This document discusses building social capital to enact policy change at various levels. At a high level, it discusses developing relationships with key decision makers through activities like attending meetings, volunteering, and participating in organizations. It emphasizes the importance of going beyond one's immediate network and insights to broaden relationships and influence. Building social capital locally can be done through continuing education, professional groups, educational events, and community involvement. The goal is to identify influential individuals and connect with them to demonstrate support for policy issues.

1. Bioinformatics practice questions: Protein fragment:
PNLPDCDMES WLNAPTVPSP INWERKTFSS CNFNMSSLLN
RVQASSFTCN NIDASKFYGMCFGSITIDKF AIPLSRKVDL
QLGSSGYLQN FNYRIDQSAT SCQMYYGIPQ NNVTVTKINP
1. Identify the source of your sequence and the location of the
fragment represented by this sequence in the protein.
2. If the source protein is not annotated, find a similar
annotated protein to infer the biological significance of your
fragment.
3. Check if the three-dimensional structure of your fragment is
known.
4. Predict secondary structure for the selected sequence.
5. Predict three-dimensional structure for the selected sequence
using homology modeling.
6. Analyze the quality of your model using one of the structure
assessment tools.
7. Provide structural classification for your model.
8. Create a visualization of your model highlighting and
annotating one of the important molecular or biological
features.
9. Compare predicted secondary structure with the secondary
structure in 3D model and interpret the results.
202 UNIT III STRATEGIZING AND CREATING CHANGE
The Little “p”
A nurse’s individual expertise is vital to shaping policy change
at every level, but nurses
must be diligent to share this expertise. From the unit level to
the hospital system level, the
observation of one nurse could improve quality of care, save the
healthcare system hun-

2. dreds of thousands of dollars, improve the efficiency of care
delivery, or develop a national
policy standard. Yet, an exceptional idea never comes to
fruition if it is not heard.
Empowered nurses can use their expertise to enact change in
their organization
(Bradbury-Jones, Sambrook, & Irvine, 2008). On the contrary,
if nurses do not feel
empowered, feelings of frustration and failure emerge
(Laschinger & Havens, 1996;
The Alliance: Nursing Organization Alliance Nurse in
Washington Internship
(NIWI)
Open to any RN or nursing student (all levels of education) who
is interested
in learning about current issues in nursing and the legislative
process. Each
participant spends time meeting with his or her members of
Congress while
participating in the NIWI Annual Advocacy Days (see Figure
7.2).
www.nursing-alliance.org/Events/NIWI-Nurse-in-Washington-
Internship
For Advanced Practice Registered Nurses
American Association of Nurse Practitioners (AANP) Health
Policy Fellowship
The AANP Health Policy Fellowship program provides AANP
members with
a comprehensive fellowship experience at the center of health
policy and
politics in Washington, DC. It is an outstanding opportunity for

3. members with
an interest in healthcare policy to promote the health of the
nation and the
advancement of NPs’ ability to work within their full scope of
practice.
www.aanp.org/legislation-regulation/federal-legislation/
health-policy-fellowship
For Nursing Students
American Association of Colleges of Nursing (AACN) Student
Policy Summit
(SPS)
The SPS is a 3-day conference held in Washington, DC, and is
open to
baccalaureate and graduate nursing students enrolled at an
AACN member
institution. It is a didactic immersion program focused on the
nurse’s role in
professional advocacy and the federal policy process (see
Figure 7.3).
www.aacnnursing.org/Policy-Advocacy/Get-Involved/Student-
Policy-Summit
For Nurse Faculty
AACN’s Faculty Policy Intensive (FPI)
The FPI is a 3-day immersion program designed for faculty of
AACN member
schools interested in actively pursuing a healthcare and nursing
policy role. It
offers the opportunity to enhance existing knowledge of policy
and advocacy
by strengthening understanding of the legislative process and

