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Ten ways to enhance the nursing profession's lobbying efforts with government
CHILD HEALTH POLICY Column Editors: Barbara Velsor-Friedrich, PhD, RN, and Doris Biester, PhD, RN, FAAN
Ten Ways to Enhance the Nursing Profession's Lobbying Efforts With Government Kathleen Kovalik, BSN, RN, MPH nurses are to take their rightful place in I f setting health policy, they must know the issues as well as understand the political system and participate in it. Some of the issues that surround nursing as a profession include scope of practice, reimbursement, unlicensed assistant personnel, and advanced practice. These issues have contributed to the debates about legislative and regulatory changes in health care policy. In addition to these issues that have challenged nursing practice, the image of the profession has been affected. There have been increasingly wide and obvious discrepancies between the importance and sensitivity of the work nurses do and the level of reward--economic and professional--that can be expected for that work. Becoming informed and involved as nurses and citizens is crucial. Nurses in all practice settings must be knowledgeable of and active in the political process because it is this process that drives the health and welfare delivery systems (Milburn, Hays, & Griffith, 1988; Wakefield, 1990). It is essential that we take our legitimate place as players in the arena in which decisions are made, whether it be the U.S. Congress, state legislatures, local government, professional nursing associations, or the workplace. I have spent a good deal of time during the last several years as a nurse lobbyist interacting with Pennsylvania's elected officials. In November 1992, as health care reform gained momentum, professional nursing associations lobbied Kathleen Kovalik, BSN, RN, MPH, lives in Hershey, PA. She maintains an interest in government relations and continues to address professional nursing issues at the local, state, and national levels. Copyright 9 1995 by W.B. Saunders Company 0882-5963 / 95/1005-000853. O0/ 0 328
and presented health care testimony before state committees and Congress. In 1994, the nursing community was visible with endorsements and financial contributions to the candidates of their home states. Whenever a campaign plank focused on health care, nurses were there to mobilize, organize, and provide candidates with the facts, the ideas, and the perspective to improve the U.S. health care system. Throughout this time, I did not meet one politician who did not welcome this support from nurses; however, several remarked that there were few nurses involved within the political process and questioned the lack of participation. Politicians learned early in the health care debate that professional nurses work hard and know the issues. Nurses persuaded those who managed campaigns that nurses have the skills to motivate others to action and that we have the commitment to effect change. The stage has been set, and although the political characters may seem to be taking a hiatus from health and welfare reform, they are not laying dormant. As nurses, we must use this inertia to our advantage by collecting information and analyzing strategies that can maintain our presence within the policy arena (Mason, Talbott, & Leavitt, 1993). Additionally, we must increase the active participation of our colleagues who state reasons for not getting involved in governmental affairs. It is imperative that members of our profession not react to change as change occurs. Instead, our profession must maintain and expand the collective participation and support of nurses who can develop and use their political skills to promote progressive public policies. An important political skill is lobbying. Lobbying, or attempting to influence or persuade a Journal of Pediatric Nursing, Vol 1O, No 5 (October), 1995
LOBBYING EFFORTS
decisionmaker to see an issue as you do, is an art as well as a science. Different strategies will work with different members and on different issues.
329
2.
METHODS OF LOBBYING Methods of lobbying fall into two classes of communication: indirect and direct (Bushy & Smith, 1990).
Indirect The indirect approach involves influencing public opinion, which then encourages the policymaker to take action. A calculating maneuvering tactic can place registered nurses in a pivotal position as each assumes the role of a "grassroots lobbyist," which is a term used to identify public advocacy efforts. An example of an indirect lobbying effort would be launching an education campaign about a nurse-managed, community-based school health program in which both health teaching and health services, including primary care and environmental aspects, play a role. By persuading radio stations to broadcast public service messages about maternal-child health agendas, the benefits of a cost-effective, nurse-managed clinic can be publicized through the media. This provides the public with information and creates support for additional successful models.
