Maryann Alexander, PhD, RNMichelle Buck, APN, CNS
2007 and 2010IllinoisHawaii, Kentucky and Maryland
Uniformity to APRN Regulation
OutlinePreparation for Grassroots CampaignBuilding a CoalitionTaking ActionGetting the Bill PassedUsing Data Effectively and Other Strategies
John Kingdon (2000)247 detailed interviews (133
specifically related to health care)1/5th congressional staff1/3rd executive branchRemaining: outside government
#1: Cohesion Speaking with one voice and convincing legislators that the policy truly represents the preferences of the entire group.
84% of the respondents thought this was the most influential factor in the political agenda.
GrassrootsGrassroots Campaign
Astroturfing
Step 1: Preparation
What Changes Need to Be Made and Where Will They Be Made?
StatutoryRules/RegulationsPolicy
Begin Informal Discussions/Ensure Awareness of IssuesBoard of NursingMajor Nursing OrganizationsOther Health Care OrganizationsUmbrella Agency for Professional
Regulation
Other influencesNational organizationsState Medical BoardState Medical AssociationConsumer Groups
Professional OrganizationTalk with Executive BoardDiscuss with Government Relations
CommitteeInform Membership
Ensure Cooperation and Support
Vision without action is merely a dream.
Action without vision just passes the time.
Vision with action can change the world.
Joel Barker
Step 2: Taking Action/Building the
Coalition
Formal Meeting
Key representatives from all APRN groupsExplain changes and how will affect
APRNs in stateOutline a plan for building a consensusGet their inputGive the coalition a name/Develop a
mission statement
Formal MeetingAsk for them to submit names/CVs
of their members wiling to participate
Date of the meeting with the entire coalition
Pledge support for the effort and everyone stands united
Professional OrganizationPresent the proposed changes to the
MembersGet feedback from membersProvide feedback to BON Educate the membershipBuild support within the organizationSelect representatives for the coalition
Representatives for The Coalition
Executive BoardGR CommitteeKey Members
Choose State/Team CaptainsDivide state into regionsOne captain for every regionAssign team members to captains
Strategically choose co-captains
Building the Coalition Team
If possible-one member of every organization represented on every team in the coalition
The Coalition Meeting
Vision StatementConsensus Model for APRN RegulationChanges to be Made/How they will affect
APRNs in state-focus on positiveResource MaterialsShow how the state is divided up/introduce
captains
Kick-off MeetingStrategiesOppositionMost important! Everyone must speak
the same language, use the same termsCommunication plan/website/dates of
future meetingsEveryone agrees to work together and
pledges support
Responsibilities of the State CaptainsPrimary CommunicatorEstablish a means of communication with
team membersStrategize as to how you will educate the
APRNs in your regionDistribute resource materials
Responsibilities
Represent the region at coalition meetings Meet with legislators/coordinate legislative
activities
Step 3: Getting the Bill Passed
Prior to the Opening of the Legislative Session and Ongoing…
Educate the APRNs in the state:Post information and toolkit on BON and
Professional Organization website State Captains
Distribute materials to APRNs Give presentations at Hospitals/Nurses Week Get on agenda of local chapter meetings Coach team on how to talk with legislators
Choose Sponsors for the BillSupportive of
Nursing/Knowledgeable about health care
Experienced in successfully passing legislation
Influential in both parties
Preparing for the bill to be IntroducedLegislative handbookData/Talking PointsLanguage for the billDecide who will lead the lobbying efforts
Bill is introduced and in committeeTarget the committee members-explain why
the changes are important and how they will positively affect the health care provided to the citizens of your state.
Constituents contact committee membersFact sheetsDataState Captains
Bill is in CommitteeAddress OppositionProvide TestimonyGather Consumer Support
Bill is out of committee and goes to House or Senate floorAll out effort is needed for APRNs to contact
their legislatorsBill number is importantEncourage all supporters of the bill to
NCSBN website for resource materials they may need
Addressing the OppositionBoard of Nursing Professional
OrganizationBoard of Medicine State Medical
Association
Other opposition
NegotiationsHave data readyBe prepared for all questions/have
counter-arguments preparedUse personal contacts/capitalize on
existing relationships
Using Data Effectively and Other Strategies
Florence Nightingale
Florence Nightingale's Visual Rhetoric in the Rose DiagramsLee Brasseur Technical Communication Quarterly; Spring 2005; 14, 2; ABI/INFORM Global pg. 161-182
The Rose Diagrams/Evidenced Based Policy
Scientific data to identify a problemFramed within the context of the political
environmentAnticipated questions/opposing argumentProposed a solution and provided data
supporting the effectiveness of the solution
The Model
Statistics are not merely numbers; they reveal patterns that allow human beings to control destiny.
Florence Nightingale
John Kingdon (2000)
Second most important influence on the policy process…
#2: Academicians, Researchers, Consultants66% rated these as the second
most important influence in the policy process.
Data and expert opinion
ResourcesNCSBN Member Board ProfilesNCSBN dataOther States/Other Professions Within Your
StateStatisticsOther data sources
One Board of NursingProblemTwo boards of nursing places an undue burden on the IL Dept of Professional Regulation in terms of budget and staff.
A high number of disciplinary cases on the RN/LPN board. (Public Safety)
Board of NursingProposed solution
Combine the boards and create one board of nursing with 13 members.
Board of NursingAnticipated opposition
Removing the physicians from the APRN board will endanger the public.
Board of NursingData to support the proposed solutionThe APRN Board has not met over the past two
years. There has been no increased in discipline cases or any other indication of a threat to the public.
Prior to the past two years the attendance record indicates only one out of the 3 physicians on the board ever attended the board meetings.
Additional data to support the proposed solutionIllinois is only one of 2 states to have an
APN boardIllinois has no voice at the national level
in APN regulatory issues since the APN board is not a member of NCSBN.
Combining the boards will provide substantial savings for the dept.
Additional Lessons
Elimination of Collaborative Practice AgreementsProblem
APNs that work in collaborative practice agreements with MDs that They don’t know Don’t know what their role is/what the collaborative
agreement is for Physicians uncomfortable with the process APRNs in rural settings are having difficulty finding
physicians to collaborate with and APRNs are avoiding working in those areas.
They are redundant
Elimination of CPAProposed change:
Elimination of collaborative practice agreements
IncrementalismTaking small steps to achieve a large goal
Collaborative AgreementsNegotiated
All four advanced practice specialties may practice in a hospital or ASTC without a collaborative agreement when credentialed and privileged by the governing body of that institution.
Elimination of Collaborative Practice Agreements in Hospitals and ASTCs
Wasn’t what was wanted, but it was what we could get
Step in the right directionOpportunity to collect data
In Conclusion…
Concerted EffortEveryone needs to be unified, speak the same language
Common MessageOpen lines of CommunicationWell-coordinated
Message sent to the Right PeopleMessage from the BON and Professional
Organizations is consistent, clear and concise
The right people sent the message from the start and are involved in the process
Individual Voices make a DifferenceBON and Professional Organizations need to
ensure each participant is valued for their participation
May take some cheerleadingAPRNS and others in state need to know
their voice is important and will be heardConstituents have power
Nurses have a Powerful Impact when they work
together