Susan McCarthy MSN, RN, CNRN
PA Nurse Alliance, SEIU
Quality Care Summit 2012
suemac1128@aol.com
September 25, 2012
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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
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
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Regulates by licensing: protects public health
ANA Code of Ethics, advocate for profession
Nurses should act individually, collectively
through political actions for social change.
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Provision 9.4 : Social Reform
Professional Nursing associations speak for
nurses in reshaping health care policy,
legislation
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Accessibility, Quality, Cost
Violation of human rights, homelessness, hunger,
violence, stigma of illness
http://www.seiuhealthcarepa.org/nursealliance/Supreme_Court_Upholds_Health_Reform_Law.aspx
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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.
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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)
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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
Diane Carlson Evans (1993)
Vietnam Women’s Memorial
http://upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Lillian_Wald_
Lillian Wald,(1893)
Public Health Nursing
http://georgiainfo.galileo.usg.edu/statues/vietnam-women2.jpg
http://blog.tcs-inc.us/Portals/39196/images/needle_stick.jpg
Civil War Nursing Memorial
Dupont Circle
Washington D.C.
http://www.empirecontact.com/images/statuary/Sisters_memorial_right.jpg
Spanish American War
Nursing Memorial
Arlington Cemetery
http://www.arlingtoncemetery.mil/photos/SpanAmericanNurses.jpg
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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)
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~15% of hospital
patients still being
harmed
20% discharged
elderly patients
readmitted ,
30 days
Nurses spend 30%
time, direct patient
care
(IOM, 2012)
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“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)
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Opinion leaders, 90% want nurses to improve
quality, safety, reduce medical errors
(GallupPoll,2010)
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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)
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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)
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ACA Implementation
Safe, Healthy Work Environments
Eliminate Manual Patient Handling
Reduce Work Place Violence
Mandate Safe Staffing
Education, Recruitment, Retention
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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)
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Expert:
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Interpersonal:
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Combines science, technology, caring
Excellent negotiators, communicators, problem
solvers, team players
Power in Numbers: 2.9 million
 # will grow 26%, 2010 to 2020
Latent Power:
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Untapped, underused
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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)
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Workplace:
Procedures, budget, practice, bargaining table
shared governance committees
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Government:
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Professional Organizations:
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Local, state, national legislation, run for office
Provide information, activities, leaders
Community, Public Education:
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↑ Nurse visibility, health fairs, endorse candidates
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
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2. Networking, crucial for action, change
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Establish, maintain interdisciplinary relationships,
asking for help is OK
3. Powerful Persuasion
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Passion, thoughtful analysis of ideas, clarity, ability
to communicate, important to audience
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4. Collective Strength
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5. Strategic Perspective
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Professional organizations, interdisciplinary
Voices louder, persuasion greater
Group consensus, strengthen the individual
Stepping back, place health in broad context
See Nursing as political activity
Questions emerge, government influence on
populations, health, environments of care
6. Perseverance
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Remain Optimistic, you don’t always win
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SEIU Nurses share political action experiences
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Stage One: Buy-In
Individual nurses take position/react to issue affecting
profession, public. Decide to take action.
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Stage Two: Self-Interest
Individuals begin establish political identity, voice. Organize,
develop strategies to resolve issue.
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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.
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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.
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Keep informed of issues affecting nurses and public
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Join Professional organizations, SEIU committees/actions
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Find a Mentor, be a mentor
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Participate in public demonstrations
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Participate in shared governance councils,
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Meet with elected officials in their offices
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Write a letter to elected officials
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Publish
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Political actions bring social change
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Nurse laws, ethics code support political action
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Keep informed
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Join professional organizations
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Take Action
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Achieve political competency
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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 , www.votesmart.org
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.
www.paheathaccess.org 215-557-0822
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Abood, S. (January 31, 2007). "Influencing Health Care in the Legislative
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Antrobus S (2003) What is political leadership? Nursing Standard. 17, 43,
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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), 259-266.
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.
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Hughes, F. ( 2005) Role of nursing management in health care policy
development. Retrieved from http://www.slideserve.com/rubaina/roleof-nursing-management-in-health-care-policy-development
IOM (Institute of Medicine). 2012. 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
http://www.rwjf.org/pr/product.jsp?id=5435
SEIU (2001) The Fight for Our Lives: How We Won Safer Needles. Retrieved
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http://www.youtube.com/watch?feature=player_embedded&v=g51Wk
B9zpEk
Warner, J. ( 2003). A Phenomenological Approach to Political Competence:
Stories of Nurse Activists. Policy, Politics, & Nursing Practice. (4).2.