NTI2010 Policy Politics And You Act With Intention

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2010 NTI Mastery Presentation

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  • Policy encompasses the choices that a society, segment of society, or organization makes regarding its goals and priorities and the ways it allocates its resources to attain those goals. Policy choices reflect the values, beliefs, and attitudes of those designing the policy (Mason, Leavitt, Chafee, 2007 p.3).
  • ICN – International Council of Nursing
  • Reference: ENCYCLO Online encyclopedia – http://www.encyclo.co.uk/define/social%20policy.
  • Organizational policies: are applicable to specific organizations, for example to: - their resources - their staff their operations include policies - made by an organization that affect the organization as a whole - made by sections of an organization that affect the internal operations of those sections may also be public policies if they affect the public at large
  • Audience participation: What does the term politics mean to you? Where do you see politics being used predominantly? Who is involved in nursing policy/politics within your own organizations? What is the importance of being active in these decisions?
  • Points: Gilligan (1982) and Pinch (1996) – Caring is not gender based: Women do not “own” nurturing, compassion and caring. To view caring as “female” trivializes the concept and precludes it from being integral to policymaking.
  • A values framework for politics and policy process. This figure illustrates the steps in the policy process. Politics can influence the process in any step. Both the politics of policy development and the policy itself are grounded in and influenced by values.
  • Prenatal care: Prenatal care cost relatively little compared with high cost of neonatal intensive care – Lowest birth weight infants cost an average of $250,596 (Cuevas, Silver, Brooten, Youngblut, Bobo, 205). Once the infant is stabilized – sent home without a guarantee the mother will receive support she needs. Mandatory Overtime: Used to ensure adequate staffing for nursing care – The policy fails to reflect caring about patients or nurses – Shown to be harmful to patients Found nurses working mandatory overtime have an increased number of medication errors Nurses who are single parents – must decide whether to commitment between their patients or their children. Nurse to Patient Ratios: Hospitals cite financial constraints in their argument against improving nurse-patient ratios Rothberg, Abraham, Lindenauer & Rose (2005) – report that the cost of nurse staffing as a safety intervention finding that the “cost per death averted” with a staffing ratio of 1:4 was not as expensive as that of a Pap test or the use of thrombolytics after and MI. Two procedures which are viewed as a standard of care and reimbursed accordingly. (Mason, Levitt, Chaffey, (2007). Summary – If nurses want institutions and government to develop policies that reflect nursing’s values, then nurses must be a part of the decision making process --- The Political Process
  • 1. Power – Men tend to embrace hierarchic models of power -”Power grabbing” or power over. Whereas women tend to gravitate to power with , sharing 1. Transformational Leadership – popular with both sexes – espousing the style that embraced collaboration, creativity and empowerment. Mason, et.al (1991) identified three components for the political empowerment of nurses: 1. Consciousness raising about the sociopolitical realities of a nurse’s life and work within society. 2. A sense of self-efficacy and self-esteem regarding nurse’s ability to participate in the policymaking process. 3. Development of skills to influence the policymaking process: knowing how to use the traditional methods as well as new methods of relating to power and politics.
  • Utilize your local or national newspaper to identify key issues which need attention. Identify the parties responsible for the any legislation that may be taking place currently. Most newspapers will print a listing of your state’s political figures including those in Washington, D.C. Utilize Professional Organizations are a primary source of up-to-date information on political issues, current legislation, and provide sources to further your research. 1. Utilize your association’s Legislative Action Center page: www.aacn.org/healthpolicy - AACN; www.aone.org/aone/advocacy – AONE; http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues.aspx - ANA;
  • 1. List out the workplace policies and procedures manuals.
  • TCAB – Strategy for reducing the shortage in nursing staff and improving the quality of nursing care by changing the way care is delivered at the bedside. Joint project with Institute for Healthcare Improvement (IHI) – aimed at changing the work environment of hospitals to support bedside nurses as the key change agent PVHS experience: 2 year involvement with RWJF and IHI in the collection of data. Making changes in the way nurses provide care at the bedside with over 50 processes completed and either adapted or adopted. The simplest – Moving the ice bags from the store room to the pantry where the ice machine is. Saved 2 steps. Second – Incorporating a “resource” nurse for the day/week. This nurse was assigned to do the discharge teaching and medication reconciliations for all patients being discharged. This allowed the other nurses to continue with their patient care duties and not have to worry about assessments and discharges at the same time.
  • 1. Government – New EPA regulations for the handling of certain medications: Coumadin, Antibiotics, Nicotine patches, etc… Evolution of small waste bins in the medication rooms to waste these medications in.
  • We live in a society in which we are all interconnected; welfare and safety of each one of us depends on the health and welfare of a cooperative and collective enterprise. Provides society with a legal definition of what nursing is, and it defines what nurses may do.
  • Jacob Hacker (Yale Political Scientist) – Road to NoWhere after the Clinton administration’s proposal in 1993.
  • Knowledge@Wharton – 2008 Presidential Candidates Push Health Care Reform, but who will pay? Senator Clinton’s plan is scaled back from her previous plan in 1993 – 1994. “Hybrid between free-market and her earlier proposal. President Obama calls for a Universal coverage and a mandate that all children be covered. His plan stops short of extending the mandate to adults. $65 billion plan – “National Health Insurance Exchange” – Similar to Hacker’s plan. Senator McCain – Attacks the nations health care problems from the cost control issue. His proposal seeks better management of chronic conditions (diabetes and CAD). The plan calls for hospital and doctor compensation based on performance, starting with Medicare and Medicaid. – Eliminates employer based write-off. Proposes a tax deduction of $2,500 for individuals and $5,000 for families which would go toward the purchase of health insurance.
  • As public citizens, chapter members have the right to make their voice heard in government. Chapter members are prohibited from using their membership in AACN or AACN chapters to endorse or oppose a candidate for elective office at any level of government.
  • 1. Late 1970’s and early 80’s, nurses recognized they were excluded from important policy developments – Decisions were made that influenced practice without our input
  • Mason, Leavitt, & Chaffee – Chapter 3. pp 34-36
  • This phase – build on the valuable expertise of nursing and health care leaders in health policy. Policymakers and legislators turn to nursing to be the experts on their health advisory committees. Nursing becomes more involved at the table: Health boards, commissions, appointments to policy-making bodies.
  • 1. 111 th Congress – Only three nurses serve.
  • Working Nurse (2008). 100 nurses serve in legislation either at the state level or in Congress. Currently there are 10 states that have at least one nurse serving in elected offices: 15 states have two, five states have three, 2 states have at least four nurses and 3 states have at least six or more. a. Montana – 6 b. Minnesota – 7 c. Washington - 8
  • Reference: Kubsch, Sternard, Hovarter & Matzke (2004) – in Mason, Leavitt, Chafee (2007). Policy & Politics in Nursing and Health Care . Saunders, St. Louis. Pp. 36-37.
  • Wald fought to have rights of children – Argued that it was shameful for a nation to have policies and departments protecting animals but not children.
  • The Comstock Act of 1873 was targeted not only at obscenity and “dirty books” but at birth control devices and information on such devices, at abortion, and at information on sexuality and sexually transmitted diseases. It was widely used to prosecute those who distributed information or devices for birth control. In 1938, in this case involving Sanger, Jude August Hand lifted the federal ban on birth control, effectively ending use of the Comstock Law.
  • Do not write a letter regarding issue with your state’s practice act to a federal legislator. When writing to a committee chair; Write them at their committee’s address and not their congressional address. Hints: Be brief, be personal, be specific, be polite, and be sure to sign your name and include your address: REMEMBER – Thank you notes are IMPORTANT.
  • Salutation: Include formal title and last name. Identify Yourself: Assert your credibilty as a nurse, a member of a specialty or organization, a professional, a registered voter concerned about_____.
  • NOTE : When writing to the Chair of a committee or the Speaker of the House – Dear Mr. Chairman or Madam Chairwoman; Dear Madam Speaker or Mr. Speaker;
  • NTI2010 Policy Politics And You Act With Intention

    1. 2. Policy, Politics and You: Act with intention unifying Nursing’s Political Voice Todd M. Grivetti, MSN, RN, CCRN, CNML Clinical Nurse Manager Regional Neurosciences Center Poudre Valley Hospital Ft. Collins, CO
    2. 3. House Keeping Please Turn your Cell phones and pagers to Vibrate.
