promotion may best be facilitated by the use of empowerment and assisting individuals and communities in articulating their problems and solutions. Discovering what is most important to the community and providing access to that information while supporting leadership from within the community and encouraging them to overcome bureaucratic hurdles to action are important parts of community empowerment. This helps to improve problem-solving skills and abilities (Kulbok, Thatcher, Park, & Meszaros, 2012; Piper, 2011; Wong, Zimmerman, & Parker, 2010). Maryland and Gonzalez (2012) note that sharing personal experiences and stories with legislators is one effective method of advocacy.
Real stories about clients having problems gaining access to services or resources, not receiving adequate or timely treatment, or about the need for more school nurses who are currently spread so thin that they cannot adequately perform their assigned roles and functions. Firsthand knowledge of how our health care system works (or doesn’t work) can be very persuasive when a nurse shares personal examples in a way that demonstrates a passion for clients and communities.
So, how can PHNs influence policies that affect the clients and communities they serve? And, how do we influence policymakers to hear our concerns and act on them?
Seasoned advocates have developed skills in influencing policy decisions; ground rules also exist by which to play the game. Some call them the “ten commandments of lobbying.”
However these steps are described, advocates adhere to the basic ideas inherent in the following:
1. Honesty is the best policy. Being known as someone who has integrity is a lasting virtue. Never mislead a legislator or someone who is likely to support your interests, as it is difficult to regain credibility once you lose it. Speaking beyond your level of expertise gets advocates into trouble. If you don’t know the answer, say so; but if you promise to get the answer, then do so. Do not promise what you can’t deliver.
2. Start early. Planning always takes longer than you think it will. Your interests are not everyone’s interests and convincing others they should be involved always involves time. If you are planning policy change at the state or federal level, it is vital to know the legislative process and the critical time lines.
3. Know what you want. Be aware of all sides of the issue prior to approaching a policy maker, know the pros and cons, and be prepared to answer questions and provide data on both sides of the issue. Understand the role politics plays in getting what you want and how policy makers may respond to your issue. Targeting your story to the goals, emotions, and interests of the legislator is important and may result in a positive outcome. Be clear about what you are asking the legislator for—to carry legislation, or to vote no or yes on specific legislation. Asking your legislator to vote a certain way is perfectly legitimate, and if you don’t ask, the opposition will.
4. KISS (Keep it simple, stupid). Be able to articulate your issues in a clear and concise manner. Do not confuse possible supporters with complicated arguments. Key issues should be concise and clear and on one page, no more than two. Leave behind an informational packet with pertinent information about the community and/or services
and programs.
5. No permanent enemies, no permanent friends. Political affiliation doesn’t always determine what interests a person has or whether they are likely to support your interests. It behooves you to speak with everyone on your issue; if nothing else, you may find out who they are and why they may oppose your concerns. Remember, in politics, there are only permanent interests.
6. Know your opponents. Visit with all possible supporters—just because someone opposed you in the past doesn’t mean they won’t support you on a current issue.
Respectful disagreement keeps the door open for future agreement and compromise.
7. Compromise. Ask for much more than you think you can get. When negotiating, you can give up something without hurting your priorities or your bottom line. In politics, rarely does anyone get all they want, but priority setting is key: What do we expect to accomplish with this activity?
8. There is strength in numbers. The more groups involved, the more likely you are to be successful. Any opportunity for networking is an opportunity to enlarge your coalition. Including disparate groups means you may have accessed conflicting political persuasions. Additionally, it is useful to have groups who can speak with those who are not viewed as “friends.” Cross-fertilization of groups is politically expedient, but understand that next time you or they may be in opposition.
9. Work at the local level. Legislators are interested in their constituents—these are the people who elected them to office and who will keep them in office. To be noticed by policy makers, sharing information with them about their constituents is the surest way to capture their attention. Information sharing should occur on issues both in the community where you live and in the one where you work.
10. Thank you. Everyone loves to be told, “Job well done.” To maintain your coalitions, always recognize the work of others. Spreading the credit is like sowing seeds: the wider the spread, the more bountiful the crop.
Common methods of generating a conversation with legislators are by e-mail, over phone, or in person. Often, your first contact will be a staff member. It is important to organize your thoughts and carefully craft an “Ask” or what legislation you want the legislator to support that is also something of interest to them and their constituents (Kostas-Polston et al., 2015, p. 12). If possible, you can prepare a “one-pager,” with your contact information and credentials listed, along with brief bulleted points on the subject of interest that includes current statistics and research (p. 13). If you meet with a legislator, it is important to remember that they are not allowed to discuss campaign contributions in their legislative offices. Finally, it is important for those new to advocacy to understand that the thing with the most critical influence on policy is money. Nurses, even with the passage of the recent health care reform legislation, must become even more actively involved in the process of influencing policy. How many nurses understand that the nurse practice acts, or portions thereof, under which they work are developed by legislators or special interest groups who don’t have a background in health care? How many nurses know who their
legislators are at either the state or federal level? How many nurses have written their legislators about pending health care legislation or legislation that affects nursing?
Political Action Committees
One reason why nurses are less politically active can be tied to a lack of money. Nurses don’t earn as much money or appear not to have access to as much money as other health care interests (e.g., hospitals, physicians, insurance companies, and health care plans), and as such, there is much less money for nursing organizations to use for lobbyists or to assist chosen candidates. As mentioned earlier, the ANA has a PAC that supports federal candidates on a nonpartisan basis; candidates must demonstrate an interest in and willingness to vote for nursing issues or issues that nurses support. To participate in the PAC, you must be a member of ANA (this also allows your family to contribute to the PAC). By giving to the ANA-PAC, one maximizes their contribution by joining with other nurses—this power in numbers increases our influence with those candidates we choose to endorse. ANA-PAC has the “Race for the Million” campaign to raise money in support of candidates and legislators who back nurses’ issues (Song, n.d.). However, giving to your personal legislator can keep you on their mailing list, and it may get you invited to local legislative activities. It also lets your legislator know you are interested in whether she remains in office. Being in regular contact with your legislators provides an avenue for introducing legislation that impacts nursing or other health-related issues, and when you call to ask for a vote “for” or “against” an issue, the legislator is more likely to entertain your request. Aren’t you more likely to respond to someone you know, rather than someone who comes to you out of the blue to ask for a favor?
Lobbyists may work for PACs or independently represent various special interests or groups. Lobbying is the process of influencing legislators or other policy makers to make decisions on policy issues. Professional organizations or other special interest groups (individuals who share a common interest and work politically to make their goals a reality) may retain paid lobbyists. Lobbyists are professionals who know the rules governing the state or federal political process, have or develop relationships with policy makers, provide guidance for members of the organizations employing them on how to impact public policy decisions, and work behind the scenes to influence policy discussions and outcomes. States and the federal government have laws and regulations that determine the legal actions of lobbyists as well as the organizations that employ them (Mason et al., 2016; Milstead, 2016). However, some lobbyists are former legislators or staff members who “take lucrative jobs representing the very industries” they formerly regulated, and this “revolving door”
lobbying is disconcerting to most citizens as they are often seen as selling their access to current key legislators (LaPira & Thomas, 2014, p. 4).
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.