Thursday February 23rd 2017

Political advocacy, anyone?

Across the country, RNs participate in lobby days and other crucial actions

Nurses flex their political muscle at the Virginia Nurses Association’s Legislative Day.
Photo courtesy of Virginia Nurses Association.

Long-time nurse and Virginia Nurses Association (VNA) member Mary Menafra, MSN, RN, CEN, works across the street from the Virginia state house. This geographic proximity recently proved quite fortuitous for Virginia nurses, because she was able to provide crucial testimony to legislators about the frequency and degree of workplace violence against nurses.

Meanwhile, perioperative staff nurse Bonnie Vencill, RN, CNOR, continues building grassroots activity among nurses so they will speak out on issues that affect nursing practice and patient safety, including a recent bill requiring an RN in the operating room at all times. She helped prepare nurses participating in VNA’s 26th Annual Legislative Day on Feb. 2 and the Virginia Council of periOperative Registered Nurses (VCORN)’s Lobby Day on Jan. 17.

Menafra and Vencill are not alone in their efforts. As 2011 and new legislative sessions rang in, nurses all around the country began using their expertise and voice to meet face-to-face with their state policymakers through “lobby days”  to discuss a range of nursing, patient, and health care issues. All along the way, they are being supported by the American Nurses Association (ANA), their constituent and state nurses associations, and their specialty associations.

Nurses in action

Now semi-retired, Oregon Nurses Association (ONA) member Karen Elliott, BSN, RN, volunteers as a staff nurse in a primary care clinic serving the uninsured in her area. She also is active in ONA’s legislative work, and has served as chairperson of ONA’s Cabinet on Health Policy, which develops legislative priorities, and as president of her district.

“As a young nurse raising a family, I found it hard to get involved in ONA beyond the collective bargaining roles I had at work,” said Elliott, a staff nurse for about 40 years. “Now it’s time to give back to my profession. I’m very committed to nursing, I want to improve the workplace for new nurses, and I believe health care reform is important to improving the health of citizens.”

Elliott became involved in her first lobby day two years ago, and this year was a participant and a group leader at the Feb. 15 event.

“This year was awesome,” Elliott said. “We had nearly 300 nurses and student nurses participate.”

The event began with a group session in which nurses received information on ONA’s two top legislative priorities, as well as strategies to effectively bring their messages across to state policymakers.  Gov. John Kitzhaber and Sen. Laurie Monnes Anderson, the only nurse in Oregon’s legislature, also spoke to nurses, and participants had the opportunity to role-play lobbying their state representatives and senators before they headed to the capitol.

Elliott helped prepare a group of nursing students and accompanied them on their rounds with legislators.

“We met with legislators who were not necessarily in our camp, but it went well,” she said. “And ONA made sure all legislative districts were covered.”

ONA’s top priorities for Lobby Day were promoting SB 99, which calls for creating the Oregon Health Insurance Exchange, and HB 3229, which requires more comprehensive reporting of health care workplace violence.

A health insurance exchange is a one-stop marketplace for individuals and small businesses to purchase state-regulated health plans from private insurers, according to ONA legislative materials. This exchange will “create a greater reliance on nursing services, drive down the cost of care for everyone, and continue Oregon’s tradition of blazing our own trail to improve the lives of Oregonians.”

Oregon already has a workplace violence law on the books, but the proposed measure will help close the gaps in reporting and provide the data to form a complete picture of violence in the workplace.

Right now only “intentional” assaults are reported, Elliott said. The new legislation would require that any physical contact that results in an injury be reported.

“It also will help spot trends, so we can determine better ways to prevent and reduce workplace violence,” she said.

Lobbying in Arizona

Ray Kronenbitter, MSN, RN, PCCN, a staff nurse at Yuma Regional Medical Center, joined the Arizona Nurses Association (AzNA) and became immediately engaged in legislative and political action committee (PAC) activities upon graduating from his nursing program 12 years ago.

“From the very beginning I was mentored by other AzNA nurse members, and now I’m director of government affairs for AzNA,” Kronenbitter said. “I couldn’t imagine working in a profession and not having a say in our practice, and the statutes and regulations that affect it.

“And if we don’t speak out about health care policy, we will have to just go with the flow of the river, and never have a role in making positive changes.”

Since becoming a member, Kronenbitter has never missed a Lobby Day, and now he helps organize two events, “Nurses Lobby Day,” which was held Feb. 8, and “APRN Lobby Day,” which was held Feb. 22.

Instead of asking nurse participants to talk about numerous bills, this year AzNA’s Nurses Lobby Day strategy was to largely focus on who RNs are and what they do, and how state budget cuts to the Arizona Health Care Cost Containment System, the state Medicaid program, would harm patients’ access to needed care, and take away some 30,000 health care jobs from the state, which ultimately would lead to less revenue for the state, Kronenbitter said.  The theme specifically was “Imagine a World without Nurses,” and nearly 80 nurses met with policymakers in 27 of Arizona’s 30 legislative districts at the Feb. 8 event.

