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

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