The policy formulation and evaluation roles in the American health care systems deliberately excludes RNs and APRNs from the policy decision making process. In spite of these exclusionary policies, nurses are well-versed on fundamental operational approaches applied in health care organizations. As the daily caregivers of patients and implementers of the different policies adopted towards improving the health care system, they possess the pre-requisite competencies to actively engage with policymakers and regulatory agencies on the evaluation process ( Cassidy, 2012) . In the procedural phases of performing performance appraisal reviews and the administrative feasibility assessment for policies implemented, nurses can play an active and effective evaluation process.
It denies the health care system an opportunity to capture nurses' perspectives as crucial stakeholders in the health care system by excluding them from these fundamental procedural frameworks. Their role in the day-to-day operations of health care facilities and vast knowledge of the challenges experienced in the policy implementation processes qualifies them as a potentially valuable partner in the health care evaluation process ( Naylor & Kurtzman, 2010) . Arguably, involving them would help introduce new dimensions of effective strategies of appraising policies and conducting administrative feasibility assessments.
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However, several challenges may pose significant threats to attaining this goal, including the lack of technical expertise and opposition from doctors. Overcoming these challenges requires extensive training programs for RNs and APRNs, especially those in leadership positions nurses in different performance tools. For doctors' resistance, sensitization campaigns towards the importance of involving nurses in the policy evaluation process would greatly help overcome these challenges.
According to Abood (2007) the best strategies to advocate for nurses' involvement in Performance Appraisal Reviews and participation in administrative feasibility assessment of policies would include intense lobbying activities and direct engagements with the stakeholders. A change in the structural policies that keep nurses outside decision-making would increase their access to these opportunities (Abood, 2007) .
In summation, incorporating nurses in the decision-making frameworks would be a tremendous step towards improving the policy evaluation frameworks. More importantly, it would make the whole process more inclusive for all fundamental health care practitioners.
References
Abood, S. (2007). Influencing Health Care in the Legislative Arena . Ojin.nursingworld.org. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.aspx .
Cassidy, A. (2012). Nurse Practitioners and Primary Care | Health Affairs . Healthaffairs.org. https://www.healthaffairs.org/do/10.1377/hpb20121025.457840/abs/ .
Naylor, M., & Kurtzman, E. (2010). The Role Of Nurse Practitioners In Reinventing Primary Care | Health Affairs . Healthaffairs.org.https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010.0440.
