Nurses and Health Policy
The 2009-2010 healthcare reform agenda of President Obama and the 111th Congress clearly illustrates the importance of nurses’ efforts to influence health policy. Individual nurses and professional organizations across the country who took part in town hall meetings, wrote letters to the editor, and voiced their opinions to elected officials helped generate momentum leading to the passage of H.R.3962, “The Affordable Health Care for America Act” (American Nurses Association, 2009). The congressional debates that followed and resulted in passage of the historic health care reform bill, H.R. 3590, “The Patient Protection and Affordable Care Act,” also demonstrate that sustained effort is essential to achieve health policy change (American Nurses Association, 2010).
Health policy advocacy requires participation in political arenas; many nurses may not feel prepared to navigate these arenas effectively (Abood, 2007). Taking political action on behalf of the public, as well as advocating for the nursing profession, begins with staying informed and networking to shape reform efforts. Therefore, the goal of this column is to help nurses search for and evaluate health policy information on the Internet. Useful health policy websites are provided.
Searching for Health Policy Information
Information is a critical resource for political involvement. Although the Internet provides nurses access to excellent resources to keep abreast of leading health policy issues, busy professionals need help dealing with today’s Internet information overload. Sorting through millions of electronic documents to find relevant information can be daunting and time consuming. Furthermore, nurses need quick and easy access to high quality information, such as systematic reviews of health policy research, to guide the development of solutions for health-related problems (Fox, 2005; Lavis, Posada, Haines, & Osei, 2004). Useful guidelines for searching peer-reviewed, and professional literature databases, such as PubMed and CINAHL (The Cumulative Index to Nursing and Allied Health Literature), have been published by Klem and Northcutt (2008) and also Morrisey and DeBourgh (2001). The practical strategies and tips we offer in this column for searching Internet sites for health policy information complement the scholarly literature.
A successful health policy Internet search begins with thorough planning. The first and most important step for obtaining highly relevant search results is formulating a clear and concise health policy issue statement that succinctly describes and quantifies the problem to be addressed (Bardach, 2000). The next step is to identify the target audience for the advocacy efforts. This step will help to determine how complex and detailed the information that you gather will need to be (Andrews, Burr, & Janetos, 2004). Consider, for example, whether the goal is to inform the public about healthcare reform proposals generally or to work with congressional experts to obtain Medicare reimbursement for transitional care. The final step is to identify key words and phrases to look for information using a search engine. Brainstorming the concepts that are most relevant to the policy topic is an effective way to generate key words.
Search engines, such as Google, Bing, and Yahoo! Search, are the most common tools to find information on the Internet. Search engines are actually large databases of web documents created by automated search programs (Barker, 2003). Working at the interface between the searcher and the Internet, the search engine locates information by matching key words entered into the search box to websites and documents in the databases. Then, the engine weighs and ranks the web pages according to relevance. Search engines differ in size, speed, coverage of the Internet, search options, and the schemes used for ranking, so each will return slightly different search results (Hanes-Ramos, 2009).
The simple mode of searching by typing key words into a search box typically retrieves thousands of documents; however, the search may or may not yield relevant, high quality, health policy information. It is important to strike a balance between a search that is too broad and one that is too narrow. Keep trying! For example, a search in Google for transitional care retrieves over 2,000,000 websites. Focusing the search to transitional care model narrows the search considerably, to approximately 287,000 websites—a yield still too large to be meaningful. Fortunately, search engines attempt to list the most useful results on the first few pages.
Be careful when adding more search terms. Since search engines by default restrict the search to websites containing all the key words entered, adding the word model is valuable only when finding information about models is the goal. Making the search too specific could eliminate potentially relevant websites. It is best to identify the most important terms that describe the topic and then keep the query simple and focused. For example, the phrase nurse patient ratio legislation is a better search phrase than names of people promoting nurse patient ratios legislation. An even better strategy when looking for specific legislation is to use the exact title of the bill when known, e.g., Registered Nurse Safe Staffing Act. If the first set of results is unsatisfactory, try different combinations of key words, advanced search options, or a different search engine to improve the relevance of the search.
Evaluating Health Policy Information on the Internet
Coinciding with using the Internet to gain information related to health policy advocacy is the need to critically evaluate information sources. Even a well-constructed search can retrieve poor quality information. Criteria for evaluating websites, as outlined by several experts in the field (River Campus Libraries University of Rochester, 2009; University Libraries University of Maryland, 2009), include the following:
- Authority and Accuracy: Knowing who the author is, as well as the author’s affiliation and qualifications, helps to determine the credibility and reliability of the information presented. Scholarly references and/or documentation for the material presented adds credibility. In contrast, typographical errors suggest a lack of attention to accuracy and detail. The site’s Internet address (uniform resource locator, or URL) can also provide clues about authority. Domain names that indicate likely sources of reliable information include government sites (.gov), academic institutions (.edu), and non-profit organizations (.org).
