Advocacy 101: Tips, Tools, and Terminology

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Advocacy 101 Tips, Tools, and Terminology

• Michigan Perioperative Nurses Lobby Day
• September 23, 2008
• AORN National Legislative
• Committee
• Department of Government
• Affairs
• Sharon Robinson,RN, MSN, CNOR Chair, National
  Legislative Committee

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What is Grassroots Advocacy?

• GRASSROOTS
• Grassroots is individuals coalescing around a
  specific issue using a common argument and/or
  message to achieve a common goal guided by a
  singular strategy.

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What is Grassroots Advocacy?

• ADVOCACY
• The act of pleading or arguing in favor of
  something, such as a cause, idea, or policy
  active support. (The American Heritage
  Dictionary, 4th Edition)

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AORN s Affiliate Status with ANA

• As an affiliate member of ANA, you will receive
  notices of politicians they (ANA) is supporting.
  As a grassroots member of AORN, we give you the
  tools to grow as an advocate for your profession
  and your private life. AORN does NOT support
  political candidates but encourages participation
  in the legislative process for the candidates of
  their choice by its members.

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Grassroots Advocacy

• Efforts at the local level to affect public
  policy. Voices of many for the same goal.
• Education to decision-makers on public policy
  issues.
• Networking with colleagues, coalition partners to
  leverage influence.
• The power of constituency.

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Why should I get involved?

• Who is the most qualified expert in perioperative
  nursing? YOU
• If you dont speak out, provide your expertise,
  or participate in the process, who will do it for
  you?
• What information do you want a decision-maker to
  consider when an issue affects your practice?
• Who do you want make decisions about the
  perioperative nursing practice?
• You are the constituent. You are the expert. You
  are responsible for protecting your practice

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How do I get Involved?

• Join the AORN Grassroots Network
• grassroots_at_aorn.org
• Coordinate with your Chapters and Councils
• Karen Knapp, State Legislative Coordinator
• Identify the issues affect you and your practice
  at the local level
• Nursing, Healthcare, Others?
• Establish your position and share information
• Network with your local colleagues
• Other nursing or healthcare personnel
  associations
• Be active

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Tips Why are Nurses Good Advocates

• We are the experts!
• We have the education
• We have the experience
• We know the issues
• We are respected
• Our stories make the issues real!
• Participation increases knowledge and confidence
• The difference between a rank novice and a
  public policy expert is one visit.

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Tips Opportunities to Influence Public Policy

• Agency Actions
• Guidance Statements
• Committees
• Rulemaking
• New Rules
• Rule Review
• Legislation
• Proposed
• Monitor
• Support / Oppose

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Tips Agency Actions

• Guidance / Position Statements
• Board Announcement or Identified Problem
• Contact Agency
• Determine Position
• Offer Expertise
• Study Groups / Committees
• Evaluate Need
• Identify Issue
• Collect Information
• Recommend Position or Action

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Tips How to be involved in Agency Actions

• Join newsletter, email, or listserv group to
  receive notices of pending decisions.
• Call the agency to see if they are addressing a
  particular concern.
• Offer your own professional expertise on the
  issue
• Offer your availability and time or identify
  yourself as a resource for review purposes.
• Recommend other experts in the area to serve on
  the committee or provide input.

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Tips Rulemaking

• Administrative Process
• By law in each state and at federal level must
  be open to public
• Comments and Hearings
• New Rules
• To address a new issue
• Can be proposed by anyone
• Rule Review
• Every certain number of years
• All proposals for revisions must be addressed

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Tips How to be involved in the Rulemaking
Process

• Request to be on agencys interested party
  notification list.
• Become familiar with the process for new rules
  and rule reviews.
• Submit written comments (use appropriate format)
• Attend public hearings and offer testimony
  (verbal or written)
• Contact agency and request that they consider a
  rule to address your particular concern.

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Tips How to be involved in the Legislative
Process

• Be the Champion contact your legislator with a
  concern and request their support.
• Be the subject matter expert by providing
  suggested bill language.
• Monitor proposed legislation to identify issues
  of interest.
• Visit, call, email, and write legislators to
  support your issue or oppose an initiative
  adverse to your interests.
• Attend open committee hearings. Be prepared to
  offer testimony.
• Engage your colleagues.

