infections. The majority of these conditions can be prevented by excellent nursing care, yet the nursing profession has not effectively convinced the Congress or the American public that nursing care is the key ingredient safeguarding the public from these problems (Leavitt, 2009).
Another example is the “killing grandma” and “death panel” controversy, sparked by wording in the August 2009 congressional health care reform bills. Thousands of nurses across the country have daily, intimate contact with patients and families in the throes of decision making about DNR orders, advance directives, and other end-of-life issues. Nurses have close personal knowledge about how they and other clinicians facilitate discussions and considerations about palliative care and life-extending treatments. Despite this, nurses were largely silent in the face of widespread public misunderstanding and resulting acrimonious outcry over what is intended in counseling patients facing such decisions. This silence is surely an outgrowth of the inattention of nursing curricula to health policy.
The Healthy People Curriculum Task Force, convened by the Association of Academic Health Centers and the Association of Teachers of Preventive Medicine, with representatives from medicine, nursing, pharmacy, and physician assistants, as well as their educational associations recommended the following four domains fundamental to health professions curricula on health policy (http://www.atpm.org/CPPH_Framework/index.html):
Organization of clinical and public health systems (connecting the pieces of the system; connecting clinical care to public health structures)
Health services financing (underlying determinants of cost and options for payment and cost containment; comparison to health systems of other countries)
Health workforce (understanding the roles and responsibilities of other health professionals)
Health policy process (introduction to the impact of policy on health and clinical care, the processes involved in developing policies, and opportunities to participate in those processes, whether within a local institution or state or federal legislation)
Medicine has advocated the inclusion of these domains in all medical school curricula (Riegelman, 2006). Nursing curricula should do no less.
As emphasized above, health policy curricula are needed at the baccalaureate, master’s, and doctoral levels of nursing education, with increasing scope and complexity as the student advances. Political competence requires continuing skill development that begins early in students’ education, thus setting the course toward the graduate’s life-long engagement.
Baccalaureate students need to understand the role of policies at the unit level that shape the environment in which they will eventually work. Workplace policies (e.g., mandatory overtime, nurses’ authority to close beds to new admis-