public policy

Friends in All Places

T HE FIRST STEP in policy making, like dealing with

the stubborn mule, is to get its attention: get on the

agenda. Nursing has had many friends in high places who

have helped us (1) get on the federal agenda for access to

care (third-party reimbursement), nursing home reform,

and adequate supplies of personnel (funding for nursing

education) and (2) push for representation of nursing on

policymaking groups. We have had our parochial axe to

grind, but the agenda is already set.

Because nursing is so immense and varied, so subtle and intimate, and so loaded with stereotypes that are hard to

break through, it is difficult for us to write about the work

to attract agenda-making attention. Suzanne Gordon is a freelance journalist who writes reg-

ularly for the Boston Globe, including its Sunday magazine.

But what she really does is write brilliantly about nursing

for any publication that will take it, from the Los Angeles

Times to the alumni magazine of Massachusetts Institute of

Technology to Moth Jones Magazine (Gordon, 1992). She

describes what modern nursing is like, including what the

thinking is, in ways that we find hard to do:

. nurses on 7 North [at Boston’s Beth Isreal Hospital) like nurses all over the country, have come to realize that

there are many invisible conflicts that a DNR order can’t

solve.

If you have a DNR order, sometimes people think it just

means that if the patient has a cardiac arrest we don’t try to

resuscitate him. I remember when I drew blood on a

patient who was very old and frail. There was a DNR order

. but there I was, probing around The skin was just

“+Adele] Pike [a CNS] pauses, shudders at the memory,

and gropes for the right word--“it was just like thin antique

parchment. I tried to make the needle very, very fine to be

gentle. But you felt you were torturing her” (p. 45).

Then she zings in the policy message:

The need for a powerful nursing voice has never been greater.

Our health care system is neither healthy nor car-

ing, nor even a system. A recognition of nursing’s expertise

and importance is critical to changing that (p. 46).

Another friend at work for us is Barbara Safreit, JD,

LLM. She first took on nursing’s cause in Oregon, where she helped the Oregon nurses straighten out their prescrip-

DONNA DIERS, RN, MSN, FAAN The Annie W. Goodrich Proffisor

Chair, Adult Health Division

School of Nursing

Yale University

25 Park St, Box 9740

New Haven, CT 06536

Copyright 0 1993 by W.B. Saunders Company

8755-7223/93/0902-0002$03.00/O

tive authority statute (Safreit, 1988). In 1992 Barbara pub-

lished the definitive article on advanced practice nursing in

a law, not a nursing, journal (Safreit, 1992). In 70 pages

and 285 footnotes, she makes a compelling argument for

unleashing advanced practice nurses from overregulation

and restrictive political pressures so that we may make our

proper contribution to cost-effective health care. Her pro- posals are quite specific:

in defining scope of practice, states should eliminate all

reference to mixed-regulator entities, and vest sole govern-

mental authority over advanced practice nursing in the BON [Board of Nursing] (p. 478); legislatures should amend

their Nurse Practice Acts to include both a specific acknowl-

edgement of advanced practice nursing and a basic definition

of an APN the fewer references made to specific cate-

gories of advanced practice, the better (p. 479); legis-

latures should modify their statutory definitions of

nursing to include those acts of APNs authorized under reg-

ulations adopted by the BON (p. 480); legislatures

should eliminate any statutory requirements for formalized

APN/MD collaboration or practice agreements, as well as for

physician supervision or direction (p. 480); legislatures

may choose either to statutorily acknowledge that APNs may

prescribe or leave such specification to their BONs (p.

480); States that have not done so already should enact

non-discrimination requirements for health insurance or

health care service plans and contracts [to) insure that any

service covered when performed by any other practitioner

would be covered when provided by APNs (p. 481).

She concludes, “APNs are proven providers, and remov-

ing the many barriers to their practice will only increase

their ability to respond to the pressing need for basic health care in our country” (p. 488). So there! Throughout the

monograph, Barbara uses the AMA’s own language to hang

them. Her words are directed to policymakers, including

legislators. Barbara has seen to it that reprints of her article

have reached the hands of as many policymakers at state and

federal levels as she could think of, and the requests for reprints now number in the thousands.

Like Suzanne Gordon’s work, this is very powerful am- munition for nursing coming, as it does, from “disinter- ested” parties. These are advocates but not hired guns, and

their work is all the more effective because they are not beholden in any way except through respect for nursing and our issues. Policymakers are impressed. We should be, too.

References

Gordon, S. (1992, Sept/Oct) What nurses know. MotherJones, 40-46.

Safreit, B. J. (1988). The legal perspective. In C. Lindeman

(Ed.), Alternate conreptiom of work andsociety (pp. 11 I- 157). Wash-

ington, DC: American Association of Colleges of Nursing.

Safreit, B. J. (1992). Health care dollars and regulatory sense:

The role of advanced practice nursing. Yale Journal on Regulation, 9(2), 417-487.

70 Journal of Professional Nursing, Vol 9, No 2 (March-April), 1993: p 70