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The Professional Nurse and Political Activism

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1 The Professional Nurse and Political Activism
Susan McCarthy MSN, RN, CNRN PA Nurse Alliance, SEIU Quality Care Summit 2012 September 25, 2012

2 Objectives Identify professional nurse role, taking responsibility to shape social policy. Discuss policy, politics and power in nursing Identify barriers to nursing political activism Explore skills to achieve political competence List points of access for policy development Recognize past and current nurse activists

3 Laws, Standards, Codes Roots of activism, social justice embedded in professional practice laws, standards, ethics A social contract with society, demands professional responsibilities. The Pennsylvania Code : State Board of Nursing Regulates by licensing: protects public health ANA Code of Ethics, advocate for profession Nurses should act individually, collectively through political actions for social change.

4 and for Social Justice Provision 9.4 : Social Reform
Professional Nursing associations speak for nurses in reshaping health care policy, legislation Accessibility, Quality, Cost Violation of human rights, homelessness, hunger, violence, stigma of illness

5 Is Healthcare the New Civil Right?

6 The Nurse Alliance of SEIU
Politics and Policy Statement: Good healthcare policy happens when practicing RNs are sitting at political and policy-making tables Effective partners with a strong, clear agenda Advocate for more nurse political involvement Current focus on healthcare reform implementation.

7 Politics and Social Justice
Poverty, cruelty rise, level of social awareness Political action is taken, Acts, U.S. Congress. The 1935 Social Security Act 1946 Mental Health Act 1964 Civil Rights Act 1965 Medicare Act 1990 Americans with Disabilities Act 2010 Affordable Care Act (http://www.nih.gov/about/almanac/historical/legislative_chronology.htm)

8 Nurse Activists Florence Nightingale (1850’s), Environment, British Army, Educational Reform Clara Barton (1881), Founded USA Red Cross Lillian Wald,(1893), Founded Public Health Nursing Diane Carlson Evans (1993), Vietnam Women’s Memorial Karen Daley (2000), Needle-Stick Prevention and Safety Act

9 Vietnam Women’s Memorial
Diane Carlson Evans (1993) Vietnam Women’s Memorial Lillian Wald,(1893) Public Health Nursing

10 Civil War Nursing Memorial
Spanish American War Nursing Memorial Arlington Cemetery Civil War Nursing Memorial Dupont Circle Washington D.C.

11 Nurse Activists Needed Now
U.S. Healthcare System in Crisis 2012, U.S. will spend $2.8 trillion Cost of healthcare is unsustainable Environment ↑ complex, inefficient, stressful Waste $750 billion/year Plan: Best Care at Lowest Cost Do more, with less $, increase efficiency (IOM, 2012) Unsustainable growth: Post wwII, eggs would cost $55, health care costs increasing much faster than the economy Health care costs in the United States far outpace the growth rate of costs in the rest of the economy. The growth in health care costs has contributed to stagnation in real income gains for American families. A substantial portion of health care spending is wasteful. Wasteful health expenditures directly stifle progress on other priorities

12 Result: Demand ↑ Accountability

13 OSHA Never Events CDC HCAHPS Magnet Status IOM
Joint Commission Press Ganey IOM NDNQI Never Events OSHA CDC Overwhelmed by complex public policy Do not address policy decisions affect nursing Do not see our lack of political action Leads to inability to influence policy Remain task oriented, loss of vision, Implementers, not designers of policy Affects our clinical environment Department of Health HCAHPS Patient Satisfaction Survey

14 Nursing’s Accountability
~15% of hospital patients still being harmed 20% discharged elderly patients readmitted , 30 days Nurses spend 30% time, direct patient care (IOM, 2012) Overwhelmed by complex public policy BECOME TUNNEL VISIONED ON OUR TASKS Do not address policy decisions affect nursing Do not see our lack of political action Leads to inability to influence policy Implementers, not designers of policy Affects our clinical environment

15 Why Nursing? “When we are hospitalized, in a nursing home, managing a chronic illness, nurses are the ones we will encounter, spend most time, be dependent upon.” (Keeping Patients Safe, IOM,2004) Gallup Poll 2011, 12th time/13 years, Nurses #1, ethics and honesty Nurses full partners, with physicians, health care professionals, redesign health care in U.S. (IOM, 2008) Opinion leaders, 90% want nurses to improve quality, safety, reduce medical errors (GallupPoll,2010) Gallup Poll: Firefigheter #1 in 2001, nest higherst were pharmacists, doctors, lowest were Members of Congress, lobbysits, car salesman What is the IOM

16 Nurse Political Actions
Nursing Professional Organizations/Unions advocated for and won Federal Needlestick Safety and Prevention Act, 2000 California (1999, effective 2003) , Mandated Nurse -to -Patient Staffing Ratios Increased Scope of Practice, Advanced Practice Nurses (2007) Elimination of Mandatory Overtime (2008)

17 Barriers to Political Involvement
Powerlessness Lack a structure to be heard Limited leadership opportunities HIPPA, fear to breach confidentiality Differing levels of education Lack of education in policy development Overwhelmed by complex policies Need more mentors, leaders (Des Jardin, 2001) Sources of Powerlessness: time constraints, heavy workloads, shift work, understaffing, family time, moral distress, fear of retaliation oppressive images, heriarchail structures limits opportunuty for involvement Complex public policy: Joint commission, never Events, NDNQI nUrse sesitive Indicators, HCAHPS conumer assessemnts, includes nursing Governmental bodies influence our work: nurse practice acts, reimburesment issues, resource allocation, medicare reimbursement, health structure reform Nurses need clear guidance on how to accompish policy development

