Pursuing a Career in Public Policy: No Longer the Road Less Traveled in Nursing

Pursuing a Career in Public Policy: No Longer the Road Less Traveled in Nursing

A nursing career in public policy was considered unique decades ago. However, increasingly nurses have developed the skill and expertise needed to inform the policy-making process through their professional and voluntary endeavors. Nurses now serve in numerous leadership roles where they use their health policy expertise to shape the policy discourse, monitor the impact of legislation, and oversee regulatory processes.

In addition to the increased numbers of nurses working in governmental and nongovernmental agencies, nurses serve as elected officials and work as health ­policy consultants or health care ­lobbyists. Regardless of role or setting, nurses working in the policy arena are ­required to use their public policy acumen to inform legislation, oversee regulations, or advocate for policies that are of benefit to consumers, patients, and the profession.

Nurses serving as elected/­appointed officials or health care lobbyists are immersed in the policy-making process and have a front row seat in influencing the public ­policy ­agenda. Both opportunities ­require a comprehensive knowledge of the complexities associated with ­lawmaking and a willingness to listen and ­assess varying perspectives. The ability to communicate well and build partnerships while working with diverse ­stakeholders cannot be overemphasized.

Noteworthy, three nurses are serving as elected officials during the 115th Congress. Representative Karen Bass, APRN, represents California’s 37th congressional district and is in her fourth term. ­Congresswoman Bass serves as a ranking member of the Subcommittee on ­Africa, Global Health, Global ­Human Rights, and International ­Organizations.

Representative Diane Black, BSN, has represented ­Tennessee’s sixth congressional ­district since 2010. She serves on the House Ways and Means Committee.

Representative Eddie Bernice Johnson, BSN, is the first nurse elected to the U.S. Congress and is now in her thirteenth term representing the 30th congressional district of Texas. Representative Johnson serves on the House Committee on Science, Space and Technology; House ­Transportation and Infrastructure ­Committee; the Aviation Subcommittee; the Highways and Transit ­Subcommittee; and Water ­Resources and Environment Subcommittee.

Many nurses are familiar with former representative, Lois Capps. Capps represented ­California’s 24th congressional district after winning the seat in 1998 after her husband died in office. She championed numerous nursing and health care issues and started the ­Congressional Nursing Caucus.

No doubt, other nurses are well poised to follow suit bringing their expertise to an elected office. For example, Lauren Underwood launched her campaign last fall to represent the fourteenth congressional district in Illinois. Underwood brings a wealth of nursing and government expertise and is passionate about ensuring ­access to high-quality health care for all.

Nurses are also well suited to serve as health care lobbyists because of their vast knowledge of nursing, health, and health care. An extensive knowledge of these and other areas is critical to advocating for legislation aimed at improving access to health care, enhancing health outcomes, and transforming our health care delivery system. Additional competencies needed for such a role include strong interpersonal communication skills, research/analytical skills, detail orientation, knowledge of political, legislative, and ­regulatory processes, and the ability to create and deliver messages to a wide array of diverse stakeholders including legislative officials. Health lobbyists are ­responsible for ­conducting policy analyses and summarizing information that is suitable for a variety of audiences. Nurse lobbyists may work as a consultant employed by a professional/­specialty nursing or non-­nursing ­organization, health care facility, insurance company, or ­pharmaceutical company, to name a few.

The current push to increase the number of nurses serving on boards provides yet another opportunity for nurses to ­become more engaged in aspects of the policy-making process. Depending on the mission of the organization, board members may be responsible for shaping a legislative or advocacy agenda on behalf of the constituents they serve. To ­illustrate, I ­acquired some of my health policy skills while serving as the Chair of ­Public Policy for my local Susan G. Komen Affiliate. In this capacity, I along with board members advocated for breast cancer funding for underserved women and helped to ­shape and monitor the organization’s legislative agenda. This experience provided a unique opportunity for me to serve as a lead spokesperson providing testimony before my state legislature ­regarding the “­Reducing Breast Cancer ­Disparities bill.” This bill includes significant provisions designed to reduce breast cancer disparities among underserved and underinsured women across the entire state.