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Tips Contacting Decision-makers

• Letters and Emails
• Individualized v Forms
• Identify
• yourself (and who you represent)
• the issue
• your position
• Be Brief
• Use facts and personal stories
• Make the ASK
• Request a reply
• Follow-up

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Tips Contacting Decision-makers

• Phone Calls
• Capitol office or district depends on time in
  session
• State your name and reason (issue) for calling
• Be brief / to the point
• Request support or opposition from decision-maker
  (you will probably talk to staff so be clear and
  concise so that the message is delivered
  properly)
• Leave contact information
• Request follow-up

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Tips Contacting Decision-makers

• Office Visits
• Most effective form of contact
• Staff contact is just as effective
• Schedule appt Be on time!
• Be Prepared with Talking points
• If youre in a group choose a lead speaker
• Have 2 talks ready 3 minutes / 15 minutes
• Be clear regarding position Stay on Point!
• Be positive dont argue!
• Make a direct request
• Offer self as resource for follow-up

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Tips Effective Contacts
Yes Some
No
Source Fitch, Brad and Goldschmidt, Kathy
Communicating with Congress How Capitol Hill is
Coping with the Surge in Citizen Advocacy
Congressional Management Foundation (2005).
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Tips The 3 Hs of Decision-making for Legislators

• Head
• Is this good policy?
• Is this a smart course of action?
• Does this make logical sense?
• Heart
• Is this the right thing to do?
• Is this an issue that I am passionate about?
• Is this a moral or ethical issue?
• Health
• Is this a politically healthy thing to do?
• Will my position on this keep me in office?
• How will this issue affect my reputation?

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Tips Building Grassroots Support

• Use Chapter / Council meetings as recruitment
  forums
• Contact Colleagues for support
• Explain Issue and Specific Position
• Articulate Why Issue is Important to You and to
  Them
• Get Commitments for Support - Energize
• Discuss Strategy and Resources
• Mobilize at Critical Moments
• Provide Support and Appreciation

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Tips Barriers to Effective Advocacy
THE Is HAVE IT

• Ignorance
• You can educate ignorance, but you cant teach
  stupid.
• Inertia
• I never lost a football game, I just ran out of
  time. Joe Paterno
• Inconsistency
• I feel strongly both ways.
• Inattention
• A bill not considered today is a bill not
  considered today.

• Indifference
• Someone else will take care of me.
• Interference
• I have too much to do. There are too many
  obstacles.
• Intimidation
• The opposition is bigger and has more money.
• Intractability
• Well never resolve our issues with the other
  parties.
• BUT NOT IMPOSSIBILITY!!

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Tips Responding to Opposition

• Identify Opponents
• Traditional
• Issue-Oriented
• Unexpected
• Identify Motivations for Opposing
• Money Costs
• Effect on Industry/Profession
• Evaluate Effect of Opposition
• How persuasive are they
• Be Prepared to Respond
• Do not ignore any opposition
• Be Positive but Direct
• Refute with Facts
• Stay Consistent with Your Message
• Is there Common Ground
• Compromise
• Commitment to Neutrality

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Potential Opposition in Michigan

• Hospital
  Association
• Michigan State Medical Society

• Other Nurses Legislators
• Coalition of free-standing surgical clinics

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Tools AORN Vision and Mission

• VISION
• AORN is the global leader in promoting excellence
  in perioperative nursing practice.
• MISSION
• AORN supports registered nurses in achieving
  optimal outcomes for patients undergoing
  operative and other invasive procedures.

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Tools AORN Documents

• Recommended Standards and Practices defines
  perioperative roles and standards.
• Position Statements states AORNs formal stance
  on issue.
• Guidance Documents offers AORN expertise.

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Tools AORN Legislative Priorities

• RN as Circulator
• Preserving and Protecting the Perioperative
  Nurses Scope of Practice
• RNFA Financial Reimbursement
• Supporting Workplace Safety and Patient Safety
  Initiatives
• http//www.aorn.org/PublicPolicy/AORNAdvocacy/Legi
  slativePriorities/

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Tools Legislative Priorities

• RN as Circulator
• AORN maintains that every surgical patient
  deserves a perioperative registered nurse in the
  operating room throughout the surgical procedure
  and actively promotes laws and regulations to
  ensure the supervisory presence of the
  professional RN in the perioperative setting both
  at the state and federal levels. AORN will seek
  support from the Center for Medicare and Medicaid
  Services (CMS) and other regulatory bodies to
  ensure that the RN in the circulating role is
  continually protected for patient safety.

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Tools Legislative Priorities

• Preserving and Protecting the Perioperative
  Nurses Scope of Practice
• AORN will preserve and protect the Perioperative
  Nurses Scope of Practice at the state level by
  working with the appropriate regulatory and
  legislative bodies for language regarding
  education, certification, registration/licensure,
  supervision, roles, responsibilities and duties.
  AORN will monitor, evaluate, and respond to any
  proposed legislative initiatives by allied
  healthcare professionals that may affect the
  perioperative nursing scope of practice and
  profession.

