Running Head: NURSING AND POLITICS

Issue Analysis of Nursing within the Legislative Process and Politics

Andrew Smith
Ferris State University

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Abstract
This paper highlights several research articles and their relevance with nurses advocating in the
legislative arena. A brief discussion of a relevant nursing theory and a non-nursing theory as they
apply to the legislative process. A thorough assessment of the healthcare environment and the
related resources and policies that nurses can obtain will also be attained. The implications
involved with the lack of nurses in the legislative process will then be examined and then
concluded with recommendations to approve the safety and quality of the nursing practice with
the aid of ANA Scopes and Standards of Practice and the QSEN KSA competencies.
Keywords: politics, legislation, nursing, healthcare, ANA, QSEN

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Issue Analysis of Nursing and the Legislative Process

The roles involved with being a nurse continue to grow however the primary role
continues to be that of an advocate. This includes being an advocate for the patient in the clinical
setting, but also being an advocate for the patient and our profession by impacting public policy
in the community and the legislative arena. According to Gonzalez and Maryland (2012),
advocacy involves persuading someone to consider and understand the viewpoint of another
individual. Nurses can advocate on the local, state, national, or even global level of politics.
From attending school board meetings, speaking with state officials, lobbying congressman, or
even participating within the International Council of Nurses, nurses have countless
opportunities to get involved and make an impact.
These movements arent usually done by a single individual though. Through the
involvement of nursing organizations such as the American Nurses Association (ANA), nurses
can gather and advocate with hundreds to thousands of voices on a large scale. Even today
nurses are heavily involved in the political and legislative scene, but the number can still grow.
Currently there are six nurses serving on Congress split between the House of Representatives
and the Senate. The political scene is also starting to ramp up as the 2016 election process
begins. Currently numerous possible candidates have been announced including Hillary Clinton
(Democrat) and Rand Paul (Republican). Both of these candidates will have a healthcare agenda
and the votes of nurses and other citizens will decide the fate of the United States (US)
healthcare policy. The purpose of this paper will be to discuss the issues of nurses involved in
politics and analyze the lack of involvement of nurses in the legislative process.

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Theory Base
Nursing Theory
Nursing is a discipline of theories and a relevant nursing theory to this topic would be
Block and Jostens Ethical Theory of Population Focused Nursing (2001). This theory is focused
on the mixing of public health and policy with nursing practice (Allender & Spradely, 2001). It
relates to the legislative process in how nurses can advocate within this unique setting to prevent
adverse health outcomes on a large scale, advocate for the health of all populations, and
implement effective policies and programs that promote health and healthy behaviors. Nurses
have been involved in advocacy and policy changing from the days of Florence Nightingale
(Gonzalez & Maryland, 2012), and this hasnt changed even till today.
Political Science Theory
While nursing is a discipline of theories, it is also a discipline involving collaboration and
the use of interdisciplinary practice. The Public, or Social, Choice theory from the political
science discipline is based on the concepts from Condorcet and Kenneth Arrow. This theory is
mostly focused on the study of political behavior (Social Choice Theory, n.d.), and this can be
applied to the concepts of special interest groups, lobbying, and political action committees
(PACs). Special interest groups are small groups within an organization such as the ANA that are
intent on advancing the cause and awareness of current issues involved with nursing such as
nursing retention and healthcare reform. The concept of lobbying is focused on influencing the
decision making of political officials to side with a certain stance or opinion. For example the
ANA could lobby for a politician to campaign for specific legislation that benefits the profession

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of nursing and patient care. Finally, PACs are organizations within larger organizations, such as
the ANA-PAC, where members pool their campaign contributions and donations to fund
campaigns that are either for or against candidates or legislation. PACs have a major influence
during election season due to there major financial contributions and the sway that they can have
regarding candidates and voting patterns.
Policy changes impact the entire healthcare system and can also be viewed from the
interdisciplinary perspective. Every facility, from a hospital to insurance company, every
employee, and every patient is impacted. These policy changes can be either small or large and
the impact seen can vary as well. This most recently can be seen with the passage of the Patient
Protection and Affordable Care Act (ACA) that had major influences with healthcare reform.
While the ACA was signed in 2010 by President Barack Obama it didnt go into until 2014 and
some results have yet to still occur until as late as 2016. On a collaboration and compliance
approach, the ACA (2010) forced individuals and facilities to change their own policies and
procedures in order to comply with the new laws and avoid the fees and consequences involved
with breaking them.
Healthcare Environment
The legislative setting is one of unknown and possible fear to many nurses contemplating
entering it. This new healthcare setting, to some nurses, needs to be introduced to see what
policies, resources, and safety/quality issues may be involved with it. Nurses can have major
influence into the formulation and creation of new bills and laws. But many nurses may not even
know how a bill is introduced and ultimately made a new law. Gonzalez and Maryland (2012)
provide a brief synopsis of this complicated process in that an individual, such as a nurse,
addresses a certain problem or issue, for example safe staffing levels. The nurse then

