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Political Action in Nursing Lydia M. Lopez, MSN, RN, C

Nursing 206“One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors.” -Plato

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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

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Introduction

• Nurses have influenced politics in many ways, even from the very beginning. Today’s 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 decision-making 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

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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

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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

Nurses and Political Action

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

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Nurses and Political Action

Influence can be exerted on:Workplace by affecting the development of institutional policies,Community through activities on local boardsProfessional organizations by participating on committees or serving as an officer, andGovernment 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

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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 Liberals

• Less governmental regulation

• Fewer taxes• Smaller social programs• Antiabortion• Anti–gun control• Anti-stem cell research • Anti–socialized health care• Pro-choice on education• Fundamentalist religious

values

• 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, pro–gun

control, pro–government-regulated health care, and anti-choice 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 Nurse’s 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

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

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Nurse’s 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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Nursing’s Political Weaknesses

• Primarily, relatively new to the political arena

• Historically, been a lack of ideological and political unity within the profession

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 reduced-rate 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)28

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

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http://www.nursingworld.org/FunctionalMenuCategories/AboutANA/

WhatWeDo/Nursing-Video-Gallery/HOD-2010-Obama-Speech.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

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

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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• Register to vote: an initial step to becoming influential in

the political process• Communication with legislators and officials

• 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

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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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Nursing’s 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

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 (LAW-

Bill Passed June 2008)• Nursing Care Quality Protection Act

(LAW-Passed July 2009)• Protecting the title “nurse” (LAW) 50

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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 home “quicker and sicker”

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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 candidate’s 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

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What Drives Legislation?

• Who introduces legislation?• Any elected official, including governor,

mayors, county commissioners, city council members

• Issues:• Funding• Public demand (Megan’s Law)• Program issues (requests for increase in

cable TV rates• Constituent-specific issues (cost of

prescription meds for elderly)

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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

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

64Assemblywoman Aileen Gunther, RN

Nurse in the NYS Senate

65Hon. Ruth-Hassell Thompson

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National Nurse Legislators

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

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

The next one could be YOU….!

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

California