Direct A direct approach is structured to speak directly to the decision maker. The direct approach includes accessing the decisionmaker, developing of the presentation, and acquiring knowledge and expertise about the issue so that you can be persuasive about the points that you are articulating (Kingdon, 1984). When legislation is drafted and referred to a committee, the first step in a successful direct lobbying campaign is to communicate effectively with legislators. Although a number of principles have been written on effective lobbying techniques by individuals within the government relations field, there are general rules to follow when directly contacting a legislator: 1. Do your homework. Be sure that you have reviewed the material and information you want to discuss. Learn as much as possible about your legislator's views on the issue that you plan to discuss. For example, if your legislator does not support a change in the Nurse Practice Act, find out why. What
3.
4.
5.
6.
7.
8.
are his or her concerns, and how has he or she reacted to previous requests for support? Identify yourself. When you present yourself to your legislator, identify yourself as a constituent, a health care professional, and a member of a large group, organization, or coalition (e.g., "I am a registered nurse and a member of the Pennsylvania Nurses Association, the fifth largest constituent membership of the American Nurses Association."). Be specific. When you interact with a legislator, you want to be very specific about the type of action that you are requesting after you have reviewed and shared the information that you have brought to his or her attention. Do you want the member to cosponsor the bill? Do you want the member to hold hearings on a legislative proposal or to vote in a specific manner? Be clear about the request, and ask for the member to make a commitment or to state a position. Do not let the legislator "slip, slide, and duck" around your request. Be concise. Time is of the essence for both you and the legislator. Keep letters and information that you plan to distribute to one page. Consolidate your information into a "talking points" format, which is similar to an outline. Be constructive. If a legislative bill deals with a problem that you admit exists, but you believe that the bill is presenting the wrong approach, inform the member of your opinion, and suggest an alternative. Be persistent. Do not stop with one contact. In many cases, writing more letters, followed by additional visits or phone calls, helps to keep track of when the bills are being reviewed in committee. Use persistence to monitor the process and to focus your contact with the legislator. Always be courteous; do not threaten. Communicate nursing's viewpoint effectively and in a positive manner. Keep in regular contact. Write a member to congratulate him or her on a speech you heard or to extend thanks for a vote. It is much easier to contact a member directly with a specific request if you have established regular contact. As with all interpersonal relationships, cultivating rapport is essential to the legislative process.
330
KATHLEEN KOVALIK
9. Report back. The most effective strategies involve coordination between you, the group's contact person, and your organization's lobbyist. Usually, the organization's lobbyist monitors and tracks responses that the organization's members have sent to legislators and/or phone calls about a particular issue. It is invaluable information. Tracking the support and/or opposition of a legislator on an issue is important to the profession of nursing. 10. Acknowledge. Legislators are human. They appreciate an occasional "thank you" from people who believe that they have done the right thing. Identifying and accepting the challenge to lobby a policymaker is a fundamental part of moving our profession forward. It is a role that
is central to the profession's promise to society because nurses are also advocates for patients. As changes occur within the health and welfare delivery systems, the written language of a legislative bill and its omission of named professions within an agency that directs public policy must be reviewed by nurses. It is well known that the governmental process is continuous. Communicating with policymakers should be an ongoing endeavor. Who are your elected officials? Have you made an appointment to see them? How can nurses provide the leadership necessary to transform our health care system? Once you become involved, politics and policy can transform the worlds of health care and the nursing profession. Give your profession the commitment, and those colleagues who follow will advance the vision.
REFERENCES Bushy, A., Smith, T. (1990). Lobbying: The hows and wherefores. NursingManagement, 21(4), 39-45. Kingdon, J.W. (1984). Agendas, alternatives, and public policies. New York: Harper Collins. Mason, D.J., Talbott, S.W., & Leavitt, J.K. (1993). Policy and politics for nurses--Action and change in the workplace,
government, organizations and community (2nd ed.). Philadelphia: Saunders. Milburn, L., Haye, K., & Griffith, H. (1988). The information seeker's guide to health policy news. Nursing and Health Care, 9(6), 307-309. Wakefield, M.K. (1990). Political involvement: A nursing necessity. NursingEconomics, 8(5), 352-353.