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communicates that concern via a phone call, email, or personal meeting to their local legislator.
That legislator then develops the bill and introduces it. The bill is then sent to either the House of
Representatives or the Senate for deliberation. If needed, it is then reviewed by a Committee
where a public hearing or testimony is needed. Nurses are often involved in this step because
they can offer their expertise and background with evidence-based practice to provide factual
information that may be required for a bill move further through the system. Following this there
is then voting in the other chamber. With the bill passing in both Chambers the bill is sent to
either the Governor or President for their signature to make it a law. It doesnt technically end
there because a law can always be repealed or vetoed and then the whole process starts anew.
There are countless resources available for nurses to learn about the legislative process
from finding who their local congress representative is, joining nursing organizations, and
learning about relevant issue affecting nursing today. Contacting their local congress
representative is one of the best options for a nurse to learn about the legislative process and to
voice their concerns about problems and issues affecting them. With this in mind some nurses
may not know how to contact or even know who their congress representative may be. Nurses
can go to the House of Representatives website (www.house.gov/representatives/find/) and enter
in their zip code to discover their congressional district and who their representing member is.
The website also provides hyperlinks to the congressional members personal website where you
can learn their background, stances, and other relevant information.
Advocating in the legislative arena is often done on the large scale and usually requires
the use of professional nursing organizations. Table 1 highlights a few examples of nursing
organizations and a small description of them.

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Table 1. Examples and descriptions of nursing organizations

The American Nurses Association (ANA) is
the only full-service professional organization
representing the interests of the nation's 3.1
million registered nurses through its
constituent and state nurses associations and
its organizational affiliates. The ANA
American Nurses Association (ANA)

advances the nursing profession by fostering

high standards of nursing practice, promoting
the rights of nurses in the workplace,
projecting a positive and realistic view of
nursing, and by lobbying the Congress and
regulatory agencies on health care issues
affecting nurses and the public (ANA, 2015).
Operated by nurses and leading nurses
internationally, ICN works to ensure quality
nursing care for all, sound health policies
globally, the advancement of nursing

International Council of Nurses (ICN)

knowledge, and the presence worldwide of a
respected nursing profession and a competent
and satisfied nursing workforce. Its mission is
to represent nursing world-wide, advancing

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the profession, and influencing health policy

(ICN, 2011).
With 2,100 members, the Academy serves
the public and the nursing profession by
American Academy of Nursing (AAN)

advancing health policy and practice through

the generation, synthesis, and dissemination
of nursing knowledge (AAN, 2015).
With a membership of 60,000 nationwide,
the National Student Nurses' Association
mentors the professional development of
future registered nurses and facilitates their

National Student Nurses Association (NSNA)

entrance into the profession by providing
educational resources, leadership
opportunities, and career guidance (NSNA,
2015).

These 4 nursing organizations are just a small example of the hundreds of other
professional organizations that are available nationally and globally for nurses to get involved
with other like-minded professionals. The ANA also keeps a list of the current issues that affect
nursing practice for both registered nurses and advanced practicing nurses. Some of these issues
include safe staffing levels, safe patient handling and mobility, home health, health reform, and
nursing workforce development. When nurses stay informed about these issues they are able to
utilize evidenced-based practice and use that background to inform others about how these could
affect patient care and the nursing profession.

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Implications and Consequences

