Political Action in Nursing

One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors. -Plato

Lydia M. Lopez, MSN, RN, C Nursing 206

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Nuts and Bolts Approach to Politics

Ask

not what your country can do for you, but what you can do for your country. J.F.K.
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New York State Capitol

Introduction
Nurses have influenced politics in many ways, even from the very beginning. Todays ever-changing health care environment creates the need for all nurses to be more politically aware.

What exactly is Politics?

Ways in which people try to influence decisionmaking and the allocation of scarce resources Vital took that enables the nurse to nurse smarter The art or science of influencing or guiding governmental policy

What are Political Issues?

Those created, affected or regulated by decisions within either the executive, judicial or legislative branches of government. Partisan: when political parties take opposing positions on an issue

Politics and Nurses

Historically, most nurses avoided becoming engaged in government or politics Nurses can gain much by using the tools of political action Their professional survival depends on it
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Nurses and Political Action

Politics is a means to an end, the end consisting of public policy Political involvement leads to public policy formation If nurses wish to affect outcomes in policy formation, they must be involved in politics The term politics refers to the "exercise of influence" 8

Nurses and Political Action

Influence can be exerted on:
Workplace by affecting the development of institutional policies, Community through activities on local boards Professional organizations by participating on committees or serving as an officer, and Government through involvement in campaigns, letter writing, and voting
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Political Action
Political action: a set of activities, methods, tactics, and behaviors that affect or have the potential to affect governmental and legislative processes and outcomes Examples Grassroots efforts to change policies Activities of lobbyists to change elected officials opinions or votes Compromise within legislative bodies Veto by the chief executive of a governmental structure
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3 Processes of Government
Partisanship
Membership in a political party

Self-interest
Most important factor in politics
Dictates the kind of issue the legislator becomes involved in and present to their constituents as the key issue

Ideology
Embodies beliefs and principles of an individual or group (i.e., conservatives, liberals, radicals)
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What are Political Parties?

Organized groups with distinct ideologies that seek to control government.

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Other Political Groups

Common cause: a consumer lobbying group AARP: American Association of Retired Persons League for Women Voters Church organizations

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Conservatives
Less governmental regulation Fewer taxes Smaller social programs Antiabortion Antigun control Anti-stem cell research Antisocialized health care Pro-choice on education Fundamentalist religious values

Liberals
Government has a moral responsibility to do good for society Larger government structures Increased taxes Spending for a wide range of social programs Pro-choice, progun control, pro government-regulated health care, and antichoice on education

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Other Political Parties

Libertarians Populists Radicals

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Relevance of the Political Process for Nurses

Political process is relevant to nurses because many questions regarding care are answered through legislation:
What difference does it make for patients? What difference does it make for healthcare Why be involved as an individual? Why be involved as part of a group?
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What Are the Skills That Make Up a Nurses Political Savvy ?

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Nursing, Policy & Politics

It is through knowledge, experience and intimacy with the health care needs of the population that nursing is in the unique position to bring balanced to the policy making process

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Health Care Decisions Will Be Made with or without Nurses Input

Patient care is a political endeavor Essential that nurses are involved to ensure that the nursing perspective is represented

Nurses Political Strength

Most sizeable group of health care providers Nurses have traditionally been perceived in a favorable light Once nurses become involved in health policy, they usually continue to be active Best method for nurses to influence those in power is by
Taking an active role in institutional decision-making
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Nursings Political Weaknesses

Primarily, relatively new to the political arena Historically, been a lack of ideological and political unity within the profession

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Health Policy

Nurses Involvement in Health Policy and Political Action

Health Care Decisions Will Be Made With or Without the Input of Nurses

Patient care is a political endeavor Essential that nurses are involved to ensure that the nursing perspective is represented

What is Health Policy?