18 “There is still so much to do” Florence Nightingale, 1893
ACA Implementation Safe, Healthy Work Environments Eliminate Manual Patient Handling Reduce Work Place Violence Mandate Safe Staffing Education, Recruitment, Retention

19 Making it Happen Policy is a course of action.
Politics, process of influencing allocation of scarce resources. The result is policy. Power enables a group to influence others through political process. To effect policy, must be involved in politics so others do not speak for nursing practice. If we understand process around policy formation we can target our nursing leadership into influence. (Hughes, F., 2005)

20 Power in Nursing Expert: Interpersonal: Power in Numbers: 2.9 million
Combines science, technology, caring Interpersonal: Excellent negotiators, communicators, problem solvers, team players Power in Numbers: 2.9 million # will grow 26%, 2010 to 2020 Latent Power: Untapped, underused

21 Nurse Politicians/Leaders
Eddie Bernice Johnson ( D-TX), first nurse elected to U.S. House of Representatives (1992) Carolyn McCarthy, LPN ( D-NY), elected 1996, US House, leader on gun control , nursing Lois Capps (D-CA), third nurse elected to House 1998, school nurse, Medicare Reform, Nursing , School Health and Safety Virginia Trotter Betts, national nurse leader, mental health policy As of 2011, seven nurses in U.S. House of Representatives Mary Wakefield, Ph.D., R.N., current administrator of the Health Resources and Services Administration (HRSA)

22 Points of Access for Policy Development
Workplace: Procedures, budget, practice, bargaining table shared governance committees Government: Local, state, national legislation, run for office Professional Organizations: Provide information, activities, leaders Community, Public Education: ↑ Nurse visibility, health fairs, endorse candidates

23 Six Skills for Political Competence (Warner, 2003)
1. Nursing Expertise as Valued Currency Clinical experience, policy connections Values: caring, health promotion, informed and self care, holism (Cohen et al, 1996) Observation, decision making skills 2. Networking, crucial for action, change Establish, maintain interdisciplinary relationships, asking for help is OK 3. Powerful Persuasion Passion, thoughtful analysis of ideas, clarity, ability to communicate, important to audience Introduce Study

24 Political Competence Skills
4. Collective Strength Professional organizations, interdisciplinary Voices louder, persuasion greater Group consensus, strengthen the individual 5. Strategic Perspective Stepping back, place health in broad context See Nursing as political activity Questions emerge, government influence on populations, health, environments of care 6. Perseverance Remain Optimistic, you don’t always win

25 Our Experience “We see a future where America leads not only by the example of our power, but by the power of our example.” Joe Biden, DNC, 2012 SEIU Nurses share political action experiences

26 Stages of Nursing’s Political Development (Cohen et al, 1996)
Stage One: Buy-In Individual nurses take position/react to issue affecting profession, public. Decide to take action. Stage Two: Self-Interest Individuals begin establish political identity, voice. Organize, develop strategies to resolve issue. Stage Three: Political Sophistication Seek to influence policymakers, ↑awareness ,value contributions of nursing to public, health policy. Testify before legislative committees, appointed to policy-making bodies. Stage Four: Leading the Way Very involved, setting agenda, initiating policy development, often enacted through legislative process. Copyright © 2003, New Jersey Collaborating Center For Nursing Workforce Development. 

27 Strategies for Political Involvement
Keep informed of issues affecting nurses and public Join Professional organizations, SEIU committees/actions Find a Mentor, be a mentor Participate in public demonstrations Participate in shared governance councils, Meet with elected officials in their offices Write a letter to elected officials Publish

28 Key Points Political actions bring social change
Nurse laws, ethics code support political action Keep informed Join professional organizations Take Action Achieve political competency

29 Health Policy Resources
Nurse Alliance Round Up CDC AHRQ World Health Organization IOM ANA Smart Briefs Professional Journals www. RN.com Project Vote-Smart (PVS),Non-profit, non- partisan, collects and distributes information, U.S elected official’s voting records and candidate’s positions , The Pennsylvania Health Access Network (PHAN) is a statewide coalition of organizations working to protect high quality health insurance coverage for individuals and businesses and to expand coverage to the uninsured.

30 References Abood, S. (January 31, 2007). "Influencing Health Care in the Legislative Arena". OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1, Manuscript 2. Antrobus S (2003) What is political leadership? Nursing Standard. 17, 43, Chitty, K. K., Black, B.P. (2011). Professional Nursing—Concepts and Challenges. 6th Edition. Philadelphia, PA: Elsevier, Saunders. Cohen, S.S., Mason, D.J., & Kovner, C., Leavitt, J.C., Pulcini, J., & Sochalski, J. (1996). Stages of nursing’s political involvement: Where we’ve been and where we ought to go. Nursing Outlook, 44(6), Des Jardin, K. (2001) Political involvement in Nursing: education and empowerment. AORN Journal. (74)4. Des Jardin, K. (2001). Political Involvement in Nursing: Politics, Ethics, and Strategic Action. AORN Journal, (74) 5.

31 References, cont’d. Hughes, F. ( 2005) Role of nursing management in health care policy development. Retrieved from IOM (Institute of Medicine) Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press . Robert Woods Johnson Foundation (2010). Nursing Leadership from Bedside to Boardroom: Opinion Leaders' Perceptions. Retrieved from SEIU (2001) The Fight for Our Lives: How We Won Safer Needles. Retrieved from Warner, J. ( 2003). A Phenomenological Approach to Political Competence: Stories of Nurse Activists. Policy, Politics, & Nursing Practice. (4).2.


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