Leading and Managing in Nursing

Subject: Nursing
Pages: 11
Words: 3062
Reading time:
11 min
Study level: Master

The selected policy is the addition of the requirement that a bachelor’s degree in nursing serves as the entry level into the profession. There are numerous reasons why such a policy should be put in place. One such explanation is that it directly influences the quality of service that is offered by nurses at all facilities. Currently, there are certificates and other post-graduate diplomas that have been used as entry level into the profession. It is, thus, common to find people who are not interested in the art of treatment of people in the sector. Such an inclusion lowers the quality of service that is expected of the same profession. Additionally, the issue affects nursing practice, healthcare delivery, and health outcomes for individuals, families and/or the community at large as it directly influences the type of care they will get at their local health facility. Traditionally, nurses have also been overlooked when it comes to management positions (Yoder-Wise, 2018). A Bachelor’s degree in the course also teaches the importance of nurses getting decision-making roles in the facilities they will be attached to. Indeed, such options will give nurses the needed edge to be better at their work.

This essay uses a top-down and a bottom-up approach to bring out a new perspective that should be included in the stated policy. The paper provides a policy brief for the same, giving suggestions on other elements that should be considered in the stated law. It is important to note that an evaluation of success of the work will be critical. This will be done through proposed values and ethical positions that underpin the given perspective. Some of the standards and moral principles include importance to the community, teaching and learning, and open dissemination. The policy will indeed focus on local community participation to further enrich the law-making process.

Reflection Essay

Section 1

Segment a. This policy will require that a Bachelor’s degree be a mandatory requirement for entry into the nursing profession. Nurses will be required to do any Bachelor’s degree in nursing to be able to practice at any hospital in the state. This section of the paper will reflect on the selected policy through the application of the three mentioned values and ethical principles. The regulation will allow for installation of critical concepts that can only be covered in the four-year program to allow the same quality of care for patients across the state. The plan affects both the people working in the healthcare industry and the general public.

One reason why this policy issue was selected is the fact that there have been numerous cases of ineffective and substandard treatment of patients in some facilities. This is an unfortunate event as it creates a bad image in regards to healthcare management in the region. Secondly, the issue was selected due to the intensity of the degree course compared to other certificates and programs. At entry level, much of what the nurse has learned is theoretical. However, due to the intensity of the degree course, their knowledge on human ailments and treatment of people is far more superior to that of nurses who have only gone through certificate/alternative programs.

Segment b. Porter-O’Grady and Malloch (2015) argue that the nursing profession is a calling, unlike many other jobs that are just about skill acquisition. The scholars go further to suggest that people who are forced to either study nursing or become nurses because they need a job end up miserable in their workplace. One reason why this is so, is the dedication that is required to become a valuable and skillful nurse. This dedication is crafted throughout the degree course. The nurses are able to study theory and combine this with ward rotations to become a whole-rounded health practitioner. Currently, the world is battling with the COVID-19 pandemic and nurses are among the essential workers ensuring that patients are well taken care of to allow for recovery. Despite it being a new health condition, it can be argued that nurses who were well prepared through a degree course are fully aware of how to manage the patients’ conditions.

Indeed, such acts require both dedication and passion for helping others. The suggested policy ensures that all nurses that show this dedication understand what it takes to be a quality primary healthcare provider. Holloway and Galvin (2016) argue that the need for nurses to also be qualified in other aspects is important as it not only opens up their minds, but also prepares them for management positions. The fact that these professionals interact with death and pain makes the policy change more important as it ensures the people working in the sector are also mentally prepared for the challenges that come with the profession. All these are covered intensively in the degree program making it the best option for entry-level nurses.

Segment c. Due to the fact that the public policy on requirements needed for nursing school is already in place, the act will not have a significant impact in terms of finances to the community. In order to understand the need for finances for such an activity, it is crucial to acknowledge how public policies are funded, which is through tax. Arguably, all activities from the conception to the passing of the policy are funded by the taxpayer. The changes to the policy will, therefore, also be funded by levies collected from the community. However, the success of the policy change will save the larger community money as it encourages healthcare workers to offer quality services to their patients. Gerad (2017) explains that many patients end up using more money due to “incompetency” within the healthcare system. Some of the mentioned problems are brought on by simple issues that would have been avoided if all nurses had the same basic requirement (skill and knowledge) for entry-level into the profession.

