SEFTJ2MBER 2000, VOL 72, NO 3 H E A L T H P O L I C Y l S S U E S

The Nurses in Washington Internship program allows nurses to learn about

the legislutjve process he Nurses in Washington Internship (NIWI) prigram provides nurses the opportuni-

ty to learn how to influence health care through the legislative process. This program is spon- sored by the National Federation of Specialty Nursing Organiza- tions (NFSNO), a national coali- tion of 37 individual specialty nursing associations, including AORN, that represents more than 400,OOO RNs. This coalition developed the NIWI program to educate the leaders of its member organizations about legislative and health policy issues that directly affect the practice of nursing. Many member organizations of NFSNO offer scholarships or financial assistance for NIWI to their members. A scholarship also is provided directly by NFSNO. Two internship scholarships are available through AORN’s Legislative Committee and the Government Affairs Department.

Applications for NIWI are available through AORN’s Government Affairs Department by calling (800) 755-2676 x 233 or x 263. A subcommittee of the Legislative Committee selects two interns based on the follow- ing criteria:

participation in AORN activi- ties, 25%; recent political or government affairs activities, 25%; professional activities, 20%; and goals for applying the knowl- edge gained through the pro- gram to promote the legisla-

tive priorities of AORN at the state and federal levels of gov- ernment, 30%. The value of nurses’ clinical

knowledge and experience is out- lined to health policymakers throughout the four-day program. Interns are taught a blend of didactic education and practical experience to influence policy- making at both the federal and state levels of government, as constituents and as members of specialty nursing organizations.

ATTENDANCE AND PURPOSE Nurses who attend this confer-

ence do not need to have health policy experience. Student nurses and RNs from across the United States attended the 2000 internship program. No formal requirement for attendance exists; participants only need the desire to learn and the commitment to use their knowledge proactively when they return home.

This year’s interns represented approximately 28 different organi- zations and networked to present a united front on health care issues with their congressional representatives. Some issues were universal, such as nursing ratios, nursing shortage, patients’ rights and safety, access to care, work- place violence, and confidential medical records. Other topics focused on specific legislation, such as Medicare reimbursement for certified RN first assistants, the State Children’s Health Insurance Program, Title XXI, and various pain management

bills. Although individual special- ty organizations focus on specific issues, NrWI gives attendees the opportunity to unite broadly as nurses-people working in a pro- fession based on quality, safe patient care.

PREPARING FOR THE INTERNSHIP Internships are announced in

January, at which time interns begin to plan for the week in Washington, DC. Interns should verify the program schedule as soon as possible. Classes usually begin on Sunday morning. Schedules should include time for sightseeing or additional appoint- ments with government represen- tatives. On Wednesday, planned congressional visits are made. Thursday may be reserved for meetings with key individuals at regulatory agencies (eg, the Occupational Safety and Health Administration [OSHA], the Health Care Financing Administration [HCFA]).

Information regarding prepara- tion for the NIWI program can be found in many places, including AORN by calling Kimberly Matson at (800) 755-2676 x 233. A brief summary of tips for mak- ing the internship effective is list- ed below.

Identify the current AORN legislative priorities through the Government Affairs Department or consult AORN Online at www.aorn.org/govt. Plan to meet with AORN lob- byists before your Capitol Hill visits. Design a notebook of

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information, fact sheets, position statements, brochures, and your business card for each legislator, as well as for other NIWI participants. AORN staff members and lob- byists can help you prepare this material.

m Locate the telephone number and e-mail address of your senators and representatives. Telephone numbers are listed in the front of your local tele- phone book, on the Internet at http://thomas.loc.gov, through the US Capitol operator at (202) 224-3121, or at any pub- lic library. Tight scheduling may require taxi rides from the Senate to the House office buildings located on opposite sides of the Capitol. When making appointments, it is important to plan meetings in consideration of the House and Senate office buildings’ locations.

m When calling a legislator for an appointment, ask for the appointment secretary or the legislative assistant (LA) for health. Identify yourself as a perioperative nurse attending a legislative workshop in Washington, DC. Request a meeting with the legislator to discuss the practice of nursing, the health care needs of the people in your district, and AORN’s legislative priorities. Confirm the date, time, build- ing, room number, and the name of the person with whom you will be meeting. Take note of the secretary or LA’S name so you can introduce yourself and thank him or her for sched- uling the appointment. Allow 30 minutes for each appoint- ment and at least 30 minutes between each commitment, as

it could take 20 to 30 minutes to get from the Senate to the House office buildings. You may be told that other nurses have an appointment. Feel free to accept a group appointment. During the internship, you can meet with colleagues to collab- orate on meeting content and

n Please be on time for appoint- ments. Present your business card to the receptionist to ease notification of your arrival. After a brief introduction, iden- tify your issues in a concise manner. Understand the rela- tionship of your issues to the legislator’s committee appoint- ments. Know the opposition to your issues. Remember, you are the perioperative nursing expert. Give your legislator a packet or a brief summary of your concerns. Be prepared to answer questions. Thank the legislator and his or her staff members for their time and interest in your issues. Also, this is a great opportunity to have a photograph taken with your senator or representative. Take a camera. Follow up with a thank-you note to the legislator or his or her staff members. Summarize the issues discussed and request continued support of your issues.

