Donna Emanuele, DNP, RN, FNP-BC, FAANP

CNMA Annual Meeting San Diego

October 7, 2017

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Discuss engaged advocacy as a concept to explore

community and professional practice engagement

Describe strategies to cultivate and build partnerships, sustainable relationships, and coalitions

Identify legislative strategies used to influence health policy

Address key issues driving audacious policy change

Objectives

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subject to copyright restrictions. Copying and/or distributing for purposes other than educational use by currently registered conference attendees or other authorized users is strictly prohibited.

Copyright

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This speaker has not received any financial

assistance or grant support funding from any private or not-for-profit enterprise.

Disclosures

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What’s your Mission?

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What do you Seek?

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“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” –Margaret Mead

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Drivers of Change

Challenges in Health Care

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High Costs

Fragmentation

Health Care Disparities

Aging and Sicker

Population

Primary Care and Public

Health Shortages

Healthcare Challenges

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CNM Practice Environment

Shifting the conversation: What’s Wrong with the Map?

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And other APRNs?

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Patients

Families

Communities

What do we share as common?

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Legislative Strategies

Influencing Health Policy

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The essence of strategy is choosing to perform activities differently

than rivals do Michael E. Porter , 1996

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Complex process Multiple levels of government

Private & public sectors

Five components to a policy cycle: Issue raising

Policy design

Building public support

Legislative decision-making & building policy support

Policy implementation (p. 303)

Policy Cycle & Process

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What Can We Do Differently?

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Creating Momentum

Primary Issues

Access to Health Care Health disparate and

vulnerable groups

Safety & Quality

Cost of Care

Primary Influences

Stakeholder Groups Consumers & Consumer

Advocacy Groups

Organized Health Systems Payors/Insurer’s

Professional Organizations

Evidence

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Managing Conflict Encounters can provide opportunities Negotiate & Compromise Reciprocity may not be immediate Incremental approach

Building Coalitions Identify & Leverage Interests Broadens the Larger View

Establishing Political Outreach with Organized Networking Build Capacity & Expand Reach establishes trust & credibility communicates the value you add

Involved Processes

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Interest groups and strong lobbies can advance or

block legislation

Adversarial relationships

Competition between health care disciplines over practice boundaries

Expansive SOP proposals

State statutes and regulations that grant APNs the right to practice through licensure, do not necessarily sanction their autonomy to perform as practitioners

Factors & Assumptions

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Political Advocacy

Creating Action for Change =Engagement

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Coalitions & Partnerships

Group of individuals representing diverse organizations or

constituencies who agree to work together to achieve common goals

(Feighery & Rogers, 1990)

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Building Relationships

Increase Networks & Create Opportunities:

Participate on Advisory Groups

Task Forces

Strengthen Alliances

Develop Partnerships

Create Coalitions

Maximizing Potential Get involved!

Attract new members & grow more diverse

Link with non-traditional partners

Learn from others’ experiences

Disseminate promising practices & strategies

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Consumer Groups Need to better communicate Inform about issues, listen & develop alliances for support

Action Coalitions (ACs) States taking a lead role in implementation of IOM-FON

Review & Know the Policy Process What are the types of legislation affecting practice? Understand the issues Get to know your politicians and regulatory boards Attend meetings, make visits, write letters

Become advocates for the profession & take an active role Support your professional nursing organization Legislative & regulatory change takes funding (harsh reality

of the landscape)

Stakeholder Involvement

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Advocacy strategies & campaigns are crucial factors in

the decisions about: when to act, where to act, and how to act

What is wanted? What are the goals you are attempting to achieve? Must consider: The authority to make it happen? (i.e., Who is the intended target

audience?)

What messages do authorities need to hear to motivate them to act?

Who are the most effective individuals or groups to deliver those messages?

