• policy development;
  • Medicare;
  • nursing role;
  • advanced practice nurse


To analyze why U.S. legislation for direct Medicare reimbursement to advanced practice nurses (APNs) was approved during the 105th congressional session. Help in understanding the complexities of policy making and in strategizing future policy activities is needed. Given their vast numbers, nurses are a formidable group with potential to influence policy.

Organizing Construct:

Kingdon's (1995) framework indicates that policy formation involves constant interaction among participants and the problem, its politics, and policy. When a policy is enacted into legislation, the three come together and an opportunity for policy formation exists, if even fora short period. Methods for data extraction included telephone interviews, information provided by the American Nurses Association (ANA), and information from the internet to access information.


Lack of access to health care by Medicare beneficiaries, tagging a policy proposal onto the Balanced Budget Act of 1997, the national mood to provide cost-effective quality care, and lobbying by interest groups helped to make direct Medicare reimbursement for advanced practice nurses a reality.


When lobbying for the enactment of legislation, nurses should decrease their tendency to fragment. Nurses should be more effectively organized and concentrate on specific agendas. Working together can influence policy and change clinical situations to improve patient care.