In addition to some of the previously mentioned career opportunities in the health policy arena, nurses in the following roles utilize their policy knowledge and expertise to advance the nursing profession and transform today’s health care delivery system:

  • Dean/Associate Dean of a School or College of Nursing
  • Director of Government and/or Regulatory Affairs
  • Office of Government Relations
  • Director/CEO of a Government Agency
  • CEO or Executive Director of a Nonprofit Health Care Organization
  • CEO of a Professional Nursing Organization
  • Chief Nursing Officer
  • Surgeon General/Assistant Surgeon General
  • Chair of Health Policy ­Committee for a Professional or Specialty Organization
  • Health Commissioner
  • Board Member for a Health Department, Hospital, or Community-Based Health Care Organization
  • Chair of a Health Policy Committee for a Voluntary Organization
  • Nurse Attorney
  • Hospital Administrator
  • Executive Director of a State Board of Nursing
  • Health Policy Analyst
  • Nurse Regulator

Nurses wishing to pursue a career in health policy can begin by first identifying what is most important to them. ­Nurses who do not have a background in political science or law may need to invest in professional development through formal/informal education. Taking health policy courses is a good step as such course work provides an overview of the policy-making process and may provide some exposure to in-person or virtual lobbying.

Getting involved with the advocacy/legislative arm of one’s professional or specialty organization is yet another great way to gain exposure and experience related to the policy-making process. Many nursing organizations have a policy agenda and work to ensure that their voices are heard on things of importance to the profession and those they serve. Serving as an intern in a legislative ­office for an elected official may also provide some beginning exposure to the policy and legislative process. These types of experiences can enhance one’s credibility when launching a career in public policy.

Participating in health policy fellowships, internships, or other structured immersion activities can go a long way in laying the foundation for future engagement in the policy arena. I cannot overestimate the value of talking with those already in the field. Elected ­officials, nurse/health care lobbyists, and individuals currently running for office as well as other nurse leaders can provide valuable insights regarding the expectations for this type of role. Attending a state board of nursing ­meeting is ­another excellent way to become ­acquainted with the regulatory aspects of the policy-making process. Finally, staying abreast of current and emerging issues in health care and nursing provides a critical foundation for future advocacy and political activism in the health policy arena.

Advocating to Advance the Profession of Nursing: Opportunities for Student Engagement

Advocating to Advance the Profession of Nursing: Opportunities for Student Engagement

Planting the health policy seed has become increasingly important to professional nursing organizations, nurse educators, and even nursing students who applaud the call for integrating health policy and advocacy content in today’s nursing curricula. As nursing students become acquainted with the policymaking process, they are also encouraged to familiarize themselves with the various professional and specialty nursing organizations who advocate on behalf of the nursing profession and the patients/consumers they serve.

Numerous nursing organizations including the American Nurses Association (ANA), National Council State Boards of Nursing (NCSBN), and National League for Nursing (NLN), to name a few, work to ensure that nursing’s voice is represented during policy discussions on issues that impact health care delivery, patient outcomes, nursing workforce development, and other issues of concern to the profession. These and other organizations advocate to ensure that students have financial support to attend nursing school, have access to loan repayment programs, and support to advance their nursing education and training. These organizations work diligently to help ensure that today’s nursing workforce is well prepared to meet the demands of providing high-quality health care services in an ever-changing complex and challenging health care environment.

Suzanne Miyamoto

In this article, we present information about the American Association of Colleges of Nursing (AACN) and share insights from AACN Chief Policy Officer Suzanne Miyamoto, PhD, FAAN, RN.

