U.S. Congress plays a critical role when it comes to the enactment of legislation that seeks to revamp or change the healthcare sector in the U.S. healthcare system is one of the most advanced globally although it faces numerous challenges, including a continued rise in healthcare cost, lack of access to healthcare for certain populations, and a lack of universal health care coverage among others. Nursing care is one of the sub-sectors of healthcare that encounter numerous problems. Therefore, the U.S. Congress has enacted bills to improve nursing care and the overall welfare of nurses. One of these is Title VIII Nursing Workforce Reauthorization Act of 2019, which seeks to revamp nursing care across the U.S.
Identification of Bill and Short Description of Policy and Policy Issues Addressed
Title VIII Nursing Workforce Reauthorization Act of 2019 is one of the laws that have played a critical role in addressing a number of issues associated with the nursing profession and the roles of nurses. The act was introduced to the House of Representatives on January 23, 2019, by David Joyce, the Representative for Ohio’s 14th congressional district and a member of the Republican Party. Its bill number is H.R. 728, and detailed information about the bill can be obtained from https://www.govtrack.us/congress/bills/116/hr728/text. Moreover, the bill has several provisions in relation to nursing care provision and the welfare of nurses. For example, it specifically outlines that significant improvement of the quality of healthcare nurses requires the engagement of nurses in career development programs; provision of proper incentives to nurses; granting nurses loans to help them in developing further their area of practice; and ensuring that nurses’ rights are well protected across various health care settings (“H.R. 728,” 2019). The act also pushes for nursing programs to be expanded to have them support both internships and residency programs encouraging mentoring and development of specialties (“H.R. 728,” 2019). Title VIII further pushes for the recognition of clinical nurse leaders as having the responsibility of oversighting and improving health outcomes through thorough research into the nursing profession. The choice to focus on this act is based on the need to understand how it addresses issues surrounding the nursing profession and the role of nurses.
Indication of Where Bill Is in The Legislative Process
Before the introduction of H.R. 728, a similar bill identified as H.R. 959 had been introduced in the House of Representatives on February 7, 2017, by David Joyce. Although the House passed H.R. 959 on July 23, 2018, it was not passed in the Senate. On January 23, 2019, David Joyce introduced H.R. 728. Upon introduction of bills to the House or Senate, they are referred to select committees for debate before being ushered to the whole chamber for further consideration (GovTrack.us, 2020). H.R. 728 went through this process. On July 11, 2019, there was a hearing by a select committee for the bill’s consideration, which was followed by issuance of a report to the full chamber proposing that the bill be considered further for debate. That the bill made it out of committee was a big step as only 1 out of 4 bills make it out of the stage. On September 24, 2019, the bill was reported by the House Committee on Energy and Commerce chamber with the committee giving a detailed report on the bill (GovTrack.us, 2020). On October 28, 2019, H.R. 728 was passed by the House in a vote chamber (GovTrack.us, 2020). Currently, the bill awaits introduction to the Senate. If passed by the Senate without major changes, it will proceed to the president who will then sign it into law.
Explanation of How Policy Became A Priority on The Legislative Agenda
H.R. 728 became a priority in the political and legislative agenda, given America’s need for more nurses and nurse faculty who can help meet the ever-rising demand for nursing care. Currently, the U.S. faces a high demand for nursing care in various community settings, particularly among people who live in rural communities and those that are medically underserved. With the enactment and signing of H.R 728 into law, it was believed that all nursing schools could fast track their mission of preparing the next generation of nurses who are essential in the provision of nursing care. The fundamental role of nurses in the healthcare sector also played a critical role in the prioritization of H.R. 728 on the political and legislative agenda. Nurses are known to provide frontline care in several settings, and they are involved in the supervision and coordination of care for patients. The execution of these responsibilities necessitates employing many nurses. The Bureau of Labor Statistics projects that roughly 203,700 nurses are to be hired to meet the high demand for nurses (“Title VIII Nursing Workforce Reauthorization Act,” n.d.). In as much as there is a growth in nursing school enrolment, it is not growing as fast as expected to help meet the projected demand for nurses across the U.S. healthcare sector.
The policy is yet to be implemented as it awaits to be passed by the Senate before being signed into law by the President. If the Senate passes it and signs it into law, it will be enforced and authorize various amounts of money for nursing programs for every year between 2020 and 2024 (Congressional Budget Office, 2019). According to the Congressional Budget Office (2019), amounts that would be authorized include $78 million for advanced education nursing grants; $18 million for workforce diversity grants; $44 million for nurse education, practice, and quality grants; as well as $91 million for the repayment and scholarship programs. These funds are expected to contribute significantly to achieving the goals of the law
Key Stakeholders Involved in The Policy and How They Might Influence It
A number of stakeholders are involved in H.R. 728 bill. Other than the sponsor and cosponsors of the bill in both the House and Senate, various committees have been involved in passing it. In the House, the Energy and Commerce, as well as Health committees, held hearings and issued reports recommending further consideration of the bill. In the Senate, the Health, Education, Labor, and Pensions committee is involved in as it holds hearings and determines whether the bill should be recommended for further consideration. Outside Congress, various nursing organizations and associations advocate for the bill and push for it to be signed into law. The National Association of Neonatal Nurses (NANN) has singled out H.R. 728 as one of two bills affecting its patient population. The organization has since acknowledged sponsors and cosponsors of the bill in the House and Senate. NANN’s Health Policy and Advocacy Committee (HPAC), owing to its commitment to optimize care and health outcomes for neonate and their families, strongly advocates for the passing and signing of H.R. 728 into law. The National League for Nursing (NLN) is also involved in the bill (National League for Nursing, 2019). NLN recently applauded the Senate Committee for approving the act when it was introduced in the Senate.