Ten Ways to Enhance the Nursing Profession's Lobbying Efforts With Government Kathleen Kovalik, BSN, RN, MPH nurses are to take their rightful place in I f setting health policy, they must know the issues as well as understand the political system and participate in it. Some of the issues that surround nursing as a profession include scope of practice, reimbursement, unlicensed assistant personnel, and advanced practice. These issues have contributed to the debates about legislative and regulatory changes in health care policy. In addition to these issues that have challenged nursing practice, the image of the profession has been affected. There have been increasingly wide and obvious discrepancies between the importance and sensitivity of the work nurses do and the level of reward--economic and professional--that can be expected for that work. Becoming informed and involved as nurses and citizens is crucial. Nurses in all practice settings must be knowledgeable of and active in the political process because it is this process that drives the health and welfare delivery systems (Milburn, Hays, & Griffith, 1988; Wakefield, 1990). It is essential that we take our legitimate place as players in the arena in which decisions are made, whether it be the U.S. Congress, state legislatures, local government, professional nursing associations, or the workplace. I have spent a good deal of time during the last several years as a nurse lobbyist interacting with Pennsylvania's elected officials. In November 1992, as health care reform gained momentum, professional nursing associations lobbied Kathleen Kovalik, BSN, RN, MPH, lives in Hershey, PA. She maintains an interest in government relations and continues to address professional nursing issues at the local, state, and national levels. Copyright 9 1995 by W.B. Saunders Company 0882-5963 / 95/1005-000853. O0/ 0 328
and presented health care testimony before state committees and Congress. In 1994, the nursing community was visible with endorsements and financial contributions to the candidates of their home states. Whenever a campaign plank focused on health care, nurses were there to mobilize, organize, and provide candidates with the facts, the ideas, and the perspective to improve the U.S. health care system. Throughout this time, I did not meet one politician who did not welcome this support from nurses; however, several remarked that there were few nurses involved within the political process and questioned the lack of participation. Politicians learned early in the health care debate that professional nurses work hard and know the issues. Nurses persuaded those who managed campaigns that nurses have the skills to motivate others to action and that we have the commitment to effect change. The stage has been set, and although the political characters may seem to be taking a hiatus from health and welfare reform, they are not laying dormant. As nurses, we must use this inertia to our advantage by collecting information and analyzing strategies that can maintain our presence within the policy arena (Mason, Talbott, & Leavitt, 1993). Additionally, we must increase the active participation of our colleagues who state reasons for not getting involved in governmental affairs. It is imperative that members of our profession not react to change as change occurs. Instead, our profession must maintain and expand the collective participation and support of nurses who can develop and use their political skills to promote progressive public policies. An important political skill is lobbying. Lobbying, or attempting to influence or persuade a Journal of Pediatric Nursing, Vol 1O, No 5 (October), 1995
LOBBYING EFFORTS
decisionmaker to see an issue as you do, is an art as well as a science. Different strategies will work with different members and on different issues.
329
2.
METHODS OF LOBBYING Methods of lobbying fall into two classes of communication: indirect and direct (Bushy & Smith, 1990).
Indirect The indirect approach involves influencing public opinion, which then encourages the policymaker to take action. A calculating maneuvering tactic can place registered nurses in a pivotal position as each assumes the role of a "grassroots lobbyist," which is a term used to identify public advocacy efforts. An example of an indirect lobbying effort would be launching an education campaign about a nurse-managed, community-based school health program in which both health teaching and health services, including primary care and environmental aspects, play a role. By persuading radio stations to broadcast public service messages about maternal-child health agendas, the benefits of a cost-effective, nurse-managed clinic can be publicized through the media. This provides the public with information and creates support for additional successful models.