How to target audiences to hear those messages? (American Cancer Society/UICC Tobacco Control Strategy Planning Guide #3, 2006)

Strategic Planning

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Patience and Strategic Planning

Collaboration

Networking

Consistent messaging

Evidence

Legislation

Regulation

How Do We Get There

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Actions to Influence Policy Outcomes

Specific actions that an interest group can take to influence policy outcomes:

Mobilizing members

Writing press releases

Seeking elected officials endorsements to achieve influence

Monitoring public opinion

Building coalitions

Citizen contact

A combination of various tactics that complement each other and provide the best chance for the group to achieve its goals:

Inside lobbying (direct work with legislators and elected officials)

Outside lobbying (media and grassroots activities to place external pressure on political leaders)

Lobbying

Tactics

Lobbying Strategy

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Leveraging Your Voice

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Speaking with a Powerful Voice

“Get to the table and be a player, or someone who

does not understand nursing will do that for

you." Loretta Ford

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Policy is shaped by how policy makers learn about

health care issues

Perceived benefits of change shape decisions

affected by timing, economic costs and politics of the day

Understanding past policy failures and successes

provide direction in planning for future implementation

Considerations

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What is it?

Concept of “Engaged Advocacy”

Community

Professional Engagement

Engaged Advocacy

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Definition:

engaged in public policy is not strictly about lobbying

Concept of Engagement

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When the denominators of two or more fractions (health

professions) are the same, they are Common Denominators. Full Practice Authority is “mathematics”

before we can add or subtract fractions (health professions), the fractions need to have a common denominator to leverage influence…do we?

>22,000/ ? + >1200/? =

Our strength is in working together as APRNs

Who’s the Common

Numerator/Denominator?

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Ask Yourself

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Common Goals-Shared Vision

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What would that look like?

How could we achieve it?

How can we make that happen?

What if we shaped a

Different Conversation?

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Storytelling

Patient, family and community involvement

From engagement to activism

What are the differences?

Policy and Practice

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Legislative & Regulatory

Decision Making: A Combined Approach

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Who does the BRN represent?

Why are we frustrated?

What can we do?

How can we educate?

Is evidence enough?

Legislation & Regulation

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Legislative

Regulatory

Practice Barriers

CNM Issues

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Burke, A. (AB: 1306, 1612) Hernandez (SB 323) Friedman, L (AB 1560) What happened? Why? Good or bad decision? Can we enter the back door differently? Strategy change? (Does culture eat strategy for lunch?)

Legislation

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CNM Bills

Burke-AB 1306

CNMs provide care to childbearing women during pregnancy, labor and birth, and during the postpartum period; and in communities where obstetricians and gynecologists are not available, they can be a critical part of the primary care team for women’s health.

Updates the practice requirements for CNMs to better reflect their training and capacity to manage normal pregnancies and births.

Burke-AB 1612

Repeals the requirement that a certified nurse-midwife be under the supervision of a licensed physician and surgeon.

Authorizes a certified nurse-midwife to furnish and order drugs and devices related to care rendered in a home under certain circumstances.

Authorizes a certified nurse-midwife to perform and repair episiotomies and other lacerations in a home setting and an accredited birth center. 2-Year Bill 43

NP Bills

Hernandez-SB 323

SOP Nurse Practitioners. This bill would authorize a NP who holds a national certification from a national certifying body recognized by the board to practice without the supervision of a physician and surgeon, if the NP meets existing requirements for nurse practitioners and practices in one of certain specified settings.

Friedman-B 1560

NP ratio expansion. Prohibits a physician or surgeon from supervising more than a specified number of nurse practitioners, certified-nurse midwives, and physician assistants at any one time.

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Bills

SB 554-Stone

Nurse practitioners: physician assistants: buprenorphine. Chaptered.

SB 799-Hill

Board of Registered Nursing: Sunset Extension. Relates to the Nursing Practice Act.

Amends an existing law which, on January 1, 2018, repeals provisions establishing the Board of Registered Nursing and a specified executive officer position.

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SB 562-Lara

The Healthy California Act. Creates the Healthy California program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.

Provides that the program incorporates benefits from existing programs. Provides for the participation of health care providers in the program.

Creates the Healthy California Trust Fund for financing of the program. Authorizes providers to collectively negotiate rates of payment.

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Bills

Who’s a CNMA Member?

http://california.midwife.org/index.asp?sid=12

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To facilitate the integration of nurse midwives into the health care

system of California, promote legislation/regulations supportive of maternal child health and nurse-midwifery practice, and provide a forum for interaction with other groups sharing common maternal-child health goals. Promoting the health of women and the children in California through

provision of high quality care. Supporting and promoting professional achievement among nurse-

midwives. Representing nurse-midwives as leaders and as major resources for the

development and delivery of quality health care for women, infants, and families in California.