“This was the most successful Nurses Lobby Day we had to date, and I believe legislators understood our message,” said Kronenbitter, who also was one of first nurse fellows to go through ANA’s American Nurses Advocacy Institute (ANAI).

Back in Virginia

Vencill is a perioperative staff nurse at Southside Regional Medical Center in Petersburg, VA. She became involved in legislative-focused activities after she participated in a government affairs event held by the Association of periOperative Registered Nurses (AORN), an affiliated organization of ANA, roughly 10 years ago.

Virginia nurses head to the Capitol to discuss nursing and health care issues. Photo courtesy of Virginia Nurses Association.

“I listened to the speakers who were discussing their grassroots involvement, and I realized they were nurses just like me,” Vencill said.  “I also felt I needed to look at the big picture, and grow professionally.”

So she became active in VCORN and VNA, and volunteered to serve as the AORN legislative state coordinator of VA/DC.

“Being politically involved should be a natural part of being a citizen,” said Vencill, who is a current ANAI fellow. “You need to be concerned about the laws where you live and work and play. And nurses need to get involved in making decisions about their patients, so those who don’t understand the issues aren’t making decisions for us.”

One of the key issues she has been working on since 2006 in Virginia is “RN as circulator” legislation. This year, HB 1466 passed the Health, Welfare, Institutions (HWI) Subcommittee, but was defeated in the HWI full committee by a vote of 15 to five. This legislation would have required a perioperative RN to be present and functioning as the circulator for every patient undergoing a surgical or invasive procedure in all Virginia hospital operating rooms and ambulatory surgery centers.

“Patient safety is important,” Vencill said. “And the role of the RN in the perioperative setting is vital to providing optimal and safe patient care.”

Despite the most recent setback, Vencill said nurses’ grassroots efforts will continue.

“We’re not going away,” said Vencill, who also believes it’s beneficial for VNA and VCORN to work together on issues.

As for VNA’s Legislative Day, Vencill provided participants with an update on the RN as circulator bill and met with her legislators to address VNA’s top legislative priorities, which focus on quality and safety of health care, access to care, and ensuring an adequate nursing workforce.

Menafra also attended this year’s Legislative Day, as well as recently testified before several legislative committees urging members to support HB 1690, which would make it a misdemeanor to assault a health care provider performing emergency care and punishable with up to 15 days in jail. (An earlier measure to make it a felony didn’t advance. This new measure ultimately was signed into law by the governor.)

Menafra, currently a resource management administrator involved in patient flow and supplemental staffing, knows the issue of workplace violence well, having worked in emergency nursing for most of her 21 years in nursing. She also is the secretary of the Virginia Emergency Nurses Association and president of the Central Virginia Emergency Nurses Association.

So VNA called her to testify before a committee that was looking into a bill on workplace violence – some two hours before the hearing. It marked the first time she ever had to speak in front of a state committee.

“They said, ‘Mary, can you go across the street? And remember you’re an expert, and you have the data to show them [about the magnitude of the issue],’” Menafra said.

At first she was nervous.

“I had written down what I wanted to say,” Menafra said. “But I put the paper down and just started talking, realizing that I knew the information. “

She also quoted data, including the results of a recent ENA survey that revealed that more than 54 percent of emergency nurses were either verbally or physically assaulted within the seven days prior to participating in the survey.

“When they [legislators] started asking me questions, I realized I knew the answers,” Menafra said. “So it became easy. The key is you have to be speaking about something you have a passion for – and that you know well.”

Prior to testifying before other legislative bodies, she gathered e-mails from other nurses to provide even more first-person accounts of workplace violence. One account told of a local magistrate who didn’t want to pursue charges against a patient who had assaulted a nurse because he erroneously believed it was “just part of a nurse’s job.”

Political action in New Mexico

Roughly 200 nurses and student nurses gathered in Santa Fe, NM, to participate in the New Mexico Nurses Association’s (NMNA) Capitol Challenge Feb. 3. Among them were NMNA member Joan Arrowsmith, MN, RN, an assistant professor of nursing at San Juan College, and student nurse Corey Benziger.

Benziger was one of 16 students in Arrowsmith’s nursing leadership class who chose to attend the Capitol Challenge.

“It was a really great opportunity and exciting to see how the legislative process works,” said Benziger, who graduated in May.  After listening to NMNA-arranged presentations, she observed a committee hearing on a bill addressing the redistribution of non-narcotic, pharmaceutical medications.

Benziger said she supports the measure because it could help relieve the anxiety of people who need certain medications, such as chemotherapy drugs, but can’t afford them. She also feels it may prevent the improper disposal of antibiotics and other medications, which ultimately will help the environment.

