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Demographic trends, population projections and emerging health problems have a direct impact on health systems. These changes happen immersed in a socioeconomic environment and a constant concern for sustainability and solvency of the health and social systems. In this context, health promotion, preventive interventions and care for people with or at risk of chronic health problems gain relevance in public health policies. This suggests that nurses will have to assume an increasingly important role in the formulation of public policies, with particular emphasis on regulation, financing, provision and professional development. Governments must be aware of the contribution of nurses. Also, nurses have no choice but to position themselves. They have the ethical obligation to be involved in the highest level of decision making in order to improve population's health, reduce health inequalities and participate in the governance of the system. Decision making and active participation in the design, formulation, implementation and evaluation of public policies necessarily implies understanding the context in which these decisions are taken, identifying stakeholders, their functions and the instruments they hold for the transformation of the health system. In order to integrate their current role in public policies, nurses must: 1) consider changes in health and social care policies based on the model, the system and the available evidence; 2) know demand, provision and public policies; 3) master regulation, evaluation and payment systems; 4) propose sustainable and efficient interventions, being aware of the opportunity cost; and, 5) enhance the contribution of nursing research through innovative solutions.

Background: a wide range of palliative care services has been implemented in Catalonia over the past 20 years. Quantitative and qualitative differences in the organization of palliative care services between districts and settings can result in wide variability in the quality of these services, and their accessibility. Methods: we implemented a benchmark methodology to compare dimensions of care and organization, to identify aspects requiring improvement, and to establish indicators to measure progress. The overall aim was to generate a consensus document for submission to the Department of Health (DoH) of the Government of Catalonia. Results: a Steering Committee convoked a meeting in Barcelona (Catalonia, Spain) and representatives (n = 114) of all the 37 districts within our health care remit (rural, urban, intermediate, and metropolitan) and settings of the health care system (hospitals, social health centers, community, and nursing homes) attended and took part in plenary sessions and workshops to define areas that, in their experience, were considered weak. Twenty-one consensus recommendations achieving high levels of consensus were generated for submission to the DoH. These included the formal definition of the model of care and organization of palliative care services at all levels in the region, the implementation of measures for improvement in different settings and scenarios, systems for continuous care, and facilities for the continuing training of health care personnel. These proposals have since been implemented in a trial region and, depending on the outcomes, will be applied throughout our health service. Conclusion: we conclude that benchmark methodology is valuable in acquiring data for use in improving palliative care organization for patients' benefit.