Advanced practice registered nurse (APRN) issues are a priority for many constituent and state nurses associations (C/SNAs), and they expend significant resources to launch advocacy efforts. So what makes a “good” state-level strategy successful? Which factors are associated with legislative success? While many variables go into a successful campaign, according to American Nurses Association (ANA) and C/SNA experts, to increase the chance of having a successful effort, make sure you:
Choose the right issue to move in the legislative arena. Not all problems need a legislative or regulatory fix. Some — for example, clinical privileges, insurance reimbursement, and aspects of the Consensus Model for APRN Regulation — might be better addressed in other ways.
Form a strong nursing coalition. C/SNAs with favorable legal and regulatory environments tend to have a formal coalition that includes the C/SNA and the groups representing each of the four APRN roles. Strong coalitions include effective channels of communication.
Develop a shared strategy. A strong coalition is not guaranteed to have a shared strategy, but it has a better chance at developing one. There is a lot of homework to be done to achieve this step, and it is time-consuming. The work being done to implement the Consensus Model for APRN Regulation has highlighted the fact that each of the four roles faces unique problems and opportunities, and a solution for one group may create unintended consequences for another.
Form a strong coalition that includes members beyond nursing. Support from other health care providers, consumer groups, and business sends a message that your issue is bigger than nursing. The September/October 2011 APRN focus column described ANA’s work with the Coalition for Patients’ Rights (CPR). Consumers are becoming increasingly sophisticated about the benefits of care from an array of qualified health care providers, as illustrated in the materials prepared by the The Citizen Advocacy Center as part of its Scope of Practice Initiative. (For more information, go to www.cacenter.org/cac/SOP.)
Create opportunity out of crisis. Successful advocacy efforts are sometimes linked to a crisis. While we likely have no control over this factor, it may affect timing of a legislative effort if the crisis can be leveraged. For example, though not a crisis per se, the deadlines imposed by the “Affordable Care Act” are driving interest in APRNs. For example, the January 2014 deadline for the establishment of state insurance exchanges provides an opportunity to address the credentialing of APRNs by third-party payers.
When legislation is the best solution
Choose the right sponsor to champion the bill. A successful effort requires a key legislator in a strong position. Who is credible and has influence? Who will really work for you? There is a difference between a sponsor and a real champion.
Hire a savvy lobbyist. A good lobbyist will know if an issue should be addressed legislatively and identify the best sponsors. There is value in the regular presence of a lobbyist. Being there all the time is important, because you never really know what is going to happen in a legislature.
Enlist sponsors from both parties and both houses. Particularly in times of strong partisan divide, issues that can be shown to cut across party lines and gain bi-partisan support are more likely to move.
Form a political action committee (PAC). A PAC not only raises money to contribute to candidates running for political office, but also increases member participation, empowers members to play a greater role in the development of public policy, and better positions the profession in the legislative arena.
Leverage personal connections and experience. Some policymakers will have personal experience that helps them understand the importance of an issue. If they don’t, arranging that sort of experience can be an important part of a strategy. For instance, you can invite them to visit a birth center and meet with clients when moving related legislation.
Be patient. Realize that many of these issues have been introduced and reintroduced, and that real change takes time.
That said, health care reform and the Institute of Medicine’s Future of Nursing report have created a window of opportunity APRNs must work quickly to seize. By supporting ANA and your C/SNA at this critical time, nurses can make a real difference.
— Lisa Summers is a senior policy fellow at ANA.