Different public health policies either in the terms of guidelines, regulations, or laws influence the outcome on health status in a significant way. Just like any other process of making decision in all public healthcare institutions, the formulation of policies of healthcare is an intricate process and relays largely on various scientific, social, political, and economic factors. According to Mackoff, Meadows, and Nash (2017), there is a substantial difference between what various researches works show as actual and the policies which are implemented and mandated. The delineation of policy covers a broader perspective which encompasses regulations, law, and jurisdictive verdicts similar to budget priorities and agencies strategies. According to Scott (2011), there are over 107 model laws that guides public health that cover about 16 issues. However, the commonly applied model laws are those that were formulated for injury prevention, tobacco control, and school health.
There is the most likely for research to influence the development of policy through an extended process of interaction and communication (Edmonson, 2015). In other words, the interface of policies regarding research is intricate due to the characteristic of scientific information that is always broad, inequality, and sometimes not accessible to those who make policy (Thompson, Navarra, & Antonson, 2015; Shirey, 2016). Various models of how research works impact policymaking have been pointed out, some of which encompasses surpassing the modest linear model to nonlinear and complex routes of impact as in continuing illumination (Thompson, Navarra, & Antonson, 2015; Mackoff, Meadows, and Nash, 2017). Batcheller (2014) adds that some nonlinear methodologies employed in decision-making as well as policy-making respect the fact that findings of research sometimes can hold less or equal important than some factors that have an ultimate impact on policy: such as value and competence of policymakers source of information which include but not limited to personal experience and anecdotes. For public health policy to be successfully enacted and implemented, it requires public health practitioners and stakeholders to have a reflection on their personal and professional actions within the environment they operate.
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Reflection can be said to be an art of examining personal thoughts and action. For healthcare practitioners, reflection means how they interact with their patients, colleagues, and environment they operate on in a daily basis in order to obtain an overhaul picture of their own action and how those actions influence the desired outcome at work (Rudisill & Thompson, 2012). Therefore, reflection as a health care policy can be summed up as a process by which practitioners can use to evaluate themselves in order to be in a better position to improve on the prevailing strength and take proper action in the betterment of the future. Patton, Zalon, and Ludwick (2018) assert that the word ‘action’ is crucial while defining reflection in that reflection is not a navel-gazing but rather a process that aims to improve professional actions in line with personal values and beliefs. According to Edmonson et al. (2017), reflection can be categorized in two fundamental forms: reflection-in-action and reflection-on-action. Patton, Zalon, and Ludwick (2018) add that it is crucial to understand and differentiate the two these two forms: because by doing so, the practitioners will be in a better position to unravel a variety of techniques they can as well employ to improve their personal and professional competence.
System Change and Strategizing and Creating Change
As modernizers, all registered nurses (RNs) are regarded as advocates of agents who are entrusted to push for process and policy influence technologies in order to provide better and more affordable health care services to persons in need and community at large (Sherriff, Wallis, & Chaboyer, 2007). In this respect, the American Nurses Association (ANA) Professional Issues Panel, Barriers to RNs Scope of Practice (SOP Panel), was formulated to single out all barriers affecting the efficiency of service delivery by RNs to the level of their experience, education, and SOP in respect to related act of nurse practice. Subsequently, the Panel’s Steering Committee found out obstructions deterring RNs for effectively carrying out their duties to maximize their potential of the training and education. Additionally, the Steering Committee made recommendations that if implemented, can help in combating the ensuing barriers in the field of public health (Sherriff, Wallis, & Chaboyer, 2007; Thomas, Seifert, and Joyner, 2016) These findings by the members of the Panel were grounded on four vital duties of registered nurses in the health care conveyance system that is RNs as innovators, RNs as advocates, RNs as collaborative leaders, and RNs as professionals.
