2.6 Strategic Planning and the Conceptual Policy Framework 34
2.3.3 Conceptual Policy Framework: Singapore Exemplar 35
2.3.3.1 Cornerstone One: Singapore Context (Legitimacy, Feasibility, Support, and Motivation for Advanced Nursing Practice Concept) 36
2.3.3.2 Cornerstone Two: Singapore Context (Definition of APN and Function in Healthcare Settings) 36
2.3.3.3 Strategic Planning and Coordination: Singapore Context 37
2.3.4 Additional Models/Frameworks for Advanced Nursing Practice 37
2.3.4.1 Scotland: An Advanced Practice Toolkit 38
2.3.4.2 Ireland: Advanced Nurse Practitioner and Advanced Midwife Practitioner 39
References 40
3: Theories of Social and Healthcare Policy 43
3.1 Hall, Land, Parker, and Webb Agenda-Setting Framework 43
3.1.1 Legitimacy 44
3.1.2 Feasibility 44
3.1.3 Support 44
3.2 Kingdon’s “Windows of Opportunity” 45
3.3 Lindblom’s Incrementalism and Disjointed Incrementalism 46
3.3.1 Disjointed Incrementalism 47
3.3.2 Strengths and Limitations of Incrementalism 48
3.3.2.1 Strengths of Incrementalism 48
3.3.2.2 Limitations of Incrementalism 48
3.4 Walt’s Framework for Policy Implementation 49
3.4.1 Principles of the Walt Framework 49
3.4.2 The Policy Process According to Walt 50
3.4.3 Implementation: Do Those Who Implement Policy Decide Policy Formulation? 51
3.4.4 Walt’s Strategy for Policy Implementation 52
3.5 A Comparison of Theories of the Policy Process 52
3.6 Commentary on the Relevance of Policy Theory for Nursing 53
References 55
4: Evidence-Based Policy Decisions 56
4.1 Reality: Is Evidence Used to Make Policy Decisions? 56
4.2 Policy Agenda Setting and Policy Decisions: Frameworks and Models 58
4.2.1 Key Decision-Makers: Power and Authority 60
4.2.2 Participation in the Policy Process: Direct and Indirect 61
4.2.2.1 Direct Participation 61
4.2.2.2 Indirect Participation 62
References 63
5: Politics: The Art of Diplomacy and Negotiation 64
5.1 Nurses’ Stages of Political Engagement 64
5.2 Acquiring the Necessary Skills 66
5.2.1 Leadership Competencies 66
5.2.1.1 Communication and Collaboration: A Beneficiary Policy Approach 67
References 69
6: Effective Change: A Strategic Approach 71
6.1 Assessment of the Healthcare Environment 71
6.1.1 Scanning the Environment 72
6.1.2 SWOT (Strengths, Weaknesses, Opportunities, Threats) Analysis 73
6.1.3 Stakeholder Analysis 74
6.2 Regulation 75
6.2.1 SSPP Model (Scope, Standards, Policies, and Procedures) 76
6.2.2 Non-medical Prescribing in the United Kingdom (UK): Policy and Legal Strategy 77
6.2.2.1 Non-medical Prescribing in the United Kingdom: The Origins 78
6.2.2.2 Toward Independent Prescribing 78
6.2.2.3 Nurse Prescribers’ Extended Formulary 79
6.2.2.4 Regulation 79
6.2.2.5 Supervision in Practice as Part of Education 80
6.2.2.6 Regulatory Standards 81
6.2.2.7 Prescribing Accountability 82
6.2.2.8 Prescribing Within the Area of Competence 82
6.2.2.9 Consent 82
6.2.2.10 Record Keeping 83
6.2.2.11 Professional Indemnity 83
6.2.2.12 Maintaining Competence in Practice and CPD 83
6.2.2.13 Competency Framework for All Prescribers 84
6.2.2.14 Impact of Prescribing on Clinical Practice in the United Kingdom 85
6.2.2.15 Conclusion 85
6.2.3 Nurse Prescribing: A Global Role Analysis 86
6.2.3.1 Advanced Practice Nursing, Advanced Nursing, and Task Shifting/Sharing 87
6.2.3.2 Global Nurse Prescribing by Role Descriptor 88
6.2.3.3 Conclusion 89
6.3 Introducing Advanced Practice Nurses: A Process 90
6.3.1 The Nurse Practitioner in New Zealand: Legislation and Process 90
6.3.1.1 Nurse Practitioner Registration, Legislation, and Processes 91
6.3.1.2 Nurse Practitioner Prescribing Legislation 92
6.3.1.3 Nurse Practitioner Education 93
6.3.1.4 Conclusion 94
6.3.2 Transition Experiences of Nurse Practitioners in Australia 94
6.3.2.1 Nurse Practitioner Implementation in Australia 94
6.3.2.2 The Importance of Intraprofessional Support 95
6.3.2.3 The Importance of Interprofessional Support 96
6.3.3 Advanced Nursing Practice Strategy and Policy in Germany 97
6.3.4 The Netherlands: Process, Legislation, and Evaluation 98
6.3.4.1 Introduction 98
6.3.4.2 Motivation 99
6.3.4.3 Educational Program 100
6.3.4.4 Legislation 101
6.3.4.5 Opportunities 102
6.3.4.6 Evaluation 102
6.4 Influencing the Process: Beneficial Debate and Discussion 103
6.5 Research and Evaluation 104
6.5.1 Dissemination of Empirical Findings and Information 105
Appendix 6.1: SWOT Analysis Matrix Template (Schober 2016) 107
Appendix 6.2: SWOT Analysis Matrix Illustration (Schober 2016) 108
Appendix 6.3: Global Nurse Prescribing by Role Descriptor 109
References 110
7: Policy Analysis 115
7.1 Process and Models 115
7.1.1 Policy Analysis Models 117
7.1.1.1 Process Model 117
7.1.1.2 Substantive Model 117
7.1.1.3 Eightfold Path 117
7.1.1.4 Logical-Positivist Model 118
7.1.1.5 Participatory Policy Analysis (PPA) 118
7.2 Indicators and Outcomes 118
7.3 Evaluation and Adaptation: Population Indicators 119
7.4 Determining the Correct Path to Follow 119
References 121
8: Rational Policy Decision-Making: Idealism Versus Realism 122
8.1 Policy-Making: A Rational Process 122
8.2 Incrementalism and Policy Decisions 124
8.3 A Debate: Rational Change Versus Disjointed Incrementalism 125
8.3.1 Assumptions of the Rational Decision-Making Model 125
8.3.2 Incrementalism and Disjointed Incrementalism 126
References 128
Index 129