Quite often a nurse will ask me how to become engaged in the health policy arena. I frequently advise nurses to get involved with their professional organizations as a start. Many nursing organizations have an advocacy and legislative agenda and are oftentimes engaged in advocating on behalf of patients and the profession. Here, we share a conversation with Aney Abraham, DNP, RN, NE-BC, who is a founding member and current president of the Indian Nurses Association of Illinois (INAI). Abraham discusses the origins of her organization and current issues they are addressing.

With regard to legislative issues, Abraham highlights a piece of legislation that was introduced during the 115th Congressional Session. The proposed legislation “H.R. 3592 South Asian Heart Health Awareness and Research Act of 2017” aims to address the high rate of cardiovascular disease in the South Asian community. And while the proposed legislation did not gain much traction during the 115th Congressional Session, the INAI is hopeful that the original sponsors of the proposed legislation will reintroduce it and continue to seek funding to support research focused on finding solutions to the high rate of cardiovascular disease in this population. This targeted approach to improving the health and well-being of this population takes into consideration cultural factors that may influence health status and calls for early intervention and treatment through education and awareness.

As president of the Indian Nurses Association of Illinois (INAI), can you share with me a bit about the INAI, its origins, its mission, and membership?

Aney AbrahamThe Indian Nurses Association of Illinois was established in 2002. I was a nurse with about 18 years of experience at this time and among one of the few nurses that thought of this idea of forming a professional organization for nurses of Indian origin. There were many reasons for starting this organization. The first and foremost was that Indian nurses who immigrated to the U.S. faced many challenges as they transitioned in the United States.

At a Glance:
South Asians and Heart Disease

  • South Asians are one of the fastest growing ethnic groups in the United States.
  • Family origins mostly from: Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka.
  • High cardiovascular prevalence not readily known due to lack of data.
  • Research examining heart disease in Asians in general lacks subgroup analyses.
  • Possible contributing factors include early onset of diabetes, cholesterol abnormalities, westernized diets, and lifestyle.

Source: American Heart Association

For a more detailed discussion of heart disease in South Asian populations, please see the American Heart Association’s Scientific Statement.

Foreign nurses become minorities overnight having little or no orientation to the country or health care facility that they worked for. We realized that many nurses were eagerly anticipating the birth of this organization and thus successfully established the organization in 2002.

The mission of INAI is to identify and meet the professional, cultural, and social needs of nurses of Indian origin. In addition to our mission, our purpose is to ensure that we provide representation and interact with other professional organizations as well as promote cultural awareness by communicating the uniqueness and diversity of the Indian culture.

What do you believe are the top nursing issues impacting our profession today?

Job safety is important to all professions; nurses are not exempt from working in unsafe environments. One of the top nursing issues impacting our profession is workplace violence. Every day, our nurses are impacted by violence perpetrated by patients, their family members, and visitors. Incidents that may start small can spiral out of control within minutes. Even though nurses are very familiar with incidents of violence, research seems to suggest that workplace violence is increasing. We certainly hear about these incidents through TV, print media, and reports from nurses.

The second issue that is impacting our nurses is stress and burnout. Nurses are on the front lines providing direct nursing care, advocating for patients’ medical needs, comforting patients/families, and working with a multidisciplinary team to ensure that patients receive safe high-quality patient care. Stress and busyness can easily escalate with the demands that are placed on nurses daily.

As nurse leaders and professional organizations, we need to work on finding ways to address awareness and ways to mitigate these issues that are facing our profession.

What are some of the top policy or regulatory issues impacting the Indian nursing community?

One of the issues impacting nurses of Indian origin is abusive employment practices. To address this, in 2008 the ANA released the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States. The code addresses minimum fair labor standards, civil rights, age discrimination, equal pay, and family/medical leave.