Registered Nurses as Agents of change
Ingham-Broomfield (2015) asserts that any registered nurse acts as an agent of change due to their ability to drive policies and processes and to leverage technologies in order to achieve the three objectives of the National Quality Strategy: better population health, better experience with healthcare, and low costs of healthcare services (Sherriff, Wallis, & Chaboyer, 2007). The members of Steering Committee recognize the ability of registered nurses to have foremost innovative concepts and performs to come up with distinct knowledge, establish healthcare practices and policies, to enhance the healthcare quality, improve healthcare information technology.
RNs as Leaders of Innovative Ideas
According to Thomas, Seifert, and Joyner (2016), the ANA Scope and Standards of Practice work hand-in-hand to help identify the standpoint through which nursing innovations are taking place within the field of healthcare practicing and nursing. He adds that nursing is utilization, protection, and promotion of abilities and health, averting of injuries and illness, healing expedition, mitigation of pain through the treatment and diagnosis of an individual response, advocacy in the care of a person, group of people, designated families, community, and populations ( Edmonson, McCarthy, Trent-Adams, McCain, & Marshall, 2017; Thomas, Seifert, & Joyner, (2016) . In the recent days, a rationalised ANA Scope and Standards of Practice document emphatically urging RNs to take leadership mantle with healthcare sector, focus on influencing public healthcare policies and to come up with new innovations ( Merriam & Tisdell, 2015 ). According to Edmonson et al. (2017) innovation is purposeful introduction and deployment of a new and distinct idea within an organization, group or a role premeditated to suggestively be of benefit to an individual, group, or to an organization. Sherman and Pross (2016) add those i mportant elements of the process of innovation include the innovation itself, and individual or team creativity, the environment under which the innovation is developed and sustained.
Grass Roots and Judging Worth and Advancing the Cause
There is an overwhelming opportunity for the government of United States to transform the nation’s health care system which will ensure that the provision of health care services is seamless, affordable, and of quality (Fackler, Chambers, & Bourbonniere, 2015). Moreover, the system should make sure that there is accessibility of health care to all citizens, they are patient-centered, are evidence-based, and should result in improved outcome. This is mostly touching on the nursing profession which is the vastest section in the sector of health care ( Reutter & Kushner, 2010 ) . Therefore, grassroots and judging worth and advancing the cause acts as a blueprint to provide the opportunity for RNs to undertake leadership roles in order to work as full cohorts in healthcare redesigning and improving efforts and to ensure that RNs are working at the top-most level of their education and nursing ( Fackler, Chambers, & Bourbonniere, 2015) . It is also meant to ensure improvement in nursing education, as well as enhancing collection of data for the workforce policymaking and planning.
In 2010, the U.S Congress passed a comprehensive health care legislation bill that was subsequently signed into by president Obama ( O’Neill, 2013) . With the implementation of such laws as Obamacare or Affordable Care Act (ACA), the United States positioned itself in a better position to overhaul the health care system to provide affordable, more accessible, safer, and high-quality healthcare services to all ( Reutter & Kushner, 2010 ). In its findings, the Committee on the Robert Wood Johnson Foundation Initiative mandated to work out on the Future of Nursing at the Institute of Medicine established a roadmap for a transformed health care system. The committee visualized a feature system that would make the accessibility of quality care to every individual living in the United States possible, which could promote wellness and prevention of diseases, and reliably improves health outcomes.
Various transformative changes are currently taking effect in the healthcare sector for which nurse, given the effective role they play, their level of education coupled with the respect they have earned in the society, are in a vantage position to contribute as well as offer an equivocal leadership role ( Melnyk et al., 2014) . To effectively contribute in shaping the aforementioned changes, nurses must have full knowledge of the factors influencing the changes, the mandates for practicing the changes as well as equip themselves with the necessary skills, attitude, and knowledge that will help them in achieving the desired outcome ( Wilson et al., 2015) . According to Merriam and Tisdell (2015), the new health paradigm requires health practitioners to actively get involved in the concerted efforts that aim to attain the triple objectives of newly-enhanced patient experience of the healthcare services encompassing satisfaction and quality ( Jones, Havens, & Thompson, 2017) . The other two objectives include minimization of the capita cost of health and improved outcomes as well as the increased number of people receiving care services.
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