Eighth National DNP Conference Seattle How to be a Better DNP in 3 days. Donna Emanuele, DNP, FNP- BC, FAANP September 18, 2015

Transcription

1 Eighth National DNP Conference Seattle How to be a Better DNP in 3 days Donna Emanuele, DNP, FNP- BC, FAANP September 18, 2015

2 Materials contained herein may include content subject to copyright restrictions. Use of all material contained therein is strictly limited to use within the educational forum for which it is intended. Copying and/or distributing for purposes other than use by attendees currently enrolled in this seminar or other authorized users is strictly prohibited.

3 This speaker does not have any financial disclosures to report and no relevant financial relationships with commercial interests

4 David and Donna (1 st DNP Conference) The Early Years

5 Identify the goals of political advocacy Recognize the significance of forming collaborative relationships and partnerships to advance full practice authority Address factors and lessons learned regarding failed legislative measures and future opportunities Discuss the DNP role in exercising engaged advocacy for the profession

6 APRNs should be able to practice to the full extent of their education and training. To achieve this goal, the FON committee recommends action (IOM, 2011)

7 Permits a NP to practice without physician supervision if the NP is certified by a national certifying body, maintains professional liability insurance that is appropriate for his or her practice setting, and is practicing in one of the following settings: A clinic, health facility, or county medical facility; An accountable care organization; or, A group practice, a medical group, or an independent practice association. Requires a NP to refer a patient to a physician and surgeon or another licensed health care provider if a situation or condition of the patient is beyond the NP's education or training. Requires these NPs to have medical malpractice insurance. Applies the physician self- referral prohibition and the peer review process requirements to these NPs. Specifies the scope of practice for NPs. Specifically, permits an independent NP, in the settings listed above, to perform services that are widely agreed to be the extent of services that NP perform today.

8 Extending Reach

9 Greater nurse involvement providing access to care influencing the cost and quality of care determining the scope and authority of practice increasing and improving the healthcare workforce Dissemination of professional knowledge Professional development United voice Matthews, J. H. (2012) /No1- Jan- 2012/Professional- Organizations- and- Advocating.html

10 Create opportunities for meaningful engagement Need to know How ideas are spread throughout systems How decisions are made How policy is developed How to build capacity & effectively use evidence to shape & change practice (Dobbins, Ciliska, Cockerill, Barnsley, & DiCenso, 2002)

11 Essential to ensure success Who are the Actors in play Alliances for change In CA: AARP- CA CA AC Bay Area Council CAPG, CHA, ACNL, APRN associations, etc.

12 Consumer Groups Action Coalitions (ACs) Review & Know the Policy Process Become advocates for the profession & take an active role

13 Policy is shaped by how policy makers learn about health care issues Perceived benefits of change shape decisions affected by timing, economic costs and politics of the day Understanding past policy failures and successes provide direction in planning for future implementation i.e., SB 491, 323 and other legislation before this

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15 Get into their heads Ask for what you need and request their support Don t be afraid to ask Leave with them with something that they will remember you Invite them to visit with you CREATING PARTNERSHIPS

16 Knowledge is power Be affable and issue focused Offer to help on the politicians issues even if they are not directly related to your issues Always be honest and ethical Always be a person of your word Network with like minded advocates Try to be bipartisan (outstanding political health advocates can be found on both sides of the aisle)

17 Strategic components of power politics Achieve goals Incremental Structural change Political skills Political arena How is power perceived Lee- V5n3-13_70-94.pdf Strategies and tactics Advocacy to activism activities Power politics: Allocation and distribution of power through building coalitions and networks to expand and consolidate a base from which to exercise political power. (Silverstein, 2007; Stivachtis, 2008). Corporate and non- profit lobbyists, political parties, grass roots organizations and citizen groups, governmental entities, political operatives in and outside of Congress (Sharp, 2010, McNutt, 2012).

18 California

19 3.2 M Registered Nurses in US >18,000 NPs practicing in CA Need for advocacy Visibility at policy tables PAC support which drives ability to legislate effectively

20 Raise Your Voice and Let It Be Heard

21 Legislative Session convened on January 5, 2015 Full time legislature Bill Introduction Deadline was February 27, 2015 Policy committees hearings started ramping up in March, go full- force in April Policy committee deadline: May 1st Fiscal committee deadline: May 29 th Deadline for bills to pass house of origin: June 5 th Last day of session: September 11th

22 A combined total of 2,454 new bills introduced: Senate bills introductions: 856 Assembly bill introductions: 1598 Capitol Advocacy, represents CANP Dedicated Lobbyist Reviews all introduced bills and sends bills impacting NPs to the CANP Health Policy and Practice Committee (HPPC)

23 Senate composition: 26 Democrats (including 1 vacancy) 14 Republicans (including 2 vacancies) Assembly composition: 52 Democrats 28 Republicans Freshman to Legislature 27 freshman members in the Assembly 6 freshman members in the Senate

24 In 2015: 40 bills impacting NPs were flagged for CANP All bills and real- time updates about their status and any amendments accessed via the Bill Tracker on the CANP website The HPPC Committee members review bills with advocacy team identify their impact on NPs potential amendments that may be needed recommend a position for CANP to adopt

25 SB 323, by Senator Hernandez/Assemblymember Eggman AB 637, by Assembly Member Nora Campos would authorize NPs or PAs, within their scope of practice, to create a valid Physician Orders for Life Sustaining Treatment (POLST) form under a physician s supervision. Sponsored by the California Medical Association (CMA). Passed and signed by Governor. SB 277, by Senator Richard Pan would eliminate the personal belief vaccination exemption children/individuals would no longer be permitted to attend school, day care and other public institutions without being vaccinated, regardless of personal belief.

