Nursing’s Role in Health Care Reform
Since the 1950s, the ANA has advocated for reforms in health care that will benefit both nurses and their patients. Their involvement in federal health care reform began in the 1960s with the passage of Medicaid and Medicare. In the 1970s, ANA formed a political action committee (PAC). PACs are organizations that raise money to contribute to political parties or candidates, with the understanding that those receiving financial and political support will be sympathetic toward issues of interest to members of the PAC.
In 1991, ANA released Nursing’s Agenda for Health Care Reform: A Call to Action—a plan so ambitious and forward looking that Senator Kennedy referenced this document when introducing his legislation on health care reform. Even though this legislation failed to pass, ANA and other nursing organizations gained wide recognition for their policy acumen and leadership abilities. During the Clinton-era health care debate, ANA continued to play a key role in the policy and political discussions on health care reform. As research and experience continued to show the need for health care reform, ANA remained steadfast in its advocacy and updated the policy agenda on health care reform and progress toward a more balanced approach incorporating primary care, community-based care, and preventive services. ANA supported the development of a single-payer system.
Understanding the time was ripe for health care reform, the ANA-PAC identified those legislators supportive of ANA’s legislative and regulatory agenda. They provided financial and political support and increased their grassroots organizing. RNs nationwide responded and through multiple activities (e.g., contacting members of Congress, testifying at hearings, sharing personal stories, participating in high-profile press conferences, attending rallies and events) lobbied for action (see Display 13–1). The frontline nurses also joined ANA’s health care reform team, and through these concentrated efforts and collaborations, health care reform became a reality in March 2010 (Lewenson, 2015).
DISPLAY 13.1 AMERICAN
NURSES ASSOCIATION (ANA) LOBBYING
Participated in hundreds of media interviews Participated in dozens of local media events Testified before three Congressional Committees
Met with White House and Congressional health care reform staff
Participated in two presidential press conferences at the White House: ANA was one of only 150 representatives invited to participate in the White House Health Care Summit on March 5, 2009
Participated in the June 25, 2009 rally—Health Care for America Now
Gathered at the July 15, 2009, Rose Garden event where President Obama personally thanked ANA for its involvement in health care reform efforts Helped organize America’s national-call-in day to Congress in October 2009 (ANA, 2011).
Nurses are increasingly becoming shapers of policy on both the local and federal level;
this is occurring because of our experience, perspective, and expertise in health care. The realization that improving conditions for nursing also improves conditions for the communities we serve and the larger society in which we live and work has enhanced our ability to organize. This increases our visibility, access to policy makers, and, more importantly, our capacity to influence the political process (Kostas-Polston et al., 2015).
See From the Case Files V: Nurses Lobby Congress.
From the Case Files V
Nurses Lobby Congress
Over 260 nurses came to Washington, DC, in June 2015 to meet and talk with over 200 members of Congress. They learned that legislators want them to participate and share their professional perspective on issues related to health, and Rep. Michelle Lujan Grisham noted that nurses have been “the best champions for health care” and have tirelessly advocated for “long-term care, public health, and greater access to care” (ANA, 2016, para. 6). At the same time, over 1,500 nurses participated in virtual Lobby Day by tweeting, posting on Facebook, and sending e-mails to their members of Congress. Some also visited their local legislator’s district offices. The nurses advocated for passing legislation—specifically the Registered Nurse Safe Staffing Act (H.R. 876/S.58), the Veterans Access to Care Act (H.R. 1247), and the Home Health Care Planning Improvement Act (H.R. 2267/S. 227), as well as asking for increased funding for Nursing Workforce Development. Through their earlier efforts, 100 new cosponsors for the nurse staffing and home health bills were found.
This is an annual event sponsored by the American Nurses Association.
Do you know about Lobby Days at your local state capitol? Do nurses participate? Which nursing organizations or groups have lobbyists working with your state legislators?
Look up the three bills mentioned above (www.thomas.gov) and analyze how this legislation might improve nursing care and patient outcomes.
American Nurses Association (ANA). (2016). ANA Lobby Day: Let the advocacy begin. The American Nurse.
