015 Citation: Toren O, Tsur Y, Nirel N, Toker A, Lipschuetz M (2019) Nurses’ authority in Neonatal Intensive Care Units (NICUs) in Israel- The disparity between policy and Practice. Arch Nurs Pract Care 5(1): 015-022. http://dx.doi.org/10.17352/anpc.000037 https://dx.doi.org/10.17352/anpc DOI: 2581-4265 ISSN: CLINICAL GROUP Abstract Background: Policy implementation is a fundamental aspect in management. This study examined gaps and barriers in the implementation process of governmental policy with respect to the division of responsibility and authority between physicians and nurses. In this study we aimed to examine the work processes and actual division of labor between physicians and nurses in the Neonatal Intensive Care Units (NICUs) and the disparities between them and the Israeli Ministry of Health policy (MOH) and to examine the attitudes of staff members towards the need for policy change Methods: A cross-sectional study, conducted among physicians and nurses at 22 NICUs in Israel. 432 recruited (50% rate). Results: A disparity was found between policy and actual practice. Many of the tasks permitted to RNs by law or regulations are not actually performed by them. The main barriers for authority implementation are the perceived need for approval by a local level, and a lack of nurses’ knowledge regarding the tasks they are permitted to perform. Almost half of the respondents believe that the division of work between physicians and nurses requires change. Conclusions: Policy is not fully implemented due to unsuitable regulations to practice processes, lack of knowledge regarding the existed policy and local barriers. There is a need for governmental policy change. Research Article Nurses’ authority in Neonatal Intensive Care Units (NICUs) in Israel- The disparity between policy and Practice Orly Toren 1 *, Yehuda Tsur 1 , Nurit Nirel 2 , Assaf Toker 3 and Michal Lipschuetz 1 1 Hadassah Medical Center, Israel 2 Smokler Center for Health Policy Research, Myers- JDC-Brookdale Institute, Israel 3 Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel Received: 20 June, 2019 Accepted: 29 July, 2019 Published: 30 July, 2019 *Corresponding author: Orly Toren, Hadassah Medi- cal Center, Israel, E-mail: Keywords: Neonatal-nurse-specialist; Neonatal Intensive care units (NICUs); RNs; Authority; Policy; Professional boundaries https://www.peertechz.com to examine these issues and the actual barriers related to the physicians’ agreement to hand over certain tasks to nurses, in order to assess whether there is a gap between policy and practice [1-3]. Policy implementation is a fundamental aspect in management and in recent years, many researchers have attempted to ascertain the factors affecting its practical execution. Baradach defines policy implementation as the continuation of the policy-making process by other parties and it’s conversion into action [4]. The first and a most significant part of policy implementation is decision-making, which is also a complex part of the process. An ideal policy decision, defines the problems, objectives and modus operandi to reach the desired outcome. Ideal conditions for effective policy implementation include a clear definition of the problem and objectives; a clear outline of the process implementation; Introduction Background Frequent changes in the health care system require a policy re-examination regarding professional boundaries between nurses and physicians. The Israeli Ministry of Health (MOH) policy in recent years increased nurse authority in areas that not long ago were the exclusive domain of physicians. This growing nursing authority is based on international trends of translating professional skills to clinical care needs. This trend also addresses financial constraints, shortage of manpower - mainly physicians - and their availability in specific clinical situations. When reviewing policy implementation of responsibility and authority among nurses and physicians, it is necessary