How to Be an Advocate for Nursing Issues

How to Be an Advocate for Nursing Issues

by by Geneviève M. Clavreul, RN, Ph.D.

"Never doubt that a small, group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."-Margaret Mead


It's often easy for us to sit back and let others speak up. But sometimes you just need to have your ownvoice heard with your unique message. Advocacy, for me, is a full-time vocation. I hope this article will inspire you to perform at least one act of advocacy in the name of
nursing this year.

So, just what is advocacy? It can be defined as "the active verbal support for a cause or position." What separates advocacy from lobbying is that lobbying is usually political in nature, where advocacy is not always confined to the political arena. In short, all lobbying is
advocacy, but not all advocacy is lobbying.

Advocacy can take many forms. Testifying at a public meeting on a specific issue; writing letters to the editor of the newspaper to get the word out or correct misinformation; commenting (either with verbal or written testimony) on changes to public policy; participating in
"Lobby Days" with fellow nursing professionals; and engaging in one-on-one meetings with elected officials and people in positions of influence are just some examples of ways you can get involved.

TESTIFYING AT A PUBLIC MEETING

Many of us participated in the public hearings that were held by the State of California for the Safe Patient/Nurse Ratio Bill. Some of you may remember SB666 where nurses gathered in unheard of numbers to not only fight, but defeat, the bill.

Participating in a public meeting is often one of the first experiences a person has in advocacy. These meetings usually consist of testimony by a panel of expert or invited witnesses, followed by time for public comment. They're often held during the hearing process of a bill or
when a substantial change to a public policy is being considered.

Individuals usually feel more comfortable when advocating in this arena since there is that "safety in numbers" feeling. Testifying at a public meeting can be exciting and energizing, especially in the case of the Safe Patient/Nurse Ratio bill. Nurses from around the state gathered and spent most of their time mixing and mingling with nurses from a
variety of care settings while waiting for their chance to speak. We all felt connected and motivated.

If you choose to speak at a public hearing, here are a few tips:

. Get an agenda. In California, our public meetings are governed by the Brown Act, which means that agendas must be published and posted 72 hours before a meeting (the exception is in the case of an emergency meeting). Check the agenda to be sure that the item you wish to address
is included and look for attachments.
. Organize your thoughts, and put them down on paper. Doing this will help make sure that you convey all your points and also allows you to submit your testimony in writing.
. Most public hearings allow for anywhere from three to five minutes per speaker. Plan your testimony accordingly.
. Provide verifiable facts when you are referring to studies and statistics. Make sure your personal experience, feelings and comments are identified as such. If you plan to present documents, you should have enough copies for each panel member and the secretary.
This is not required, but it is helpful for the panel, and can often help you bring
your points home.
. Be sure to speak clearly and slowly. Don't let having an accent hold you back. I still have my French accent and I have no problems getting my point across.
. Most importantly, stay on topic. Don't stray from the agenda item, or you can be called out of order and asked to stop speaking. If what you have to say does not fall under the specific agenda item, search for an item that is more appropriate. This, of course, applies to a hearing or
meeting where more than one item is up for discussion.
. Try not to repeat what others have said, though this is easier said
then done.

MEETING WITH OFFICIALS/COMMISSIONERS ONE-ON-ONE

This is my favorite type of advocacy, though more time-intensive then the one described above. I keep abreast of nursing issues through a variety of electronic venues (email lists, news groups, bulletin boards.), by reading the newspaper and trade journals, and by scanning
those pesky throwaways that our elected officials are always sending us to keep us "up to date" on what they are doing in Sacramento and Washington, D.C. When something falls in my area of interest I act.

For example how many of you know that there is a bill before Congress to possibly prohibit JACHO from being allowed to continue accrediting hospitals as it applies to Medicare/ Medicaid? Or that it was a Government Auditing Office (GAO) report that found that being
JACHO-accredited does not necessarily imply patient safety or quality of patient care.