Retrieved from http://www.theamericannurse.org/index.php/2015/08/31/ana-lobby-day-let-the-advocacy- begin-2/
Nurses represent the largest number of health care practitioners in America—more than 3 million—and are poised at the frontline in patient care to play a major role in implementing of health care reform. Being fully involved in the regulatory framework development (e.g., how the law will be implemented) will further demonstrate the advocacy of nurses as they work to improve the health care delivery system and remove barriers that prevent nurses from providing high-quality, competent, appropriate care. However, to change the existing system, the barriers to competent, quality care (e.g., nursing shortages, faculty shortages, a lack of proper education and training) that prevent nursing from taking its rightful place among the cadre of providers must be addressed. To that end, the Robert Wood Johnson Foundation (2010) in collaboration with the IOM began the activities necessary to “assess and transform” nursing. The document resulting from this evaluation is The Future of Nursing: Leading Change, Advancing Health (IOM, 2011). To encourage and assure public participation, three forums were held around the country.
The Future of Nursing is a seminal document that addresses the need to reform the health care and public health system of the 21st century and outlines nursing’s pivotal role in this. This is the first time nurses are seen as key to “meeting current and future health care needs” (Schultz, 2010, p. 345). In the development of this document, the process was open to all. This allowed nursing to address challenges to the profession while simultaneously putting forth solutions that result in a rationale and a comprehensive approach to the delivery of high-quality health care for all. It also encourages system responsiveness to the needs of those accessing care.
As expected, the nursing organizations were active in the process of developing this document and participated in the National Summit on Advancing Health through Nursing held in late 2010 to discuss the implications of the recommendations for the future of health care and the future role of nurses in America (Robert Wood Johnson Foundation, 2010). Four key messages from The Future of Nursing: Leading Change, Advancing Health (IOM, 2011, p. 4) include the following:
1. Nurses should practice to the full extent of their education and training.
2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.
The resulting eight recommendations are
Recommendation 1—Remove scope of practice barriers. Advanced practice RNs should be able to practice to the full extent of their education and training (p. 9). Lewenson (2015) notes the historical and current documents that call for nurses to practice to the full extent of their education and to remove barriers to practice.
Recommendation 2—Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Private and public funders, health care organizations, nursing education programs, and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices (p. 11).
Recommendation 3—Implement nurse residency programs. State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas (p. 11).
Recommendation 4—Increase the proportion of nurses with a baccalaureate degree to 80%
by 2020. Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan (p. 12).
Recommendation 5—Double the number of nurses with a doctorate by 2020. Schools of nursing, with support from private and public funders, academic administrators and university trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to increasing diversity (p. 13).
Recommendation 6—Ensure that nurses engage in lifelong learning. Accrediting bodies, schools of nursing, health care organizations, and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan (p. 13).
Recommendation 7—Prepare and enable nurses to lead change to advance health. Nurses, nursing education programs, and nursing associations should prepare the nursing
workforce to assume leadership positions across all levels, whereas public, private, and governmental health care decision-makers should ensure that leadership positions are available to and filled by nurses (p. 14).
Recommendation 8—Build an infrastructure for the collection and analysis of interprofessional health care workforce data. The National Health Care Workforce Commission, with oversight from the Government Accountability Office and the HRSA, should lead a collaborative effort to improve research and the collection and analysis of data on health care workforce requirements. The Workforce Commission and the HRSA should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor in this effort to ensure that the data are timely and publicly accessible (p. 14).
Nurses are realizing that they are an important force in health care and should be at the table with other stakeholders when important decisions are being made. The IOM report on nursing is a clear hallmark of our growth in the area of health policy and health reform.
Health care reform legislation has the potential to transform the current system to be more responsive to the least among us, is more focused on primary care and prevention, and encourages wellness and disease prevention. The resulting system change will be based on research and data collection that fosters better patient outcomes and high-quality care, but more importantly, without the anticipated transformation of nursing, it cannot occur.
“Nurses’ regular, close proximity to patients and scientific understanding of care processes across the continuum of care give them a unique ability to act as partners with other health professionals and to lead in the improvement and redesign of the health care system and its many practice environments, including hospitals, schools, homes, retail health clinics, long- term care facilities, battlefields, and community and public health centers” (IOM, 2011, p.
S-3). This is a mandate for community health nurses to be actively involved in advocacy and influencing the future development of our health care system.