Nurses as Lobbyists. Individual and Collective Strategies for Influencing Others. Melinda Mercer Ray, MSN, RN Shelagh Cooney Roberts, BA

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1 Nurses as Lobbyists Melinda Mercer Ray, MSN, RN Shelagh Cooney Roberts, BA Individual and Collective Strategies for Influencing Others n Editor s Note: Interested in a particular issue or activist topic? The following primer will get you started in no time. This how-to is excerpted from Policy & Politics in Nursing and Health Care, 4th ed., by Mason, Leavitt & Chaffee (St. Louis, MO: Saunders; see Box 3 for ordering information). Nearly everyone knows a nurse. Nurses are recognized as the most trusted group of professionals, ranking number one for trustworthiness in Gallup s (2000) most recent poll on honesty and ethics in professions. Nursing is 2.7 million individuals strong, composing the largest group of health care professionals in the U.S. The combination of reputation and presence is important to legislators. Think about the number of times people have said to you, I could never do what you do. It s this profound respect that assists nurses with lobbying efforts. You have the power to make a difference. Whether you exercise your power as the power of one the power of the nurse or as part of the voice of nursing with collective lobbying strategies, you can make a difference. Nurses are experts in health care, and they enjoy the respect and trust of the American people, as well as the respect of policy makers who recog- 438 AWHONN Lifelines Volume 6 Issue 5

2 nize that nurses are highly skilled professionals who work in stressful and life-threatening situations every day. The hardest part is getting started, and there are countless ways to begin to get involved at every level of decision making to make a difference in the policies that affect the nursing profession and the health care of all Americans. Box 1. Order Your Own Copy The newest edition of Policy & Politics in Nursing and Health Care enables readers to analyze policy issues, enhance their political knowledge and skills, and prepare for leadership roles in policy making and public health. More than 100 well-known nurses explore policy and politics, strategies for policy development and political action, and the application of these strategies in the four spheres of workplace, government, organizations and community in more than 736 pages. Order your own copy ($49.95) by any of the following ways: Elsevier Health: elsevierhealth.com ; Fax: Write: Elsevier Science, Health Sciences Division Order Fulfillment Westline Industrial Drive St. Louis, MO Armed With Knowledge Nurses can have a profound impact on the health and well-being of others, but only if armed with appropriate knowledge. Find out as much as you can about your area of interest or the issue that concerns you. Aside from paying attention to what you see in your workplace, in the newspaper, or on television, you should become a kind of detective, trying to discover the legislative history, dynamics of power, and policy particulars of bills related to your issue of interest. Check the Web sites of some of the professional nursing or other health care associations; think tanks regularly post position statements related to controversial issues on their Web sites. The American Nurses Association (ANA) and the Association of Women s Health, Obstetric and Neonatal Nurses (AWHONN) are two examples of nursing organizations that post position statements on their Web sites. Many such Web sites have legislative affairs sections that display sample letters or issue briefs to help frame some of your arguments in favor of or in opposition to a particular bill. If you are a member of a professional organization, you may want to contact someone in the federal government affairs department who has expertise on the issue, and might be able to provide you with issue briefs, reference articles, government reports, or testimony related to your area of interest. Additionally, as a result of such communication you could get support from your association and your work to coordinate your lobbying efforts with an overall strategy or lobbying plan at the federal level. Now that most government agencies and legislative branches of government make detailed government documents, including bill texts and summaries, federal agency reports and studies, and countless sources of federal data collection available online, the Internet is a great place to search for information. The Library of Congress Web site, offers complete listings of bills that can be searched by subject, key words, co-sponsors, date of introduction, and bill title or number. Additionally, every state has its own Web page with detailed information regarding elected officials and legislative activity. While the states Web sites vary in the degree of detail they provide, almost every state Web site includes the names and contact information for state senators and representatives as well as a search function to identify Nurses are experts in health care and they enjoy the respect and trust of the American people, as well as the respect of policy makers who recognize that nurses are highly skilled professionals who work in stressful and life-threatening situations every day October November 2002 AWHONN Lifelines 439

