Application: Developing a Health Advocacy Campaign
To be an effective advocate and to develop a successful health advocacy campaign, you must have a clear idea of the goals of your campaign program and be able to communicate those goals to others. In addition, it is the nature of nurses to want to help, but it is important to make sure that the vision you develop is manageable in size and scope. By researching what others have done, you will better appreciate what can realistically be accomplished. It is also wise to determine if others have similar goals and to work with these people to form strategic partnerships. If you begin your planning with a strong idea of your resources, assets, and capabilities, you will be much more likely to succeed and truly make a difference with those you hope to help.
Over the next 3 weeks, you will develop a 9- to 12-page paper that outlines a health advocacy campaign designed to promote policies to improve the health of a population of your choice. This week, you will establish the framework for your campaign by identifying a population health concern of interest to you. You will then provide an overview of how you would approach advocating for this issue. In Week 9, you will consider legal and regulatory factors that have an impact on the issue and finally, in Week 10, you will identify ethical concerns that you could face as an advocate. Specific details for each aspect of this paper are provided each week. The Final Paper will be due in Week 10. This paper will serve as the Portfolio Application for the course.
Before you begin, review the complete Assignment.
This week, begin developing your health advocacy campaign by focusing on the following:
Identifying a Problem
• Select a population health issue of interest to you and identify the population affected by the issue.
• Locate two scholarly articles, each of which provides a description of an effective health advocacy program that addresses your issue.
• Analyze the attributes of the programs to determine what made them effective.
• Reflect on a policy you could propose or a change to a current policy to further improve the health of the population you selected with regard to the issue.
• Consider how you could develop an advocacy program, applying the attributes identified in similar, effective programs.
For this section of your paper (approximately 3??"4 pages in length) address the following:
• Describe your selected population health issue and the population affected by this issue.
• Summarize the advocacy programs you researched in this area.
• Explain the attributes that made those programs effective.
• Develop a plan for a health advocacy campaign that seeks to create a new policy or change an existing policy with regard to the issue and population you selected. Be sure to include in your plan:
o A description of the public health issue and proposed policy solution
o Specific objectives for the policy you want to be implemented
o The means by which you will convey information to various stakeholders on the need for this policy change
o Be sure your proposed need is substantiated by data and evidence.
o Methods of establishing support for the policy, including how to influence policymakers
• Explain how the attributes of the effective advocacy programs you researched could be applied to your proposed advocacy campaign.
You do not need to submit anything this week. This Assignment is due by Day 7 of Week 10.
Application: Developing a Health Advocacy Campaign (continued): Legal Considerations
Last week, you began developing a health advocacy campaign for improving the health of a population through a change in policy. This week, you will continue by considering how laws and regulations can shape the way you advocate for and attempt to implement your proposed policy.
Before you begin, review the complete Assignment.
• Review Chapter 3 of Health Policy and Politics: A Nurse’s Guide (3rd ed.) to determine methods of influencing the political process
• Reflect on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation.
• Contemplate in what ways existing laws or regulations may impact how you proceed in advocating for your proposed policy.
• Consider how you could influence legislators or other policymakers to enact the policy you would like to propose.
• Think about the obstacles of the legislative process
that may prevent your proposed policy from being implemented as intended.
For this section of your paper (approximately 3??"4 pages in length) address the following:
• Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.
• Explain how existing laws or regulations could impact your advocacy efforts.
• Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.
• Summarize the obstacles you anticipate arising in the legislative process
and how you could overcome these hurdles.
This Assignment will be integrated into a Final Paper in Week 10. You do not need to submit anything this week. This Assignment is due by Day 7 of Week 10.
50 Chapter 3 • Government Response: Legislation
also provide brief biographical information, photos, and other pertinent and background material.
Why is this important? Politics is at heart a people process
and, like other centered endeavors, the relationships among and between people determine outcomes Nurses are well aware of how important communication and personal connection1 are in the care-giving context, and those same principles also affect the world of tics. Knowing a state representative and being able to recognize him or her on while also knowing something about the issues, are fundamental to producing
relationships. Just as nurses realize the importance of establishing good rapport clients, that same principle applies when establishing the connections needed to influence lawmakers.
In addition to knowing the people, one must also know the process
-how laws made. Most nurses complete a government course in high school and promptly disregard most of the subject matter because it holds little relevance for them at the While diagrams depicting "How a Bill Becomes a Law" are important, they are very rudimentary (see Figure 3-1). There is much more to the process
than can neatly depicted on a chart.
Bills are ideas that legislators have determined need to be ratified into law. ideas can come from many sources: the legislator's own experiences, the issues forward by constituents, or by special interest groups. Once the idea is drafted into the proper bill format, it is introduced into the House or Senate, depending on chamber to which the bill's chief sponsor belongs. (All budget bills are initiated in House, as it was designed to be most representative of the average citizens' Because of the importance of budgeting in regards to policymaking, it was given primary role in the budget process
.) Once introduced, a bill is then referred to a standing committee for further consideration. These standing committees are related to health care go to a health committee, finance issues to a banking committee, farm-related matters to the agriculture committee, and so on. Standing committees can be configured differently over time and subcommittees may be named to consider particular bills in greater detail. Committee hearings are important, but they often appear to be more chaotic than productive. Much of the real business of law making is conducted behind the scenes, but one must also participate in the defined processes
to earn a place at the more informal behind-the scenes-tables.