4. the dynamic
relationships between federal departments and agencies,
national nursing
associations, and the individual advocate.
www.aacnnursing.org/Policy-Advocacy/Get-Involved/Faculty-
Policy-Intensive
EXHIBIT 7.2 OPPORTUNITIES TO BUILD INTELLECTUAL
CAPITAL (continued )
Chapter Seven BUILDING CAPITAL 203
FIGURE 7.2 Nurses participating in the Nurses in Washington
Internship in 2017.
FIGURE 7.3 American Association of Colleges of Nursing
Student Policy Summit
attendees, taking part in the association’s advocacy day, are
featured with cochair of the
House Nursing Caucus, Representative David Joyce (R-OH;
center).
Manojlovich, 2007). A thorough literature review conducted by
Rao (2012) examined
the concept of nurse empowerment over time. This analysis
revealed that nurses have
viewed empowerment through a lens that focuses on
organizational structure. According
to Rao (2012), nurses rely “too heavily on rigid bureaucratic
structures rather than their
own professional power to guide practice. Limiting nurses in
this way denies the profes-
sional power their role affords them and constrains their ability

5. to achieve extraordi-
nary outcomes” (p. 401). According to Des Jardin (2001),
nurses may not believe that
they have a role to “challenge the structure of the health care
system or the rules guiding
that system” (p. 614). Because policy is change, this can cause
tension for nurses (Des
Jardin, 2001). Therefore, the first steps in many cases are
recognizing one’s intellectual
capital and then overcoming the inertia and speaking out. At
work, this process starts
by regularly attending meetings and bringing forth issues that
have policy implications,
and nursing expertise can help guide these steps. Substantive
policy changes often start
when people see problems as they carry out their jobs. The
policy may relate to an array
of practice or clinical issues. Policy on the Scene 7.1 provides
examples of how nurses in
adult and pediatric settings made change using intellectual
capital.
204 UNIT III STRATEGIZING AND CREATING CHANGE
SOCIAL CAPITAL
The second interdependent component is social capital. As
noted, intellectual capi-
tal must be expended to be of benefit; it needs to be shared.
Developing social capi-
tal is essentially relationship building. More specifically,
relationships are built and
POLICY ON THE SCENE 7.1: Using Intellectual Capital to
Change Practice

6. APRNs have a unique opportunity to use intellectual capital to
help change
practice. The work of Dianna Copley, MSN, APRN, ACCNS-
AG, CCRN, at the
Cleveland Clinic and Sue Nicholas MSN, RN-BC, WHNP-BC,
CCCTM at Akron
Children’s Hospital are used here to illustrate capital to change
practice policy.
In her first few months in practice as a new clinical nurse
specialist (CNS),
Dianna Copley observed inconsistency in care for hospitalized
patients who
needed a wearable cardiac defibrillator. As a new CNS, it was
on her list of prob-
lems to tackle, along with preparing for an upcoming
presentation she had at the
National Association of Clinical Nurse Specialists annual
conference. She was
presenting on her recent transition from clinical nurse to CNS.
While at the con-
ference, she attended a presentation describing an
interprofessional approach
to the care of patients wearing cardiac defibrillators. She also
learned that this
low-volume, high-risk device has inadvertently shocked
healthcare providers.
The CNS collaborated with CNS colleagues, clinical nurses, and
nurse leaders to
create guidelines for caring for patients with such defibrillators.
The guideline
was identified as having implications across the entire
healthcare system and
span of adult care, including emergency services, critical care,
and medical–

7. surgical nursing. What started as one CNS wanting to improve
care in her own
unit became a new policy supporting care provided by over
22,000 nurses in the
system (Dianna Copley, personal communication, November 9,
2017).
In the second example, Sue Nichols, made her change when she
participated
in her hospital’s evidence-based practice (EBP) learning
community. Her work
led to a revised policy for taking family histories in a maternal–
fetal medicine
(MFM) practice. As part of her EBP project, Ms. Nicholas
collaborated with
a team that found a self-report of family history might improve
the comprehen-
siveness of the history, result in a timelier completion of the
history, and facili-
tate opportunities for earlier and more comprehensive genetic
counseling. Using
the Rosswurm-Larrabee Model for planned change,
Ms. Nicholas and the team
synthesized evidence for analysis by linking the problem,
interventions, and out-
comes. They found that a self-report using a standardized
pregnancy health tool
increased identification of families at risk for inheritable
disease and women at
risk for pregnancy difficulties. The tool was easy for patients to
use and under-
stand, and it was free of charge. After institutional review board
approval, the
project was trialed for 6 months, with the results showing a
dramatic increase in
genetic counseling from 7% to 71% after the implementation of

