Susan McCarthy MSN, RN, CNRN PA Nurse Alliance, SEIU Quality Care Summit 2012 [email protected] September 25, 2012 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 Regulates by licensing: protects public health ANA Code of Ethics, advocate for profession Nurses should act individually, collectively through political actions for social change. Provision 9.4 : Social Reform Professional Nursing associations speak for nurses in reshaping health care policy, legislation 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 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. 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) 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 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) ~15% of hospital patients still being harmed 20% discharged elderly patients readmitted , 30 days Nurses spend 30% time, direct patient care (IOM, 2012) “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) Opinion leaders, 90% want nurses to improve quality, safety, reduce medical errors (GallupPoll,2010) 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) 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) ACA Implementation Safe, Healthy Work Environments Eliminate Manual Patient Handling Reduce Work Place Violence Mandate Safe Staffing Education, Recruitment, Retention 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) Expert: Interpersonal: 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: Untapped, underused 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) Workplace: Procedures, budget, practice, bargaining table shared governance committees Government: Professional Organizations: Local, state, national legislation, run for office Provide information, activities, leaders Community, Public Education: ↑ 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 2. Networking, crucial for action, change Establish, maintain interdisciplinary relationships, asking for help is OK 3. Powerful Persuasion Passion, thoughtful analysis of ideas, clarity, ability to communicate, important to audience 4. Collective Strength 5. Strategic Perspective 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 Remain Optimistic, you don’t always win SEIU Nurses share political action experiences Stage One: Buy-In Individual nurses take position/react to issue affecting profession, public. Decide to take action. Stage Two: Self-Interest Individuals begin establish political identity, voice. Organize, develop strategies to resolve issue. 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. 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. Keep informed of issues affecting nurses and public Join Professional organizations, SEIU committees/actions Find a Mentor, be a mentor Participate in public demonstrations Participate in shared governance councils, Meet with elected officials in their offices Write a letter to elected officials Publish Political actions bring social change Nurse laws, ethics code support political action Keep informed Join professional organizations Take Action Achieve political competency 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 Abood, S. (January 31, 2007). "Influencing Health Care in the Legislative Arena". OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1, Manuscript 2. Antrobus S (2003) What is political leadership? Nursing Standard. 17, 43, 40-44. 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. 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 from 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.