    3. 4. Disclosure Statement As a member of AACN’s Speaker’s bureau I have received an honorarium from AACN for this presentation. I have no other vested interest(s) from any other organization.
    4. 5. Learning Objectives <ul><li>At the end this session participants will be able to: </li></ul><ul><ul><li>Identify four spheres of political action in nursing along with identifying AACN’s public policy links and other resources to Act With Intention and be the Bold Voice of Nursing. </li></ul></ul><ul><ul><li>Discuss the four stages of political development of nursing and how nurses navigate to become key players in policy arenas. </li></ul></ul><ul><ul><li>Described how nurses can Act With Intention and become the voice of healthcare policy utilizing nursing’s historic mandates. </li></ul></ul><ul><ul><li>Identify resources available for political activism </li></ul></ul>
    5. 6. Introduction to Policy & Politics <ul><li>Policy: </li></ul><ul><ul><li>The principles that govern action directed towards given ends (Titmus, 1974). </li></ul></ul><ul><ul><li>More Definitions: </li></ul></ul><ul><ul><ul><li>A policy is a deliberate plan of action to guide decisions and achieve rational outcome(s). The term may apply to government, private sector organizations and groups, and individuals. Presidential executive orders, corporate privacy or human resource policies , and parliamentary are all examples of policy. </li></ul></ul></ul><ul><ul><ul><li>A set of interrelated decisions taken by a political actor or group of actors concerning the selection of goals and the means of achieving them. </li></ul></ul></ul><ul><ul><ul><ul><li>Within a specified situation where those decisions, should, in principle be within the power of these actors to achieve (Jenkins, 1978). </li></ul></ul></ul></ul><ul><ul><li>An art and a craft… </li></ul></ul><ul><ul><ul><li>Involves: vision, creativity and imagination in : </li></ul></ul></ul><ul><ul><ul><ul><li>Identifying and explaining social problems </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Creating policy to solve problems </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Ensuring the implemented policy leads to positive or negative impact. </li></ul></ul></ul></ul>
    6. 7. Types of Policy <ul><li>Types of Policy </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Social </li></ul></ul><ul><ul><li>Health </li></ul></ul><ul><ul><li>Institutional </li></ul></ul><ul><ul><li>Organizational </li></ul></ul>
    7. 8. Public Policy <ul><li>Public policy is formed by governmental bodies – </li></ul><ul><ul><li>Legislation passed by Congress and the regulations written from that legislation. </li></ul></ul><ul><ul><ul><li>Public policy related to tobacco use – including laws that ban selling cigarettes near schools and require health warning labels. </li></ul></ul></ul><ul><ul><ul><li>Policies made by government departments or other public agencies with respect to their internal operations when they affect the public at large. </li></ul></ul></ul>
    8. 9. Public Policy <ul><li>Nursing Legislative issues </li></ul><ul><ul><li>Shortage, education, workplace issues </li></ul></ul><ul><ul><li>Resources? </li></ul></ul><ul><ul><ul><li>Professional Organizations (AACN, ANA, AONE, ICN) </li></ul></ul></ul><ul><li>Patient safety goals </li></ul><ul><ul><li>Medication safety </li></ul></ul><ul><ul><li>Falls </li></ul></ul><ul><ul><li>New CMS guidelines </li></ul></ul><ul><ul><li>Resources </li></ul></ul><ul><ul><ul><li>Joint Commission </li></ul></ul></ul><ul><ul><ul><li>Organizational policies </li></ul></ul></ul><ul><ul><ul><li>Centers for Medicare and Medicaid Services (CMS) </li></ul></ul></ul>
    9. 10. Public Policy & Political Competency Guidelines <ul><li>Be aware of the impact of the state board of nursing, Center’s on Medicare/Medicaid services, and the department of health services within your state on the practice of nursing </li></ul><ul><li>Participate in organizations that impact the practice of nursing. </li></ul><ul><li>Expect colleagues to actively participate in nursing and health-care policy organizations. </li></ul><ul><li>Meet with your state legislator at least every three months. </li></ul><ul><li>Invite legislator to your organization and chapter meetings to share ideas and influence policy </li></ul>Malloch, 2005
    10. 11. Social Policy <ul><li>Social policy pertains to the policy decisions that promote the welfare of the public: </li></ul><ul><ul><li>Local ordinance on age limit for purchase of tobacco products. </li></ul></ul><ul><ul><li>Aim at improving </li></ul></ul><ul><ul><ul><li>Health </li></ul></ul></ul><ul><ul><ul><li>Education </li></ul></ul></ul><ul><ul><ul><li>Welfare </li></ul></ul></ul><ul><ul><ul><li>Social Security </li></ul></ul></ul>
    11. 12. Healthcare Policy <ul><li>Health Policy: </li></ul><ul><ul><li>The decision made to promote the health of individual citizens. </li></ul></ul><ul><ul><ul><li>Federal may pay for smoking cessation / prevention programs for all persons in the military and their families. </li></ul></ul></ul><ul><ul><ul><li>States might require coverage for smoking cessation programs by Medicaid managed care plans. </li></ul></ul></ul>
    12. 13. Healthcare Policy <ul><li>Sources: </li></ul><ul><ul><li>Organizational </li></ul></ul><ul><ul><ul><li>Organizational policy sources are developed by health care institutions to govern work places and direct behaviors. They are influenced by the demands and resources of key external suppliers, purchasers, communities, agencies and media. </li></ul></ul></ul><ul><ul><li>Social </li></ul></ul><ul><ul><ul><li>Public policy sources are authoritative decisions made within government that pertain to health. They can take the form of laws or operational rules, and can be allocative or regulatory in nature. Public policy sources are influenced by broad contextual factors such as interest groups, diverse segments of society, economics, demographics, and environmental forces. </li></ul></ul></ul><ul><ul><li>Professional </li></ul></ul><ul><ul><ul><li>Professional sources are discipline specific and multidisciplinary organizations that establish standards, guidelines, and research-based recommendations for providers and healthcare delivery systems. </li></ul></ul></ul>Taft, Nanna (2008).