8. the self-report
process. Subsequently, the completion of the pregnancy health
tool became
a standard policy in the completion of family histories for the
MFM practice
(Meghan Weese, MSN, RN, CPN, NEA-BC, Magnet®
coordinator, personal com-
munication, November 6, 2017).
Chapter Seven BUILDING CAPITAL 205
nurtured with key decision makers at the state and national
levels to influence policy
change. For the nursing profession, social capital should be the
most basic, intui-
tive, and strongest form of capital. Nurses create relationships
with their patients,
their patients’ families, fellow nurses, managers, and so on.
Contextually, it relates to
the key elements that are necessary for a positive relationship,
namely, honesty and
trust. As is often repeated in this book, but not capitalized on by
nurses, the nurs-
ing profession consistently ranks highest among all others as
being the most honest
profession (Brenan, 2017).
The Big “P”
Social capital at the big “P” level involves the development of
relationships with appointed
and elected officials. Members of Congress listen to the voices
of their constituents.
This is a reality that every lobbyist inherently knows well. It is
constituents, not the

9. registered lobbyists, who reelect legislators to serve another
term. Therefore, opinions
of constituents are tremendously more relevant than any
political wonk in the nation’s
capital. Even though many believe that and there is evidence
that wealth plays an influ-
ential role in swaying policy, the value of constituents’ opinions
and support cannot be
dismissed; however, constituents must make their opinions
known.
To simply be a nurse constituent in the district of a member of
Congress does not
mean your voice will be heard among the other hundreds of
thousands of constitu-
ents. You must be savvy. One of the best ways to accomplish
this is to gain guidance
from national or state nurses associations. If a nurse has an
opportunity to directly
communicate with a member of Congress, a nurses association’s
lobbyist could
provide background on the member’s political positions,
information about what
Congress is currently debating and what message would be most
relevant, and talk-
ing points to help prepare for an interaction (see Chapter 10)
This is the job of regis-
tered lobbyists: to prepare their members to be politically savvy
through relationships
or social capital. In relation to the big “P” political scientists
have described these as
grasstops.
Essentially, nursing needs to develop more grasstops. Grasstops
are defined as lead-
ers, such as those within an industry or field, who “usually

10. know who within their
sphere shares their interests and what other prominent leaders
may be interested”
(Gibson, 2010, p. 91). They also embody the social capital
necessary to influence a
member of Congress. “The member may listen to that person
and no one else on a
particular issue” (Gibson, 2010, p. 91). Many times, the
grasstops are constituents who
have supported members of Congress either politically (worked
on a campaign) or
financially (provided an individual donation to a campaign) or
who are leaders in their
industry (Goldstein, 1999).
To summarize, nursing can build its social capital by having
individuals who are
savvy (intellectual capital) and who have developed
relationships with their elected
representatives or staff: in other words, grasstops. The goal is to
develop a meaning-
ful relationship. That relationship helps the individual nurse be
a valued and trusted
resource to that member of Congress. At the core of social
capital is developing a long-
standing relationship.
Meaningful relationships can be nurtured through financial or
personal volun-
teerism. If financially contributing to the campaign of a member
of Congress is not
feasible, consider volunteering to work on the campaign. If your
political views do
not align with your current members of Congress, work on the
campaign of their

11. 206 UNIT III STRATEGIZING AND CREATING CHANGE
opponent. Also consider being an ever-present voice in your
legislators’ offices, no
matter their views or party affiliations. This activity can and
has led to nurses becom-
ing a major resource and influence on a legislator, a governor,
or staff member.
Offering time and expertise is a significant determinant in one’s
ability to influence a
member of Congress and staff. These relationships do not form
overnight. Do not give
up even when you are told “no.” Even when you have differing
political leanings than
the member of Congress, you can have the opportunity to
educate the legislator or staff
about issues that are important.
Relationship building takes tenacity, particularly when you are
working with a con-
gressional office that might not have the same viewpoint and
may never support the
issue at hand. This should never be a reason not to visit a
member of Congress and staff
and pass on the opportunity to educate them about the issue and
the importance to
their constituency. “No” does not always mean never.
Grasstop relationships are important in nursing, as exemplified
in the Policy
Challenge and Option for Policy Challenge in this chapter. The
type of social capital
that a high-level professional position in leadership or in