3 your legislator according to zip code or city name. Results from these searches will identify bills that will allow you to review proposed legislation on your issue of interest in great detail, and can help you gain a thorough knowledge of the legislative histories related to a given subject. Obtain a copy of past voting charts and a list of bills introduced or cosponsored by the legislator. Knowing the legislative history of an issue is vital if you are to make suggestions that are consistent with possible legislative remedies, to identify allies who support your issue, and to present yourself as a credible representative on the issue. Building Relationships At the federal level, it s primarily congressional staff people who are working with other offices and outside interest groups to create and reconcile detailed provisions in legislation. Your first step in building relationships at the federal level is to identify the person in a legislator s office who is responsible for your issues; for many nursing issues, this will be the staff liaison that works on health care issues. Usually, the easiest way to identify the correct person on your issue is to telephone the member s Capitol Hill office and simply ask the person who answers the phone for the name of the individual who handles your issue of interest. Opportunities to build relationships at the local and state levels are often more frequent and personal than at the federal level, for the simple reason that there are more occasions for networking and building informal personal relationships with policy makers. In your own town, you can invite officials to meetings of your professional organization or provide him or her with an invitation to address the group at a meeting or a luncheon. You can also frequent local and state meetings or committee hearings on issues of interest to you, volunteer to serve on a task force in your community, volunteer on a political campaign, or run for Box 2. Letter Writing When writing a letter to a member of Congress or a state or local official, there are some general guidelines to follow: Melinda Mercer Ray, MSN, RN, is the director of Health Policy and Legislative Affairs at AWHONN in Washington, D.C. Shelagh Cooney Roberts, BA, is a policy analyst at AWHONN in Washington, D.C. DOI: / Target your letter according to a legislator s responsibility. Do not write a letter regarding problems with your state s practice act to a federal legislator who has no authority on that issue. At the federal level, you are most likely to have an impact and have your correspondence taken seriously if you deal with the member of Congress who represents the geographic area in which you live Identify yourself as a nurse, particularly if the legislation has anything to do with health care. Identifying yourself as a nurse means identifying yourself as an expert. Include information about how proposed legislation would influence your personal experiences, or provide personal anecdotes that demonstrate your firsthand knowledge and experience with a certain issue Include a specific request from the representative or senator about an action that you request him or her to take. Where appropriate, include relevant committee or hearing information and/or bill numbers in your correspondence, in discussing both federal and state legislation Keep your letter relatively brief (no more than two pages) and to the point. Include hospital or other practice setting information, as well as professional credentials, and make sure to include a return address, telephone number and address if appropriate 440 AWHONN Lifelines Volume 6 Issue 5

4 office yourself. Through the informal exchanges with legislators and policy makers these activities provide, you can build the foundations for lasting relationships. The Personal Visit Both congressional staff and members of Congress respond most effectively to face-to-face lobbying. If you have arranged a personal visit with a legislative assistant or other staff member, or with a member of Congress or state or local official, you can apply many of the same guidelines for crafting your message that you would employ in letter writing on the issue. Other useful strategies include, knowing the current status of legislation keeping the visit brief, as time is usually short keeping your points succinct and germane to the topic illustrating your expertise or concern with personal, firsthand examples identifying your practice setting, particularly if you think the person you are meeting with would be familiar with it Asking for a specific action or request to close the meeting, such as We hope we can count on you to vote against Amendment XXIII on Wednesday. Other helpful strategies include providing a one- or two-page fact sheet, often called a leave behind, that illustrates your examples in a different way. Any resource that provides data or illustrates points in the form of easily digestible tidbits, or talking points, can be a useful resource to the staff member when he or she is briefing the senator, writing speeches, or drafting a press release. For a personal meeting, you should always bring several copies of your business card, as it may turn out that other people will be invited to sit in on the meeting. In general, always follow up a personal meeting with a thank-you note for the person s time, and if you indicated you would provide additional information or find an answer to a question, by all means do so in a timely manner. Correspondence When sending , always remember to include your name, address, phone number and address so that your correspondence can be responded to or you can be contacted for further information. Observe usual rules for written correspondence (see Box 2: Letter Writing). There are a few disadvantages to e- mail to keep in mind as well. Just as with telephone calls, people are getting literally hundreds of s each week, so you may want to follow up with a telephone call, or you can also use an as a follow-up device to confirm that someone received your letter. Another more intangible disadvantage is that e- mail is now sometimes seen as impersonal as well; there is neither a voice nor a handwritten signature attached with . is probably most useful as a lobbying tool when it s used in conjunction with other lobbying strategies. Lobbying Via the Net In terms of the Internet s revolutionizing politics and lobbying, the most influential change has been an increase in the quantity and depth of information related to legislative affairs that is now accessible to all Americans, instantaneously. The Freedom of Information Act, coupled with the instant access of information from the Internet has allowed Americans to view in great detail full bill texts, voting records, text of committee hearings, government agency reports and recommendations, and campaign con- Box 3. Preparing Public Testimony Be familiar with your prepared remarks. Few of us are expert public speakers that can give a cogent speech under the scrutiny of a House or Senate panel. Therefore, unless you are one of these talented folks, take the time to prepare and practice your remarks prior to the hearing. Some tips that might help: Have your remarks printed in large, bold font Practice, practice, practice your remarks in advance Make sure you are not the only one with a copy of your remarks Identify some of the likely questions that you might be asked and think through your response Prepare an appropriate response for when you do not know the answer to the question October November 2002 AWHONN Lifelines 441