    13. 14. Health Policy
    14. 15. Health Policy
    15. 16. Institutional Policy <ul><li>Institutional policies govern workplaces: </li></ul><ul><ul><li>What the institution’s goals are and how will it operate. </li></ul></ul><ul><ul><ul><li>No Smoking ban – prohibiting patients and staff from smoking anywhere in the building to the grounds. </li></ul></ul></ul><ul><ul><ul><li>Time and Attendance </li></ul></ul></ul><ul><ul><ul><li>Nursing process </li></ul></ul></ul><ul><ul><ul><li>Palliative care </li></ul></ul></ul><ul><ul><ul><li>Internet usage </li></ul></ul></ul>
    16. 17. Institutional Policy Development <ul><li>Scope: Who the policy is intended for: </li></ul><ul><ul><li>Example: Identify the range for the organization – (i.e., All PVHS Hospitals). </li></ul></ul><ul><li>Strategies for development: </li></ul><ul><ul><li>Criteria for a good policy </li></ul></ul><ul><ul><ul><li>Useful for intended users. </li></ul></ul></ul><ul><ul><ul><li>Includes policies on all levels and meets relevant criteria for accreditation and legislative requirements. </li></ul></ul></ul><ul><ul><ul><li>Will it improve quality service. </li></ul></ul></ul>
    17. 18. Institutional Policy <ul><li>Tips for writing good policies: </li></ul><ul><ul><li>Devote time at least once per month to brainstorm issues pertaining to one area of the policy and review draft versions as required. </li></ul></ul><ul><ul><li>Be aware of the need to actually tailor policies to your own organization. </li></ul></ul><ul><ul><li>Be aware that borrowing other policies may result in approaches and styles of policy which are not compatible to others. </li></ul></ul>
    18. 19. Institutional Policy <ul><li>Tips Continued: </li></ul><ul><ul><li>Keep it Simple </li></ul></ul><ul><ul><li>Ensure Drafts have a number and date for ease of tracking. </li></ul></ul><ul><ul><li>Endorsed policies should include who authorized the policy and when. </li></ul></ul><ul><ul><li>Ensure there is someone in the organization who is responsible for maintaining control of policies and production of policy manual. </li></ul></ul>
    19. 20. Organizational Policy <ul><li>Organizational policies are positions taken by organizations: </li></ul><ul><ul><li>State nurses’ associations </li></ul></ul><ul><ul><li>Associations </li></ul></ul><ul><ul><li>Professional organizations </li></ul></ul><ul><ul><ul><li>ANA – American Nurses Association </li></ul></ul></ul><ul><ul><ul><li>AACN – American Association of Critical Care Nurses </li></ul></ul></ul><ul><ul><ul><li>AONE – American Organization of Nurse Executives </li></ul></ul></ul><ul><ul><ul><li>ICN – International Council of Nurses </li></ul></ul></ul><ul><ul><li>Members may put forth a resolution for free continuing education programs. </li></ul></ul>
    20. 21. Politics - Definition <ul><li>Simply: The process of influencing the allocation of scarce resources . </li></ul><ul><li>Webster: 1a: The art or science of government b: the art or science concerned with guiding or influencing governmental policy c: the art or science concerned with winning and holding control over a government. ( www.meriam-webster.com ) 2010. </li></ul>
    21. 22. Perception of Politics <ul><li>Positive perceptions </li></ul><ul><ul><li>Influencing </li></ul></ul><ul><ul><ul><li>The opportunities to alter the outcomes of a process. </li></ul></ul></ul><ul><ul><li>Allocation </li></ul></ul><ul><ul><ul><li>Decisions being made about how to divide resources among competing groups or individuals. </li></ul></ul></ul><ul><ul><li>Scarce Resources </li></ul></ul><ul><ul><ul><li>Implies there are limits to the amount of resources available </li></ul></ul></ul><ul><ul><ul><ul><li>Financial backing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Time </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Staff </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Other entities in the process </li></ul></ul></ul></ul>
    22. 23. Perceptions of Politics <ul><li>Negative perceptions </li></ul><ul><ul><li>Smoke filled rooms </li></ul></ul><ul><ul><li>Shady deals made by power brokers </li></ul></ul><ul><ul><ul><li>Pork Barrel spending </li></ul></ul></ul><ul><ul><ul><li>Teapot Domes </li></ul></ul></ul><ul><ul><ul><li>Unethical compromises </li></ul></ul></ul><ul><ul><ul><li>Vote buying </li></ul></ul></ul>
    23. 24. Perception of Politics <ul><li>Factors </li></ul><ul><ul><li>An individual’s own biases, experiences, and knowledge of politics </li></ul></ul><ul><ul><li>How the “game” of politics is played - </li></ul></ul><ul><ul><ul><li>System in which politics is operating </li></ul></ul></ul><ul><ul><ul><li>What rules have been established as acceptable </li></ul></ul></ul><ul><ul><li>Whether the goals or end is important </li></ul></ul><ul><ul><li>Whether one is in a position to change the rules of the system </li></ul></ul>
    24. 25. Values Associated with Policy & Politics <ul><li>Nursing: </li></ul><ul><ul><li>Caring </li></ul></ul><ul><ul><li>Collaboration </li></ul></ul><ul><ul><li>Collectivity </li></ul></ul><ul><ul><li>High-touch care </li></ul></ul><ul><li>Often conflict with dominant values of society </li></ul>
    25. 26. Values Framework Politics Politics Values Evaluation Implementation Policy Alternatives Goals Agenda Politics Values
    26. 27. Values Framework <ul><li>Complex </li></ul><ul><li>Multidimensional </li></ul><ul><li>Examples: </li></ul><ul><ul><li>Prenatal care in the U.S. </li></ul></ul><ul><ul><ul><li>Not guaranteed </li></ul></ul></ul><ul><ul><ul><li>Some women receive very little or no prenatal care </li></ul></ul></ul><ul><ul><li>Mandatory overtime used by hospitals </li></ul></ul><ul><ul><li>Nurse to patient ratios </li></ul></ul>
    27. 28. Values, Policy & Politics <ul><li>Taft & Nanna (2008). </li></ul><ul><ul><li>Recognition has grown that nursing has a responsibility for engaging in actions that influence health policy, and that advocacy may reasonably be considered a role expectation for the professional nurse. If so, what knowledge and competencies do nurses need? </li></ul></ul><ul><ul><ul><li>Power </li></ul></ul></ul><ul><ul><ul><li>Empowerment </li></ul></ul></ul>
    28. 29. Values, Policy & Politics <ul><li>Mason, et.al (1991) </li></ul><ul><ul><li>Nonetheless, the idea of empowerment is one that remains important to nursing’s political development, because it “requires a commitment to connection between self and others, enabling individuals or groups to recognize their own strengths, resources, and abilities to make changes in their personal and professional lives.” </li></ul></ul>
    29. 30. Identify your Policy & Political Resources
    30. 31. Four Spheres of Political Action in Nursing <ul><li>Workplace </li></ul><ul><li>Government </li></ul><ul><li>Professional Organizations </li></ul><ul><li>Community </li></ul>
    31. 32. Four Spheres Framework Community Government Organizations Workplace
    32. 33. Four Spheres - Workplace <ul><li>Workplace </li></ul><ul><ul><li>Acute Care </li></ul></ul><ul><ul><li>Home Care </li></ul></ul><ul><ul><li>Nursing Homes </li></ul></ul><ul><ul><li>School-based clinics </li></ul></ul><ul><ul><li>Occupational Health clinics </li></ul></ul><ul><ul><li>Physician’s Offices </li></ul></ul>
    33. 34. Four Spheres - Workplace <ul><li>Policies & Procedures Manuals </li></ul><ul><ul><li>Workplace policies </li></ul></ul><ul><ul><li>Nursing care </li></ul></ul><ul><ul><li>Written & unwritten </li></ul></ul><ul><li>Examples: </li></ul><ul><ul><li>Designation of no-smoking areas or ban on smoking </li></ul></ul><ul><ul><li>Requirement for nurses to work overtime </li></ul></ul><ul><ul><li>Decisions concerning the use of unlicensed personnel </li></ul></ul><ul><ul><li>Policy permitting loved ones being present during an emergency </li></ul></ul>
    34. 35. Four Spheres - Workplace <ul><li>Magnet Hospitals </li></ul><ul><ul><li>Hallmark of a Magnet organization is nurses’ involvement in decision making at all levels of the organization and inclusion as an important voice in the development of policies </li></ul></ul><ul><li>Robert Wood Johnson Foundation (RWJF) </li></ul><ul><ul><li>Transforming Care at the Bedside (TCAB) </li></ul></ul>
    35. 36. Four Spheres - Workplace <ul><li>Summary: </li></ul><ul><ul><li>Workplace policies also shaped by: </li></ul></ul><ul><ul><ul><li>Government </li></ul></ul></ul><ul><ul><ul><ul><li>Policies on handling of hazardous waste** </li></ul></ul></ul></ul><ul><ul><ul><li>Professional Organizations </li></ul></ul></ul><ul><ul><ul><ul><li>May pressure nurses’ workplaces to use particular protective equipment in high-risk areas. </li></ul></ul></ul></ul><ul><ul><ul><li>Community </li></ul></ul></ul><ul><ul><ul><ul><li>Community needs for healthcare delivery </li></ul></ul></ul></ul>
    36. 37. Four Spheres - Government <ul><li>Governmental actions </li></ul><ul><ul><li>Laws requiring </li></ul></ul><ul><ul><ul><li>Birth records </li></ul></ul></ul><ul><ul><ul><li>Immunizations </li></ul></ul></ul><ul><ul><ul><li>Legal establishment of drinking age </li></ul></ul></ul><ul><ul><ul><li>Legal age to vote or join the military </li></ul></ul></ul><ul><ul><ul><li>Laws determining what health services people are eligible for in old age and how assets are distributed on a person’s death. </li></ul></ul></ul>
    37. 38. BREAK <ul><li>15 Minutes </li></ul>
    38. 39. Four Spheres - Government <ul><li>Government has grown bigger and centralized </li></ul><ul><li>Plays important role in nursing </li></ul><ul><li>Influences reimbursement systems for health care and nursing services </li></ul><ul><li>Determines who receives what type of health services. </li></ul><ul><ul><li>Healthcare Reform Bill 2010 </li></ul></ul><ul><ul><ul><li>www.healthreform.gov </li></ul></ul></ul>
    39. 40. Four Spheres – Government <ul><li>Health Insurance Plan </li></ul><ul><ul><li>47 million Americans without adequate health insurance. </li></ul></ul><ul><ul><li>The type of insurance held by most Americans and favored by public policy </li></ul></ul><ul><ul><ul><li>Employment based </li></ul></ul></ul><ul><ul><ul><ul><li>Tax subsidy in excess of $100 billion annually </li></ul></ul></ul></ul><ul><ul><ul><li>Individual insurance </li></ul></ul></ul><ul><ul><ul><ul><li>Held by 7% of Americans. </li></ul></ul></ul></ul>Kaiser Family Foundation, 2007; Knowledge@Wharton, 2000.