The American Association of Colleges of Nursing

Since 1969, AACN has been a leader in advancing nursing education, research, and faculty practice. Moreover, AACN serves as a national voice for baccalaureate and graduate nursing education. In addition to creating standards for designing and delivering quality nursing education programs, AACN represents over 810-member schools and colleges of nursing nationwide. The AACN has a Government Affairs Committee and a Health Policy Advisory Council that coordinate and spearhead several public policy initiatives and activities focused on advancing nursing education, research, and faculty practice. Currently, the association’s federal policy agenda focuses on four key areas: workforce, higher education, research, and models of care—all ongoing public policy imperatives.
Here, Miyamoto shares some insights about her organization and health policy advocacy.

Describe Your Role and the Role of the AACN in Preparing Today’s Nursing Students in Becoming Influential Advocates in the Health Policy Arena.

As Chief Policy Officer, I oversee AACN’s policy and advocacy work at the federal level working with all three branches of government. My role and that of our team can be described as strategist, lobbyist, and analyst. To ensure we meet the needs of our member organizations, the association has a Government Affairs Committee and Health Policy Advisory Council that provides guidance when we are reviewing legislative proposals or federal regulations. We want to ensure that what we support, oppose, or remain neutral on is in line with the experiences or challenges of our member institutions. AACN is in a unique position that we represent the schools of nursing, which includes the deans, faculty, and students. This requires our advocacy work to be nimble and abreast of the key issues Congress and the Administration are discussing. It is our role to not only develop the strategy but to educate and inform our membership on our position and why we take it. Information is the best offense and the best defense. That is why AACN fully supports all members of a nursing school to be engaged in our advocacy efforts. We have a grassroots network with other 11,000 students, faculty, and deans. This network has great potential to grow and offers real-time, advocacy opportunities.

What Are Some Top Priority Policy Issues Impacting the Profession and Health Care Today?

Some key issues impacting the profession today include
• Securing funding for Nursing Workforce Development Programs, Title VIII of the Public Health Service Act, National Institute of Nursing Research, National Health Service Corps, among others
• The Title VIII Nursing Workforce Reauthorization Act (H.R. 959, S. 1109)
• Health reform
• Deferred Action for Childhood Arrivals (DACA)
• Public Service Loan Forgiveness
• Opioid epidemic

What Can Students Do Within Their Area of Influence to Advocate for the Profession?

It is important that students stay informed of the issues. Students need to be active participants in their own learning. To understand what is happening at the federal level, a student must embrace the policy from multiple lens. It is not enough to read one source or one disciple. To truly garner the depth and breadth of the issue, the more voices, for and against, the better one’s understanding becomes. Securing a basic level of knowledge on an issue that may impact one’s education, research, or future practice is an excellent starting point.

Grassroots campaigns are central to any of our efforts. We can be more effective if we know how our national organizations are weighing in on issues. It’s also important to listen to all perspectives. Again, policy think tanks like the Center for American Progress or the Heritage Foundation may have different political viewpoints, but on some issues, they may see eye to eye. Their rationale for getting there may be different, but it is that difference that can help further an argument depending on the audience. Students can also join forces with faculty and others to reach out to legislators at the federal, state, and local level on issues important to nursing. Discussing issues with nursing faculty, who can serve as tremendous mentors for those interested in policy, can ignite a passion for this work in the future. That is how I came to seek a career in health policy and advocacy. It was the foresight of my faculty mentors who gave me the opportunities to succeed.

What Resources Are Available for Nursing Faculty Who Are Preparing the Next Generation of Health Policy Activists?

AACN established a Faculty Policy Think Tank that worked to prepare a set of recommendations for AACN’s Board of Directors on this exact question. The charge of the group was to inform and improve the state of health policy education in undergraduate and graduate education. The ultimate goal was to consider ways that will help create a generation of future nurses who understand the micro and macro drivers that impact policy—most importantly, how nurses in the future can continue to skillfully insert nursing expertise into policy discussions. The report was released in October 2017.