Direct A direct approach is structured to speak directly to the decision maker. The direct approach includes accessing the decisionmaker, developing of the presentation, and acquiring knowledge and expertise about the issue so that you can be persuasive about the points that you are articulating (Kingdon, 1984). When legislation is drafted and referred to a committee, the first step in a successful direct lobbying campaign is to communicate effectively with legislators. Although a number of principles have been written on effective lobbying techniques by individuals within the government relations field, there are general rules to follow when directly contacting a legislator: 1. Do your homework. Be sure that you have reviewed the material and information you want to discuss. Learn as much as possible about your legislator's views on the issue that you plan to discuss. For example, if your legislator does not support a change in the Nurse Practice Act, find out why. What
3.
4.
5.
6.
7.
8.
are his or her concerns, and how has he or she reacted to previous requests for support? Identify yourself. When you present yourself to your legislator, identify yourself as a constituent, a health care professional, and a member of a large group, organization, or coalition (e.g., "I am a registered nurse and a member of the Pennsylvania Nurses Association, the fifth largest constituent membership of the American Nurses Association."). Be specific. When you interact with a legislator, you want to be very specific about the type of action that you are requesting after you have reviewed and shared the information that you have brought to his or her attention. Do you want the member to cosponsor the bill? Do you want the member to hold hearings on a legislative proposal or to vote in a specific manner? Be clear about the request, and ask for the member to make a commitment or to state a position. Do not let the legislator "slip, slide, and duck" around your request. Be concise. Time is of the essence for both you and the legislator. Keep letters and information that you plan to distribute to one page. Consolidate your information into a "talking points" format, which is similar to an outline. Be constructive. If a legislative bill deals with a problem that you admit exists, but you believe that the bill is presenting the wrong approach, inform the member of your opinion, and suggest an alternative. Be persistent. Do not stop with one contact. In many cases, writing more letters, followed by additional visits or phone calls, helps to keep track of when the bills are being reviewed in committee. Use persistence to monitor the process and to focus your contact with the legislator. Always be courteous; do not threaten. Communicate nursing's viewpoint effectively and in a positive manner. Keep in regular contact. Write a member to congratulate him or her on a speech you heard or to extend thanks for a vote. It is much easier to contact a member directly with a specific request if you have established regular contact. As with all interpersonal relationships, cultivating rapport is essential to the legislative process.
330
KATHLEEN KOVALIK
9. Report back. The most effective strategies involve coordination between you, the group's contact person, and your organization's lobbyist. Usually, the organization's lobbyist monitors and tracks responses that the organization's members have sent to legislators and/or phone calls about a particular issue. It is invaluable information. Tracking the support and/or opposition of a legislator on an issue is important to the profession of nursing. 10. Acknowledge. Legislators are human. They appreciate an occasional "thank you" from people who believe that they have done the right thing. Identifying and accepting the challenge to lobby a policymaker is a fundamental part of moving our profession forward. It is a role that
is central to the profession's promise to society because nurses are also advocates for patients. As changes occur within the health and welfare delivery systems, the written language of a legislative bill and its omission of named professions within an agency that directs public policy must be reviewed by nurses. It is well known that the governmental process is continuous. Communicating with policymakers should be an ongoing endeavor. Who are your elected officials? Have you made an appointment to see them? How can nurses provide the leadership necessary to transform our health care system? Once you become involved, politics and policy can transform the worlds of health care and the nursing profession. Give your profession the commitment, and those colleagues who follow will advance the vision.
REFERENCES Bushy, A., Smith, T. (1990). Lobbying: The hows and wherefores. NursingManagement, 21(4), 39-45. Kingdon, J.W. (1984). Agendas, alternatives, and public policies. New York: Harper Collins. Mason, D.J., Talbott, S.W., & Leavitt, J.K. (1993). Policy and politics for nurses--Action and change in the workplace,
government, organizations and community (2nd ed.). Philadelphia: Saunders. Milburn, L., Haye, K., & Griffith, H. (1988). The information seeker's guide to health policy news. Nursing and Health Care, 9(6), 307-309. Wakefield, M.K. (1990). Political involvement: A nursing necessity. NursingEconomics, 8(5), 352-353.