    40. 41. Four Spheres – Government <ul><li>National Health Plan </li></ul><ul><ul><li>Hacker’s Plan – 3 Principles </li></ul></ul><ul><ul><ul><li>No one loses what they currently have. Unless, employer’s “kick” you out. </li></ul></ul></ul><ul><ul><ul><li>Creation of Health Care for American market (HCA) </li></ul></ul></ul><ul><ul><ul><ul><li>Insurers compete for business of individuals and employers. </li></ul></ul></ul></ul><ul><ul><ul><li>Group market contains strong public insurer modeled on Medicare creating competition between private companies and the public market. </li></ul></ul></ul><ul><ul><li>Source: (Kline, 2008) </li></ul></ul>
    41. 42. Four Spheres - Government <ul><li>Wyden’s Plan: Senator Ron Wyden (OR) and Senator Robert Bennett (UT): </li></ul><ul><ul><li>Lacks public insurer – no public-private competition . </li></ul></ul><ul><ul><li>Does away with employer health coverage almost entirely. </li></ul></ul><ul><ul><li>Create “Health Help Agencies” in each state. </li></ul></ul><ul><ul><li>No “cherry-picking”, no high premiums, or denials of coverage for pre-existing conditions. </li></ul></ul><ul><ul><li>Everyone pays the same price, but everyone has to buy insurance that’s at least comprehensive as the current Blue Cross-Blue Shield Standard Plan </li></ul></ul><ul><ul><li>Subsidies for low income </li></ul></ul><ul><ul><li>Penalties for those who do not buy </li></ul></ul><ul><ul><li>Medicare still exists for the elderly. </li></ul></ul>
    42. 43. Four Spheres - Government <ul><li>National Health Plan </li></ul><ul><ul><li>Lewin Group – “ Gold Standard ” Healthcare consulting. </li></ul></ul><ul><ul><ul><li>Estimates Hacker’s plan will save $1.04 Trillion over 10 years. </li></ul></ul></ul><ul><ul><ul><ul><li>Basic Efficiencies: Administrative and technological. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>If it works, it will have two effects: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Money savings by mandating the HCA to spend less money. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Caps spending and induces providers to utilize available funds more cost effectively. </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Estimates Wyden’s plan will save $1.48 trillion over 10 years. </li></ul></ul></ul><ul><ul><ul><ul><li>Not from explicit spending caps as Hacker’s plan, but from consumers who see how much they are spending on health care and then become more price-sensitive and choose cheaper options. </li></ul></ul></ul></ul>
    43. 44. Four Spheres - Government <ul><ul><li>Children’s Health Care (SCHIP’s) </li></ul></ul><ul><ul><ul><li>Created to provide health insurance coverage to children whose families who made too much money to qualify for Medicaid but too poor to afford private health insurance. </li></ul></ul></ul><ul><ul><ul><li>2007 – Reauthorization for 5 years failed and was vetoed by President Bush on Oct. 3 rd , 2007. </li></ul></ul></ul><ul><ul><ul><ul><li>Democratic leaders drafted a second bill, but unable to pass with less than 2/3 majority required to override the veto. </li></ul></ul></ul></ul><ul><li>Source: http://www.sourcewatch.org/index.php?title=State_Children's_Health_Insurance_Plan </li></ul>
    44. 45. Four Spheres – Professional Org’s. International Council of Nurses
    45. 46. Four Spheres – Professional Org’s. <ul><li>Instrumental in shaping nursing practice. </li></ul><ul><ul><li>Developing standards of care </li></ul></ul><ul><ul><li>Advocating for change in scope of nursing practice </li></ul></ul><ul><ul><li>Play a role in collective action in the workplace </li></ul></ul><ul><li>Could increase their influence if more nurses participated in them. </li></ul><ul><ul><li>ANA – Represents the interests of all nurses, yet only 5% of U.S. nurses are members. </li></ul></ul><ul><ul><li>AACN – Represents over 500,000 critical and acute care nurses with 80,000 plus members. </li></ul></ul><ul><ul><ul><li>240 Chapters </li></ul></ul></ul>
    46. 47. Four Spheres – Professional Org’s. <ul><li>Professional Organizations – Should: </li></ul><ul><ul><li>Be a visible force within its community </li></ul></ul><ul><ul><li>Have a national presence </li></ul></ul><ul><ul><li>Have local representation (chapters) </li></ul></ul><ul><ul><li>Identify issues of concern to nursing and healthcare </li></ul></ul><ul><ul><ul><li>Bring them to the attention of the public </li></ul></ul></ul><ul><ul><li>Take a leadership role in calling for the development of policies that can improve the health of the communities and ensure the provision of quality nursing care </li></ul></ul>
    47. 48. Four Spheres – Professional Org’s <ul><li>AACN’s Public Policy Agenda </li></ul><ul><li>Definitions, Principles, and Outcomes: </li></ul><ul><ul><li>Health Policy Agenda Framework </li></ul></ul><ul><ul><ul><li>AACN is a 501(c)3, not-for-profit educational organization. </li></ul></ul></ul><ul><ul><ul><li>Established in January 1996 by the Board of Directors. </li></ul></ul></ul><ul><ul><ul><li>To be used as a guide in developing, implementing and evaluating the association’s health policy agenda. </li></ul></ul></ul><ul><ul><li>April 1996 – Public Policy Work Group </li></ul></ul><ul><ul><ul><li>Reviewed and clarified the framework </li></ul></ul></ul><ul><ul><ul><ul><li>To define a future health care policy agenda that is founded on defined member needs and consistent with a healthcare system driven by the needs of patients and families. </li></ul></ul></ul></ul>
    48. 49. Four Spheres – Professional Org’s . <ul><li>AACN Public Policy Priority Issues </li></ul><ul><ul><li>AACN ensures that vulnerable populations have access to quality health care. </li></ul></ul><ul><ul><li>AACN works to ensure public and community safety. </li></ul></ul><ul><ul><li>AACN works to ensure the provision of humane and ethical care. </li></ul></ul>
    49. 50. Four Spheres – Professional Org’s. <ul><li>AACN’s Health Policy Restrictions </li></ul><ul><ul><li>Chapter’s may not participate in or contribute to political campaigns. </li></ul></ul><ul><ul><li>Chapters may not lobby on behalf of AACN. </li></ul></ul><ul><ul><li>AACN is a 501(c)3 organization which must comply with restriction placed on lobbying and political activities. </li></ul></ul><ul><ul><li>Chapter members are prohibited from using their membership for any electioneering. </li></ul></ul><ul><ul><li>Chapter members are prohibited from contributing to political action committees. </li></ul></ul><ul><ul><li>Chapter members are prohibited from speaking on behalf of AACN unless they have been designated as an AACN spokesperson. </li></ul></ul><ul><ul><li>Chapter members are prohibited from endorsing, supporting or opposing issues on behalf of AACN unless they have been asked to do so by AACN. </li></ul></ul>
    50. 51. Four Spheres – Professional Org’s. <ul><li>American Organization of Nurse Executives </li></ul><ul><ul><li>Through its grassroots network of 49 State Chapters, AONE keeps abreast of the latest issues affecting nursing on the legislative, regulatory and practice fronts. AONE provides the chapter leadership with up-to-date information on a variety of topics and allows the membership to access the most current information from government and other private and public sources through a leader list serve. And through quarterly chapter calls, AONE members are able to network and share with their colleagues across the country. </li></ul></ul><ul><ul><li>Source: www.aone.org/aone/advocacy/home.html </li></ul></ul>
    51. 52. Four Spheres – Professional Org’s. <ul><li>AONE Legislative agenda </li></ul><ul><ul><li>Education & Leadership Development </li></ul></ul><ul><ul><ul><li>Advocates for FY2010 Federal appropriations for the nurse education act </li></ul></ul></ul><ul><ul><ul><li>Support the reauthorization of the Nurse Education Act – Expired for 5 years. </li></ul></ul></ul><ul><ul><ul><li>Broaden funding available for nursing programs outside the direct purview of the Department of Health and Human Services (HHS) </li></ul></ul></ul><ul><ul><ul><li>Foster and promote a climate for patient safety and quality that is evidenced-based and NOT legislated mandates or ratios. </li></ul></ul></ul>
