Influencing Health Care in the Legislative Arena

Sheila Abood, PhD, RN


Online J Issues Nurs. 2007;12(1) 

In This Article

Abstract and Introduction

Nurses are well aware that today's health care system is in trouble and in need of change. The experiences of many nurses practicing in the real world of health care are motivating them to take on some form of an advocacy role in order to influence a change in policies, laws, or regulations that govern the larger health care system. This type of advocacy necessitates stepping beyond their own practice setting and into the less familiar world of policy and politics, a world in which many nurses do not feel prepared to operate effectively. Successful policy advocacy depends on having the power, the will, the time, and the energy, along with the political skills needed to 'play the game' in the legislative arena. This article describes the role of the nurse as health care policy advocate, identifies the power bases available to nurses as they assume that role, discusses the policy process in the legislative arena, and presents strategies for effective action. A list of selected online resources is included to help readers learn more about shaping and influencing future health policy.

The current health care environment with a myriad of policies, laws, and regulations imposed by government agencies, private sector insurers, and institutions, challenges both nurses and patients who are often caught between the cross currents of cost constraints and access to appropriate quality care. De Navas-Walt, Proctor, and Hill Lee (2006) draw on the United States Census Bureau data collected in 2005 in reporting that the number of uninsured has grown to 46.6 million while the cost of health care continues to rise. A recent report compiled by the Commonwealth Fund found that a highly variable quality of care is delivered by a system that is too often poorly coordinated, thus driving up costs, and putting patients at risk (Schoen, Davis, How, & Schoenbaum, 2006). Given today's rising costs, deteriorating access, and variable quality, improving health care performance is a matter of national urgency (Carey, 2006).

These discouraging reports noted above are not a surprise to most practicing nurses. As nurses interact with patients and their families, they are often the first providers to see clearly when and how the health care system is not effectively meeting patient needs. Every day nurses are positioned to see not only the impact of health policy on individual patients but also the need for more comprehensive changes in the policies that address many health-related issues (Kendig, 2006). Nurses come face to face with issues associated with patient safety and satisfaction, access to services, clinical outcomes, and health disparities. Dealing with these concerns and other workplace issues that having broad implications for whole groups of people, nurses have the choice to continue on trying to make do while feeling victimized by current changes (Mick, 2004) or to motivate themselves to take action and find opportunities to bring about change in the health care system itself.

When they choose to take on the role of policy advocate to change the system, nurses often have to move out of the comfort zone of their practice arena and into less familiar arenas where the laws and regulations impacting patient care are developed, and the battles for scarce resources are negotiated and decided. As challenging and time consuming as it may be, accepting this responsibility offers nurses the unique opportunity to make a difference and to have the satisfaction of being part of bringing a better health care system into reality for themselves and their patients. Advocacy adds a dimension to their professional practice that offers the reward of having more control over patient care and outcomes.

Successful advocacy to bring about changes in the health care system demands access to the resources of power, will, time, and energy, along with necessary political skills. In an effort to encourage more registered nurses to take action in the public health policy arena, this article describes the role of the nurse as health care policy advocate; identifies the power bases available to nurses as they assume an advocacy role to make changes in today's health care system; discusses the policy process in the legislative arena; presents strategies for effective action; and lists selected resources to help develop the confidence and skills to shape and influence health policy.


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