Turning to the continued need for policy advocacy at the student level, AACN also offers a three-day student policy summit open to undergraduate and graduate nursing students enrolled at AACN member institutions. The program helps to prepare students to engage in policy advocacy and the federal policymaking process. For more information, visit http://www.aacnnursing.org/Policy-Advocacy/Get-Involved/Student-Policy-Summit.

As mentioned earlier, AACN’s 2017–2018 Federal Policy Agenda is well suited to serve as a foundation for shaping policy discussions during online and classroom discussions as well as during virtual and/or actual lobby days. Students are encouraged to speak with their deans and faculty at their nursing programs to learn more about what’s happening within their institutions regarding public policy advocacy efforts that impact nursing education and nursing practice.

 

Seeking Federal Support for Nursing Workforce Development Programs: A Clarion Call for Continued Advocacy

Very central to this discussion is the need for ongoing advocacy to secure funding to support Title VIII programs. Title VIII programs are administered under the U.S. Department of Health and Human Services, Health Resources and Services Administration. The Nursing Workforce Development Program (Title VIII of the Public Health Service Act) continues to benefit countless numbers of nursing programs, practicing nurses, faculty, students, patients, and communities. In fact, numerous minority nurses continue to benefit from diversity grants because of Title VIII funding. During 2015–2016, the Nursing Workforce Diversity grants supported 7,337 students. Numerous other minority nurses, including minority nurse faculty, have received funding through this program to support their advanced nursing education or pay back student loans. To learn more about how Title VIII programs are making a difference for nursing students, practicing nurses, academic institutions, and communities at large, visit http://www.aacnnursing.org/Policy-Advocacy/Title-VIII-Community-Impact.

As a nursing student, speak with your faculty and professional organizations about how you can play a role in policy advocacy. Throughout nursing’s history, nurses have made a tremendous impact in advancing the profession and the delivery of health care by advocating for issues of importance to them. Developing your knowledge base about these and other issues impacting the profession is a great first step to becoming an influential advocate on behalf of the profession and the patients and communities you serve.

ADDITIONAL RESOURCES

American Association of Colleges of Nursing

Student Policy Summit (Check for call for applications)

Faculty Policy Intensive

Policy and Advocacy

National League of Nursing

Advocacy and Public Policy Overview

Advocacy Action Center

National Council State Boards of Nursing

Policy and Government

Health Policy Development and Engagement: What’s a Student to Do?

Health Policy Development and Engagement: What’s a Student to Do?

Increasingly, nursing students are being introduced to health policy and are encouraged to play an active role in some aspects of the policymaking process. Yes, I know, so much to do and so little time! However, opportunities to enhance one’s level of awareness and engagement regarding the policymaking process have never been greater. Planting the health policy seed has become important to professional nursing organizations, nurse educators, and even nursing students who applaud the push for integrating health policy and advocacy content in today’s nursing curricula.

Expected Competencies

Today’s nursing students must acquaint themselves with a number of policy issues that may impact their practice, the delivery of health care, and the profession of nursing. Nursing students are encouraged to develop increasing levels of knowledge, skills, and competencies related to health policy and advocacy commensurate with their advancing levels of nursing education. The American Association of Colleges of Nursing (AACN) has identified key health policy competencies to include in nursing curricula starting at the baccalaureate through the doctoral level. Nurse educators are encouraged to incorporate these competencies when designing and implementing health policy courses for nursing students across all levels of nursing.

Starting at the baccalaureate level, nursing students are introduced to aspects of health care policy, finance, and regulatory environments. Students at the master’s level are engaged in analyzing health policies and their impact on health care financing, practice, and health outcomes. Nurses at this level are expected to help interpret research findings as well as advocate for policies that will improve the health of the public and advance the profession of nursing. Building on these skills and competencies, students at the doctoral level are expected to acquire the necessary skills to demonstrate a higher level of involvement of leadership in developing policies, influencing policymakers, and assuming influential leadership responsibilities at the local, state, national, and/or international level.