THE 2000 NlWl The didactic portion of the

2000 NIWI experience involved speakers from many areas of expertise. A wide range of pre- senters spoke during the 2000 program, including health policy experts and government officials. Judith Leavitt, RN, MEd, FAAN, coauthor of the book, Policy and Politics in Nursing and Health

goals.

Care, discussed the effect of health policy on nursing practice and how nurses’ professional val- ues affect their political actions and attitudes. Her coauthor, Diana Mason, RN, PhD, editor of the American Journal of Nursing, described the media’s role in poli- tics and gave participants tools to evaluate media messages.

Mary Chaffee, RN, MS, CNA, CCRN, US Navy Nurse Corps commander, identified the four spheres of political influence and the key political skills that nurses can use to influence those spheres. Donna Dorsey, RN, MS, member of the Maryland State Board of Nursing, described the role that state boards of nursing play in policy making. She explained the expanded scope of practice and the interstate com- pact model for multistate licen- sure. Representatives from HCFA and OSHA presented information regarding the roles of their agen- cies in influencing health policy.

Sister Rosemary Donley, RN, PhD, FAAN, presented slides describing the importance of grounding policy in data. She also commented on the Perioperative Nursing Data Set and the importance of future research to document patient care outcomes. Sheila Roit, RN, MPP, senior political action specialist with the American Nurses Association (ANA), discussed the association’s role in influenc- ing legislation, health policy, and workplace safety issues. She out- lined the importance of grass- roots activity through ANA and other specialty organizations. Marguerite Baxter, RN, MSN, identified the differences between discretionary and nondiscre- tionary federal spending and explained the federal budget

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GOVERNMENT AFFAIRS TOOLBOX’

Each Rlember ol Congress hos ston members to ass& him or her during a term In affice. To be most effective in mwnlccrtlng wtit~ congressional represenpatlves, it Is Mpful to know the titles and prlnCrpal functlons of key soanmembero.

A m i s f r o f t v e osslstant or chid of sM: The administrattve assistant usually has overall responsibility for evaluat- ing I4-m polltiwl outcome of various legislative proposals and constibent requests and usually Is the person in charge of overall office operations, including the assignment of work and supatvision of key staff members. He or she reports directly to the member of Congress. L&gislahm director, senior @is/lolrve usishnf, or &g&?hw coordinator: The legislative director usually is the staff person who monitors the @islattve schedule ond makes recommendations regarding particular issues. In some congressional offices, there are several legkddtve assistants, and responsibilities are assigned to staff mem- bers wilh particular expemse in specific arms (eg, heallh issues, environmental maltm, taxes). Prsss SBMelWy or comunicotm difetm The press secretary’s responsibilrty is to build and maintain open and edec#ve Ilnes of communication behrveen the member, his or her constituency, and the public. He ar she is expect- ed to know the benefits, demands, and specral requ lmts of both print and electronic media, and how to most elkrctively promote the member‘s views or positions on specific issues. @o~ntment secrebw pevsonol secfefuy, of scheduler: The appointment secretary usually is responsible for allocallng a member’s time among the many demands that arise from congressional responsibilities, staff requirements, and constituent requests. He 01 she also may be responsible for making necessary travel amnge- ments, arranging speaking dates, or arranging visits to the district. cusewkr: The caseworker usually is assigned to help with constituent requests by preparing replies for the member’s signatwe. Responsibilities also may include helping resolve problems constituents present in relation to fedefal agencies (eg, Social Security and Medicare isms, veterans’ benefits, passports.) There offen are several roseworkers in a CongFeSsional office. Caseworkers generally work out of the district office or offices. OYw &I# t&s Other titles used in a congressional office may include executive assistant, legislative correspondent, executive secretary, office manager, and receptionist.

1 . ‘Congressional staff roles.’ Available 8om http://congress.nw.dc.us/rallcall/stoff.html. Accessed 12 July 2000. NOTE

process in a way that made it easy to understand.

Beverly Malone, RN, PhD, FAAN, talked about issues and opportunities for nurses in politics and government service. Dr Malone demonstrated her passion for nursing and her commitment to influencing health policy through examples of her work lobbying on behalf of ANA. Mary Wakefield, RN, PhD, FAAN, was an inspira- tional speaker and the only nurse member of the Institute of Medicine committee that produced the report “To Err is Human.” She used humor in her presentation on positioning for political appoint- ment and working with legislative staff members, as she described

lessons learned in seven years of expenence on Capitol Hill. Leah Curtain, RN, MS, MA, DSC, FAAN, a well-known and respect- ed leader in the nursing communi- ty, identified the ethical dimen- sions of political action. Her easy, interactive style helped interns col- laborate at the networking session after the formal program.