Defining and promoting nurse-midwifery practice in the state of California.

Initiating, supporting and/or opposing legislation affecting the health of California women and infants, and the practice of nurse-midwifery.

Representing nurse-midwives in California within professional, community, and government arenas.

Live your Mission

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Celebrate your successes

Share your stories

Empower others with your passion, knowledge, nursing practice

Embrace your pioneering spirit

Create new opportunities

Be bold, take risks

Turn your possibilities into reality

I am a Nurse, I am a Leader

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I’m Making Strides for all Women By

Speaking Up

Standing Out

Leaning In

#MidwivesMakingStrides

Be Bold,

Be Brave

Be Kind

Thank you!

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Abood, S. (2007). Influencing health care in the legislative arena. OJI: The Online Journal of Issues in Nursing, 12 (1). Retrieved from http://www.medscape.com/viewarticle/553404

American Cancer Society. (2006). Enacting Strong Smoke-Free Laws: The Advocate’s Guide to Legislative Strategies. Retrieved from http://www.strategyguides.globalink.org

American Association of Colleges of Nursing. (n.d.) From patient advocacy to political activism. AACN’s guide to understanding healthcare policy and politics. Washington, DC: Author.

American Nurses Association. (n.d.). Key provisions related to nursing. Retrieved from http://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/HealthSystemReform/Key-Provisions-Related-to-Nurses.aspx

Association of American Medical Colleges[AAMC]. (2009). The physician shortage and health care reform. Retrieved from http://www.aamc.org/newsroom/presskits/physicianshortagefs.pdf

Boehmke, F. J. (2005). Interest group lobbying strategies. In F. J. Boehmke, The indirect effect of direct legislation: How institutions shape interest group systems (pp .123-124). Columbus, OH: Ohio State University Press.

Bowen, S., & Zwi, A. B. (2005, July). Pathways to "Evidence-Informed" policy and practice: A framework for action. PLoS Medicine, 2(7), 0600-0605. Retrieved from http://www.plosmedicine.org

Cooper, R. A., Henderson, T., & Dietrich, C. L. (1998, September 2). Roles of nonphysician clinicians as autonomous providers of patient care. Journal of American Medical Association, 280(9), 795-802.

References

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Dobbins, M., Ciliska, D., Cockerill, R., Barnsley, J., & DiCenso, A. (2002, November 18). A

framework for the dissemination and utilization of research for health-policy and practice. The Online Journal of Knowledge Synthesis for Nursing, 9(7).

Federation of State Medical Boards Of the United States, Inc. (2005). Assessing scope of practice in health care delivery: Critical questions in assuring public access and safety. Retrieved from http://www.fsmb.org/pdf/2005_grpol_scope_of_practice.pdf

Feighery, E. & Rogers, T. (1990). Building and maintaining effective coalitions. Palo Alto, CA: Health Promotion Resource Center, Stanford Center for Research in Disease Prevention.

Huntington, C. G. (2001). Legislative advocacy for health professions educators. Education for health, 14(2), 241-250.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: The National Academies Press.

Institute of Medicine. (2011). Future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

Kaiser Family Foundation. (2010, March 26). Summary of new health reform law. Retrieved from http://www.kff.org/healthreform/upload/8061.pdf

Lei, S., & Douglas, S. A. (2005). Essentials of the US health care system. Boston, MA: Jones and Bartlett Publishers.

National Council of State Boards of Nursing. (2006). Changes in health care profession’s scope of practice: Legislative considerations. Retrieved from https://www.ncsbn.org/ScopeofPractice.pdf

Porter, M. E. (1996, November-December). What is strategy? Harvard Business Review, 61-78.

References

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Safriet, B. J. (1992). Health care dollars and regulatory sense: The role of advanced practice

nursing. The Yale Journal on Regulation, 9, 417-488.

Stokowski, L. A. (2010). Healthcare Reform and Nurses: Challenges and Opportunities. Retrieved from http://www.medscape.com/viewarticle/721049

U.S. Department of Health and Human Services, Health Resources and Services Administration. (2010). The registered nurse population: Initial findings from the 2008 national sample survey of registered nurses. Washington, DC: Author. http://bhpr.hrsa.gov/healthworkforce/rnsurvey

References

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