428 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
levels of nursing, particularly those of us in leadership and advanced practice roles, must
commit to becoming competent in health policy development and evaluation. “Advanced
practice registered nurses (APRNs) have positioned themselves to serve an integral role in
national health care reform. A successful transformation of the nation's health system will
require utilization of all clinicians, particularly primary care providers, to the full extent of
their education and scope of practice” (Stanley, Werner, & Apple, 2009).
Health policy competence, as described by Donley and Kiraly in this chapter, includes
two primary areas of expertise: the ability to gain access to policy environments and the
organizational acumen to build consensus around an agenda. Crucial to this process is the
ability to articulate and communicate clearly both the agenda of nursing as a profession as
well as the needs of the most vulnerable in ways that will be heard by policy makers. Donley
and Kiraly state: “Advocacy is ineffective if the person or group desiring change does not
grasp the workings of extant systems and the powerful forces that sustain them.” This state-
ment implies an obligation for health care providers to inform and educate clients regard-
ing rights and privileges with regard to their voice in developing health policy, in order to
encourage all to engage in action toward a “Culture of Health” (RAND Corporation, n.d.).
An awareness of the need to elicit the strength and power of a community or population in
addressing their own health care access needs is essential in order for policy to have mean-
ing. For how will change occur if a great majority of the population remains disenfranchised
and powerless to affect change? By providing mechanisms for community participation,
professional nurses can ensure that voices of the vulnerable will be heard.
As the largest group of health professionals in the world, there is a great potential
for nurses to create forward movement regarding a healthy society. I am in agreement
with the authors of this chapter that we have fallen short as a profession thus far. Kostas-
Polston, Thanavaro, Arvidson, and Taub (2015) articulate a clear mandate: “APNs must
come to see political engagement as a professional obligation and health policy as some-
thing that they can shape rather than something that happens to them.”
In conclusion, it is essential for DNPs to stay abreast of current population’s health
issues and to fully engage in health policy development. This engagement is inherently
multilayered and complex, from the education and representation of clients at the indi-
vidual and community level to the representation of nursing issues at the local, state,
and national levels. The ultimate goal is a safe, equitable, and affordable health care
system, ensuring an improved health and well- being of the population (RAND, n.d.).
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