- Purpose and Content: Even non-profit organizations and government agencies can have political agendas. Therefore, examining the information contained on a website with a critical eye is essential to a thorough assessment. The content of the site should reveal its purpose; the most reputable sites will contain a Mission, or an About Us, statement. It is important to remember that health policy information, especially that found on the Internet, may be either partisan or nonpartisan. The former is useful for understanding the views of different stakeholder groups; the latter offers facts, research, and analysis for building the evidence base for advocacy and changing the health care system.
- Currency: Unless the goal of the search is to find historical information, websites that have not been updated recently should be viewed with caution. Non-functional links are often an indication that a site is not well maintained.
- Organization and Ease of Use: If the website information is not readily obtainable, its usefulness is limited, even when the information found on the site is valuable. A well-designed website should be organized and easy to navigate. Web documents, such as PDF, audio, or video files should load quickly and easily.
Additional Internet Resources for Health Policy Information
Additional resources that are helpful for finding health policy information include specialty search engines, directories, and websites useful for accessing the hard-to-find, grey literature—government and technical reports, documents from research institutes, and reports and proceedings from professional organizations—not generally produced through commercial publishers (Alpi, 2005; The New York Academy of Medicine, 2009). Selected examples of these resources are in the accompanying Table.
A Note of Caution
Regardless of the search tools used, it is important to recognize the intent of the website. Websites can contain health policy information that can be used to inform, lobby, promote, and/or influence opinions and votes. Depending on the goal of the search, both subjective and objective information can be useful and appropriate. However, it is critical to understand which kind of information is being presented. For example, HealthReform.gov (U.S. Department of Health & Human Services, 2009) has been developed by the Obama administration to disseminate information about health reform. This site clearly seeks to lobby, as well as inform, the public. The site links to information that includes official government reports, news releases, and also the President’s goals and efforts in promoting healthcare reform. In contrast, The Henry J. Kaiser Family Foundation (2009), a non-profit, private foundation, strives to present a nonpartisan and objective view. This website provides in-depth information about leading healthcare issues, including health policy analyses, research, and expert commentary, as well as fact sheets, charts and data, interactive tools, issue briefs, reports, and daily email updates.
In summary, mastering the fundamentals of searching the Internet for health policy information is essential for nurses’ successful political involvement. Relevant facts, analyses, and explanations of health policy issues at the fingertips of nurses are powerful tools for influencing healthcare system change. Ultimately, how well nurses use health policy information to advance an action agenda will determine the strength of their voice in negotiating solutions to problems with other key stakeholders invested in healthcare reform.
Pamela White, MS, MLS, RN
Tobie H. Olsan, PhD, MS, MPA, RN, CNL, NEA, BC
Carolanne Bianchi, MS, MBA, RN, ANP
Theresa Glessner, MSN, RN, ACNP, BC, CCRN
Pamela Mapstone, MS, RN, CPNP
Amercian Nurses Association. (2010). Healthcare reform toolkit. Retrieved March 20, 2010, from
American Nurses Association. (2009). A message from ANA President Rebecca A. Patton. Retrieved December 3, 2009, from www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2009-PR/President-Patton-Letter.aspx
The Commonwealth Fund
Maps, data, and charts about policy topics (e.g., equity, quality, insurance, and outcomes), health system performance snapshots, comparisons of state-level health performance, and an interactive map featuring child health data
National Center for Health Statistics
Surveys and reports of United States (U.S.) health trends, fact sheets, data briefs, and customized maps
Health, United States, 2008
Annual report on trends in health statistics covering birth and death rates, health status, risk factors, health insurance, and managed care
PRB: Population Reference Bureau
Global and domestic data about population health and the environment focused in four areas: reproductive health and fertility; children and families; population and the environment; and future population issues
Evidence-Based Health Policy
Agency for Healthcare Research and Quality
Evidence-based practice guidelines, research syntheses reports, and the latest findings from comparative effectiveness research studies
Guide to Community Preventive Services
Systematic reviews of programs and policies to improve health and prevent disease, including recommendations for their use, what might effect costs of implementation, and likely return on investment
A gateway to all U.S. government health information covering nutrition, health and diseases by topic, local health services, prescription drugs, and resources for caregivers available in 90 languages
(The Library of Congress, 2009)
Library of Congress site that provides access to U.S. legislative information, such as the status and text of bills and activities of Congress and its committees
Centers for Medicare and Medicaid Services
Consumer and professional information about spending, operations, and quality of care for the entire U.S. health care system and Medicare and Medicaid
Health Care Reform Toolkit
Background information, fact sheets, and research related to health care reform and tools to promote advocacy
Health Resources and Services Administration
Focused on needs of underserved and vulnerable populations for primary care, community health centers, rural health, and supply of the health care workforce
International Council of Nurses
With the goal to represent nursing internationally and influence health policy world-wide, the site contains publications, fact sheets, and position statements with a focus on professional practice, regulation, and social economic welfare
Kaiser Family Foundation
Analyses, commentaries, and news coverage of major U.S. and global health policy issues, including health care reform, updated daily
© 2010 OJIN: The Online Journal of Issues in Nursing
Article published March 30, 2010