Two major trends will have a significant impact on healthcare delivery.

The impact of federal and state health policy and regulation on the practice of nursing cannot be ignored. Issues surrounding healthcare are often complex, involving the fields of medicine and economics and affecting individuals’ rights as well as access to healthcare.

Consumers are concerned about quality, and corporations and individual providers are concerned about economic survival.


First, there will be an increase in state and federal regulation as costs rise and managed care continues to expand. Along with regulation, there will be attempts to shift to less expensive settings and apply market forces to restrain costs.

Second, shared responsibility for the Medicaid program and the shift to managed care has resulted in an increased oversight role for the states. States must define, measure, and assess quality and serve as contractors for corporate entities while enforcing accountability of managed care organizations. Both new regulation and devolution have serious implications for healthcare delivery and the practice of nursing.

Historically, nursing’s influence on policy and regulation has been disproportionately low relative to the breadth of nursing practice and its importance within the healthcare delivery system. Nursing schools, scholars, executives, and professional nursing organizations must more actively contribute to the development of health policy and regulation. Government policy-makers, not healthcare professionals, are defining ethical issues involved in working in an integrated system, more and more constrained by economic incentives. Nursing leaders should contribute to the dialogue that defines these issues; students must be prepared for a meaningful role in the political arena.

In considering the above, what strategies will you employ to help navigate the increasingly complex landscape of patient care? What actions could you take to become more politically active? What are the barriers to becoming a political advocate?