Advocacy for children through activism

I had the opportunity last year to moderate the Legislative plenary session at NAPNAP's annual convention. As the newly appointed Health Policy/Legislative Chair, I was anxious to hear the voice of the membership and begin to translate concerns of the membership into action. I had reviewed the current legislation on all of the bills before Congress that were pending regarding child health policy and anticipated an active discussion by the membership on the issues. To my surprise, during the 40-minute discussion period at the conference session, every question was related to issues regarding scope of practice and prescriptive authority for Advance Practice Nurses (APNs). I realized that despite many victories concerning issues of APN scope of practice, there is always more to be done.

Of the forty-four bills in Congress currently being monitored by our Washington representatives, seven are related to issues impacting our practice as APNs. NAPNAP is currently monitoring legislation focusing on child gun safety and gun access, prevention of youth suicide, expansion of access to preventive health services to reduce unintended pregnancy, increasing the availability of Head Start programs and childcare, increased access to health care services for children with special health care needs, and several other bills that impact the health and well-being of children, adolescents, and families. True, scope of practice issues are now being fought at the state level by our membership, but this fight has focused our energies both state and nationally away from public policy issues. As a profession, are we ready to move on?

We have distinct advantages presently on moving the focus from solely professional practice issues to the broader focus of child health policy issues. First, nurses are highly regarded. US News & World Report(2003) rated nursing as the profession most respected by the public. There is a strong trust relationship between nurses and the public they serve. Second, APNs are experienced in the legislative arena because of the activism required to achieve success with scope of practice issues across the country. Third, nurses and health care providers represent a constituency, and there is strength when speaking with a single voice. APNs have compelling stories to share with legislators about the children they care for and are able to personalize the impact of poor public policy.

Cathryn Wright, NP, past Chair of the Public Policy Committee for the American College of Nurse Practitioners, proposed a model of advocacy for APNs which was effectively used in Louisiana to remove barriers to scope of practice legislation (Wright, 2002). The approach begins with gathering a small group of committed Advance Practice Nurses to form a public policy committee. This can be in association with a local or state chapter of NAPNAP, or a group of health care providers, parents, and others who are committed to an issue impacting children in their community with a solution ameliorated by legislative action. The goal would be to employ a model tested on professional practice issues and adapt it for advocacy on a broader public policy issue. The first step, gathering the grassroots support, is a significant obstacle.

The next steps represent an adaptation of the Wright (2002) model and are part of the process of building effective advocacy:

The steps outlined require creativity and a long-term commitment. A good dose of resiliency is also a key ingredient to success.

The last step would be to identify local candidates who are committed to championing children's issues and to changing public policy. Partner with other health care providers or groups to support the candidacy. Keep the candidate informed by sending local press articles on issues key to children's health. Include any evidence-based research findings in a few summarized paragraphs so the state health legislative aides can utilize this information when drafting legislation. Sound health policy should be based on evidence. Attend local community meetings sponsored by candidates or legislators. Inform them of the current needs of children in the community. Often a cost analysis or case report is more compelling to legislators or their health aides than scientific research. Utilize a format that will grab their attention; include visuals, which are often more effective than long narratives.

Over the past year, I have seen many indications that members are ready to shift focus to the broader policy issues facing children, adolescents, and families. With access to quality health services being reduced, and inadequate funding in many states for public education and affordable childcare, there are many issues needing immediate attention. Focusing our collective strength is an important step in establishing public policy responsive to the needs of children in the community. Childhood overweight is one issue beginning to be impacted by legislation in states like California, which recently passed a law mandating healthy snacks and beverages in school vending machines.

True, we cannot give up the fight on practice issues until every last state enacts laws for APNs that allow full access to our services. However, I think we have the momentum and the credibility to broaden our advocacy as a profession and follow in the footsteps of those Advance Practice Nurse leaders in our communities who act as resources for their elected officials and are consulted when a health aide is ready to draft a piece of legislation that impacts children. I want to hear about your experiences and successes, and I urge you to send me your thoughts. I believe that we, as APNs, are ready to move on, and the models are in place to make this change one step at a time!