Likelihood the Bill Will Pass
It is highly likely that the Senate will pass the bill will be passed, and the president will sign it into law. The fact that the bill was passed by House signals that it is a priority in the political and legislative agenda. Moreover, in the House of Representatives, a committee voted to issue a report recommending further consideration for the bill. The fact that the bill was reported out of committee in the House where only about 1 in 4 bills are reported out underlines how important it is. Further, according to Skopos Labs, there is a three percent chance of the bill being passed and enacted, and the Congressional Budget Office (CBO) has, in the past, hinted that the bill would be passed. The CBO further projects that the legislation would result in the authorization of huge amounts for each year between 2029 and 2024. All these are indicators of a high likelihood of the bill being passed and signed into law.
Social, Ethical, Cultural, and Economic Dimensions of the Policy
The policy has social, ethical, cultural, and economic dimensions. The social angle of the policy is that nurse education, practice, and quality will be improved, given the funding that will be channeled to these activities. The policy seeks to expand eligibility for advanced nursing education grants and have the program include the education of clinical nurse leaders in combined registered nurse graduate degree programs (GovTrack.us, 2020). The ethical dimension of the policy is that funding will be provided for all nurses seeking education in a variety of settings, including rural and underserved areas, while the cultural dimension of the policy revolves around its provisions that acknowledge and recognize clinical nurse specialist programs and the need for diversity in the nursing profession as well as improved access to nursing services for everyone including those in rural and underserved areas. The economic scope of the policy revolves around its anticipated authorization of huge financial amounts to support the education and training of nurses between 2020 and 2024.
Future of Policy in Improving Health/Well-Being of Citizens and Impact on Nursing
The future of Title VIII in terms of improving the health and wellbeing of U.S. citizens is that it will continue the provision of funding for nursing workforce development programs until 2024. If passed and signed into law, Title VIII will be the largest source of federal funding for nursing education and will be instrumental in increasing the number of registered nurses who practice in rural settings and underserved communities. Title VIII is expected to have numerous positive impacts for the nursing profession as a whole (Kopp, 2018). With the law in place, nurses will have access to funding for advanced nursing education in various institutions, including academic health centers, nursing schools, and others. Title VIII is also expected to impact the nursing profession as it emphasizes nurse education, practice, and retention grants that offer support to nurses at the associate-level and baccalaureate-degree levels.
A Plan for Policy Implementation
If passed and signed into law, there should be a strategic plan for enforcement and implementation of the same. The first step would be to form a committee to oversee the implementation of the policy. The committee should include experts from the nursing profession with clear knowledge and understanding of what is required in the education of nurses. The second step of the implementation plan would be to collect crucial data from experts regarding the policy. The data would thus guide further implementation of the same. Other important steps to be included in the policy implementation plan include public participation or public involvement where citizens are engaged through outreach and organization to give their views on the Act; thorough training of experts on Title VIII, dissemination of information to the general public on key findings surrounding the policy’s implementation; as well as coming up with compliance and enforcement procedures.
A Plan for Evaluation and Ideas for Modification of The Policy
A plan for evaluation includes engaging both the general public and nurses who have benefited from the policy’s provisions to give their feedback on whether the policy has positive impacts or not. The public should be reached through outreach programs to inform them about the policy; advertisements on various media platforms, including newspapers, websites, and others; holding community meetings; and issuing survey forms through which the public can give feedback with regard to the policy. Nurses should be engaged through physical visits and interactions with beneficiaries of the policy in various institutions. Nurses can also be issued with survey forms to give their responses on whether the various nursing education programs funded by the legislation are of benefit to them or not. Where shortfalls of the policy are identified, the modification would be important. Successful modification of key areas of the legislation would require setting up a committee of experts who will have to meet with concerned committees in the House and Senate to give suggestions on various areas that require modification.
Role of Nursing in Ensuring the Policy Is Implemented and Evaluated
The nursing profession has a key role to play in ensuring that Title VIII is implemented and evaluated after being signed into law. Since the act focuses on the education of nurses, nurses will play a critical role in ensuring responsibility and accountability with regard to the huge financial amounts that will be channeled to support the education and training of nurses (Schaeffer & Haebler, 2019). Moreover, when it comes to the implementation and evaluation of the policy, the nursing profession, in collaboration with various nursing associations and organizations must ensure that nursing education institutions are expanded to allow nurses to acquire the much-needed education and skills given the financial support offered by Title VIII.