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Tools Legislative Priorities

• RNFA Financial Reimbursement
• AORN will monitor and continue to evaluate a U.S.
  congressional initiative to amend current laws or
  regulations to secure Medicare reimbursement for
  the services of RNFAs.(2005) AORN will
  investigate, analyze, and respond to
  opportunities at the state level to ensure
  reimbursement for RNFAs by third-party payors.
• Focus group created at Leadership.

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Tools NLC and State Legislative Coordinators

• National Legislative Committee (NLC)
• The grassroots resource group to support the AORN
  legislative agenda.
• The NLC members work directly with each State
  Legislative Coordinator in their region to
  collect and disseminate information about public
  policy issues and initiatives in the individual
  states.
• Members appointed by President
• Chair, Co-chair
• 5 Regional Coordinators
• Board Liaison

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Tools State Councils and Chapters

• 30 State Councils Michigan has one
• About half have designated Legislative Chairs
• Address practice issues and legislative activity
  within their individual states and provide
  avenues for increased communication between
  chapters within the state via email, web pages,
  conference calls and newsletters. Input for
  model bills
• 350 Local State Chapters
• Basic building blocks of the Association
• Networking, education, and leadership development
  

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Tools Department of Government Affairs

• Advocates on behalf of perioperative nurses
  before legislative and regulatory bodies at both
  the state and federal levels.
• Tracks and analyzes nursing and healthcare laws
  and regulations.
• Provides grassroots members with research
  support, advocacy tools and training, and access
  to communicating with elected officials.
• Director Craig Jeffries
• Government Affairs Coordinator Carrie Sayre

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Tools Initiative Tools

• Policy Profiles
• RN Circulator
• RNFA . . . .
• Talking Points
• For Phone Calls
• For office visits
• Sample / Draft Letters
• _ Personalize with Stories
• Capwhiz

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Tools AORN Public Policy Website

• State-by-State Law and Regulation Collection
• Legislative Tracking
• Advocacy Tools
• Legislative Tools
• NLC / State Coordinator Info
• Grassroots Info
• Grassroots Communication Tool (Handbook)

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Tools AORN Public Policy Website
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Tools Grassroots in Action

• Ready!
• Preparation Stage
• Identify Issue, Champion, Partners
• Develop Strategy
• Set!!
• Establish Your Position and
• Expertise
• Seek Support / Build Networks
• GO!!!
• Launching the Initiative
• Implementing the Grassroots Strategy

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Tools Lobbyists

• ACCESS, INFLUENCE, INTELLIGENCE
• Eyes and Ears
• Familiarity with local process and players
• Strategy Development
• Grassroots Coordination Follow their Lead

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Tools Lobbyists

• How AORN Determines whether to hire a Lobbyist
• For AORN top legislative priority, funds for
  lobbyists are budgeted for a set number of
  states. Proactive and Reactive funding
• If state members want additional funding for
  other legislative priorities or issues, they
  submit a funding application request which goes
  to the Lobbyist Decision Team (made up of leaders
  and executives).
• Limited budget for reactionary issues
• How AORN Hires Lobbyists
• Narrows list down through personal interviews
• Conducts joint interviews with AORN local members
  for final decision
• Noah Smith , Capitol Services , hired in Michigan

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Terminology Legislative and Regulatory

• Some states use same terms in different ways
• Legislators have lingo too
• See Grassroots Advocacy Handbook 2008-2009

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Terminology

• In any grassroots initiative, it is important to
  use consistent definitions for the key terms that
  comprise the goal.
• Grassroots can demonstrate their expertise on a
  subject matter through the use of consistent
  definitions.
• Must define terms clearly and in laymens terms
  for those not familiar with your issue to
  understand. Some education will be required but
  terms should not be all clinical.
• Its important to get buy-in from other interested
  parties on defined terms.

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Terminology

• 19 Definitions established by Legislative
  Principles Task Force.
• Terms often found in legislation related to
  nursing and other healthcare issues.
• To be used for reference purposes in evaluating
  legislation.
• Derived from credible sources refined for AORN
  use.

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Terminology Regulation

• Regulation
• 3 Levels of Regulation (from least to most
  restrictive)
• Registration
• Certification
• Statutory
• Private
• Licensure
• Institutional Licensure
• Title Protection

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Stay Tuned . . . .