5 tributions as reported to the Federal Elections Commission. Due to the development of lists from organizational Web sites, many organizations now have the capability to generate an immediate call-to-action for like-minded groups who share a common interest. Many organizations, associations and interest groups keep legislative alert lists in house so they will have a list of parties who are interested in legislative affairs at their fingertips, but just as with letter writing, it s important to personalize your . Testimony Providing testimony for a political hearing is a prominent and common method used to go on record on an issue on behalf of an organization or as a constituent. As an individual or on behalf of an association, you may request to testify on a particular issue, or you may receive a call from a legislative office requesting that you testify. Testimony is accepted in two forms for most committees, as oral remarks (those who are asked to testify) and as written testimony. By far, being asked to testify as a witness is the most exciting opportunity providing the highest degree of visibility and often the greatest amount of personal satisfaction. It s best to be as prepared as possible if you find yourself in this situation. It s important to know the rules as well. All committees and their subcommittees have a format that they use to conduct the hearing, and differ not only from state to federal committees but from one committee to the next. These rules cover the conduct of the hearing, the order of witnesses, the time that is provided for each witness to provide his or her remarks and the manner in which the questions and answers are provided. If you are not familiar with these details, ask your association representative, who may have invited you to be a witness on behalf of the association, or the committee staff member what these details are. Know the issue. You don t need to be the recognized expert on an issue to present coherent, strong testimony, but it s essential that you know the issue well enough to represent it to the committee and be able to answer questions. Witnesses are often selected based on their constituency and not necessarily on their expertise, though the best witness is a constituent who has expertise in the subject matter of the hearing (see Box 3: Preparing Public Testimony) Coalitions In terms of collective lobbying strategies, one of the most common and increasingly the most effective options to bring about change is to create or join a coalition. As the number of interest groups has increased, with almost every niche group having its own association or group, it has become increasingly important to reach consensus and refine priorities with groups that share your interests before approaching federal policy makers with priorities or legislative remedies. Coalitions simplify the workload of legislators and their staff in that they spend less time meeting with any one coalition that represents 25 groups than they would if they had to arrange 25 separate meetings with individual representatives from each group. In fact, coalition expert Kevin Hula (1995) states that due to increasing demands on time, Groups are pressured to work out their differences before approaching Congress, rather than requiring Congress to sort out a seemingly infinite number of differences among groups (p. 243). Bibliography & References Davis, R. (1999). The web of politics, the Internet s impact on the American political system.new York: Oxford University Press. Frantzich, S. E. (1986). Write your congressman, Constituent communications and representation.new York: Praeger. The Gallup Organization. (2000). Annual honesty and ethics poll. Princeton, NJ: Author. Hula, K. (1995). Rounding up the usual suspects: Forging interest group coalitions in Washington. In A. J. Cigler & B. A. Loomis (Eds.), Interest group politics (4th ed., pp ). Washington, DC: Congressional Quarterly. Kealy, M., Kendig, S., Ray, M., Nolan, L., Percy-McDaniel, H., & Roberts, S. (2000). AWHONN legislative handbook: How to get started. Washington, DC: Association of Women s Health, Obstetric and Neonatal Nurses. 442 AWHONN Lifelines Volume 6 Issue 5