    52. 53. Four Spheres – Professional Org’s. <ul><li>AONE – Public Policy & Advocacy </li></ul><ul><ul><li>Build, support and work with groups that promote a unified agenda for addressing the most pressing issues facing the nursing profession. </li></ul></ul><ul><ul><li>Continue to work and collaborate with AHA, The Nursing Community, Americans for Nursing Shortage Relief (ANSR), the Tricouncil and others to address healthful practice environments. </li></ul></ul><ul><ul><li>Effectively represent the nurse leader perspective in all aspects of the practice environment. </li></ul></ul><ul><ul><li>Continue to support efforts of ongoing partnerships and the AHA Readiness Team to ensure adequate funding of first-line defenders. </li></ul></ul>
    53. 54. Four Spheres – Professional Org’s. <ul><li>AONE Public Policy & Advocacy cont. </li></ul><ul><ul><li>Advocate for and support programs and initiatives that will ensure a safe and quality driven environment for patients and patient care providers. </li></ul></ul><ul><ul><li>Develop, evaluate and support legislation that will foster the nurse executive’s leadership role in the management of the care environment, especially in areas related to staffing, information technology and patient care services. </li></ul></ul><ul><ul><li>Collaborate with quality partners such as the JCAHO, the National Quality Forum and the Federal government to ensure that proposed regulatory changes achieve desired results. </li></ul></ul><ul><ul><li>Work within taskforces and other aligned groups and associations to ensure nurses as knowledge-base professionals are able to function within their full professional capacity. </li></ul></ul>
    54. 55. Four Spheres – Professional Org’s. <ul><li>American Nurses Association </li></ul><ul><ul><li>ANA Position Statements </li></ul></ul><ul><ul><ul><li>The American Nurses Association (ANA) House of Delegates and the ANA Board of Directors are charged with setting policy in healthcare, the workplace, patient care, and many other areas where nurses are engaged. When a hot topic arises or there are various views and opinions about current events, the House of Delegates and/or the Board of Directors may address these concerns by way of a position statement. Position statements are an explanation, a justification or a recommendation for a course of action that reflects ANA’s stance regarding the concern. The development process for position statements initially involves internal deliberation by the Congress on Nursing Practice and Economics. A draft of the proposed position statement is then posted on ANA’s Web site, for public comment. Following public comment, the statement is revised if necessary and approved by the ANA Board of Directors. This process allows each and every nurse to voice their views and opinions on the various dimensions of the issue at hand. </li></ul></ul></ul>
    55. 56. Four Spheres – Professional Org’s. <ul><li>ANA Policy Statements; </li></ul><ul><ul><li>Drug & Alcohol abuse </li></ul></ul><ul><ul><li>Ethics and Human Rights </li></ul></ul><ul><ul><li>Social Causes and Health Care </li></ul></ul><ul><ul><li>Nursing Practice </li></ul></ul><ul><ul><ul><li>Electronic Health Records </li></ul></ul></ul><ul><ul><ul><li>Supporting Nurse Practitioners in Retail-based health clinics </li></ul></ul></ul><ul><ul><ul><li>Credentials for the Professional Nurse: Determining a Standard Order of Credentials for the Professional Nurse </li></ul></ul></ul><ul><ul><ul><li>Professional Role Competence </li></ul></ul></ul>
    56. 57. Four Spheres – Professional Org’s. <ul><li>International Council of Nurses </li></ul><ul><ul><li>INC Position </li></ul></ul><ul><ul><ul><li>Nurses have an important contribution to make in health services planning and decision-making, and in development of appropriate and effective health policy. They can and should contribute to public policy pertaining to the determinants of health. </li></ul></ul></ul><ul><ul><ul><li>In addition, nurses are involved in strategic planning, budgeting, efficient resource planning and utilization, and the planning, management and evaluation of programs and services. Nurses must accept their responsibilities in health services policy and decision-making, including their responsibility for relevant professional development. </li></ul></ul></ul>
    57. 58. Four Spheres – Professional Org’s <ul><li>ICN cont. </li></ul><ul><ul><li>ICN and its member associations promote and support all efforts to improve the preparation of nurses for management, leadership and policy development. This preparation should be broad and must include the development of knowledge and skills for influencing change, engaging in the political process, social marketing, forming coalitions, and working with the media and other means of exerting influence. It must recognize the complex processes and factors involved in effective decision-making. </li></ul></ul><ul><ul><li>Source: www.icn.ch/pspolicydev00.htm </li></ul></ul>
    58. 59. Four Spheres - Community <ul><li>Special interest organizations: </li></ul><ul><ul><li>Habitat for Humanity </li></ul></ul><ul><ul><li>Local / County Food banks </li></ul></ul><ul><ul><li>Rotary club </li></ul></ul><ul><ul><li>Community organizations </li></ul></ul><ul><ul><ul><li>Lions, Elks, Moose </li></ul></ul></ul><ul><ul><ul><li>County workforce centers </li></ul></ul></ul><ul><li>The other three sphere’s exist within the community sphere. </li></ul><ul><ul><li>Nurses have the responsibility to promote the welfare of the community and its members </li></ul></ul><ul><ul><li>Nurses visible in the community represent the entire profession </li></ul></ul>
    59. 60. Four Stages of Political Development <ul><li>Buy in </li></ul><ul><li>Self-interest </li></ul><ul><li>Political Sophistication </li></ul><ul><li>Leadership </li></ul>
    60. 61. Four Stages of Political Development <ul><li>Stage One: Buy – In </li></ul><ul><ul><li>Reactive Stage </li></ul></ul><ul><ul><li>Political Action Committees </li></ul></ul><ul><ul><li>Understanding the relevance of politics and policy in both our professional and personal life. </li></ul></ul>
    61. 62. Four Stages of Political Development <ul><li>Stage One: Buy In </li></ul><ul><ul><li>Reactive Stage – </li></ul></ul><ul><ul><ul><li>The profession recognizes the importance of political involvement and encourages nurses to recognize the importance of policy development to their daily lives as professionals and citizens. </li></ul></ul></ul><ul><ul><li>Political Action Committees (PAC’s) </li></ul></ul><ul><ul><ul><li>Nurses Coalitions for Action in Politics </li></ul></ul></ul><ul><ul><ul><ul><li>First PAC developed by nursing leaders in New York. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Later became the PAC for the ANA. </li></ul></ul></ul></ul>
    62. 63. Four Stages of Political Development <ul><li>Stage One: Buy-In </li></ul><ul><ul><li>Understanding the relevance of politics and policy in professional and personal life. </li></ul></ul><ul><ul><ul><li>Political activism and political commitment must become part of the definition of the nursing as a profession… Nurse witness daily the consequences of policies and need to work for justice and equity in the healthcare system. </li></ul></ul></ul><ul><ul><li>Occurred when profession began to promote political awareness of nurses to injustices or changes needed – “Aha” moment </li></ul></ul>
    63. 64. Four Stages of Political Development <ul><li>Stage Two: Self-Interest </li></ul><ul><ul><li>Appealing to self-interest is an important step in engaging nurses to participate in shaping workplace and or public policies </li></ul></ul><ul><ul><ul><li>Nursing coalitions garner political support </li></ul></ul></ul><ul><ul><ul><li>Late 1990’s: ANA-PAC became the third largest federal health care special interest group. </li></ul></ul></ul><ul><ul><li>Nurses must see the connection to politics and policy in their professional lives in order to move to action. </li></ul></ul>
    64. 65. Four Stages of Political Development <ul><li>Stage Two cont. </li></ul><ul><ul><li>Nursing began to develop its identity </li></ul></ul><ul><ul><li>Uniqueness as a political voice </li></ul></ul><ul><ul><li>It is moving from recognition of a problem to developing a plan to deal with it </li></ul></ul><ul><ul><li>Using political Skills: </li></ul></ul><ul><ul><ul><li>Enlisting support of colleagues </li></ul></ul></ul><ul><ul><ul><li>Planning strategies </li></ul></ul></ul><ul><ul><ul><li>Resolving the issue </li></ul></ul></ul><ul><ul><ul><li>Volunteer to create a task force to recommend policy changes. </li></ul></ul></ul>