She believes that political advocacy is important – and that change can come from the top down, and the bottom up.

“Our country suffers from political apathy,” Benziger said. “Many people complain about things but never take steps to change them. They would rather be victim-oriented. But everyone has an individual responsibility to become informed on issues at the local, state, and national levels. Knowing what is going on allows individuals to advocate for the changes they desire.

“And the more information people have about the world around them, the better-equipped they are to interact with others in a non-judgmental way. Maintaining a nonjudgmental attitude is critical for nurses providing care to patients.”

Arrowsmith said that participating in the Capitol Challenge is one of several activities designed to help student nurses transition to professional practice.

“Sometimes when you’re immersed in study, it’s hard to grasp the ethical, legal, and political issues that you may have to deal with in everyday practice,” Arrowsmith said. The Capitol Challenge gives students the opportunity to see how they can lend their knowledge, expertise, and voice to many issues.

While at the capitol, Arrowsmith also attended a committee hearing in which policymakers were considering funding for an ongoing nursing education project. Specifically, the effort is aimed at creating a common, basic nursing curriculum in BSN and ADN programs throughout the state, and it’s something Arrowsmith has been working on with other nursing educators for the past year.

Final words of wisdom

“Nurses often don’t know their own power,” Elliott said. “We’re highly respected in our communities, and legislators do want to listen to us. They don’t want to hear a lot of gobbledegook. They want to hear how issues affect people.

“I know it might be nerve-wracking at first to speak to legislators. But when you get involved in your professional association, you are not doing it alone. And they really help you prepare.”

Added Vencill, “Maybe the timing isn’t right for you to get involved in a Lobby Day, for example. But possibly you could send an e-mail, make a phone call, attend a community event, or network with your coworkers, friends, and neighbors about issues that affect each of us and our patients. The nursing profession is very trustworthy, and yes, we do vote.

“I do work full time and realize that only by collaborating with other interested parties can positive change occur,” she continued. “When we work together, we can accomplish a lot.”

Said Kronenbitter, “Everybody has a busy life. But if nurses want to shape patient care and our profession, they need to have a voice. And that means getting involved.”

Want to make your voice heard? ANA makes it easy with our Take Action sites. Loaded with information on the hot button issues before Congress, these sites also provide fast and easy ways for you to take action, like sending letters or making phone calls to your members of Congress. Remember, when nurses talk, Washington listens!


Growing grassroots with an advocacy institute

“Nursing is a trusted profession, representing the largest segment of health professionals in the United States,” said Janet Haebler, MSN, RN, assistant director for State Government Affairs at ANA. “Policymakers rely on nurses’ expertise and experience to identify what improvements or changes are needed for the good of patients and health care.”

With that in mind, ANA launched in October 2009 its American Nurses Advocacy Institute (ANAI) with the intent of creating a well-prepared and connected cadre of RNs equipped to influence health policy at the local, state, and national levels. Nominated by their constituent /state nurses associations (C/SNAs), ANAI fellows are nurses who have provided grassroots support to their C/SNA or to ANA and who want to strengthen their competence in the political arena. They attend a two day-plus seminar in Washington, DC; participate in a year-long formal mentoring program; and enjoy continued support from ANA and their ANAI colleagues thereafter.

Program content is designed, in part, to accomplish the following:

• Introduce the relationship between the advocacy process and policy change.

• Identify criteria and methods to conduct a political environmental scan.

• Describe the effective strategies for creating and sustaining policy change.

• Explore networking and coalition-building for effective advocacy.

• Establish an advocacy implementation plan and nurture critical links between the program participant and major stakeholders.

So far, 49 nurses have participated in the ANAI, with 24 nurses in the last group of fellows who came together in Washington in October 2010. The agenda for that ANAI included presentations entitled “Effective Strategies for Creating and Sustaining Policy Change,” and “Politics 101: Navigating the System — How a bill doesn’t become law.” Fellows also had the opportunity to meet with members of Congress to educate them about issues important to nurses.

Haebler sees nurses’ political advocacy as vital, and ANAI participation enhances fellows’  knowledge of the policy-making process and potential strategies to advance issues in their states and nationally.

Ray Kronenbitter, MSN, RN, PCCN, who had been involved in political advocacy for several years before becoming an ANAI fellow in 2009, found the connections he made to nurses in other states through ANAI crucial.

“If an issue comes up here, I can contact people in other states who may have faced the same issue and who have strategies to address it,” he said.

Bonnie Vencill, RN, CNOR, also believes the connections and ANAI fellow conference calls on pressing issues, has been invaluable to her ongoing efforts in Virginia.

For consideration as a candidate to ANAI, nurses should contact their
C/SNA. For more information on the ANAI program, contact Haebler at

— Susan Trossman is the senior reporter for The American Nurse.

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