Early on during nursing education, one should begin thinking about how legislation informs nursing practice and how public policies influence the health outcomes of the patients and communities that one serves. For example, funding for nursing education and research is an ongoing issue for the profession. This need requires ongoing and persuasive advocacy and communication with state and federal legislative officials. Each year, numerous organizations lobby at our nation’s capital to make the case for funding to support nursing education and research. In fact, increased funding levels for nursing education and research are, in part, attributed to the diligent advocacy by the nursing community and other stakeholders.

Opportunities for Policy Development

Recognizing the need to introduce nursing students to the policymaking process, the AACN hosts an annual Student Policy Summit. This three-day summit is open to nursing students enrolled at AACN member institutions and is designed to familiarize students with the policymaking process and nurses’ role in professional advocacy. Students journey to Washington, DC, to take a glimpse at the policymaking process at the federal level. Speak with your school and/or faculty to ensure that there is representation and support from your academic institution during the call for applications. For information about future offerings, I encourage you to visit the AACN’s website.

Recognizing the need to foster the policy development of its members, the National Black Nurses Association offers an annual Health Policy Institute at their annual meeting. Speakers with expertise and experience in the health policy arena have presented on topics, including health equity, prescription drug abuse, reproductive rights, and mental health, to name a few. Another example is the Oncology Nursing Society, which provides an online tutorial on the policymaking process and ways to become an effective patient advocate. Many nursing organizations hold virtual and in-person annual lobby days empowering its members to advocate on behalf of patients, communities, and the profession.

Be sure to check with your student, professional, and specialty organizations to see what opportunities they have to help supplement your classroom education. Volunteerism is yet another way to develop familiarity with the policymaking process and gain experience in advocacy. For me, I volunteered for a long time with the American Cancer Society and the Susan G. Komen for the Cure. These experiences enabled me to establish the linkage among practice, research, and patience advocacy. This in turn fueled my passion for learning more about the policymaking process and the various legislative initiatives informing the health and well-being of communities of color.

Current Legislation

Although numerous bills are introduced each year, only a small percentage will make it through the entire process, culminating in action at the executive level and signed by the President for passage. Similarly, numerous bills may be introduced or reauthorized that will have some implications for patients (e.g., reimbursement for care, increased access to care, support for clinical trials) or the profession of nursing (e.g., funding for nursing education and research).  One bill that has implications for patients and the profession is the Nurse and Health Care Worker Protection Act of 2015 [H.R. 4266/S. 2408]. This piece of legislation was introduced by Representative John Conyers, Jr. (D-MI) and Senator Al Franken (D-MN) on December 16, 2015, during the 114th Congressional Session. This is the only national legislation that improves the quality of patient care and protects nurses and health care workers by addressing the safe handling of patients. To track the progression of this legislation, visit www.congress.gov.

During your nursing education or even in the workplace, stimulate some discussion and support around legislation and health policy issues and topics that have implications for nursing. Nursing in the 21st century demands that we take our rightful place at the table and advocate for patients and the profession. Developing the wherewithal to do so at the student level is an important first step.

Policy Engagement: A Call for All Nurses

Policy Engagement: A Call for All Nurses

The need for nurses to become familiar with and engaged in the policy-making process has never been greater. While nurse leaders throughout time have emphasized the need for nurses to become more involved in advocating for patients and the profession, the passage of the Affordable Care Act (ACA) and the release of the Institute of Medicine’s The Future of Nursing report both call for the transformation of health care delivery and underscore opportunities for policy engagement.

The renewed interest in policy engagement for nurses is further evidenced by the proliferation of health policy books and resources for the nursing profession and the increased emphasis on including health policy content in nursing education programs. In fact, the American Association of Colleges of Nursing developed a set of core competencies for integration into nursing education programs, all of which emphasize the need for nurses to develop competencies in this area.