Set course of action undertaken by governments or health care organizations to obtain a desired health outcome Private health policy Public health policy

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Health Policy at the Local, State, and Federal Levels

Local health policy Cities or counties offer a variety of health care services to meet the needs of their residents Examples include free or reducedrate immunizations, tobacco-free public buildings, safe drinking water, enforcement of seat belt and child restraint laws, and provision of an emergency medical system

Health Policy at the Local, State, and Federal Levels

State health policy Governs nursing practice through the Nursing Practice Act Provides invisible services through regulatory activities Ensuring that health care facilities provide safe, quality care Pays for health care services through various programs

Health Policy at the Local, State, and Federal Levels

Federal health policy Funds health-related research Funds education for health professionals, including nurses and physicians Pays for health care through Medicare, Medicaid, SCHIP, and the Veterans Administration Health Care system Plays a monumental role in shaping nursing practice

Health Policy at the Local, State, and Federal Levels

Historical examples of federal health policy that shaped nursing practice:
Nursing Practice Acts and registration of nurses (implemented in most states by 1910) Sheppard-Towner Act (1921) Hill-Burton Act (1950) Medicare Program (1965) Renal Disease Program (1972) Diagnosis-Related Groups (DRGs) (1983)
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Overview: Health Policy Development

Complex, dynamic process that occurs in a variety of ways Enactment of legislation and accompanying rules and regulations that carry the weight of law Administrative decisions made by various governmental agencies Judicial decisions that interpret the law

Legislation and Health Policy Development

Legislative process is fundamental to movement from a public problem to a viable program Societal problems that may qualify for a policy solution are those brought to the attention of a policy maker who is willing to take definitive action through the policy process

Introduction of Legislation
Federal level: Congressional members State: State Assemblyperson or State Senator

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Health Policy & Health Care Reform

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Healthcare Reform & Nurses

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President Obama & ANA HOD

http://www.nursingworld.org/Functional MenuCategories/AboutANA/WhatWeDo/N ursing-Video-Gallery/HOD-2010-ObamaSpeech.aspx.

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Three Branches of Government

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The Political Process

Where laws begin
Any elected official Lobbyists Constituency groups Advocates Public interest groups Governmental agencies
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Grassroots Political Strategies

Registering to vote and voting in all elections Joining a professional nursing organization Working in candidates campaigns Attending a meet the candidates town hall meeting Visiting personally with policy makers or their staff (Lobbying) Communicating with policy makers by e-mail, fax, and phone

Influencing the Political Process

Become informed
News media Specialized publications Internet websites
http:///www.nursingworld.org

Organizational meetings
Nursing organizations and other health-related organization

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Influencing the Political Process

Voting Communication with legislators and officials
Register to vote: an initial step to becoming influential in the political process
Legislators are affected by the views of their consitituents:most significant impact on health care reform

Letter writing: personal letter (greatest impact & preferred way to communicate), no form letters Email Spamming Telephone calls: most immediate communication of your views Visits to congressional or state representatives Attend public meetings (town hall meetings) Constitutent pressure is perhaps the most effective weapon for lobbyist 39

Influencing the Political Process

Group action: attention is paid to positions held by groups of nurses Non-lobbying nursing organizational effort-nonprofit groups involved in politics: these groups testify to facts, organizational positions and concerns in the health care arena.
Ex., ANA
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Influencing the Political Process. cont.

Political Action Committee (PACs)
Political groups created by organizations to finance political campaigns Lobby for the passage or defeat of bills Support candidates for public office Ex., ANA-PAC, NYSNA-PAC
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Influencing the Political Process..cont.

Testify for decision-making bodies Individual support for legislation & candidates Working in policy-making agencies Seeking election to an office

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Finding the Answers

How would a nurse find the answer to the following questions: Who is the state Senator? Who is the state Representative? Who is the federal Senator? Who is the federal Representative?

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The Art of Lobbying

Lobbying is the attempt to influence or sway a public official to take a desired action Characterized as the education of legislators regarding nursing issues
Majority of legislators do not have health care background

Lobbyist keep organizations informed of proposed changes to a piece of legislation Demands that nurses are aware of current issues and proposed legislation
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Methods of Lobbying
Most familiar is the face to face Grassroots
Involves mobilizing a committed constituency to influence the opinions of policy makers
Organized letter writing Implementing campaigns designed to mobilize public opinion

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Promoting a Particular Legislative Agenda

