Eighth National DNP Conference Seattle How to be a Better DNP in 3 days Donna Emanuele, DNP, FNP- BC, FAANP September 18, 2015
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David and Donna (1 st DNP Conference) The Early Years
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
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)
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.
Extending Reach
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) http://www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/vol- 17-2012/No1- Jan- 2012/Professional- Organizations- and- Advocating.html
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)
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.
Consumer Groups Action Coalitions (ACs) Review & Know the Policy Process Become advocates for the profession & take an active role
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
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
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)
Strategic components of power politics Achieve goals Incremental Structural change Political skills Political arena How is power perceived http://www.psysr.org/jsacp/ 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).
California
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
Raise Your Voice and Let It Be Heard
2015 2016 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
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)
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
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
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.
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
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.
Senate Bill moved smoothly through the Senate Committees B&P, Ed and Approps passing the full house on May 7 vote of 25-5
June 30 set for first hearing. Failed passage in committee. Reconsideration granted Amendments considered; not accepted July 14 hearing postponed by committee
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
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
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
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)
And Nursing Advocacy
Senator Hernandez Legislative and Policy Change Advocates
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