Policy analysis and policy implementation: can nursing manage without them?

Nursing education reform in South Africa--lessons from a policy analysis study

BACKGROUND

Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013.

OBJECTIVE

We undertook a policy analysis study of the development of the new Nursing Qualifications Framework in South Africa.

DESIGN

We used a policy analysis framework derived from Walt and Gilson that interrogated the context, content, actors, and processes of policy development and implementation. Following informed consent, in-depth interviews were conducted with 28 key informants from national and provincial government; the South African Nursing Council; the national nursing association; nursing academics, managers, and educators; and other nursing organisations. The interviews were complemented with a review of relevant legislation and policy documents. Documents and interview transcripts were coded thematically using Atlas-ti software.

RESULTS

The revision of nursing qualifications was part of the post-apartheid transformation of nursing, but was also influenced by changes in the education sector. The policy process took more than 10 years to complete and the final Regulations were promulgated in 2013. The two most important changes are the requirement for a baccalaureate degree to qualify as a professional nurse and abolishing the enrolled nurse with 2 years training in favour of a staff nurse with a 3-year college diploma. Respondents criticised slow progress, weak governance by the Nursing Council and the Department of Health, limited planning for implementation, and the inappropriateness of the proposals for South Africa.

CONCLUSIONS

The study found significant weaknesses in the policy capacity of the main institutions responsible for the leadership and governance of nursing in South Africa, which will need to be addressed if important nursing education reforms are to be realised.

Are your IPC policies fit for purpose?

Infection prevention and control practitioners are well versed in protecting patients from harm. Recent political, public and media attention about unsafe organisations has brought doubts into many minds as to the safety of our healthcare services. Infection prevention and control policies are the mainstay in ensuring compliance with best evidence-based practices, but with many mergers of community and secondary care infection prevention and control teams, policies have to be reviewed and revised to ensure they meet both organisational and patient/employer safety needs. This paper reflects contemporary literature around policy development. It will discuss how to develop, implement and evaluate comprehensive policies that will fit the needs of organisations while protecting their population of employees and patients.

Fertility services for same-sex couples: policy and practice

Access to safe and high-quality fertility services is essential for the health of both the woman requiring services and any resulting child. While having children is a human right and legislation and society have become more liberal, same-sex couples may have problems accessing fertility services for several reasons. There is still significant opposition to same-sex couples accessing fertility treatment services, which are already stretched and vary across the country. Some lesbian couples access private clinics, which involve a number of costs because they believe these are more willing to treat same-sex couples. Women may make informal self-fertilisation arrangements; this poses health risks in terms of sexually transmitted infections and a lack of prenatal and holistic advice and care. As patient advocates, nurses and nurse managers can identify areas where services could be more inclusive. Nurses could push for accessible, high-quality fertility services, using policy and evidence to support their development. On way forward may be to encourage more self-insemination at home in a safe way. This has the potential to increase patient empowerment and reduce costs to the NHS. However, any such innovation should always have the safety and equality of patients at its core.

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

AIMS

To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary.

BACKGROUND

Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role.

METHODS

A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100.

RESULTS

Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident.

CONCLUSION

The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.