    65. 66. Four Stages of Political Development <ul><li>Stage Three: Political Sophistication </li></ul><ul><ul><li>ANA’s Nursing’s Agenda for Healthcare Reform 1992. </li></ul></ul><ul><ul><li>Nurses were appointed to federal panels, agencies and commissions. </li></ul></ul><ul><li>Requires: </li></ul><ul><ul><li>Synergy between policymakers who recognize the importance of nursing perspectives and nurse who are ready to respond by adding their voices to policy debates and decision making. </li></ul></ul>
    66. 67. Four Stages of Political Development <ul><li>Stage Three – cont. </li></ul><ul><ul><li>National Health Council – est. 1929 </li></ul></ul><ul><ul><li>“A dynamic forum for policy development” </li></ul></ul><ul><ul><ul><li>By the end of 2005 – 110 volunteer health agencies, nonprofit organizations with an interest in health, business and industry including the American Academy of Family Physicians, the American Thoracic Society, and the Association of Schools of Allied Health Professions </li></ul></ul></ul><ul><ul><ul><ul><li>Not one Nursing organization. 2010 – Only the American Academy of Nursing is represented. </li></ul></ul></ul></ul>
    67. 68. Four Stages of Political Development <ul><li>Stage Four: Leadership </li></ul><ul><ul><li>When nursing embraces a political identity exemplified by “setting an agenda” for change </li></ul></ul><ul><ul><ul><li>Functioning at the highest level of political involvement. </li></ul></ul></ul><ul><ul><ul><li>Nursing becomes the initiator of crucial policy change </li></ul></ul></ul>
    68. 69. Four Stages of Political Development <ul><li>Stage Four cont. </li></ul><ul><ul><li>Achieving appointments outside of nursing </li></ul></ul><ul><ul><ul><li>University Presidencies </li></ul></ul></ul><ul><ul><ul><li>Heads of agencies within federal and state governments </li></ul></ul></ul><ul><ul><ul><li>Senate and House Seats. </li></ul></ul></ul><ul><ul><li>Nurses are recognized for their expertise and perspectives </li></ul></ul><ul><ul><ul><li>Seen by multiple constituencies bringing solutions to issues related to the well-being of society. </li></ul></ul></ul><ul><ul><li>The longer nurses remain in stage four, the more the public will benefit from nurses’ knowledge and leadership in solving issues </li></ul></ul>
    69. 70. Advocacy & Activism <ul><li>Powerful advocates </li></ul><ul><ul><li>Curtin (1979) – described the end purpose of nursing “as the welfare of other human beings.” </li></ul></ul><ul><ul><li>Nursing is seen as “common humanity” leading to the development of “human advocacy” </li></ul></ul><ul><ul><li>The nurse patient advocate </li></ul></ul><ul><ul><ul><li>Revised Code of Ethics for Nurses with Interpretive Statements. (ANA, 2001). </li></ul></ul></ul>
    70. 71. Advocacy & Activism <ul><li>Nursing Serving as Advocates </li></ul><ul><ul><li>Legal Advocacy </li></ul></ul><ul><ul><ul><li>Protect patient rights </li></ul></ul></ul><ul><ul><li>Moral-Ethical Advocacy </li></ul></ul><ul><ul><ul><li>Uphold patient values </li></ul></ul></ul><ul><ul><li>Spiritual Advocacy </li></ul></ul><ul><ul><ul><li>Provide access to spiritual support </li></ul></ul></ul><ul><ul><li>Substitutive Advocacy </li></ul></ul><ul><ul><ul><li>Protect vulnerable patients </li></ul></ul></ul><ul><ul><li>Political Advocacy </li></ul></ul><ul><ul><ul><li>Facilitates equal access to health care </li></ul></ul></ul>
    71. 72. Advocacy & Activism <ul><li>The Nurse Activist </li></ul><ul><ul><li>Contacts public officials through letters, e-mails or telephone </li></ul></ul><ul><ul><li>Registers people to vote </li></ul></ul><ul><ul><li>Contributes money to political campaigns </li></ul></ul><ul><ul><li>Works on a political campaign </li></ul></ul><ul><ul><li>Lobbies decision-makers by providing pertinent statistical and anecdotal information </li></ul></ul><ul><ul><li>Forms or joins coalitions that support an issue of concern </li></ul></ul>
    72. 73. AACN’s Advocacy Tool Kit: 12 Rules for Working with Public Officials <ul><li>Don’t underestimate public officials. </li></ul><ul><li>Don’t look down on government and politics. </li></ul><ul><li>Be understanding. </li></ul><ul><li>Forge Relationships. </li></ul><ul><li>Be Reasonable. </li></ul><ul><li>Be Thoughtful. </li></ul><ul><li>Don’t blame public officials for “Failing” to do what you wanted. </li></ul><ul><li>Be Cooperative. </li></ul><ul><li>Be Realistic. </li></ul><ul><li>Be Practical. </li></ul><ul><li>Be a good Proponent. </li></ul><ul><li>Be Informed </li></ul><ul><li>Source: AACN-Advocacy Tool Kit </li></ul>
    73. 74. Nursing’s Influence & Historical Mandates <ul><li>Florence Nightingale </li></ul><ul><li>Sojourner Truth </li></ul><ul><li>Lillian Wald </li></ul><ul><li>Margaret Sanger </li></ul><ul><li>Other contemporary pioneers </li></ul>
    74. 75. Nursing’s Influence & Historical Mandates <ul><li>Florence Nightingale </li></ul><ul><ul><li>Consummate politician and visionary. </li></ul></ul><ul><ul><li>Transformed </li></ul></ul><ul><ul><ul><li>British health care </li></ul></ul></ul><ul><ul><ul><li>Indian health care </li></ul></ul></ul><ul><ul><ul><li>Military health care </li></ul></ul></ul><ul><li>Knew the value of data in influencing policy changes </li></ul><ul><li>Saw nursing in all its forms as advocacy </li></ul>
    75. 76. Nursing’s Influence & Historical Mandates <ul><li>Sojourner Truth </li></ul><ul><ul><li>Provided nursing care to union soldiers and civilians – Civil War </li></ul></ul><ul><ul><li>Advocate for abolishing slavery </li></ul></ul><ul><ul><li>Supporter of women’s rights </li></ul></ul><ul><ul><li>Helped transform racist and sexist policies limiting the health and well-being of African Americans and women </li></ul></ul><ul><ul><li>Worked to free slaves – Underground Railroad </li></ul></ul><ul><ul><li>Fought for human rights </li></ul></ul><ul><ul><li>Lobbied for federal funding to train nurses and physicians. </li></ul></ul>
    76. 77. Nursing’s Influence & Historical Mandates <ul><li>Lillian Wald </li></ul><ul><ul><li>Recognized the connection between health and social conditions </li></ul></ul><ul><ul><li>Established – Henry Street Settlement House in New York City. </li></ul></ul><ul><ul><ul><li>Safe place built to help establish programs for largely poor immigrant population </li></ul></ul></ul><ul><ul><li>Driving force behind development of the Children’s Bureau </li></ul></ul><ul><ul><li>Called by the White House frequently to participate in developing national and international policies. </li></ul></ul><ul><ul><li>Campaigned for Presidents even she could not vote. </li></ul></ul>
    77. 78. Nursing’s Influence & Historical Mandates <ul><li>Wald cont. </li></ul><ul><ul><li>Promoted Public Health Nursing education </li></ul></ul><ul><ul><li>Formed the National Organization of Public Health Nursing (NOPH). </li></ul></ul><ul><ul><li>1902 – Moved the board of health to hire a school nurse </li></ul></ul>
    78. 79. Nursing’s Influence & Historical Mandates <ul><li>Margaret Sanger </li></ul><ul><ul><li>Transformed the nation’s attitudes and approaches to family planning </li></ul></ul><ul><ul><ul><li>Jailed and risked own life </li></ul></ul></ul><ul><ul><li>Distributed literature on birth control when at the time it was illegal </li></ul></ul><ul><ul><ul><li>1912 wrote article about Syphilis – US Post Office invoked the Comstock Act (1873) and prohibited the distribution of information about contraception </li></ul></ul></ul>
    79. 80. Nursing’s Influence & Historical Mandates <ul><li>Sanger cont. </li></ul><ul><ul><li>1914 – Traveled to Europe seeking safe contraception measures. </li></ul></ul><ul><ul><li>October 1914 fled the US after being indicted on claim that women could separate procreation from the sexual act and published her ideas in Women Rebel </li></ul></ul><ul><ul><li>1915 – Returned to U.S. and with public sympathy, government dropped the charges </li></ul></ul>
    80. 81. Nursing’s Influence & Historical Mandates <ul><li>Sanger cont. </li></ul><ul><ul><li>Best known for what? </li></ul></ul><ul><ul><ul><li>Planned Parenthood of America </li></ul></ul></ul>
    81. 82. Nursing’s Influence & Historical Mandates <ul><li>Contemporary Leaders </li></ul><ul><ul><li>Wilma Scott Heide (1973) </li></ul></ul><ul><ul><ul><li>National Organization for Women (NOW) </li></ul></ul></ul><ul><ul><li>JoAnn Ashley </li></ul></ul><ul><ul><ul><li>Challenged nurses to reflect on who they were and what their role was as a nurse </li></ul></ul></ul><ul><ul><ul><li>Feminist movement </li></ul></ul></ul><ul><ul><li>Senator Lois Capps (R-CA). 2005. </li></ul></ul>
    82. 83. Legislation 2010 What is currently in the works?