INTERNS ON THf HIf L

tors was exciting and invigorating. AORN lobbyists Karen Sealander, JD; Greta Todd, MA; and Mike Romansky, JD, assisted AORN interns Sheila Allen, RN, BSN, CNOR, CRNFA, AORN President-elect; Patrice Spera,

The day spent visiting legisla-

RN, MS, CNOR, CRNFA; Tim Clemons, RN, CNOR; and Lora Lee Grutkowski, RN, BSN, CNOR, CRNFA, in preparing for the NIWI experience. Interns were ready to storm the Hill with well-organized, professional infor- mation packets. Program organiz- ers suggested that interns visit their two senators and congres- sional representatives, but AORN interns visited nearly all legisla- tors from their respective states. Although each intern made his or her own appointments, the AORN lobbyists organized a master list of appointments to enable one intern to attend another’s appoint- ment if time permitted. AORN lobbyists were able to attend some

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of the meetings with each intern, providing a memorable opportuni- ty to lobby with professionals and seasoned colleagues.

Every appointment on the Hill was exciting and challenging. Interns developed a rapport with several legislators through letters, telephone communication, and Hill visits, and found it rewarding to discuss issues with them and their LAs in person. Three of the four interns explained that they were CRNFAs and frequently asked leg- islators if they were aware of the CRNFA role in the perioperative arena. Many were familiar with the CRNFA’s role and had received let- ters and CRNFA information from their constituents. All AORN interns were able to explain the role of the perioperative nurse in the OR. Legislators asked if there was any opposition to the CRNFA Medicare Reimbursement bill, and interns responded that there was none. They also asked legislators to be original cosponsors of the bill.

In one office, interns met with an experienced LA. The LA pro- claimed that he and the senator he worked for were interested in revamping the entire Medicare system, not just one aspect of it. This is a grand challenge to com- plete in a short legislative session. Fortunately, AORN lobbyist Karen Sealander joined interns on this visit and responded to numer- ous objections expressed by the

SUGGESTED READING

LA. As patient quality of care and safety issues monopolized the conversation, the LA’S attitude appeared to soften.

As they walked through the halls of a House office building, interns noticed the office of Mary Kaptur (D-Ohio). Rep Kaptur sup- ported AORN’s prior legislative attempts, and the interns wanted to thank her. They were welcomed in the reception area and waited only a few minutes to see Rep Kaptur’s LA for health care. After formal introductions, interns expressed appreciation for Rep Kaptur ’s sup- port and shared AORN’s current legislative agenda with her.

As part of the strategy, interns delivered information packets to legislators with whom they did not have official appointments to ensure they were aware of the importance to their constituents of the packet’s information. Prior coaching from AORN lobbyists put interns at ease and prepared them for their informative visits on the Hill. Their encounters helped make the experience memorable.

NlWl PROGRAM IMPACT Interns gathered for a debrief-

ing session on the fmal afternoon of the program to share experi- ences. They left Washington knowing that legislators under- stood the nursing community more clearly as a result of their visit.

The impact of the “I experi-

ence easily can be compared to throwing a pebble in the water. Just as the pebble sends out a ripple that creates movement far away from the center, interns carry the mes- sage and insights of the experience to policymakers. Each individual can have a direct impact on health policy through the political process. People who hear the sto- ries told or read the articles written by intems take some part of the experience with them. Hopefully this article will stimulate the inter- est of AORN members to become involved in AORN’s Legislative Grassroots Network.

Interns can use the tools learned at NIWI at the state level as well. Legislative leaders want to hear from their constituents. Just as they depend on nurses as constituents, they recognize peri- operative nurses as experts in quality patient care and the issues that affect the health care of their constituents---our patients, the American people.

SHEILA ALLEN RN, BSN, CNOR, CNRFA

PRESIDENT-ELECT BATON ROUQE GENERAL MEDICAL CENTER

BATON ROUGE, IA STAFF NURSE

PATRICE SPEW W, MS, CNOR, CRNFA

J W CEMR OF EXCELLENCE TAMPA GENERAL HOSPITAL

TAMPA, Fu

AORN Journal 68 (July 1998) 111-114. Bocchino, C A; Wakefield, M K. “Forces influencing Mason D J, Leavitt J K, eds. Policy and Politics in

Nursing and Health Care, third ed. Philadelphia: W B Saunders Co, 1998, 577.

Smith, K. “The legislative process.” Orthopaedic Nursing 14 (September/October 1995) 58-65.

Wakefield, M K. “A capitol experience.” Nursing Economics 14 (July/August 1996) 248-251.

public policy.” Nursing Economics 10 (January/ February 1992) 53-55.

Cohen, S, et al. “Stages of nursing’s political develop- ment: Where we’ve been and where we ought to go.” Nursing Outlook 44 (November/December 1996) 259-266.

Krug, P. “Nurses in Washington internship program.”

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