• More Advocacy Modules Under Development for
  Specialized Training
• Activating the Grassroots
• Close Encounters with Legislators
• Whos Making the Rules
• Coalition-Building The Nitty-Gritty
• Model Bill
• And More . . .
• Look for NLC Congress Session

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The New York Scene

• Bruno vs. Spitzer
• 2007
• Not 1 Nursing bill brought to senate floor

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S 1608 RN Circulator Bill

• Passed in Assembly in 2007
• 3rd reading in Senate
• Waiting for Senate Vote
• Not on agenda when senate returned 2007
• In 2008 passed in assembly
• In 2008 passed in senate
• Signed into law

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A 1206

• S T A T E O F N E W Y O R K ______________________
  __________________________________________________
  1206--A 2007-2008 Regular Sessions I N A S S E M
  B L Y (PREFILED) January 3, 2007 ___________
  Introduced by M. of A. GUNTHER, DelMONTE, JACOBS,
  FIELDS, COLTON -- Multi-Sponsored by -- M. of A.
  BENJAMIN, CAHILL, GLICK, JOHN, MAYER- SOHN, J.
  RIVERA, P. RIVERA, ROBINSON, WEISENBERG, WRIGHT,
  ZEBROWSKI -- read once and referred to the
  Committee on Health -- committee discharged, bill
  amended, ordered reprinted as amended and
  recommitted to said committee

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RN as Circulator

• AN ACT to amend the public health law, in
  relation to requiring a circu- lating nurse to be
  present in operating rooms THE PEOPLE OF THE
  STATE OF NEW YORK, REPRESENTED IN SENATE AND
  ASSEM- BLY, DO ENACT AS FOLLOWS 1 Section 1. The
  public health law is amended by adding a new
  section 2 2805-s to read as follows 3 S 2805-S.
  CIRCULATING NURSE REQUIRED.
• A REGISTERED NURSE, QUALIFIED BY 4 TRAINING AND
  EXPERIENCE IN OPERATING ROOM NURSING, SHALL BE
  PRESENT AS A 5 CIRCULATING NURSE IN ANY AND EACH
  SEPARATE OPERATING ROOM WHERE SURGERY 6 IS BEING
  PERFORMED FOR THE DURATION OF THE OPERATIVE
  PROCEDURE. NOTHING 7 IN THIS SECTION PRECLUDES A
  CIRCULATING NURSE FROM LEAVING THE OPERATING 8
  ROOM AS PART OF THE OPERATIVE PROCEDURE, LEAVING
  THE OPERATING ROOM FOR 9 SHORT PERIODS OR, IN
  ACCORDANCE WITH EMPLOYEE RULES OR REGULATIONS, 10
  BEING RELIEVED DURING AN OPERATIVE PROCEDURE BY
  ANOTHER CIRCULATING 11 NURSE ASSIGNED TO CONTINUE
  THE OPERATIVE PROCEDURE. 12 S 2. This act shall
  take effect on the ninetieth day after it shall
  13 have become a law. EXPLANATION--Matter in
  ITALICS (underscored) is new matter in brackets
  is old law to be omitted.

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Grassroots Advocacy

• Call your senators
• Follow up with letter
• Ask them to contact Majority Leader to bring the
  bill to a vote
• Tell them of your concerns

• Election year
• 1 in 44
• Call Majority Leaders office
• Ask to bring bill to floor for vote
• Stress patient safety

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Other efforts

• Regulatory
• Need stories
• What bad things happen when RN not in room
• Ask colleagues how hospitals routinely staffed
• Is RN in hall while tech/LPN circulating
• Can perform circulating duties
• Do they staff more than 1 room
• Get name of hospital
• No repercussions

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Mandatory overtime S 6342

• Sponsored by Gunther- NYSNA
• We can support Assembly version of bill
• Concerned with senate proposal of adding letter
  d, section 3 An ongoing procedure in which the
  nurse is actively engaged and whose continued
  presence thru the completion of the procedure is
  needed to ensure the health and safety of the
  patient.
• Passed, signed by Governor 08/14/2008

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On a Federal note

• Take Action
• Urge support of 169.7 million appropriation for
  funding Title VIII Nurse Workforce Development
  Programs
• Contact both senators and rep.

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Grassroots Advocacy

• Follow up with letter
• Reiterate request
• Thank them

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Final Thoughts

• Action speaks louder than words, but not nearly
  as often. Mark Twain
• Look for the second right answer. Albert
  Einstein
• Okay, youve convinced me. Now go out there and
  bring pressure on me. FDR
• 1 in 44 registered voters is a RN the remainder
  are potential patients. Sharon Robinson

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Questions?