Practice, Research, Policy: Connecting the Dots

I recall the aha moment when I realized the importance of identifying the policy implications of my practice and research. While I had worked in underserved communities for many years, it was not until I started conducting breast cancer disparities research with underserved women that it occurred to me that someone (e.g., survivors or cancer organizations) was advocating for legislation to improve access to cancer screening services. Concurrently, the Breast and Cervical Cancer Mortality Prevention Act of 1990 directed the Centers for Disease Control and Prevention to establish the National Breast and Cervical Cancer Early Detection Program to assist low-income and uninsured women in gaining access to breast and cervical cancer screening and diagnostic services. Expanding on the need for follow-up care, the Breast and Cervical Cancer Prevention and Treatment Act was signed into law in 2000, helping to ensure access to breast cancer treatment services for low-income and uninsured women diagnosed with breast cancer.

As a volunteer for the American Cancer Society and the chair of public policy for the Chicagoland Affiliate of Susan G. Komen for the Cure, I started participating in lobby days advocating for more affordable and accessible cancer prevention and treatment services.

Building on my desire for more engagement, I began lobbying with my professional nursing organizations to advocate for funding to support nursing education and research. Thankfully, I realized the strong connection between practice, research, and policy—and now encourage nurses to do the same.

To Get You Started, Suggested Activities Include the Following:

• Complete a health policy course during your nursing education and your nursing career.

• Become more involved through your professional and specialty organizations.

• Attend state lobby days sponsored by your nursing organizations or home institutions.

• Participate in virtual lobby days.

• Invite congressional leaders to tour your nursing program, professional meetings, or community activities.

• Look for policy implications in presentations, publications, and textbooks.

• Seize the opportunity to identify public policy implications in your everyday practice.

• Incorporate a policy component into your clinical experience (e.g., student interviews with state lawmakers and city council members, and student attendance at public hearings).

• Tap into your institution’s Office of Government Relations.

• Read policy-related journals (e.g., Nursing Outlook or Policy, Politics, and Nursing Practice).

• Become familiar with websites that offer health policy resources (e.g., National League for Nursing, American Nurses Association, and the American Public Health Association).

• Tap into your professional organization’s resources for policy development.

• Share your personal experiences in the policy arena.

Regardless of practice setting, there are public policies and legislative initiatives that influence the scope of nursing practice or the amount of available resources to provide patient care or support nursing education. For example, the recent push toward full scope of nursing practice has already influenced the way advanced practice nurses practice in each state. Members of the nursing community, along with a number of stakeholders, are working with state and federal legislative officials to see what legislative and regulatory actions are needed to ensure that nurses are practicing to the full extent of their preparation. The outcomes of these efforts will have huge implications for the nursing profession and the patients we serve. Akin to this are the provisions outlined in the ACA, many of which have direct implications for nurses. Key provisions focused on primary workforce, patient-centered care, nurse-managed health centers, school-based clinics, quality improvement, and patient safety, to name a few. These provisions present opportunities for nurses to pursue leadership roles that will enable them to help implement aspects of the ACA legislation.

What a great time for nurses to contribute to the policy discourse that is taking place on the local, state, and federal level. From the new grad to the more seasoned professional, nurses are encouraged to become familiar with the policy-making process and identify ways in which they can make a meaningful contribution to improving the quality of patient care and advancing the profession through advocacy and political activism.


Health Policy Resources

American Association of Colleges of Nursing Government Affairs
www.aacn.nche.edu/government-affairs

American Nurses Association Policy & Advocacy
www.nursingworld.org/MainMenuCategories/Policy-Advocacy

Center on Budget and Policy Priorities
www.cbpp.org

GovTrack (site for tracking legislative bills)
www.govtrack.us

Kaiser Family Foundation
http://kff.org

National Conference of State Legislatures
www.ncsl.org

National League for Nursing Advocacy & Public Policy
www.nln.org/advocacy-public-policy

Office of Legislative Policy and Analysis
https://olpa.od.nih.gov

Office of Minority Health
www.minorityhealth.hhs.gov