Another issue impacting Indian nurses (majority of which are of South Asian descent) is that they suffer from heart disease, high blood pressure, and diabetes too frequently and too early in life. Compared to other ethnic groups, South Asians are four times more likely to have heart disease, experience heart attacks 10 years earlier in average, and have a 50% higher mortality rate from heart disease. To address this, in 2017 Rep. Pramila Jayapal (D-WA-7) proposed H.R. 3592 “South Asian Heart Health Awareness and Research Act of 2017.” This is a very specific piece of legislation targeting Asian Americans.

What is the overall purpose of this legislation, and why is it important to you as a nursing organization and to the Asian community at large?

Representatives Pramila Jaypal and Joe Wilson co-sponsored this bill to raise awareness of the alarming rate at which the South Asian community is developing heart disease.

The overall purposes of this legislation are to:1) promote heart healthy eating among Asians; 2) conduct research to understand why South Asians are at an increased risk for developing heart disease and; 3) develop educational tools about heart disease for South Asians.

This legislation is important to us as a nursing organization and to the Asian community at large. The members of the Indian Nurses Association spend a tremendous amount of time offering free community services in the Indian community. Our advanced practice nurses spend time on the weekends visiting the various churches conducting health fairs, offering lectures, and educating the community on the dangers of heart disease and diabetes. Legislation that supports research will enhance our ability to learn more about the root causes of the high risk for the Asian community and prepare us to share lifesaving information with the community at large.

Are there any updates on this given this did not pass out of committee?

We will continue to monitor where this is going as the original sponsors are committed to raising awareness and supporting research in this area.

What are some of the ways that your organization has engaged in community education regarding Asian American cardiovascular disease?

Every year we host a minimum of three community health fairs and lectures in the Indian community. Our members, many of which are advanced practice nurses, have the skills, expertise, and knowledge to effectively lead these health fairs. In addition to the health fairs, we offer free BLS and ACLS certification.

How does INAI prepare its members to be influential advocates in the policymaking arena?

INAI invites public officials and elected officials to speak at our meetings and conferences. For example, some of our guests in the past have included, at that time, Senator Barak Obama before he went on to become President of the United States and Dr. Ann Kalayil, Bureau Chief, Cook County Bureau of Asset Management. Dr. Kalyil was the former President of the South Asian American Policy and Research Institute.

Additionally, members stay informed through educational seminars and educational offerings posted on social media outlets such as Twitter and Facebook. We also stay abreast of issues by following the legislative agenda of the American Nurses Association.

Are there other policy issues that are a part of your health policy agenda?

Many of our members are advanced practice nurses. Thus, we support the policy agenda of the National Association of Clinical Nurse Specialists (NACNS). Their priorities—including nursing workforce issues, health care reform, and health information technology—resonate with our legislative priorities.

The Indian Nurses Association is an organization of about 200 members. We can be more impactful when we combine our voices with other nursing organizations to enhance our policy advocacy on behalf of patients and the profession.

If you had to offer advice on why nurses should be engaged in advocacy and policy advocacy on behalf of patients and the profession, what would you say?

Nurses instinctively advocate for their patients. Equally important is for nurses to engage in legislative and political advocacy. This is needed to advance the profession and patient care. It is important for the voice of the nurse to be heard when any new legislation or bill is being introduced. An example of a recent bill is SB2151, a bill sponsored by Senator Hastings. This bill is about the Nurse Practice Act language surrounding delegation. Specifically, nurse delegation in community-based settings is of concern. Nursing has to provide the definition of what nursing practice entails, how nursing interventions and tasks can be delegated, and in what care settings the delegation can occur.

Nurses can stay informed on legislation that impacts their practice and profession by following nursing forums like @ANAnurses [and] @RN Action.

To stay engaged or not engaged in policy advocacy is a decision each nursing professional has to make, and he or she must always err on the side of staying actively engaged on behalf of the patients and those they serve.

Janice Phillips, PhD, FAAN, RN

Janice M. Phillips, PhD, FAAN, RN, is an associate professor at Rush University College of Nursing
and the director of nursing research and health equity at Rush University Medical Center.
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