Ways Nurses Can Play A Leadership Role in Health Policy Formation
Nurses are well conversant with the fact that the health system of today needs to be revamped for much-desired improved health outcomes; thus, many of them are motivated to assume a leadership role in health policy formation. The leadership role played by these professionals includes taking part in advocacy with the ultimate objective of influencing the establishment and implementation of policies as well as legislations that impact the American health system in one way or another. In as much as nurses may not have adequate preparation with regard to their profession, they are instrumental in the health policy arena given their influence on the formulation and implementation of various policies and laws surrounding America’s health systems. In the history of the nursing profession, countless nurses have exhibited their ability to influence or shape operations or activities undertaken in the nursing system majorly by influencing the policymaking process (Sundean, 2019). A typical example of nurses who have made outstanding contributions with regard to shaping the nursing profession was Florence Nightingale. Nightingale and several nurses have played advocacy roles on matters policy.
Given the myriads of challenges that nurses encounter in various health settings, they have assumed an advocacy role with their primary objective being to bring substantial changes to the health system to improve healthcare service provision in entirety. Other objectives of nurses include making sure that healthcare stakeholders’ rights are protected with health care quality being improved. Assumption of the advocacy role by nurses has not been an easy ride for them, given that most may not have been effectively prepared for the same. Nevertheless, an individual nurse’s move to play an advocacy role requires one having experience and being prepared on health policy matters. Assumption of the advocacy role in the arena of health policymaking also requires that a nurse must have power and influence. A nurse must also be knowledgeable in how and where he or she can exert influence in the policymaking context. According to Sundean (2019), power refers to one’s ability or potential to exert the much-needed influence, and it is one of the most important components when it comes to human interaction. Moreover, Sundean (2019) avers that various sources of power exist, including reward power, coercive power, legitimate power, referent power, and expert power. Nurses’ leadership that is manifested in their advocacy in the advocacy responsibilities has been instrumental in shaping a number of health bills across the U.S., a good example being H.R. 278: Title VIII Nursing Workforce Reauthorization Act of 2019.
U.S. Congress has enacted several bills aimed at improving the healthcare sector, particularly nursing care and the overall welfare of nurses. Title VIII Nursing Workforce Reauthorization Act of 2019 is a good example of such bills that is in the process of being passed by the Senate after successfully being passed by the House. Title VIII has been a majority priority on the political and legislative agenda owing to the high demand for nursing care in various community settings across America. A number of stakeholders are involved in the bill both within and outside Congress. Within Congress are special House and Senate Committees, whereas outside Congress are nursing organizations and associations such as NANN and NLN. There is a high chance that the bill will be passed and signed into law. If passed and signed into law, it will have social, ethical, cultural, and economic implications in the nursing care context. It is also set to improve the health and wellbeing of U.S. citizens and positively impact the nursing profession. A good plan for implementation and evaluation of the policy after it is signed into law must be out in place. The nursing profession and nurses will be instrumental in the implementation and evaluation of the law.
Congressional Budget Office. (2019, October 16). H.R. 728, Title VIII Nursing Workforce Reauthorization of 2019. Retrieved from https://www.cbo.gov/publication/55736
GovTrack.us. (2020). H.R. 728 — 116th Congress: Title VIII Nursing Workforce Reauthorization Act of 2019. Retrieved from https://www.govtrack.us/congress/bills/116/hr728
H.R. 728: Title VIII Nursing Workforce Reauthorization Act of 2019. (2019, October 29). Retrieved from https://www.govtrack.us/congress/bills/116/hr728/text
Kopp, G. S. (2018). VIII Nursing Workforce Reauthorization Act–An Update. AAACN Viewpoint, 40(6), 11-11.
National League for Nursing. (2019, October 31). National League for Nursing Applauds Senate Committee Approval of the Title VIII Nursing Workforce Reauthorization Act in the Senate. Retrieved from http://www.nln.org/newsroom/news-releases/news-release/2019/10/31/national-league-for-nursing-applauds-senate-committee-approval-of-the-title-viii-nursing-workforce-reauthorization-act-in-the-senate
Schaeffer, R., & Haebler, J. (2019). Nurse Leaders: Extending Your Policy Influence. Nurse Leader, 17(4), 340-343.
Sundean, L. J. (2019). Advocacy and Policy Roles for Nurses in Population Health. Population Health for Nurses. https://doi.org/10.1891/9780826148346.0002
Title VIII Nursing Workforce Reauthorization Act of 2019. (n.d.). U.S. Government Publishing Office. Retrieved from https://www.govinfo.gov/content/pkg/CRPT-116hrpt216/html/CRPT-116hrpt216.htm