Volunteering
Money is not the only way to build a relationship with your legislator. Volunteering your time can be just as important (see Perspectives—Voices from the Community). Candidates for office need people to get things done (e.g., phone banking, stuffing mailers, answering phones, putting up flyers and campaign posters, walking door to door to spread the message, and assisting in the development of issue papers). Candidates develop issue papers to tell their constituents where they stand on key campaign concerns. Nurses have the expertise to assist legislators in developing an agenda on health care policy or at the least to review and comment on issue papers.
PERSPECTIVES VOICES FROM
Relationships are critical in policy development and in affecting public policy. As demonstrated earlier, being a friend can reap huge benefits when health care policy is on the line. Being involved in local and state elections can take many forms. Voting, for instance, is vital—RNs represent a substantial block of potential voters (Nickitas et al., 2016). Joining your local and state professional organizations is vital to having the voice of nursing heard at all levels. You can become more actively involved by writing legislators about the health care issues that impact the communities, both where you live and work. It is also vital to understand the importance of critically timing those communications.
Effective communications with legislators should be tied to times when the issues are being heard in policy committee—thus, you must know when your issue is scheduled to be discussed in committee. For example, it is prudent to send letters on your issue—via fax or regular mail—close to the time of the committee hearing. Holding a press conference or getting other media coverage when the bill is introduced, or on the day it will be heard in committee, is quite effective in drawing attention to your issue. Writing letters to the editor of your local newspaper on health issues and writing articles for various publications are also effective methods of persuading others to back your issue. Other methods for influencing health policy or nursing issues include applying for positions on boards and commissions; each local area has advisory committees for their locally elected officials at the city and county level. The state board of RNs needs nurses willing to sit on their board or to serve on various advisory committees and task forces. At your state capitols, there are usually vacancies on policy committees, or legislators may be looking for new staff—either personal or policy. And, who better to serve in this capacity than a nurse! Who else has more knowledge about health issues than nurses? When all else fails, run for office.
S U M M A R Y
This chapter has reviewed briefly the disparities in health outcomes and discusses the relationship between health policies and population health outcomes. Public health policy is explained, and types of policies (e.g., substantive, procedural, distributive, redistributive, regulatory) are described. Policy competence, or an understanding of policy formulation, implementation, and modification, is important for public health nurses because of the ability to influence both the policy process and the impact of policies on the clients. PHNs need to determine first the level at which policies are considered (e.g., local, state, national).
The legislative process (i.e., how a bill becomes law, rulemaking, implementation, evaluation, judicial action) occurs in similar ways at the state and national levels. Policy analysis requires the ability to comprehend policy from various viewpoints, and the rational framework and Kingdon’s framework, along with Longest’s model, provide guidance in determining windows of opportunity upon which public health nurses may act to initiate policy changes.
The political process is inherent in the development of health policies, and the public health nurse has a role in policy and advocacy within those processes. Lillian Wald, and others like her, provided a rich history of political action and advocacy in public health nursing as they worked to provide a voice for vulnerable and disenfranchised populations.
Social justice remains a pillar of our current practice.
Advocacy for our clients is always important, but professional advocacy through affiliation and activity in our professional nursing organizations is also vital so that we, as PHNs, may have a “collective voice.” Politics may be uncomfortable and foreign to many of us, yet it provides the methods for needed change through lobbying or influencing legislators. Nurses and special interests groups can gain access to legislators individually or through the services of a professional lobbyist or PACs. Nurses can also serve on various advisory and community boards, and provide input on policy matters by sharing expertise, research/evidence, and personal experiences.
Policies are actions or agendas that can be used to implement important goals and objectives, such as the health objectives found in Healthy People 2020, and PHNs can use processes to impact policy formulation, adoption, implementation, and evaluation. Tips on how to influence policy makers were outlined, and nurses may consider volunteering time to a candidate of their choice as a means of gaining greater access to the political process.
Nurses’ role in health care reform was discussed, along with IOM’s The Future of Nursing and examples of lobbying efforts. Current U.S. policies, including the ACA and the National Prevention Strategy, provide opportunities for PHNs to improve the health of populations and share with policy makers and legislators the importance of social determinants of health.
Community health nursing is by nature political because we deal with many issues that affect the health and well-being of the diverse populations we serve. Power and
empowerment are important concepts to both public health nursing and politics; Arnstein’s ladder provides guidance on citizen participation. Every community health nurse should hone political action and advocacy skills.