Aug 14, 2020

Nurses: How to Advocate for Federal Policy Change

Ellen Kurtzman, PhD, RN, FAAN, (front row, far right) and the other 2018–2019 Robert Wood Johnson Foundation Health Policy Fellows on Capitol Hill. Fellows gain insight into health policy through an immersive experience in the federal government.

As the nursing profession continues its central and frontline role in the COVID-19 pandemic, many nurses are calling for policy changes large and small to improve health care delivery and mitigate the impact of the virus on the well-being of Americans.

How can nurses advocate for federal policy change?

The Robert Wood Johnson Foundation (RWJF) Health Policy Fellowship has been providing an unparalleled view of the advocacy process since the program began in 1973. Recent fellow Ellen Kurtzman, PhD, RN, FAAN, associate professor at the George Washington University School of Nursing, found herself in a front-row seat during the 2018-2019 legislative season. She was placed in the office of the Speaker of the U.S. House of Representatives, the Honorable Nancy Pelosi (D-CA-12). From that vantage point, Kurtzman talked with hundreds of the speaker’s constituents and other stakeholders who visited the office to express their views.

After observing how nurses, physicians, insurers, consumers, and other health care advocates delivered their messages, Kurtzman has advice for nurses and professional nursing organizations that want to “up” their policy game. We talked with her well before the coronavirus took center stage, so we went back to her this week to ask how she would tailor her advice to fit current circumstances.

“This is an unprecedented crisis and there’s no operating manual for how to proceed,” she said. “I’ve been told that most Hill offices are working from home. Because face-to-face meetings won’t be possible for a while, nurse advocates may need to hone their abilities to communicate remotely through emails, phone calls, letter writing, and video-conferences. I personally wouldn’t even think of approaching a congressional office at present unless I had something very specific to discuss about COVID-19 or one of the pieces of legislation that’s moving.”

“Right now, we need to support Hill staff who are working 24/7 to resolve the crisis, and, if we can, provide the expertise they need to get the job done. Eventually, the crisis will abate, new COVID-19 infections will slow down, and folks will recover, so I would encourage advocates not to abandon other pressing concerns. As attention returns to these issues, nursing needs to be prepared.”

Here’s what else Kurtzman had to say.

While working on the Hill, what insights did you gain into how nurses can use their expertise to influence policy?

There’s probably no better example of that than Representative Lauren Underwood, who of course is a freshman congresswoman and nurse from Illinois (D-IL-14). She brings her expertise to lawmaking and to Congress, and this role is probably the pinnacle of how nurses can and should be involved in influencing policy.

Of course, most nurses are not going to run for elected office, but I would encourage all nurses to vote, to know who represents them in Congress, to develop relationships with lawmakers, and to learn how to talk about the most pressing issues that affect nurses, their patients, and the health care system.

Nurses also need to know how to engage with lawmakers and their staffs. It’s definitely a different language than, say, the language nurses use at the bedside. Talking to policymakers takes practice, and it’s useful to observe somebody else do it effectively.

How do you get that practice and learn that language?

Many of the large associations brief nurses ahead of time when they bring them to D.C. to talk to legislators. That’s very helpful, but I suspect that they’re not doing role-playing, where they set up a real-life scenario for these nurses and pretend to talk to a lawmaker. Until you’re doing it, until the words are coming out of your mouth and you’re telling your story casually but with technical accuracy, I’m not sure it can be mastered.

Nurses who visited the speaker’s office while I was there spoke about the challenges they face and the value they contribute. They were also passionate about—and felt very protective of—speaking on behalf of patients. But I found that they were less able to speak about issues that plague our health system, issues that I frankly think nurses should weigh in on. For example, issues around insurance coverage and access, issues around payment and affordability, how the Affordable Care Act is working or not working. I found that nurses tended not to talk about those issues.

Is it that nurses avoid these topics, or is it that they don’t know about these topics?

I suspect it’s a little bit of both. When I heard nurses talking about insurance coverage, for example, they spoke about it in terms of specific patient exchanges. For example, “This patient could not receive ‘x’ diagnostic test, because their insurance is bad.” The root problem is likely something about coverage or exclusions or authorization, right? So they view the issue through the lens of their patient, which is completely understandable—but when you’re talking to lawmakers, the conversation should be about what policy levers they can pull to achieve the desired outcome.

What else do nurses and their organizations need to know about advocacy on Capitol Hill?

I think it’s worth noting that I spent nine months in the speaker’s office, and very few nurses came to visit our office to discuss health care issues. There were plenty of physicians and probably even more dentists than nurses who came to talk about workforce, delivery system reform, and patient care issues. Physician groups and insurers came by pretty regularly. Nurses only came when their association, their union, or their institution brought them to town in some organized fashion. It seems like a missed opportunity. There’s a ton of legislation that’s happening on the Hill. It may not have the word “nurse” in it, but nurses absolutely should have input into it, and the legislation would be better if nurses did.

Kurtzman provided a glimpse at near-term policy possibilities in a previous blog post.