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Title: Advocacy 101: Tips, Tools, and Terminology


1
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

2
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.

3
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)

4
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.

5
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.

6
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

7
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

8
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.

9
Tips Opportunities to Influence Public Policy
  • Agency Actions
  • Guidance Statements
  • Committees
  • Rulemaking
  • New Rules
  • Rule Review
  • Legislation
  • Proposed
  • Monitor
  • Support / Oppose

10
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

11
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.

12
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

13
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.

14
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.

15
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

16
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

17
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

18
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).
19
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?

20
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

21
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!!

22
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

23
Potential Opposition in Michigan
  • Hospital
    Association
  • Michigan State Medical Society
  • Other Nurses Legislators
  • Coalition of free-standing surgical clinics

24
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.

25
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.

26
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/

27
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.

28
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.

29
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.

30
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

31
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

32
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

33
Tools Initiative Tools
  • Policy Profiles
  • RN Circulator
  • RNFA . . . .
  • Talking Points
  • For Phone Calls
  • For office visits
  • Sample / Draft Letters
  • _ Personalize with Stories
  • Capwhiz

34
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)

35
Tools AORN Public Policy Website
36
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

37
Tools Lobbyists
  • ACCESS, INFLUENCE, INTELLIGENCE
  • Eyes and Ears
  • Familiarity with local process and players
  • Strategy Development
  • Grassroots Coordination Follow their Lead

38
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

39
Terminology Legislative and Regulatory
  • Some states use same terms in different ways
  • Legislators have lingo too
  • See Grassroots Advocacy Handbook 2008-2009

40
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.

41
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.

42
Terminology Regulation
  • Regulation
  • 3 Levels of Regulation (from least to most
    restrictive)
  • Registration
  • Certification
  • Statutory
  • Private
  • Licensure
  • Institutional Licensure
  • Title Protection

43
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

44
The New York Scene
  • Bruno vs. Spitzer
  • 2007
  • Not 1 Nursing bill brought to senate floor

45
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

46
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

47
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.

48
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

49
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

50
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

51
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.

52
Grassroots Advocacy
  • Follow up with letter
  • Reiterate request
  • Thank them

53
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

54
Questions?
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