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Kathleen Miller is an assistant professor and coordinator of the Family Nurse Practitioner Graduate Nursing Program at Molloy College, Rockville Centre, NY. She is also a family nurse practitioner at Long Beach Medical Center Family Care Center, Long Beach, NY. Steven Weiner is the clinical manager, Employee Health Services, NYU Medical Center, New York, NY, and 1998 president of the New York State Coalition of Nurse Practitioners.
Nurses, especially advanced practice nurses, know that legislation and regulation—regarding title recognition and licensure, scope of practice, prescriptive privileges, and reimbursement from public and private payers—greatly influence our ability to practice. While APNs now have title recognition in 50 states (and we should pause to savor that accomplishment), in many states we’re actively defending our status from challenges by some medical professionals.
We know that we need to be knowledgeable and active in influencing our federal and state governments. Yet many of us hesitate to become active advocates on our own behalf because of a lack of time, fear of doing it “wrong,” doubts that our voices will be heard, or shyness about politics.
Even people who have been involved with their state’s professional association for many years admit to feeling anxiety before lobbying visits to their state capital. There’s pressure to be articulate and to put forward the best possible face for colleagues. But every time we meet with legislators we relearn the lesson: We don’t have to be salespeople or know everything. Legislators, state agency staffs, and their aides spend much of their time meeting with people just like us. They welcome the chance to hear our concerns. Even in this era of cynicism about politics and the role money plays in government, votes are more precious than currency.
I once led a group of nurses and students to visit a state legislator from a rural district in New York. He welcomed us and asked what we wanted to discuss. I told him that we represented the New York State Coalition of Nurse Practitioners and that we wanted to speak about two bills. His response revealed the role that individuals can assume in the legislative process. “Oh, yes,” he said, “I’ve received three letters from people in my district about this, and one person visited my district office to discuss these bills.” He had checked the files. He knew there was significant concern among some of his constituents, and he was prepared to give us his time and full consideration.
This means we can use our influence—and the power inherent in it—to ensure that our profession can exist and thrive. We wield this influence by registering to vote and by being active members of our state professional associations. In both areas, numbers count.
Call or write to your legislators on salient issues. A handwritten letter works as well as anything fancier. Describe the issue, the bill being discussed (if there is one), and its effect on you and your patients. (You can get the bill’s reference number from your state professional association.) If you’re a constituent of that legislator, make that clear. Legislators pay attention to letters because each letter may represent many potential votes.
Visits to legislators’ offices are even more powerful. By your visit, the legislator knows that an issue concerns you, and that you’re also more likely to vote and to mobilize votes. A visit to the legislator’s district office near your home is at least as important as a trip to the state capital. The staff is there to listen to constituents. They let the legislator know that you’re a local voter, and your voice is heard clearly.
At critical times, your professional association may request that you call your legislator. Phone calls carry great weight; enough calls can change votes. For example, we asked a committee chair why he voted for a bill that we knew he opposed. “You don’t know how many calls we got!” he answered. He told us he had changed his position so that “those people would stop calling.” Your local phone book usually lists the names and telephone numbers of your legislators. When calling, describe the issue, bill, and position that you support. Visits to state regulatory agencies are often also needed. Letters and visits from representatives of professional groups usually are welcome, although telephone calls are less appreciated.
We can influence public policy and private insurers by practicing good public relations in our professional and private lives. How many of us choose nurse practitioners as primary care providers for our families and ourselves? How many of us request that our insurance plan reimburse them? We must make ourselves visible in the offices and agencies where we practice. We must educate our patients, employers, and colleagues about who we are, what we do, and how our care is special and distinct from physicians’ care. I wear a pin attached to my name badge that says “nurse practitioner.” It has opened numerous discussions with patients and others in the waiting room. Many state nurse practitioner groups have brochures available describing who we are and what we do. Use them.
— Steven R. Weiner, MS, MPA, FNP