Influencing Health Care in the Legislative Arena

Sheila Abood, PhD, RN


Online J Issues Nurs. 2007;12(1) 

In This Article

Ways to Advocate for Health

Beginning with Florence Nightingale, there have been outstanding examples of individual nurses throughout the history of the profession who have demonstrated their capacity to shape health. Nurses have done this through initiating policy proposals, changing or vetoing others' proposals, and/or substantially influencing the implementation of health policy. As in earlier times, many nurses today are inspired to take on some form of advocacy to bring about change in the current policies, laws, or regulations that govern the larger health care system. Becoming comfortable with the advocacy role takes a little preparation and some experience but does not need to be overwhelming.

Many state nursing and specialty nursing organizations sponsor annual state legislative days, offer policy internships or fellowships (Hofler, 2006), and conduct policy workshops, all designed to give nurses the opportunity to learn more about current health care issues and the legislative process. They provide new advocates with easy access to more experienced nurse advocates willing to serve as mentors. Jan Howard, an experienced nurse advocate from New York, has served as a mentor to many fledging advocates. She reports that it's exciting to watch a registered nurse with no legislative experience grow into the realization that she/he can make a difference for the profession legislatively. Another nurse stated, "I had no idea how important legislation was to my practice at the bedside." It's rewarding to watch a nurse progress from saying, "Please go with me for the legislative visit. I won't know what to say," to one who can independently discuss legislative issues and articulate his/her position so well that the legislator becomes supportive of the legislation being discussed.

Any nurse who has an interest in influencing the policy process, even one with limited time and resources, can find a way to become a confident advocate. It's up to you as the advocate to decide on strategies you think will be effective, that you feel comfortable doing, and that are realistic given your time and energy. There are multiple ways to get actively involved ranging from simply writing a letter or making a call about an issue to getting elected to public office.

Once one is aware of a situation in which a change in policy would improve the health care environment or the delivery system, one can move to exploring the pros and cons of possible solutions, and then work to get others interested and involved in the issue. Depending one's level of confidence and where the issue is in the policy process, one could also testify about the problem at public meetings and describe the merits of the solution one is advocating, lobby decision makers for or against proposed health policy changes under consideration, and/or work with the media to bring attention to the problem and the proposed solutions.

Many issues are too big or complex to be easily resolved by a few phone calls or even the dedicated efforts of one person. In reality, very few policy changes take place without the concerted efforts of many advocates working together to bring about a common goal.

Complex health care policies require the knowledge and efforts of organized groups, the help of professional lobbyists, and sustained activity of months or even years. Joining a professional nursing organization is an important way to enhance individual advocacy efforts. Nurses in an organized professional association have more resources, and are able to strategize more effectively to bring nursing's perspective to health policy decision makers than do individual nurses. Professional nursing organizations are able to monitor public policy and offer ways for their members to learn about health policy. They also serve as a resource for reliable information related to policy issues and policy makers.

Another way that professional associations work for the benefit of nurse advocates is by providing information and tools to ensure that candidates who are supportive of nursing are elected to, or remain in, office. Registering to vote and voting in all elections is a must for every nurse advocate (Cherry & Trotter Betts, 2005). Here again, being part of a professional association with an established political action committee (PAC) can be very helpful in discovering where elected officials stand on issues and finding opportunities to work for the candidates who are supportive of nursing and health care issues.


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