MN507-5: Evaluate the role of health policy and organizational structure on quality improvement within health care environments.

Nursing practice is affected by various changes that include changing health needs (drug-resistant infections, acute illnesses (COVID-19), and evolving healthcare policies (such as globalization of health)). These changes have professional and individual implications that change how nurses study and practice nursing and contribute to emerging nursing issues (Schaeffer & Haebler., 2019). Nurse leaders are vital policymakers, and they play a delicate role in professional and patient advocacy, ensuring a balance in both. Nurses are expected to adjust to these changes to deliver the best care to patients while maintaining professional integrity. This essay analyzes and supports a policy change in nursing leadership in primary care to ensure access to quality care in developed and developing countries.

Current Nursing Issues Due To Globalization

The globalization of health has expanded social, economic, political, and cultural values in health and nursing. The globalization of health has led to various problems in the nursing profession. The first problem has been nurses’ immigration. In search of greener pastures, nurses’ immigration from underdeveloped to developed countries is alarming (Cabanda, 2021). The developing countries invest significantly in the education process but cannot employ the nurses or pay them well. The nurses then migrate to developed countries where they work. The issue is a current silent issue that has led to cycles of nurses shortages in developing countries (Furtado & Artego, 2020). There are already few nurses globally, and the immigration of nurses further aggravates the problem in developing countries. Policymakers should devise ways to absorb the nurses into the local system before allowing their workforce (lost investment, labor, and skills) to move to developed countries (Cabanda, 2021).

Nursing ethical issues are a rising problem due to globalization. According to Calenda and Bellini (2021), the different interpretations of ethics depend on cultural and social beliefs and merits and vary across nations. Each country values life differently, and not all accepted values are reflected accordingly. The globalization of nursing ethics has posed a significant challenge to the nursing profession and the local authorities. Many ethical issues considered acceptable in some countries are unacceptable in some, and these different values affect the nursing process, yet their integration is vital.

However, the globalization of health has some positive effects on the nursing profession. The most immediate impact is improved networking and social interactions (Patrício et al., 2018). Nurses can share local concerns and have transnational interventions that produce positive results across nations. Through well-structured global education programs, improved education has improved education (Dori et al., 2019). Given the uniform education of nurses, they can work in any nation adequately.

The Policy Change Proposal

The chosen policy is making it mandatory for nursing leaders to have undergone a leadership program before overtaking a leadership position and ensuring all leaders without formal leadership training have undergone a leadership education and training (Major, 2019). The number of nurses with specific leadership training is alarmingly low. Most nursing leaders are MSN-prepared nurses and above, having taken several modules in nursing leadership. Their training ensures that they fully pledge to deliver while serving in leadership positions. Strengthening nursing leadership is an essential step in achieving professional liberation. Nurse leaders are hardly involved in the policy-making process in various literature.

Nurse leaders are primarily involved in the implementation process. According to Scharffer and Haebler (2021), there is a need for strong leaders who will protest for active leadership and question the current methods to promote change. Strong leadership is the foundation for improved practice and professional practice and influences policy-making. Before addressing the policy-making processes, it is essential to equip nurses with knowledge and skills to participate fully and influence the health policy globally. Investing in nursing leadership is vital for the future of the nursing profession and health policy.

Agenda Setting Strategies

Gaining buy-in from stakeholders is usually a challenging process and requires various considerations. There are multiple ways to ensure that stakeholders fully support the policy change proposal. A professional presentation in the organization and nursing conferences is vital (Varghese et al., 2018). Presenting the proposed policy change in meetings critical to the nursing profession ensures the right professionals pick the ideas, increasing the chances of its implementation. The hospital noticeboard is also an important avenue. Preparing a precise poster that will capture their attention will be integral to ensuring they read and gain attention (Varghese et al., 2018). The other strategy is emailing the healthcare leaders and care providers. A precise email detailing the purpose, intention, drivers, and a copy of the proposal will help gain buy-in.

