¶ … honored to meet a delegation of nurses from ten different countries, because I feel we have a lot to learn from each other in terms of different philosophies of nursing. At the same time, we are all shifting more to evidence-based practice, which transcends linguistic and cultural differences. One of the most difficult things to explain would be access to care, as the United States has the top equipment and doctors in the world but the highest cost of care, too. I would try to explain that although many Americans support the Affordable Care concept, and would even like to see Obamacare taken a step further to improve access and quality of care, many citizens remain uninformed and believe that the current profit-driven model is acceptable. Most problems can be framed as a policy issue, because policy has real implications for day-to-day practice. Longest's policy framework demonstrates how American policymaking is a "continuous, highly dynamic cycle," containing three main phases including policy formulation, implementation, and modification (Mason, Gardner, Outlaw & O'Brady, 2015, p. 65). For example, we are currently facing a staff shortage that could be remedied by policy. Therefore, we are at the policy formulation stage.

The policy and advocacy component of the American Nurses Association offers a treasure trove of information helpful to nurses who wish to become more effective leaders. We are the largest group of health professionals, according to the ANA (2016), which is why we need to recognize and wield our power effectively. One of the ways we can serve as advocates would be to learn how to write more effective letters to editors, leaders, and politicians. In the tips for writing letters, we learn that letters to the editor should clearly identify the speaker and concisely address the issue as follows.

Dear Editor,

I am thrilled to find out that a new clinic for geriatric ambulatory care has opened in our community. As a nurse working for the local hospital, I understand the need for improved care services for seniors. Many seniors enter the emergency room with non-emergencies, burdening the hospital unnecessarily, and those patients can be diverted to the ambulatory care clinic where they can receive the specialized treatment that they need. I am writing to express my sincere appreciation to the Increasing healthcare costs are due to a number of factors, many of which are complex and more within the province of economics than healthcare such as inflation and labor costs. However, there is a lot of wastefulness and redundancy in the system, which is profit-driven and therefore based on the motivation to sell products and services that may not be entirely necessary. Nursing has been impacted by efforts to contain costs, seen in our staff shortages in particular.

Healthy People 2020 goals include reducing health disparities, with a focus on identifying the "determinants of health." Those determinants include access to education, which is linked to health, as is access to nutritious food, good housing that is affordable, clean water and air, and health insurance. Many disparity measures focusing primarily on ethnicity fail to take into account economic issues too. This is not to say that ethnic and cultural factors are not important in improving overall wellbeing, as nurses are becoming more culturally competent. In terms of maternal, infant, and child health, Healthy People 2020 acknowledges that disparities exist and are largely due to affordability and accessibility. The disparities can be minimized through effective healthcare policy.

H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 is pending in the U.S. House…