Susan McCarthy MSN, RN, CNRN

PA Nurse Alliance, SEIU

Quality Care Summit 2012
suemac1128@aol.com
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 Spanish American War
Dupont Circle Nursing Memorial
Washington D.C. Arlington Cemetery

http://www.empirecontact.com/images/statuary/Sisters_memorial_right.jpg
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:
 Combines science, technology, caring
 Interpersonal:
 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:
 Local, state, national legislation, run for office
 Professional Organizations:
 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
 Professional organizations, interdisciplinary
 Voices louder, persuasion greater
 Group consensus, strengthen the individual
 5. Strategic Perspective
 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/role-
of-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.