Committee chairs are extremely influential, particularly with respect to the subject matter areas that are the focus of the committee's work. Chairs determine what bills will be heard and when, and they establish the procedural framework under which the committee operates. The chair's position on an issue can determine its fate from the outset. Because of the extent of their power and influence, committee chairs are able to raise large sums of money from special interest groups to support their re-election, and re-election is always an important consideration for lawmakers. House and Senate leadership (elected by their colleagues) determine who will be named as committee chairs. Certain committees are seen as more prestigious than others, so being named the chair of one of those committees is even more important to an ambitious legislator. Not surprisingly, political considerations play a role in this entire process
. Being aware of the dynamics that are the foundation of the overall committee process
helps ensure more effective representation by those who want to influence the outcome of the committee's work.
If a bill is able to garner committee approval, it goes to the full chamber for a vote. The timing for scheduling a vote, as well as various attempts to amend the bill or delay the vote, are all integral parts of the lawmaking process
. Much maneuvering occurs backstage and the ability to influence these less public interactions is as important as the words or concepts being debated. Again, peoples' relationships and politics determine the ultimate results. To be able to be effective in one's efforts to influence outcomes, one must be aware of these relationships and take them into account. Once a bill is approved in either the House or Senate, it must begin the process
again in the other chamber. The chief executive (president or governor) must sign the bill before it can become law and all of this must happen within a single legislative
cycle-two years. It is not surprising that it often takes several years for a particular legislative
issue to finally become law, especially when the issue is not one that garners a lot of public interest or attention. The state and federal processes
each have special nuances, but the overall process
is similar for both, as are the people dynamics that affect each step of the process
Given all the hidden factors that affect success on Capitol Hill or in state legisla tures, how can an individual nurse hope to have sufficient knowledge or time to make a difference in the policymaking aspects of the profession? Fortunately, the American Nurses Association (ANA) and its state constituent associations, as well as specialty nursing groups, can provide their members with the tools they need to be successful. The success of these organizations' efforts in the legislative
arena depends in large part on their members' involvement with and understanding the importance of an effective legislative
presence on behalf of the profession in Washington, D.C., and in statehouses across the country. An individual nurse need only become a member of his/ her professional association and then take advantage of the resources provided by these organizations to be part of the cadre of politically-active nurses who are taking seriously the obligations set forth in the profession's social policy statement and its code of ethics. These organizations keep .nurses informed about what, why, and how things are happening, as well as help develop succinct messages to be conveyed to key lawmakers.
EFFECTIVE LOBBYING: A THREE-LEGGED STOOL
In addition to knowing the procedural aspects of lawmaking, nurses can also benefit from understanding the lesser known but equally important relational aspects of the process
: the connections not depicted on any chart purporting to show how a bill becomes a law. Success in the legislative
arena is much like a three-legged stool, with each leg essential to the sturdiness of the stool as a whole. The first leg is the formal lobbying effort provided by independent paid individuals, many of whom have close ties with elected and appointed officials. Leg number two is the grassroots leg, and the third leg is the political leg-the one that actively tries to influence the outcome of elections.
Leg One: Professional Lobbyists
No bill becomes law without lobbyists' input. Lobbying is the act of influencing-the art of persuading-a governmental entity to achieve a specific legislative
or regulatory outcome. While anyone can lobby, lobbyists are most often individuals who represent special interest groups and are looked to as the experts by lawmakers who need information and rationale for supporting or not supporting a particular issue. The role of lobbyists has become even more critical as the complexity of legislation has increased; for example, the 1914law creating the Federal Trade Commission was a total of eight pages, the Social Security Act of 1935 totaled 28 pages, and the Financial Reform bill (conference version) of 2010 contained 2,319 pages (Brill, 2010). Legislators, often pressed for time, rely on lobbyists' expertise to help them understand what they are voting for or against.
According to the Center for Responsive Politics, there were 10,404 federal lobby- ists in 1998; in 2010, there were 12,488. While this number represents a decrease from a high of 14,869 in 2007,"the number of lobbyists has significantly increased over the years. In 1998, $1.44 billion was spent on lobbying; in 2010, the total was $2.61 billion, again down from $3.49 billion spent in 2009. Nevertheless, this represents a general increase overall. The American Nurses Association reported spending $1,197,342 on its lobbying efforts, utilizing the services of six lobbyists. The American Hospital Association, on the other hand, spent $13,585,000 and employed 72lobbyists, many of whom were categorized as "revolving door" lobbyists, or individuals who left positions in the legislative
or regulatory arenas for typically more lucrative private sector employment. (The revolving door provides an entry and that are invaluable to a lobbyist and the special interests he/she represents. The more revolving door lobbyists an organization employs, the better connected it is to the inner workings of Capitol Hill.)