26 SB 491 (2013) by Senator Hernandez held in Assembly Appropriations Committee Significant opposition from the California Medical Association (CMA) and other specialty medical groups Significant support from AARP, California Hospital Association (CHA) and the California Association of Physician Groups (CAPG) Highest profile legislation for NPs to date Most intense opposition from organized medicine to date Significant interest from national NP groups Extensive media coverage

27 Permits a NP to practice without physician supervision if the NP is certified by a national certifying body, maintains professional liability insurance that is appropriate for his or her practice setting, and is practicing in one of the following settings: A clinic, health facility, or county medical facility; An accountable care organization; or, A group practice, a medical group, or an independent practice association. Requires a NP to refer a patient to a physician and surgeon or another licensed health care provider if a situation or condition of the patient is beyond the NP's education or training. Requires these NPs to have medical malpractice insurance. Applies the physician self- referral prohibition and the peer review process requirements to these NPs. Specifies the scope of practice for NPs. Specifically, permits an independent NP, in the settings listed above, to perform services that are widely agreed to be the extent of services that NP perform today.

28 Senate Bill moved smoothly through the Senate Committees B&P, Ed and Approps passing the full house on May 7 vote of 25-5

29 June 30 set for first hearing. Failed passage in committee. Reconsideration granted Amendments considered; not accepted July 14 hearing postponed by committee

30 Is the tail wagging the legislative dog? This means that the least important part of a situation has too much influence over the most important part

31 Sticking point was the committee s call for an amendment that would apply the bar on the "corporate practice of medicine" to NPs a change which was strongly opposed by hospitals and numerous other groups, and which co- author Senator Ed Hernandez declined to accept

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33 Two- year bill, SB 323 could thus be reconsidered by the same committee in January 2016 Working on grassroots advocacy and outreach Goal to meet with all 120 legislators Building relationships Strengthening coalition support

34 Lobbying Tactics Specific actions that an interest group can take to influence policy outcomes: Mobilizing members Writing press releases Seeking elected officials endorsements to achieve influence Monitoring public opinion Building coalitions Citizen contact Lobbying Techniques A combination of various tactics that complement each other and provide the best chance for the group to achieve its goals: Inside lobbying (direct work with legislators and elected officials) Outside lobbying (media and grassroots activities to place external pressure on political leaders)

35 And Nursing Advocacy

36 Senator Hernandez Legislative and Policy Change Advocates

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38 38 American Association of Colleges of Nursing. (n.d.) From patient advocacy to political activism. AACN s guide to understanding healthcare policy and politics. Washington, DC: Author. American Nurses Association. (n.d.). Key provisions related to nursing. Retrieved from HealthSystemReform/Key- Provisions- Related- to- Nurses.aspx Association of American Medical Colleges[AAMC]. (2009). The physician shortage and health care reform. Retrieved from Boehmke, F. J. (2005). Interest group lobbying strategies. In F. J. Boehmke, The indirect effect of direct legislation: How institutions shape interest group systems (pp ). Columbus, OH: Ohio State University Press. Bowen, S., & Zwi, A. B. (2005, July). Pathways to "Evidence- Informed" policy and practice: A framework for action. PLoS Medicine, 2(7), Retrieved from Dobbins, M., Ciliska, D., Cockerill, R., Barnsley, J., & DiCenso, A. (2002, November 18). A framework for the dissemination and utilization of research for health- policy and practice. The Online Journal of Knowledge Synthesis for Nursing, 9(7). Federation of State Medical Boards Of the United States, Inc. (2005). Assessing scope of practice in health care delivery: Critical questions in assuring public access and safety. Retrieved from

39 39 Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: The National Academies Press. Institute of Medicine. (2011). Future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press. Kaiser Family Foundation. (2010, March 26). Summary of new health reform law. Retrieved from Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (Eds). (2007). Policy & politics in nursing and health care. St. Louis, MO: Saunders- Elsevier. Safriet, B. J. (1992). Health care dollars and regulatory sense: The role of advanced practice nursing. The Yale Journal on Regulation, 9, Stokowski, L. A. (2010). Healthcare reform and nurses: Challenges and opportunities. Retrieved from U.S. Department of Health and Human Services, Health Resources and Services Administration. (2010). The registered nurse population: Initial findings from the 2008 national sample survey of registered nurses. Washington, DC: Author. U.S. Department of Health & Human Services. (2010, September 28). Workforce grant announcement. Retrieved from 28_press.html