Write it down. What Would You change?
List five things that you would like to change about nursing or the health-care system. Prioritize the changes that you have identified. Write a one-page essay about the change that you believe is most needed. Identify the strategies that you could use individually and collectively as a profession to make the change happen. Be sure that you are realistic about the time, energy, and fiscal resources you have to implement your plan.
Nursing’s advocacy role in Legislation and public policy
A distinctive feature of American society is the manner in which citizens can participate in the political process. People have the right to express their opinions about issues and candidates by voting. People also have relatively easy access to lawmakers and policy makers and can make their individual needs and wants known. Theoretically, then, any one person can influence those in policy-making positions. In reality, this rarely happens; policy decisions are generally focused on group needs or wants.
Much attention has recently been paid to nurses and the importance of the nursing profession and how nurses impact health-care delivery. This has been especially true in the areas of patient safety and staff shortages.
In addition to active participation in national nursing organizations, nurses can influence legislation and health policy in many other ways. Nurses who want to be directly involved can lobby legislators either in person or by letter. This process may seem intimidating to the new nurse; however, there are many books and workshops available that deal with the subject and a common format is used. In addition to nurse-leaders and individual nurses, there is a need for collective influence to impact health-care policy. The need for organized group efforts by nurses to influence legislative policy has long been recognized in this country. In fact, the first state associations were organized expressly for unifying nurses to influence the passage of state licensure laws.
Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes.
Political action committees (PACs) of the Congress of Industrial Organizations attempt to persuade legislators to vote in a particular way. Lobbyists of the PAC may be members of a group interested in a particular law or paid agents of the group that wants a specific bill passed or defeated. Nursing must become more actively involved with PACs to influence health-care legislation, and PACs provide one opportunity for small donors to feel like they are making a difference.
In addition, professional organizations generally espouse standards of care that are higher than those required by law. Voluntary controls often are forerunners of legal controls.
What nursing is and should be depends on nurses taking an active part in their professional organizations. Currently, nursing lobbyists in our nation’s capital are influencing legislation on quality of care, access to care issues, patient and health worker safety, health-care restructuring, direct reimbursement for advanced practice nurses, and funding for nursing education. Representatives of the ANA regularly attend and provide testimony for meetings of the U.S. Department of Health and Human Services, the Department of Health, the National Institutes of Health, the OSHA, and the White House to be sure that the “nursing perspective” is heard in health policy issues (Huston, 2014c).
As a whole, the nursing profession has not yet recognized the full potential of collective political activity. Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes.
Because they have been reluctant to become politically involved, nurses have failed to have a strong legislative voice in the past. Legislators and policy makers are more willing to deal with nurses as a group rather than as individuals; thus, joining and supporting professional organizations allow nurses to become active in lobbying for a stronger nurse practice act or for the creation or expansion of advanced nursing roles.
Personal letters are more influential than form letters, and the tone should be formal but polite. The letter should also be concise (not more than one page). Be sure to address the
legislator properly by title. Establish your credibility early in the letter as both a constituent and a health-care expert. State your reason for writing the letter in the first paragraph, and refer to the specific bill that you are writing about. Then, state your position on the issue and give personal examples as necessary to support your position. Offer your assistance as a resource person for additional information. Sign the letter, including your name and contact information. Remember to be persistent, and write legislators repeatedly who are undecided on an issue. Display 6.5 displays a format common to letters written to legislators.
March 15, 2014 The Honorable John Doe Member of the Senate State Capitol, Room ____
City, State, Zip Code Dear Senator Doe,
I am a registered nurse and member of the American Nurses Association (ANA). I am also a constituent in your district. I am writing in support of SB XXX, which requires the establishment of minimum RN staffing ratios in acute care facilities. As a staff nurse on an oncology unit in our local hospital, I see firsthand the problems that occur when staffing is inadequate to meet the complex needs of acutely ill patients: medical errors, patient and nurse dissatisfaction, workplace injuries, and perhaps most importantly, the inability to spend adequate time with and comfort patients who are dying.
I have enclosed a copy of a recent study conducted by John Smith and will be published in the January 2014 edition of Nurses Today. This article details the positive impact of legislative staffing ratio implementation on patient outcomes as measured by medication errors, patient falls, and nosocomial infection rates.
I strongly encourage you to vote for SB XXX when it is heard by the Senate Business and Professions Committee next week. Thank you for your ongoing concern with nursing and health-care issues and for your past support of legislation to improve health-care staffing. Please feel free to contact me if you have any questions or would like additional information.
Respectfully,
Nancy Thompson, RN, BSN Street
City, State, Zip Code
Phone number including area code E-mail address
DISpLAy 6.5 sample: a Letter to a Legislator
Other nurses may choose to monitor the progress of legislation, count congressional votes, and track a specific legislator’s voting intents as well as past voting records. Still other nurses may choose to join network groups, where colleagues meet to discuss professional issues and pending legislation.
For nurses interested in a more indirect approach to professional advocacy, their role may be to influence and educate the public about nursing and the nursing agenda to reform health care. This may be done by speaking with professional and community groups about health- care and nursing issues and by interacting directly with the media. Never underestimate the influence that a single nurse may have even in writing letters to the editor of local newspapers or by talking about nursing and health-care issues with friends, family, neighbors, teachers, clergy, and civic leaders.
Nursing and the Media
“Although registered nurses are among the most knowledgeable, educated, frontline healthcare providers in the country, their voices are rarely ever heard or consulted by mainstream media organizations” (Taking Media into Our Own Hands, 2011, p. 10). This is because too few nurses are willing to interact with the media about vital nursing and health-care issues. Often, this is because they believe that they lack the expertise to do so or because they lack self- confidence. This is especially unfortunate because both the media and the public place a high trust in nurses and want to hear about health-care issues from a nursing perspective.
The reality is that the responsibility for nursing’s image as perceived by the public lies solely upon the shoulders of those who claim nursing as their profession. Until such time as nurses are able to agree upon the desired collective image and are willing to do what is necessary to both tell and show the public what that image is, little will change (Huston, 2014d). Nurses should take every opportunity to appear in the media—in newspapers, radio, and television. Nurses should also complete special training programs to increase their self- confidence in working with journalists and other media representatives. Regardless, the first few media interactions will likely be stressful, just like any new task or learning. The following tips may be helpful to nurses learning to navigate media waters (Display 6.6):
• Remember that reporters often have short deadlines. A delay in responding to a reporter’s request for an interview usually results in the reporter looking elsewhere for a source.
• Do not be unduly paranoid that the reporter “is out to get you” by inaccurately representing what you have to say. The reporter has a job to do and most reporters do their best to be fair and accurate in their reporting.
• Come to the interview prepared with any statistics, important dates and times, anecdotes, or other information you want to share.
• Limit your key points to two or three and frame them as bullet points to reduce the likelihood that you will be misheard or misinterpreted. Brief, but concise sound bites are much more quotable than rambling arguments.
• Avoid technical or academic jargon.
• Speak with credibility and confidence, but do not be afraid to say that you do not know if asked a question beyond your expertise or which would be better answered by someone else. If you choose not to answer a question, give a brief reason for not wanting to do so, rather than simply saying “no comment.”
• Avoid being pulled into inflammatory arguments or blame setting. If you feel that you have been baited or that you are being pulled off on tangents, simply repeat the key points you intended to make and refocus the conversation if possible. Remember that you cannot control the questions you are asked, but you can control your responses.
• Provide contact information so that the reporter can contact you if additional information or clarifications are needed. Be aware, however, that most reporters will not allow you to preview their story prior to publication.