How to get started? Get a copy of the proposed legislation and read it. Then there are three possible courses of action. The easiest would be to make a telephone call to the sponsoring individuals and letting their office know that you support or don't support the measure/bill.
The second option is to write a letter and in that letter detail why you support or don't support the measure/bill. If you choose to write a letter, take the time to share your personal and direct experience, and always thank them for their time. The third option, and my favorite
(though I am a strong proponent of letter writing, as well) is a face-to-face meeting.

Below are the steps you should take to arrange such a face-to-face visit.

. Ask for an appointment in writing. I usually send a faxed request to the scheduling secretary, so I have a confirmation that the fax was received. You can also send the request by mailing a letter. If you do, be sure to address it to the Congressperson/Senator in care of their
scheduling secretary, which you'll get by calling the office and asking for his/her name. You can get telephone numbers online by going to www.assembly.ca.gov or www.senate.ca.gov for California and www.senate.gov or www.house.gov for Federal.
. in your letter, briefly outline why you wish to meet with the Senator/Congressperson. Provide them with the dates you will be in town and a contact number where you can be reached prior to and during your trip. If possible, also include a brief biography on yourself; for example your title, degrees, and years of experience in nursing. You should send your request at least two weeks prior (though you can send it earlier than that if you wish) to the proposed meeting time.
Please note many Congresspeople/Senators will only meet with constituents. However, their staff will usually be available to meet with any concerned citizen and you should not turn that opportunity down. If asked to meet with the staff, request to meet with the aide handling health issues, since your goal is to speak about nursing.
. have copies of all your faxed or mailed correspondence with you in a folder, along with any supporting documents. If you have a letter or information packet prepared, be sure to bring enough copies to leave one set at each office you plan to visit. And, by all means, bring
business cards. If you don't have business cards may I suggest investing in one of the computerized print-house programs such as Print Shop or Print Explosion. They all have pre-designed templates. You can then print out business cards as you need them without a great deal of expense.
. When meeting with the elected official or his/her staff, please remember to be on time. You will probably get anywhere from 15 to 30 minutes to present your "case." Use your time well. Provide a brief history of your background, why you have chosen to speak out, and the
reason you support or don't support the issue. Be prepared to provide possible solutions, because you will be often asked, "What would you suggest." If you have compiled documents to support your side, be sure to leave a copy of them with the individual. Get the business card of
the person you are meeting with so you can send a thank you note later (this is important).

You can also do a "drop-in." I usually do this in addition to the formal meetings I schedule. My philosophy is that since I'm already in town, I might as well get as much bang for my buck as I can. Also, you never know what your results will be.

Two months ago, an impromptu visit to a Congresswoman's office to thank her for work on the nursing shortage garnered me a brief meeting with the Congresswoman herself. She asked me if there was anything else she could do. Never one to be shy, I asked if she could help facilitate a
meeting with Secretary of Health Thompson's office. Two days later I had an hour and half meeting with one of Secretary Thompson's Special Assistants.

Advocating isn't for everyone, but it can grow on you. Though many may be intimidated by the thought of speaking with elected officials, it's probably easier than speaking with your bosses about making changes. As nurses, it is second nature to support our patients. Advocating for the
profession of nursing isn't all that different; it's just a larger audience. And, more importantly, it can ultimately have a positive outcome for nurses, patients, and quality of care.

There can also be a great sense of satisfaction when you realize that what you said at a pubic meeting, or shared with an elected official, actually had an impact. Not that long ago thanks to efforts of a small group of individuals (probably less than 25 people), including myself,
we were able to change a County ordinance, alter the composition of a commission to streamline it, cut its full-time paid staff from a proposed 25 people to nine, and a few other changes. It took three years, but it was done all because of our passion for the cause and our advocacy.

Geneviève M. Clavreul is a health care management consultant. She is an RN and has experience as a director of nursing and as a teacher of nursing management. She can be reached at: Solutions Outside the Box; PO Box 867, Pasadena, CA;
gmc@solutionsoutsidethebox.net; 626-844-7812.