THE PROFESSIONAL NURSE AND POLITICAL ACTIVISM

Susan McCarthy MSN, RN, CNRNPA Nurse Alliance, SEIU

Quality Care Summit 2012suemac1128@aol.comSeptember 25, 2012

Objectives

Identify professional nurse role, taking responsibility to shape social policy.

Discuss policy, politics and power in nursing

Identify barriers to nursing political activism

Explore skills to achieve political competence

List points of access for policy development

Recognize past and current nurse activists

Laws, Standards, Codes

Roots of activism, social justice embedded in professional practice laws, standards, ethics

A social contract with society, demands professional responsibilities.

The Pennsylvania Code : State Board of Nursing Regulates by licensing: protects public

health ANA Code of Ethics, advocate for

profession Nurses should act individually,

collectively through political actions for social change.

and for Social Justice

Provision 9.4 : Social Reform Professional Nursing associations speak

for nurses in reshaping health care policy, legislation Accessibility, Quality, Cost Violation of human rights, homelessness,

hunger, violence, stigma of illness

Is Healthcare the New Civil Right?

http://www.seiuhealthcarepa.org/nursealliance/Supreme_Court_Upholds_Health_Reform_Law.aspx

The Nurse Alliance of SEIU

Politics and Policy Statement:

Good healthcare policy happens when practicingRNs are sitting at political and policy-making tablesEffective partners with a strong, clear agendaAdvocate for more nurse political involvement

Current focus on healthcare reform implementation.

Politics and Social Justice Poverty, cruelty rise, level of social

awareness Political action is taken, Acts, U.S.

Congress. The 1935 Social Security Act 1946 Mental Health Act 1964 Civil Rights Act 1965 Medicare Act 1990 Americans with Disabilities Act 2010 Affordable Care Act

(http://www.nih.gov/about/almanac/historical/legislative_chronology.htm)

Nurse Activists

Florence Nightingale (1850’s), Environment, British Army, Educational Reform

Clara Barton (1881), Founded USA Red Cross

Lillian Wald,(1893), Founded Public Health Nursing

Diane Carlson Evans (1993), Vietnam Women’s Memorial

Karen Daley (2000), Needle-Stick Prevention and Safety Act

http://upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Lillian_Wald_

Lillian Wald,(1893)Public Health

Nursing

http://blog.tcs-inc.us/Portals/39196/images/needle_stick.jpg

http://georgiainfo.galileo.usg.edu/statues/vietnam-women2.jpg

Diane Carlson Evans (1993) Vietnam Women’s Memorial

http://www.empirecontact.com/images/statuary/Sisters_memorial_right.jpghttp://www.arlingtoncemetery.mil/photos/SpanAmericanNurses.jpg

Spanish American War Nursing Memorial

Arlington Cemetery

Civil War Nursing MemorialDupont Circle

Washington D.C.

Nurse Activists Needed Now U.S. Healthcare System in Crisis 2012, U.S. will spend $2.8 trillion Cost of healthcare is unsustainable Environment ↑ complex, inefficient,

stressful Waste $750 billion/year Plan: Best Care at Lowest Cost Do more, with less $, increase efficiency

(IOM, 2012)

Result: Demand ↑ Accountability

Nursing’s Accountability

~15% of hospital patients still being harmed

20% discharged elderly patients readmitted ,

30 days Nurses spend

30% time, direct patient care

(IOM, 2012)

Why Nursing? “When we are hospitalized, in a nursing

home, managing a chronic illness, nurses are the ones we will encounter, spend most time, be dependent upon.” (Keeping Patients Safe, IOM,2004)

Gallup Poll 2011, 12th time/13 years, Nurses #1, ethics and honesty

Nurses full partners, with physicians, health care professionals, redesign health care in U.S. (IOM, 2008)

Opinion leaders, 90% want nurses to improve quality, safety, reduce medical errors (GallupPoll,2010)

Nurse Political Actions Nursing Professional

Organizations/Unions advocated for and won

Federal Needlestick Safety and Prevention Act, 2000

California (1999, effective 2003) , Mandated Nurse -to -Patient Staffing Ratios

Increased Scope of Practice, Advanced Practice Nurses (2007)

Elimination of Mandatory Overtime (2008)

Barriers to Political Involvement

Powerlessness Lack a structure to be heard Limited leadership opportunities HIPPA, fear to breach confidentiality Differing levels of education Lack of education in policy development Overwhelmed by complex policies Need more mentors, leaders (Des

Jardin, 2001)

“There is still so much to do”

Florence Nightingale, 1893

ACA Implementation Safe, Healthy Work Environments Eliminate Manual Patient Handling Reduce Work Place Violence Mandate Safe Staffing Education, Recruitment, Retention

Making it Happen Policy is a course of action. Politics, process of influencing

allocation of scarce resources. The result is policy.

Power enables a group to influence others through political process.

To effect policy, must be involved in politics so others do not speak for nursing practice.

If we understand process around policy formation we can target our nursing leadership into influence.