Section 2

The mentioned values have a significant impact on the policy change suggested. The three ideals are individual and community healthcare management competency, commitment, and accuracy in care. One way these stated values will influence the issue is that they can be used to measure the success of the policy change. As stated, the idea behind the change is to ensure that students joining nursing school are not only equipped with a previous skill, but are willing to go the extra mile to join the profession. This requires some level of maturity and respect for the profession. Issues of measures are important as they also encourage accountability. Secondly, the values will also affect the stated position if the policy is unsuccessful. Although this is highly unlikely, any negative aspects that will arise from the policy development will offer great insights into the requirements needed to ensure the right students get into any type of nursing program.

An ethical principle theory in nursing that underpins the need for the policy inclusion is fidelity. Gerad (2017) describes the fidelity theory on nursing as the ability to be true to one’s (nurse’s) promises. Arguably, in order for the healthcare worker to fulfill the promises she or he made when he or she became a nurse, he or she must first be qualified to provide the same. Fidelity theory encourages that nurses offer quality care to all their patients. The fact that the professionals deal with different people, suffering from different diseases, and with different mortality rates makes it one of the toughest jobs in the industry. Indeed, there are several other theories that would still apply to the suggested policy inclusion such as justice, autonomy, beneficence and non-maleficence as they all affect the quality of care the nurses are able to provide.

Policy Brief

Section 1

The policy brief will be received by either State Representative Charles Owen or Governor John Bel Edwards. It is also important to note that the office of Jennifer M. Manning DNS, APRN, CNS CNE, will also be targeted. Jennifer is currently a member of the Louisiana State Board of Nursing Education. Indeed, the policy will have better impact if pushed through the formal education system as well. It is critical to point out that many nurses are also unaware of what policies affect their profession (Gerad, 2017). The Board would be critical in shaping the regulatory processes and requirements that the policy suggests. Porter-O’Grady and Malloch (2015) explain that nurse leaders often stress the need to instill values at the institutions of learning to ensure a standard quality of nurses in the facilities. It can be argued that the policy issue raised requires the attention of the Governor and the State Representative as well as it is part of their work to ensure that the citizens of Louisiana receive the best health care by pushing for progressive policies.

Section 2

One of the main challenges that will be faced while addressing the selected policy issue is funding. This goes beyond the development of the policy but also the implementation of the same. It is anticipated that the implementation costs will be charged to both the state and the nursing schools in the region. If the state is not able to fund the implementation of the same and by so doing help lower the cost of tuition fee, and then nursing schools would either increase some of the prices (thereby directly affecting the students, as their fees might be more expensive) or look for other types of funding. A second disadvantage is that it will take some time for the public to agree to the policy. This is anticipated due to the fact that the state still has a shortage of nurses, and this process, would ensure that graduation of nurses from school to health facility takes a longer time. It is due to this fact that the education sector will be included in the development of the policy, so that alternatives such as a slightly compressed curriculum are developed.

Section 3

One primary intervention for the identified decision makers, in particular, the Governor or the State Representative, is ensuring that all public health facilities are equipped with the best equipment and staff to provide quality healthcare to the larger community. This is a tangible intervention as it can be measured through the number of lobbying meetings and the eventual acceptance of the policy. It is critical for both the implementation of the policy and the general health of the community. Indeed, as Gerad (2017) observes, the majority of people all over the country have to go to private clinics to get different medical procedures done. This is due to the belief that the private facilities offer the best services, with their nurses trained in better patient care. The suggested policy will ensure that all nurses get to fully understand their role in promoting health, as they would all have the same entry-level skills into the profession.

Section 4

It is critical to think of a persuasive course of action for the decision makers identified in order to avoid the challenges that have been discussed. Impact stories can be used to first lobby for the need for policy change. This is a critical step, as it will allow the decision makers to witness first hand why there is a need for the requirement suggested. Arguably, the media will be a critical partner in highlighting these impact stories. A sample of nurses willing to participate can be selected and then be used as champions of the same especially in regards to their experiences. Some of the nurses who will be used will have entered the profession with a Bachelor’s degree while some will have other alternative requirements. It is important that healthcare lawyers not be involved at the beginning, as this will not be well received by the decision makers. It is only after the realization and appreciation of the extent of the problem that the lawyers can be involved to work on and finalize the policy. On the same note, the challenges identified can be expressed to the decision makers so that they feel like part of the process in determining solutions for the same. This will, in turn, help create a buy-in from the same group of people.

Section 5

The top-down approach means that management will carry out the initial changes at both the state and facility levels. The evaluation of the success of the policy brief will be divided into four phases, which are support, transparent involvement, combined analysis, and participatory governance. This is a top-down approach starting with the people who will pass the policy to the nurses and the general public.