The willingness of entities to invest the level of resources associated with lobbying efforts is indicative of how important the connections forged by lobbyists are to the reputations of the interest groups, and to their ability to get the job done. Members of special interest groups expect legislative
success, and that success comes with a price. Tellingly, it is a price many nurses are reluctant to embrace. Nurses must be more aware of the key role that lobbyists play and be willing to support the lobbying efforts of professional associations by becoming members of these organizations. Success in the halls of Congress and at statehouses is integral to the advancement of the profession itself and its societal values. Nurses want their legislative
agenda advanced success- fully, and that expectation comes with a price tag that only nurses can pay.
Leg Two: Grassroots Lobbyists
While the paid lobbyists are the ones who most commonly come to mind when thinking of lobbying efforts, the so-called grassroots lobbying can be more effective if appropriately organized and informed. Grassroots lobbyists are constituents who have the power to elect officials through their vote. When constituents have expertise and knowledge about a particular issue (such as nurses in the healthcare reform debates), they are especially valuable resources for their elected officials. While issues debated in Washington, D.C., are national in scope, members of Congress are still concerned about how the issue is perceived back home. The connections established by a nurse constituent with his/her lawmakers at the federal, state, and local levels may provide timely access and a listening ear at key points during the policymaking process
. To be effective, grassroots lobbyists must recognize that getting a law passed can take many years and entails compromise and commitment, along with an understanding of the political forces at work. In addition to employing paid lobbyists, professional nurse organizations have become increasingly aware of the strength of grassroots lobbying-seen by some as the most effective of all lobbying efforts (deVries & Vanderbilt, 1992).
The legislative process
is an evolving one, founded on compromise. Settling for part of an initiative may be the best way to eventually achieve the entire goal. Willing- ness to persevere and keep returning to the legislature year after year, if necessary, is essential. New faces are chosen at each election and the volatility of the entire political arena can result in major philosophical changes in a relatively short time.
Leg Three: The Role of Money
The final leg of the stool is the one that causes much discomfort and concern to nurses and others: money. Politics in its most primitive form is on display when considering how money influences who wins or loses an election. The amount of money that flows to and through the legislative process
has raised serious questions as to whether the whole process
is "For Sale" to whoever has the deepest pockets. Unfortunately, winning an election or re-election, even at the local level, can be a very expensive proposition
costing millions of dollars. The total spending by political parties, candidates, and issue groups for the mid-term elections in 2010 is estimated to have exceeded $4 billion-a trend that is likely to continue in light of the recent United States Supreme Court decision in Citizens United v. Federal Election Commission (2010).
Not only has the amount of money flowing to campaigns increased dramatically, the source of those dollars (who has the deep pockets) has also changed and is expected to change even more in the future. For example, American Crossroads GPS (the brain- child of Republican strategists Karl Rove and Ed Gillespie, both of whom held influential staff positions under former President George W. Bush), American Action Network, Republican Governors Association, and the Chamber of Commerce are groups based in Washington, D.C., that financed state races across the country on behalf of Republican interests in 2010. On the Democratic side, organized labor, EMILY's List, and the League of Conservation Voters continue to contribute millions to fund campaign messages (Crowley, 2010). While these groups may appear to operate independently of each other, in actuality "coordination is as easy as walking across the hall" of their shared office space (p. 31). How this evolving dynamic will affect future elections and alliances remains to be seen, but its existence cannot be ignored or under estimated.
Application: Developing a Health Advocacy Campaign (continued): Ethical Considerations
This week, you will continue to work on the Assignment begun in Week 8 as you examine the ethical issues that may arise in advocating for the policy you selected.
Before you begin, review the complete Assignment. You will combine the sections of your paper developed in Weeks 8, 9, and 10 into one cogent paper due by Day 7 of this week.
To prepare for this final portion of your paper:
• Review provisions 7, 8, and 9 of the ANA Code of Ethics in relation to advocacy for population health.
• Reflect on the ethical considerations you may need to take into account in your advocacy campaign.
• Research the ethical considerations, laws, and reporting requirements (with respect to lobbying) that are relevant to the location where your advocacy campaign will occur.
• Consider potential ethical dilemmas you might face in your campaign.
For this section of your paper (approximately 3??"4 pages in length), address the following:
• Explain any ethical dilemmas that could arise during your advocacy campaign, and how you would resolve them.
• Describe the ethics laws and reporting requirements that are applicable to your advocacy campaign.
• Evaluate the special ethical challenges that are unique to the population you are addressing.
Reminder: You will combine the sections of your paper developed in Weeks 8, 9, and 10 into one cogent paper.
Due by Day 7 of this week.
2001 Approved provisions
The ANA House of Delegates approved these nine provisions of the new Code of Ethics for Nurses at its June 30, 2001 meeting in Washington, DC. In July, 2001, the Congress of Nursing Practice and Economics voted to accept the new language of the interpretive statements resulting in a fully approved revised Code of Ethics for Nurses With Interpretive Statements.
1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
6. The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
American Nurses Association, Code of Ethics for Nurses with Interpretive Statements, © 2001 By American Nurses Association. Reprinted with Permission. All rights reserved.
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