    83. 84. Nursing Legislation - 2010 <ul><ul><li>H.R. 4601 – The National Nurse Act of 2010 </li></ul></ul><ul><ul><ul><li>Amend the Public Health Service to establish the Office of the National Nurse </li></ul></ul></ul>
    84. 85. Nursing Legislation 2010 <ul><li>S. 73 / H.R. 4138 – Registered Nurse Safe Staffing Act of 2009 – Reintroduced to the 111 th Congress as S. 54. </li></ul><ul><ul><li>Would require establishing a staffing system that ensures a number of registered nurses on each shift and in each unit. </li></ul></ul><ul><ul><li>Would require public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs. </li></ul></ul><ul><ul><li>The staffing system takes into account the following: account for architecture and geography of the environment and available technology; reflect the level of preparedness and experience of those providing care; reflect staffing levels recommended by specialty nursing organizations; account for ancillary staff support; provide that an RN not be assigned in a particular unit without first having established the ability to provide professional care in such a unit; be based on methods that assure validity and reliability. </li></ul></ul><ul><li>Sponsor: Sen. Daniel Inouye (D-HI). </li></ul>
    85. 86. Nursing Legislation <ul><li>H.R. 1001 – Nursing Relief Act 2009 </li></ul><ul><ul><li>Purpose: </li></ul></ul><ul><ul><ul><li>To create a new non-immigrant visa category for registered nurses, and establish admission requirements for such nonimmigrant's. </li></ul></ul></ul><ul><ul><li>Background: </li></ul></ul><ul><ul><ul><li>Hospitals spending hundreds of millions of dollars recruiting foreign nurses under current immigration laws. </li></ul></ul></ul><ul><ul><ul><li>Cost is passed on to consumer’s and adds to the rising cost of healthcare </li></ul></ul></ul><ul><ul><ul><li>Healthcare providers cannot efficiently and effectively recruit qualified foreign nurses through existing immigration process </li></ul></ul></ul><ul><ul><li>Sponsors: John Shadegg (R-AZ), Co-Sponsors: Jeff Flake (R-AZ) and Ed Pastor (D-AZ). </li></ul></ul>
    86. 87. Communicating with Legislators
    87. 88. Telephone Communication <ul><li>Telephone: 202-224-3121 </li></ul><ul><ul><li>Ask for your Senator’s or Representative’s office. </li></ul></ul><ul><ul><li>Search the Congressional database for your representative. http://www.capwiz.com/criticalcare/directory/condir.tt </li></ul></ul>
    88. 89. Telephone Communication <ul><li>Phone calls are not generally handled by the member of Congress. They have assigned staff aides which do this. </li></ul><ul><ul><li>Identify yourself and ask to leave a brief message for Senator/Representative (_____) that you either support or oppose (S.____/H.R.___). </li></ul></ul><ul><ul><ul><li>“Good Morning, My name is _____ and I am a Critical Care Registered Nurse. I would like to leave a message for Representative _____ in support/opposition of HR 1001.” </li></ul></ul></ul>
    89. 90. Telephone Communication <ul><li>You may also want to state your reason for your support or opposition. </li></ul><ul><li>Ask for the senator’s or representative’s position on the bill. Also request a written response to your telephone call. </li></ul><ul><li>Write down the name of staff member you spoke with for future reference. Utilize them as your point of contact. </li></ul><ul><li>Source: AACN – www.capwiz.com/criticacare/issues/basics/?style=comm </li></ul>
    90. 91. Telephone Communication - Pitfalls <ul><li>No written documentation – no visual proof you actually made the phone call. </li></ul><ul><li>No way of guaranteeing that your message or your name, telephone number or address is recorded correctly. </li></ul><ul><li>Generally not ideal for introducing yourself to a legislative assistant. </li></ul><ul><li>Source: (Mason, 2007). </li></ul>
    91. 92. Letter Writing tips <ul><li>The saying “The pen is mightier than the sword” is prolific in nursing’s political action arena. As nurses, we know what happens on a daily basis and WE have the power to Act With Intention and facilitate change in daily practice. </li></ul><ul><li>The nurse with political competency </li></ul><ul><ul><li>knows what the rules are or policies are for the profession and the industry </li></ul></ul><ul><ul><li>knows who or what organization created them, the rationale for their existence, and how they impact the provision of health-care services. </li></ul></ul>
    92. 93. Three “rights” of letter writing: <ul><li>Right Letter. </li></ul><ul><li>Right elected official. </li></ul><ul><li>Right time. </li></ul>
    93. 94. Writing guidelines <ul><li>When writing to members of congress or a state or local official there are general guidelines: </li></ul><ul><ul><li>Direct your letter according to the legislator’s responsibility. </li></ul></ul><ul><ul><li>Only write to the elected officials that represent you. </li></ul></ul><ul><ul><li>Clarify your issue. You may write to the chair of a specific committee if your representative does not sit on that particular committee. </li></ul></ul><ul><ul><li>Time your letter(s) to allow staff to address issues prior to pressing any legislation. </li></ul></ul><ul><ul><li>Your purpose for writing should be stated in the first paragraph of the letter. If the letter pertains to a specific legislative bill, identify it accordingly, e.g., House bill: H.R. ____, Senate bill: S.___. </li></ul></ul><ul><ul><li>Be courteous, to the point and include key information, using specific examples to support your position. </li></ul></ul><ul><ul><li>Address only one issue per letter. Keep the letter to a minimum of one page. </li></ul></ul><ul><ul><li>Source: AACN Legislative Center http:// www.capwiz.com/criticalcare/issues/basics/?style = comm </li></ul></ul>
    94. 95. Letter to Senator <ul><li>Address: </li></ul><ul><ul><li>The Honorable (Full Name), (Rm #), (name of) Senate Office Building. United States Senate, Washington, D.C. 20510 </li></ul></ul><ul><ul><ul><li>The Honorable ___________702 Hart Senate Office Building, Washington, D.C. 20510-0605. </li></ul></ul></ul><ul><ul><ul><li>Salutation: Dear Senator ______________ </li></ul></ul></ul><ul><li>Source: (AACN Legislative Center, 2008; Mason, 2007). </li></ul>
    95. 96. Letter to Representatives <ul><li>Address: </li></ul><ul><ul><li>The Honorable (Full Name), (Rm#), Name of House Office Building. United States House of Representatives, Washington, D.C. 20515 </li></ul></ul><ul><ul><ul><li>The Honorable ______________, 1507 Longworth House Office Building, Washington, D.C. 20515-0604 </li></ul></ul></ul><ul><ul><ul><li>Salutation: Dear Representative _________, </li></ul></ul></ul><ul><li>Source: AACN Legislative Center. </li></ul>
    96. 97. E-Mailing Tips <ul><li>Generally, same guidelines as with letter writing. </li></ul><ul><ul><li>Most legislators have e-mail addresses embedded on their websites. </li></ul></ul>
