Public policy, policy analysis, policy process-these phrases have become some of the most popular buzzwords in nursing and health care today. Nearly every journal has a "policy corner" to keep us updated on important legislation. At least once in nearly every article we read of the importance of contacting our legislators or the necessity of being politically active. Nursing texts include chapters about the role of nurses in the political marketplace. Nurse organizations supply us with the latest "calls for action" through member listserves. With all of the hype about the subject, what does health policy really mean for front-line administrators who have to deal with slash- and-burn approaches to budgets, personnel, supplies, capital equipment, and everything else for which we have responsibility?
What public policy really constitutes is a pragmatic approach to identifying problems that government might help alleviate and seeking solutions. Problems can come from many quarters-labor, education, transportation, health, and so on. The idea is to bring a problem to the attention of the president and his advisors (known as agenda-setting) so that they can work with Congress to develop a rational response (usually a law, regulation, or program). The nurse shortage is just such an opportunity, and administrators have data to demonstrate nursing's worth. Creating solutions involves "being at the table" with suggestions for the creative use of policy tools such as scholarships, loans and loan forgiveness plans, research funding, demonstration projects for innovative nurse-managed populations, and changes in regulations that restrict the full capacity of advanced-practice nurses (e.g., the requirement in many states for physician supervision of nurse prescriptive authority).
Even after laws are passed and programs are begun, there still are opportunities for nurse input into regulations and to modify the way in which programs are implemented and evaluated. How many times have we heard that legislators usually know very little about nursing and health care? How many times have we missed chances to become involved, because we were either too busy or a little uncomfortable knowing how to approach policy makers, or just because we figured that others would do the job? We cannot wait for legislation to appear. Nurses must lead the charge-for patient safety, care of the underserved, and the rightful place of nurses in the health care arena. Policy is not a concept "out there" somewhere in cyberspace; it is a core component of the nurse's role.
Nurses have a great opportunity to participate in a democratic process. Those who live with terrorism and hatred do not know freedom. Freedom takes work; it is not free. Liberty requires active participation in a self-governing society. Nurse administrators have a responsibility to exert leadership in the policy process; we cannot wait for others to determine our problems, our solutions, or our future.