policy implementation analysis: Nurse aide certification in Florida

Policy implementation is recognized as a major component of the public policy process, and an important area for public administration research. The literature calls for the examination of public projects to improve policy design and implementation, for the comparison of expected implementation with actual implementation, and for the examination of the role of states in implementing federal policy. This dissertation addressed those areas by analyzing the implementation of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) which contains federal requirements for certification of nurse aides (nursing assistants) who are employed in Medicare and Medicaid funded nursing homes. The dissertation focused on the state of Florida and three levels of analysis: policies and practices of the state, nursing home operations and procedures, and individuals in the certification process. Multiple methods of data collection and data analysis were used and included: an analysis of the history, development and content of the federal policy, interviews with state administrators, a survey of nursing home administrators, an analysis of state certification statistics, documentary analysis, factor analysis and content analysis. Some of the data indicate that, although Florida has had a nurse aide certification process in place since 1982, there may be some uneven implementation of the certification process at the local level, and that race may have an impact on the certification rate. These areas were recommended for further study. A descriptive model, developed from the research design, outlined three dimensions that should be examined in order to conduct a comprehensive analysis of policy implementation: the origin of the policy, the agent of the policy, and the target of the policy. Additionally, a comprehensive analysis should examine the communication between the dimensions. In this dissertation, the federal legislation was the origin, the state of Florida was the agent, and nursing homes and prospective nurse aides were the targets. The descriptive model can be used for future implementation studies whether the origin of the policy is federal, state or local legislation.