Applying Kurt Lewin’s Theory to Effect Change

Kurt Lewin developed a change theory that will be integral in managing change, especially in healthcare. The theory’s three stages- unfreezing, moving, and refreezing involve a series of activities that will help garner support from nurses and nurse leaders in implementing the policy. Hussain et al. (2018) identify that the activities revolve around identifying the barriers (blocking forces), drivers (enabling forces), and focusing on achieving equilibrium. Change management is not an easy task due to nurses’ resistance and lack of support from fellow staff and other leaders in the healing environment. The first stage entails leading old habits and creating the need for new ones.

In this step, data collection on the importance of mandatory leadership training and a universal leadership program. Data collected will help convince nursing leaders and nurses of the importance of developing a universal leadership program for nurses. The second step, moving, entails determining the driving forces and supporting the nurses to implement the change (Hussain et al., 2018). After developing the program, there should be rewards for nurse leaders who implement the policy and employ leaders who have undergone leadership programs to influence others to implement the same.

The nurse leader should also influence the nurses to take the leadership program to ensure well-prepared nurse leaders are available for various leadership positions. Refreezing entails solidifying the impact by embedding the change in the organizational policy (Hussain et al., 2018). In this stage, there is a need to support the nurse leaders in implementing the changes in the organizational policy. The nurse leaders should influence the institution only to employ nurses who have completed the training problem. The organizational policy will ensure the permanency of the change.

Design Strategies

The function-oriented and structured designs are chosen for this policy change proposal. The structured design (the most chosen design) elaborates the policy proposal elements: evaluating leaders on their management education and skills, training leaders without elaborate leadership backgrounds, and ensuring all new leaders have elaborate leadership training and education (Peters, 2018). These interventions will help solve poor leadership adequately. It will also ensure leaders have the confidence and skills to stand up for the nursing profession and practice and greatly influence the profession’s policy development involvement.

Implementation Strategies

The policy change will require several implementation strategies. Evaluation and iterative strategies by first conducting a survey to identify barriers and professional opinions will be integral and suit change proposal activities. According to Mathieson et al. (2019), these activities will help plan activities, minimize resource wastage, and promote the achievement of objectives. Next is preparing a written proposal detailing the policy, justification, and purpose. Identifying the stakeholders, including nurses, nurse leaders, and hospital organizations, will follow. After identifying them, educating them on the change proposal is paramount to creating knowledge and eliciting reactions vital for planning other activities. Identifying and educating them are crucial strategies because they will provide an opportunity and chance to convince them and gain their support (Mathieson et al., 2019). Change management using Lewin will be a vital strategy in this step to help gain buy-in. Change infrastructure such as changes in the organizational hiring policy to include nurses with leadership education will be an integral implementation strategy for the change proposal.

Evaluation Strategies

There are three evaluation types: structure, process, and outcome evaluation strategies. The policy change will require advanced reporting and briefings every three months for a year. As Rinaldi et al. (2018) note, the briefings and advanced reporting will help ensure the leaders implement the required tasks adequately. The briefings will also help determine if there is a need to improve the policy. Besides the briefings, there will be a need to determine if the leaders selected to fulfill the basic requirements. The expected outcome is improved leadership in the nursing profession. As identified earlier, changing nursing leadership will require concerted effort. An adequately structured appraisal of the leaders is vital for evaluating the policy’s impact. The goal is better leadership, and performance appraisal tools such as the management by objectives strategy will be integral (Sigh, 2020). The numerical results will be analyzed compared to the previous year’s appraisal results after one year’s evaluation period is over.


Influencing nursing leadership and promoting their involvement in policy development first requires strengthening nursing leaders. Nursing leadership, as seen above, requires robust education to help integrate leadership concepts into nursing. Nurses are prepared to be leaders through nursing leadership modules, but there is a need for specific leadership training before taking up leadership positions. The policy will benefit from a presentation at conferences, emails to leaders, hospital notice boards, and hospital meetings. The structured design will help prepare the policy change. Evaluative and iterative strategies, identifying and educating stakeholders, and availing of change infrastructure are integral implementation strategies for the change proposal. Meeting briefs, advanced reporting, and analysis of performance appraisal results will help evaluate the policy change proposal.



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