Silence Gives Consent: Practice, Politics, and Patient Care
This is not to suggest that only full-time staff can make a difference. When resources are limited, Towers says, “Volunteers have done an excellent job of monitoring state board meetings, advocating for legislation in the state.”
Strong membership numbers can also impact legislators’ perceptions. If, for example, an organization professes to represent PAs in New York, a legislator may want to know what percentage of the state’s PAs belong to the group. “And you don’t want to have to say it’s five,” Davis says. “You want to be able to say it’s the majority.”
Did We Mention Networking?
Active involvement is the best way to make a difference. While letter-writing and cold-calling campaigns can help when legislation is on the table, everyone agrees that establishing long-term relationships is most beneficial.
“The more you have a rapport with a legislator or regulator, so they understand the issues when you really need them, then they’re going to be there for you,” Towers says. She adds that frequent staff turnover in legislators’ offices often necessitates repeat visits or calls to ensure that the legislator stays on top of health care issues.
It may be an arduous process, but connections can pay off in the long run—as NPs in Oregon learned last year when legislation to establish a “scope-of-practice review board” was proposed. The original bill was intended to evaluate new scope-of-practice requests from a variety of health care providers, and was not viewed by the sponsoring senator—herself an RN—as a threat to established practitioners, according to Bunny Lewis, NM, NP, Chair, Nurse Practitioners of Oregon (NPO; a special interest group affiliated with the Oregon Nurses Association [ONA]).
“What became a problem was when they were trying to fund it, the Board of Medical Examiners stepped up and said, ‘Hey, we’ll be glad to do this,’” Lewis explains. At that point, concern among NPs escalated. “We would not be comfortable with that,” Lewis says—especially if future amendments to the bill allowed reconsideration of already-approved practice parameters.
The NPO and ONA capitalized on their long-standing relationship with the sponsoring senator to find ways to water down and eventually stifle the bill. What made the difference, Lewis says, was “meeting one-on-one with the senator, going to her and saying, ‘You’ve got to stop this. This is threatening every NP in the state.’”
It didn’t hurt that NPO and ONA “have a reputation for being honest and trustworthy and supporting those issues that are truly important,” Lewis adds. “We’ve worked for a lot of years; this is not something that just happened overnight.”
Of course, legislators are not the only people PAs and NPs need to connect with if they want to continue to advance their practice. “You really need to be in tune with what’s going on with the department of insurance in your state, with the state boards of nursing [or medicine]—the people who make the rules, not just the statutes,” Towers points out.
And never underestimate the power of forming coalitions with like-minded groups. “The more you can reach out to groups that are interested in the same issues, whether it be other health care professional groups or other citizen groups, such as AARP, and create coalitions there, the better it is,” Towers says.
Davis agrees. If the state legislature is considering legislation to allow parents to administer insulin on school grounds, for example, PAs alone may have a modest influence. However, she says, “if we show up with the pediatricians and the certified diabetes educators and the nurses association and the emergency room physicians and the American Diabetes Association local chapter to talk about the same issue, that’s pretty good—we’ll get their attention.”
At the Heart of It
Perhaps the most important thing to remember, when legislative initiatives seem too difficult or time-consuming to tackle, is that patients are at the heart of them all. “It’s very important to look at it from the perspective of patient care and not just ‘me, me, me,’” Towers says. “This has to do with our ability to provide care to our patients and has to do with access and quality of care.”
Clinicians cannot practice at all without laws and regulations that allow them to do so, and each additional privilege they receive enhances their ability to help someone else. Asking the state legislature to open the formulary isn’t about résumé enhancement for clinicians; it’s about providing patients with the medications they need. But even local issues that may not directly relate to PAs and NPs—such as the closure of an adult day care facility in the area—can impact patients’ well-being, and these may provide a small but vital opportunity to speak up. “If something is good for patients, then of course we must endorse it,” Davis says.
