Original Medicare produced an increased index of suspicion regarding health costs in 1965. As services expanded, costs escalated. Policy makers moved to control upward spending trends in an attempt to leverage resources across the population. Changes in reimbursement accompanied by the expansion of levels of care during an episode of illness caused stakeholders to carefully analyze value based opportunities. The groundbreaking Patient Protection and Affordable Care Act (ACA) compels nurses to continue innovation, transformational leadership, and care coordination as major stakeholders in provision of the next generation of cost containment, quality advances, and patient access improvements. This article discusses the nurse impact on national health cost reduction, value based healthcare reimbursement, and opportunities for nurses to impact healthcare quality. In addition, we consider the nurse impact on healthcare quality and access to care, as well as continued opportunities for nurses to impact access and lead change.

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Background Pandemics can generate considerable distress, which can affect prevention behaviors. Resilience may buffer the negative effects of distress on engagement in relevant prevention behaviors, which may also hold true for COVID-19 prevention behaviors. The objective of the current study was to evaluate whether resilience moderated the relationship between distress and COVID-19 prevention behaviors early in the pandemic. Methods Data were collected via surveys in which all students at a large midwestern university were emailed invitations beginning March 18, 2020. Surveys were completed by 5,530 individuals. In addition to demographic questions and items about COVID-19 prevention behaviors, distress was assessed using the K6 Distress Scale and resilience using the Brief Resilience Scale. Data were analyzed using moderator regression analysis. Results Resilience moderates the effects from distress to prevention behaviors, such that the relationship was stronger for individuals with higher resilience than for individuals with lower resilience. When resilience was one standard deviation below the mean, at the mean value of resilience, and when resilience was one standard deviation above the mean, there was a significant positive relationship between distress and COVID-19 prevention behaviors. However, the relationship was strongest for those with high resilience, and lowest for those with low resilience. Conclusions In the current sample, resilience appeared to influence the strength of the relationship between distress and COVID-19 prevention behaviors. Having higher resilience may promote positive adaptation to distress, leading individuals to engage in a greater number of disease-related prevention behaviors. Future research should examine this relationship longitudinally and in relation to differing constructs of resilience.

Policy changes that impact nursing occur at multiple levels. The scope and pace of policy changes make it impossible for one faculty member to fill the role of policy advocate. Faculty are frequently reticent to participate, yet, policy work can be very rewarding for faculty. When engaged in policy advocacy, nursing faculty can be a valuable resource to the university, to legislators, and to other stakeholders. This article discusses the team approach to policy advocacy activity and outlines key steps in the policy process. Strategies for overcoming barriers when merging academic and advocacy responsibilities are identified. An example of a college of nursing faculty policy team that utilized nursing presence and their combined intellectual, social, and political capital is provided. In this example, the policy team influences policy discussions on issues impacting both the university community and citizens throughout the state. The strategies provided and the policy process steps discussed are applicable to policy changes at the local, state, and federal levels. Nursing faculty are positioned to engage students, alumni, practice leaders, and community stakeholders in interdisciplinary and transdisciplinary efforts that influence policy initiatives.

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