(Hughes, F., 2005)

Power in Nursing Expert:

Combines science, technology, caring Interpersonal:

Excellent negotiators, communicators, problem solvers, team players

Power in Numbers: 2.9 million # will grow 26%, 2010 to 2020

Latent Power: Untapped, underused

Nurse Politicians/Leaders

Eddie Bernice Johnson ( D-TX), first nurse elected to U.S. House of Representatives (1992)

Carolyn McCarthy, LPN ( D-NY), elected 1996, US House, leader on gun control , nursing

Lois Capps (D-CA), third nurse elected to House 1998, school nurse, Medicare Reform, Nursing , School Health and Safety

Virginia Trotter Betts, national nurse leader, mental health policy

As of 2011, seven nurses in U.S. House of Representatives

Mary Wakefield, Ph.D., R.N., current administrator of the Health Resources and Services Administration (HRSA)

Points of Access for Policy Development

Workplace: Procedures, budget, practice, bargaining tableshared governance committees

Government: Local, state, national legislation, run for office

Professional Organizations: Provide information, activities, leaders

Community, Public Education: ↑ Nurse visibility, health fairs, endorse

candidates

Six Skills for Political Competence

(Warner, 2003)1. Nursing Expertise as Valued Currency

Clinical experience, policy connections Values: caring, health promotion, informed

and self care, holism (Cohen et al, 1996)

Observation, decision making skills

2. Networking, crucial for action, change Establish, maintain interdisciplinary

relationships, asking for help is OK

3. Powerful Persuasion Passion, thoughtful analysis of ideas, clarity,

ability to communicate, important to audience

Political Competence Skills 4. Collective Strength

Professional organizations, interdisciplinary Voices louder, persuasion greater Group consensus, strengthen the individual

5. Strategic Perspective Stepping back, place health in broad context See Nursing as political activity Questions emerge, government influence on

populations, health, environments of care 6. Perseverance

Remain Optimistic, you don’t always win

Our Experience“We see a future where America leads not only by the example of our power, but by the power

of our example.” Joe Biden, DNC, 2012

SEIU Nurses share political action experiences

Stages of Nursing’s Political Development (Cohen et al, 1996)

Stage One: Buy-In Individual nurses take position/react to issue affecting profession, public. Decide to take action.

Stage Two: Self-InterestIndividuals begin establish political identity, voice. Organize, develop strategies to resolve issue.

Stage Three: Political Sophistication Seek to influence policymakers, ↑awareness ,value contributions of nursing to public, health policy. Testify before legislative committees, appointed to policy-making bodies.

Stage Four: Leading the Way Very involved, setting agenda, initiating policy

development, often enacted through legislative process. Copyright © 2003, New Jersey Collaborating Center For Nursing Workforce Development. 

Strategies for Political Involvement

Keep informed of issues affecting nurses and public

Join Professional organizations, SEIU committees/actions

Find a Mentor, be a mentor

Participate in public demonstrations

Participate in shared governance councils,

Meet with elected officials in their offices

Write a letter to elected officials

Publish

Key Points

Political actions bring social change

Nurse laws, ethics code support political

action

Keep informed

Join professional organizations

Take Action

Achieve political competency

Health Policy Resources

Nurse Alliance Round Up CDC AHRQ World Health Organization IOM ANA Smart Briefs Professional Journals www. RN.com Project Vote-Smart (PVS),Non-profit, non- partisan, collects and distributes

information, U.S elected official’s voting records and candidate’s positions , www.votesmart.org

The Pennsylvania Health Access Network (PHAN) is a statewide coalition of organizations working to protect high quality health insurance coverage for individuals and businesses and to expand coverage to the uninsured.

www.paheathaccess.org 215-557-0822

References Abood, S. (January 31, 2007). "Influencing Health Care in the

Legislative Arena". OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1, Manuscript 2.

Antrobus S (2003) What is political leadership? Nursing Standard. 17, 43, 40-44.

Chitty, K. K., Black, B.P. (2011). Professional Nursing—Concepts and Challenges. 6th Edition. Philadelphia, PA: Elsevier, Saunders.

Cohen, S.S., Mason, D.J., & Kovner, C., Leavitt, J.C., Pulcini, J., & Sochalski, J. (1996). Stages of nursing’s political involvement: Where we’ve been and where we ought to go. Nursing Outlook, 44(6), 259-266.

Des Jardin, K. (2001) Political involvement in Nursing: education and empowerment. AORN Journal. (74)4.

Des Jardin, K. (2001). Political Involvement in Nursing: Politics, Ethics, and Strategic Action. AORN Journal, (74) 5.

References, cont’d.

Hughes, F. ( 2005) Role of nursing management in health care policy development. Retrieved from http://www.slideserve.com/rubaina/role-of-nursing-management-in-health-care-policy-development

IOM (Institute of Medicine). 2012. Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press .

Robert Woods Johnson Foundation (2010). Nursing Leadership from Bedside to Boardroom: Opinion Leaders' Perceptions. Retrieved from http://www.rwjf.org/pr/product.jsp?id=5435

SEIU (2001) The Fight for Our Lives: How We Won Safer Needles. Retrieved from http://www.youtube.com/watch?feature=player_embedded&v=g51WkB9zpEk

Warner, J. ( 2003). A Phenomenological Approach to Political Competence: Stories of Nurse Activists. Policy, Politics, & Nursing Practice. (4).2.