Nurses want to begin by enlisting policy makers who have the following characteristics:
Legitimate power An interest in the power An affinity for nursing or health care in general Time and energy to invest in the process The respect of colleagues Committee or other positions that are appropriate to the particular legislation
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Lobbying Campaign
Letter writing Personal visits: more powerful Political campaigns

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Building Coalitions
Coalition: Group of individuals or organizations that share a common interest in a single issue Based on the assumption that there is strength in numbers Formal structure to meet a common goal Capitalize on all members strength

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Nursings Legislative Agenda

Four goals:
Maintain control of nursing practice Influence health care policy development & reform Advocated on behalf of health care consumers Initiate workplace reforms

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Current Legislative Activity: NYS

Safe Staffing Ratios Educational Advancement for RNs Addressing Violence Against Nurses (LAW-PASSED SEPT. 2010 Safe Patient Handling Prohibiting mandatory overtime (LAWBill Passed June 2008) Nursing Care Quality Protection Act (LAW-Passed July 2009) Protecting the title nurse (LAW) 50

How to Be Politically Active

Identify specific goals that affect nurses Examples:

Sicker clients who require more complex levels care Increasing responsibilities for nurses in delegation and supervision of unlicensed healthcare personnel Loss of control of the work environment through managed care organizations Shorter hospital stays resulting in clients being sent 51 home quicker and sicker

How to Be Politically Active

Four groups of people
Haves Have nots Have a little and want more (nurses): possess the most potential for bringing about change Sit back and watch

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How to Be Politically Active

Nurses in office Develop a political relationship with a legislator or a political operative Begin with local legislators and candidates Identify an issue Attend political events Know and understand the issues Learn and use tactics Join professional organizations
Best way for nurses to influence legislative process at the federal and state level. Organization speaks with a unified voice when presenting their concerns
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Maintaining a Working Relationship with an Official

Express appreciation for efforts Attend political social functions where elected officials appear Be honest, forthright Do homework on issues Work on a campaign/contribute money Maintain an open communication
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Participating in the Election Process

First, study the positions to be filled Select the candidate whose views on healthcare closely match yours Find candidates headquarters, contact the volunteer coordinator and see if help is needed-identify yourself as a nurse.
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Locating Information
Professional organizations
New York State Nurses Association: www.nysna.org. American Nurses Association: nursingworld.org

State
http://www.state.nu.us/

Federal
For issues on the national level Thomas Legislative Information: an easy method to track status of federal legislation
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Letter Writing
Describe bill by number and title Introduce yourself as a constituent; include return address Be succinct and to the point; one page Use conversational terms; include personal experiences Include facts and figures that support your view State the actions you want taken Be persuasive, not argumentative or demanding Thank the legislator 57

What Drives Legislation?

Who introduces legislation?
Any elected official, including governor, mayors, county commissioners, city council members

Issues:
Funding Public demand (Megans Law) Program issues (requests for increase in cable TV rates Constituent-specific issues (cost of 58 prescription meds for elderly)

How Bills Become Law

Sponsors sign on Tracking number assigned Referred to a committee Committee hearings Scheduled debate Passage or veto The fiscal note Housekeeping bills
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Bill Consideration on the Floor of the Legislative Body of its Origin

Bill is read in its original or revised form Members vote to accept or reject it Nurses can telephone, write or visit with their elected officials from legislative districts in which they reside

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Act of Congress
When a bill is passed by both the House & Senate, it becomes an Act of Congress The act is referred to the President, who may sign the bill into law or veto the bill Nurses can write or telephone the White House:
The White House 1600 Pennsylvania Ave NW Washington, DC 202-456-1111 202-456-1414 Fax: 202-456-2461 president@whitehouse.gov

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Do you know who is your representative?

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Do you know who is your representative?

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Nurse in the House

Assemblywoman Aileen Gunther, RN

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Nurse in the NYS Senate

Hon. Ruth-Hassell Thompson

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National Nurse Legislators

Carolyn McCarthy, LPN, (D), 4th Congressional District, NY

Lois Capps, RN, (D), 22nd Congressional District, California

Eddie Bernice Johnson, RN, (D), 30th Congressional District, Tx

The next one could be YOU.!

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