12. politics provides is important
in not only opening doors to the discussion of issues, but also
providing support that
can sway support of or defeat a project or legislation. Although
discussed under the big
“P” here, there are grasstop advocates at the little “p” level. As
a chair of a local political
party or a local board, you may have access to influencing to
influence other opinion
leaders.
The Little “p”
Social capital can ensure policy change at the little “p” level in
many of the same ways as
at the big “P.” The goal is developing relationships with
individuals making the policy
decisions and with individuals who have intellectual and social
capital themselves. It is
critical to identify who those individuals are and how you can
connect with them. Often,
at the big “P” level, the individuals with whom you want to
develop relationships may
be obvious, and at the little “p” level, it is sometimes less clear.
At first, one may think
of only the organizational hierarchy where you work as
important in building social
capital. Those relationships are vital. However, a good strategy
is starting with your
existing base of relationships and then broadening those
relationships and networks.
Consider all your acquaintances as potential opportunities to
extend your social capi-
tal. As your network grows, it extends to people who do not
necessarily think like you
or do the same job as you. You will become less insulated in
your views, friendships,

13. and networks.
As discussed in the section Political Capital, there is power in
numbers. Building
a network of colleagues (nurses and non-nurses) who agree with
the premise of the
policy change can better solidify the chances of its
implementation. Demonstrating
that more than one individual supports the policy change can
influence the decision.
Establishing this network can sometimes be done easily.
Talking during a shift or dur-
ing an after-hour socialization are some ways. Oprah Winfrey
popularized her “book
club,” and thousands began discussing literature. Take a cue
from Oprah to create a
“policy club,” a network that can offer information and
assistance.
Building social capital at the local level can be accomplished in
many ways: attending
continuing education programs provided by your employer,
participating in district
nurses associations or other nurses’ groups, serving as a
moderator for educational
sessions, joining or participating in local organizations’ social
events or journal clubs,
Chapter Seven BUILDING CAPITAL 207
using break times to socialize with key leaders in your
organization, or volunteering
for your organization’s community events. For example, one
new graduate built social

14. capital when she was asked by her nurse manager to volunteer
for her hospital’s
community health fair a week before her employment start date
because one of the
volunteers had an emergency. The graduate had experience in
organizing community
events. She fulfilled an important need in making the event a
success while building
important social capital.
A particularly effective way of learning about social capital is
from a mentor.
Mentors can, formally or informally, help you by advising you
through stories and
exemplars of how they were successful and not so successful in
relationship building.
Nurse leaders, such as committee chairs, managers, or nurse
executives, can serve as
mentors. Successful nurse leaders embrace helping nurses with
less experience; they
often tell you they owe their success to a mentor or mentors.
They believe in paying
it forward.
Whether social capital is built at the state, national, or local
level, the key is not
necessarily quantity, but quality. As your network grows, it is
important to monitor and
continually scan for changes in opinions, relationships, and
opportunities to advance
your social capital. Just as in building any relationship, it takes
time and commitment
to establish a trusted long-term relationship. A visit or phone
call once a year is not
enough. Consistent, regular communication is necessary. At the
big “P” level, consis-

15. tently taking the time to send your legislators a new study or
simply checking in and
offering assistance establishes that necessary connection.
Moreover, creating opportu-
nities to connect with your network at the little “p” level is also
accomplished through
consistent purposeful communications. Simple measures for
maintaining a relation-
ship yield great return on the social capital investment and can
ultimately assist in
creating policy changes.
POLITICAL CAPITAL
Political capital is influence. It can take multiple forms:
financial, social, and intellec-
tual. For the context of this section, political capital is
described as advocacy and “lob-
bying” efforts undertaken by nurses and the nursing profession.
Often when the term lobbying is heard, it may carry a negative
connotation,
depending on an individual’s experience with the political
process. Lobbying used in
the general sense is promoting an agenda to influence specific
decisions. However,
there are precise definitions and regulations for lobbying at the
federal and state levels
that govern practices. The education of policy makers (e.g.,
providing information)
and advocacy on an issue (see Chapter 2) are closely related but
often misunderstood.
The concepts of grassroots, free riders, and coalitions are
introduced and clarified
in relation to lobbying (see the section Financial Capital for the
financial aspects of
lobbying).

16. The Big “P”
At the federal level, the Lobbying Disclosure Act (LDA) defines
lobbying contact as
any oral, written, or electronic communication to a federal
official that is made on
behalf of a client as specified in the LDA (Office of the Clerk,
2017). Moreover, lob-
bying activities include “any efforts in support of such contacts,
including preparation