Partnership Plan

Section 1

The organization selected is the Louisiana State Board of Nursing Education. Jennifer M. Manning, will be the targeted Board member to push the policy. This is due to the fact that the education department has also been keen on improving the nursing curriculum and including some necessary courses (“About Us”, n.d.). Specifically, the Board has been questioned on the quality of nurses posted in different public health facilities. Such cases of accusation – where some nurses and some facilities are described to have better nurses than others – are not acceptable. Access to quality healthcare is a human right for all, despite the facility, and this will serve as the motivation the Board needs to support the policy.

Section 2

CBPR principles. One of the philosophies supported by community based participatory research (CBPR) is the fact that it focuses on the issues that are of importance to the community. The second principle is the use of the approach to enable teaching and learning for all parties involved. Lastly, the principle of open dissemination, which allows the results to be tested and debated in other regions of the country and the world at large, is important.

Partnership with selected organizations. Approaching the two selected institution (Louisiana State Board of Nursing Education) will be done through first, introductory meetings to share the concept and reasons why the policy is required. An invitation for partnership will then be given based on the values and beliefs of the institutions in regards to the regulatory practices. The approach will be customized to highlight what benefits the partner (the Board) will get by being part of the team that pushes for the suggested change.

Alignment of goals. As mentioned previously, the primary goal of Louisiana State Board of Nursing Education is to promote regulatory effectiveness (“About Us”, n.d). The Board is also tasked with ensuring efficient and timely responses to nursing issues affecting patient safety (“About Us”, n.d). These goals can be aligned to the objective of the policy seamlessly. All parties primarily seek the provision for quality healthcare to all members of the community. On the same note, the attainment of this goal can only be achieved through proper policies that create an environment for the same.

Action steps. The first action step will be the development of a concept note that highlights the importance of the policy, gives testimonials, and shows how it aligns with the goals and the objectives of the targeted partner. The second phase will involve identifying the right people in the organization (Jennifer has already been targeted) to engage with, on a more concentrated level. This will then ideally lead to meetings and further discussions on how the best go ahead with the lobbying for the policy change.

Roles and responsibilities. One role of the Board will be to help lobby for the policy change at the top level. It will be expected to lead the team in lobbying for the policy within the education sector. Getting goodwill from this sector will push the discussions further to ensure it reaches state level. Capacity building responsibilities will be shared among all the partners depending on their strengths. It is anticipated that this approach will help the entire team anticipate and solve problems that would arise in a fast and effective manner.

Developing a collaborative evaluation plan. As discussed previously, the evaluation plan will adopt the CBPR principles. One key element of developing a collaborative evaluation plan based on the principles is the sense of responsibility and accountability. The partners will be clearly briefed on their roles and evaluations and it will then be upon them to fulfil the objectives set for their specific tasks. Secondly, transparency will be key in ensuring that the community feels like part of the process.

Evaluating success at community level. A bottom-up approach will be used to evaluate the success of the policy at the community level. The incorporated matrix will be divided into three phases. The three stages of measuring will be extent of change in procedural deliveries at the facility level, change in facility policies to incorporate the suggested law, and participatory governance at the highest level.

Strengths and Challenges of the Top-Down and Bottom-Up Approaches

Section 1

One strength of the top-down approach in achieving policy change to support the selected public policy issue is that it focuses more on the mindset of the people who can actually pass the law. This is critical as in policy development, buy in at the top level is the most difficult compared to the same at the bottom level. On the other hand, one advantage of the bottom-up approach is that it clearly identifies the needs of the community, which are then used to create the right and most relevant policy at that specific time.

Section 2

One challenge of the bottom-up approach is that it can be time consuming. Significant base-line surveys have to be done to ensure proper public participation. Additionally, more time will be required to analyze the data and then come up with the policy brief. On the same note, the top-down approach also has its disadvantages. For instance, the implementation of the policy might not be received well by the public or other parties, as they will feel there is a hidden agenda by the management (or the state).

Section 3

The top-down approach is recommended for this specific policy despite its limitations. One way of curbing the challenges identified is through public participation, which takes a shorter time and allows the public to make suggestions on the already identified problem. The additional fact that the public have already been exposed to some level of understanding the mental burden that constitutes the nursing profession makes this the best approach.


About us. (n.d). Web.

Gerad, C. (2017). Doctors and mental health. Occupational Medicine, 67(9), 660–661.

Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare. New York. NY: Wiley.

Porter-O’Grady, T., & Malloch, K. (2015). Leadership in nursing practice: Changing the landscape of healthcare. New York, NY: Jones & Bartlett Publishers.

Yoder-Wise, S. P. (2018). Leading and managing in nursing – E-Book. (7th ed). Lubbock, TX: Elsevier