Maryann Alexander, PhD, RN Michelle Buck, APN, CNS

2007 and 2010 Illinois Hawaii, Kentucky and Maryland

Uniformity to APRN Regulation

Outline Preparation for Grassroots Campaign Building a Coalition Taking Action Getting the Bill Passed Using Data Effectively and Other Strategies

John Kingdon (2000) 247 detailed interviews (133 specifically related to health care) 1/5 th congressional staff 1/3 rd executive branch Remaining: outside government

#1: Cohesion Speaking with one voice and convincing legislators that the policy truly represents the preferences of the entire group. 84% of the respondents thought this was the most influential factor in the political agenda.

Grassroots Grassroots Campaign

Astroturfing

Step 1: Preparation

What Changes Need to Be Made and Where Will They Be Made? Statutory Rules/Regulations Policy

Begin Informal Discussions/Ensure Awareness of Issues Board of Nursing Major Nursing Organizations Other Health Care Organizations Umbrella Agency for Professional Regulation

Other influences National organizations State Medical Board State Medical Association Consumer Groups

Professional Organization Talk with Executive Board Discuss with Government Relations Committee Inform Membership Ensure Cooperation and Support

Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world. Joel Barker

Step 2: Taking Action/Building the Coalition

Formal Meeting Key representatives from all APRN groups Explain changes and how will affect APRNs in state Outline a plan for building a consensus Get their input Give the coalition a name/Develop a mission statement

Formal Meeting Ask for them to submit names/CVs of their members wiling to participate Date of the meeting with the entire coalition Pledge support for the effort and everyone stands united

Professional Organization Present the proposed changes to the Members Get feedback from members Provide feedback to BON Educate the membership Build support within the organization Select representatives for the coalition

Representatives for The Coalition Executive Board GR Committee Key Members

Choose State/Team Captains Divide state into regions One captain for every region Assign team members to captains Strategically choose co-captains

Building the Coalition Team If possible-one member of every organization represented on every team in the coalition

The Coalition Meeting Vision Statement Consensus Model for APRN Regulation Changes to be Made/How they will affect APRNs in state-focus on positive Resource Materials Show how the state is divided up/introduce captains

Kick-off Meeting Strategies Opposition Most important! Everyone must speak the same language, use the same terms Communication plan/website/dates of future meetings Everyone agrees to work together and pledges support

Responsibilities of the State Captains Primary Communicator Establish a means of communication with team members Strategize as to how you will educate the APRNs in your region Distribute resource materials

Responsibilities Represent the region at coalition meetings Meet with legislators/coordinate legislative activities

Step 3: Getting the Bill Passed

Prior to the Opening of the Legislative Session and Ongoing… Educate the APRNs in the state: Post information and toolkit on BON and Professional Organization website State Captains Distribute materials to APRNs Give presentations at Hospitals/Nurses Week Get on agenda of local chapter meetings Coach team on how to talk with legislators

Choose Sponsors for the Bill Supportive of Nursing/Knowledgeable about health care Experienced in successfully passing legislation Influential in both parties

Preparing for the bill to be Introduced Legislative handbook Data/Talking Points Language for the bill Decide who will lead the lobbying efforts

Bill is introduced and in committee Target the committee members-explain why the changes are important and how they will positively affect the health care provided to the citizens of your state. Constituents contact committee members Fact sheets Data State Captains

Bill is in Committee Address Opposition Provide Testimony Gather Consumer Support

Bill is out of committee and goes to House or Senate floor All out effort is needed for APRNs to contact their legislators Bill number is important Encourage all supporters of the bill to NCSBN website for resource materials they may need

Addressing the Opposition Board of Nursing Professional Organization Board of Medicine State Medical Association Other opposition

Negotiations Have data ready Be prepared for all questions/have counter- arguments prepared Use personal contacts/capitalize on existing relationships

Using Data Effectively and Other Strategies

Florence Nightingale Florence Nightingale's Visual Rhetoric in the Rose Diagrams Lee Brasseur Technical Communication Quarterly; Spring 2005; 14, 2; ABI/INFORM Global pg

The Rose Diagrams/ Evidenced Based Policy Scientific data to identify a problem Framed within the context of the political environment Anticipated questions/opposing argument Proposed a solution and provided data supporting the effectiveness of the solution The Model

Statistics are not merely numbers; they reveal patterns that allow human beings to control destiny. Florence Nightingale

John Kingdon (2000) Second most important influence on the policy process…

#2: Academicians, Researchers, Consultants 66% rated these as the second most important influence in the policy process. Data and expert opinion

Resources NCSBN Member Board Profiles NCSBN data Other States/Other Professions Within Your State Statistics Other data sources

One Board of Nursing Problem Two boards of nursing places an undue burden on the IL Dept of Professional Regulation in terms of budget and staff. A high number of disciplinary cases on the RN/LPN board. (Public Safety)

Board of Nursing Proposed solution Combine the boards and create one board of nursing with 13 members.

Board of Nursing Anticipated opposition Removing the physicians from the APRN board will endanger the public.

Board of Nursing Data to support the proposed solution The APRN Board has not met over the past two years. There has been no increased in discipline cases or any other indication of a threat to the public. Prior to the past two years the attendance record indicates only one out of the 3 physicians on the board ever attended the board meetings.

Additional data to support the proposed solution Illinois is only one of 2 states to have an APN board Illinois has no voice at the national level in APN regulatory issues since the APN board is not a member of NCSBN. Combining the boards will provide substantial savings for the dept.

Additional Lessons

Elimination of Collaborative Practice Agreements Problem APNs that work in collaborative practice agreements with MDs that They dont know Dont know what their role is/what the collaborative agreement is for Physicians uncomfortable with the process APRNs in rural settings are having difficulty finding physicians to collaborate with and APRNs are avoiding working in those areas. They are redundant

Elimination of CPA Proposed change: Elimination of collaborative practice agreements

Incrementalism Taking small steps to achieve a large goal

Collaborative Agreements Negotiated All four advanced practice specialties may practice in a hospital or ASTC without a collaborative agreement when credentialed and privileged by the governing body of that institution.

Elimination of Collaborative Practice Agreements in Hospitals and ASTCs Wasnt what was wanted, but it was what we could get Step in the right direction Opportunity to collect data

In Conclusion…

Concerted Effort Everyone needs to be unified, speak the same language Common Message Open lines of Communication Well-coordinated

Message sent to the Right People Message from the BON and Professional Organizations is consistent, clear and concise The right people sent the message from the start and are involved in the process

Individual Voices make a Difference BON and Professional Organizations need to ensure each participant is valued for their participation May take some cheerleading APRNS and others in state need to know their voice is important and will be heard Constituents have power

Nurses have a Powerful Impact when they work together