    97. 98. Political Resources How to identify the issues at hand to allow you to Act With Intention
    98. 99. American Nurses Association
    99. 100. American Nurses Association <ul><li>Current Health Care policy agenda’s </li></ul><ul><ul><li>Nursing’s agenda for the future </li></ul></ul><ul><ul><li>ANA’s Health Care Agenda 2005 </li></ul></ul><ul><ul><li>Workforce trends among U.S. Registered Nurses. </li></ul></ul><ul><ul><ul><li>Position Statements: </li></ul></ul></ul><ul><ul><ul><ul><li>Stem Cell Research 1/10/2007 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Privacy and Confidentiality 12/8/2006 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Assuring Patient Safety: Registered Nurses’ Responsibility in All Roles and Settings to Guard against Working when Fatigued 12/8/2006. </li></ul></ul></ul></ul>Source: American Nurses Association, 2008. http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements.aspx
    100. 101. ANA Resources Center <ul><li>Created to be a one-stop resource to help find information about the 2008 elections. </li></ul><ul><ul><li>Provides information on election processes </li></ul></ul><ul><ul><li>Candidate information both Democrat and Republican. </li></ul></ul><ul><ul><li>Publish Capitol update 10 times annually. </li></ul></ul><ul><ul><ul><li>http:// www.capitolupdate.org /newsletter </li></ul></ul></ul>
    101. 102. American Organization of Nurse Executives www.aone.org
    102. 103. American Organization of Nurse Executives <ul><li>Education of members </li></ul><ul><li>Public Policy and Advocacy </li></ul><ul><li>Information Technology </li></ul><ul><li>International Nurses </li></ul><ul><li>Access and Coverage </li></ul><ul><li>Reimbursement Policy </li></ul><ul><li>PAC </li></ul><ul><li>Web Resources: www.aone.org/aone/advocacy </li></ul>
    103. 104. American Association of Critical Care Nurses www.aacn.org
    104. 105. AACN Resources Capwiz Home Page
    105. 106. AACN - Resources Capwiz Elected Officials
    106. 107. American Association of Critical Care Nurses http://www.capwiz.com/criticalcare/home
    107. 108. International Council of Nursing www.ich.ch
    108. 109. Joint Commission
    109. 110. Joint Commission <ul><li>Mission: </li></ul><ul><li>To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.  </li></ul>
    110. 111. Joint Commission
    111. 112. Institute for Healthcare Improvement - IHI
    112. 113. Institute for Healthcare Improvement <ul><li>Programs </li></ul><ul><ul><li>Improvement map </li></ul></ul><ul><ul><li>Passport </li></ul></ul><ul><ul><li>Campaign </li></ul></ul><ul><ul><ul><li>5 Million Lives – Video link http://www.ihi.org/ihi/files/campaign/2006_12_12_Berwick5MillionForumPlenary.wmv </li></ul></ul></ul><ul><ul><li>Critical Care </li></ul></ul>
    113. 114. IHI – Critical Care
    114. 115. Robert Wood Johnson Foundation www.rwjf.org/publichealth
    115. 116. Robert Wood Johnson Foundation www.rwjf.org/healthreform
    116. 117. State and Local Resources <ul><li>Utilize Kaiser Family Foundation </li></ul><ul><li>Utilize your state nursing association </li></ul><ul><li>Utilize your state’s hospital association to find out any upcoming or pending legislation issues. </li></ul>
    117. 118. References <ul><li>American Association of Critical Care Nurses (2008) Legislative Action Center . http:// capwiz.com/criticalcare/home </li></ul><ul><li>Eliss-Najar, B., Hubbard, H. (2008). The Value of Nurse Leaders on Federal Advisory Panels: Experience with the Agency for Healthcare Research and Quality. Policy, Politics and Nursing Practice. 9: 299-304. Retrieved May 28, 2009 from, http://ppn.sagepub.com.dml.regis.edu/contect/vol9/issue4 . </li></ul><ul><li>Hewison, A. (2008). Evidence-Based Policy: Implication for Nursing and Policy Involvement. Policy, Politics and Nursing Practice. 9: 288-98. Retrieved May 22, 2009 from, http://ppn.sagepub.com.dml.regis.edu/content/vol9/issue4 . </li></ul><ul><li>International Council of Nursing (2000). Participation of Nurses in Health Services Decision Making and Policy Development. Retrieved May 30, 2009 from, http://www.icn.ch/pspolicydev00.htm . </li></ul>
    118. 119. References <ul><li>International Council of Nursing (2001). Guidelines on Shaping Effective Health Policy. Retrieved May 30, 2009 from, http://www.icn.ch/Guidelines_shaping.pdf . </li></ul><ul><li>Kurtzman, E. (2009) Unifying Nursing’s Political Voice. Editorial. Policy, Politics and Nursing Practice. 10: pg. 6. Retrieved May 30, 2009 from, http://ppn.sagepub.com.dml.regis.edu/content/vol10/issue1 . </li></ul><ul><li>Mason, D., Leavitt, J., Chaffee, M. (2007). Policy and Politics in Nursing and Health Care (5 th Ed). Philadelphia, Saunders Elsevier. </li></ul><ul><li>Mattie, A., Ben-Chitrit, R. (2007). Patient Safety Legislation: A look at health policy development. Policy, Politics and Nursing Practice. 8: 251-61. Retrieved May 22, 2009 from, http://ppn.sagepub.com.dml.regis.edu/content/vol8/issue4 . </li></ul><ul><li>Taft, S., Nanna, K. (2008). What are the sources of health policy that influences nursing practice. Policy, Politics and Nursing Practice. 9: 274-87. Retrieved May 28, 2009 from, http://ppn.sagepub.com.dml.regis.edu/content/vol9/issue4 . </li></ul>
    119. 120. Web References <ul><li>Agency for Healthcare Research and Quality (AHRQ) – www.ahrq.gov </li></ul><ul><li>American Association of Critical Care Nurses Legislative Action Center – www.capwiz.com/criticalcare/home </li></ul><ul><li>American Hospital Association – http://www.aha.org </li></ul><ul><li>American Nurses Association – http://www.nursingworld.org/gova/ </li></ul><ul><li>American Organization of Nurse Executives – www.aone.org </li></ul><ul><li>C-SPAN – www.c-span.org </li></ul><ul><li>GEM-Nursing: Online mentoring Program – www.gem-nursing.org </li></ul><ul><li>Hastings Center – http://www.thehastingscenter.org </li></ul><ul><li>Institute for Healthcare Improvement – http://ww.ihi.org </li></ul><ul><li>Institute of Medicine (IOM) – http://www.iom.edu </li></ul><ul><li>International Council of Nursing – http://www.icn.ch </li></ul><ul><li>Kaiser Family Foundation – http://www.kff.org </li></ul>
    120. 121. Web References <ul><li>Library of Congress – http://thomas.loc.gov </li></ul><ul><li>Policy analysis site – www.hschange.org </li></ul><ul><li>Resource on multiple policy issues – http://hippo.findlaw.com/hippohome.html </li></ul><ul><li>Roll Call – Congressional news source – www.rollcall.com </li></ul><ul><li>Synopses of national political news – http://politicalinsider.com </li></ul>
    121. 122. Estes Park, CO Fish Creek – Steamboat Springs, CO
    122. 123. Questions & Answers Contact Information: Todd M. Grivetti, MSN, RN, CCRN, CNML [email_address]

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