The lack of nurses involved in the legislative process is a patient safety and quality of
care issue. The basis for safety and quality issues starts with policy making. The decisions that
politicians make can directly impact patient care, the nursing profession, or even the entire
healthcare system as seen with the recent passage of the ACA. Other legislation has been passed
in the past that has benefited patient care and the profession. One such example includes the
Nurse Training Act of 1964 that was signed in 1964 to increase the nursing workforce to lower
critical shortages and in the long run improve patient care. The previous iteration of this bill was
signed in 1943 due to World War Two and the returning veterans needing nursing care.
The ANA, as shown above, states that healthcare reform continues to be an issue
impacting nursing care even with the recent passage of the ACA. One of the main goals of the
ACA (2010) is to increase patient safety by lowering the uninsured rate and by decreasing
healthcare costs across the whole spectrum.
One of the primary consequences of nurses not getting involved and advocating in the
legislative process is that political apathy can set in. This quote by Trossman (2011) summarizes
the concept of political apathy: Our country (the United States) suffers from political
apathy.many people complain about things but never take steps to change them. They would
rather be victim-oriented. But everyone has an individual responsibility to become informed on
issues at the local, state, and national levels. Knowing what is going on allows individuals to
advocate for the changes they desire. Political apathy can be viewed similarly to a victim
complex and the nurses desire to want to change things will continue to wane as the apathy sets
in and this does not benefit the nursing profession.

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Recommendations for Improvement

Processes can always be improved and in the case of nurses in the legislative process, it is
to impact and benefit patient safety and quality care. Nurses should first register to vote in their
congressional district so they are able to vote in important elections and on legislation that could
impact the nursing profession. Listed above were a few examples of key issues that are affecting
nursing practice and nurses need to find that issue that they are passionate and want to see
changed. Joining like-minded colleagues and organizations allows a nurse to become involved
with issues and participate on a large scale from volunteering to even campaigning for a specific
cause. Along with nurses becoming familiar and educated about relevant issue, nurses need to
start conversations and debates to promote learning with other professionals, colleagues, and
citizens. Starting these conversations allows for the spread of information and while that
information could possibly be construed and interpreted the wrong way, that is where the
informed nurse can offer their expertise and influence beliefs and policy
ANA Standards of Practice
The ANA created the Scopes and Standards of Practice (2010) for nurses to inform their
thinking and decision-making, and guide their practice (p. 7). This document is comprised of 16
standards of practice that comprises the expectations set forth by the ANA for the roles of the
professional nurse. These standards can be applied to any healthcare setting and situation and
that includes the legislative setting. Standard seven, ethics, is focused on the professional nurse
performing in an ethical manner. This standard relates to the legislative process in that nurses

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need to advocate for equitable healthcare consumer care. An example of this would be with the
Affordable Care Act (2010) and how it makes healthcare and insurance more accessible and less
costly for those populations that cannot afford it. Some examples of the provisions set forth by
the ACA (2010) is that it ends pre-existing condition exclusions for children, covers preventative
care, and keeps adults covered on their parents plans up to the age of 26. This is just a few
examples of the hundreds of regulations set forth by the US government with the assistance of
nurses, nursing organizations, and thousands of other healthcare workers and organizations all
advocating for one cause. Standard 10, quality of practice, as it pertains to the legislative process,
is how the professional nurse develops or implements policies, procedures, or guidelines to
improve the quality of our practice. In the legislative arena, nurses can assist with the
formulation of new policies and laws by providing their expertise and educational background.
Finally, the final standard, leadership, is when the professional nurse participates in professional
organizations, such as the ANA, and participates in efforts to influence healthcare policies.
QSEN Competencies
Knowledge, skill, and attitudes (KSAs) need to be completed by all nurses to adequately
provide safe and quality patient care. The QSEN competencies (2015) encompass these KSAs
and how they relate to nursing and the legislative process. The first component, patient centered
care, is how the nurses main goal when it comes to making a new law is how it will impact the
patient and if their best interest is at heart. For teamwork and collaboration, nurses need to
assemble and collaborate with other nurses so that while one voice may not be heard, a group of
hundreds to thousands of voices can be heard on the legislative stage and create change
(Tomajan, 2012). In the same regards to continuing education credits, nurses need to ensure they
stay informed with the key issues and make sure that evidence based practice is applied so the

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latest information and research can be applied to their policy and stance. Policy change is all
about quality improvement and how an individual may not agree with the current situation or
policy and they want to change it and improve its quality. This can be seen with passage of the
Needle-Stick Safety and Prevention Act of 2000. This law, passed following the advocating of
nurses and the ANA, required employers to use safe work practice controls and safer needle
devices to keep healthcare workers safer and prevent contamination with blood-borne pathogens.
Along those lines is the safety improvement KSA. With new policies we want to ensure that the
change will increase the patients safety more efficiently and not make them less safe in the long
run. Finally, informatics is focused on the use of technology and information to impact patient
care. In the technology driven world of today there are hundreds of resources available online for
nurses to learn about how to get involved and advocate in the legislative arena. Table 2
highlights a few examples and descriptions.
Table 2. Online Resources for Nurses
Official website for the United States House of
House.gov

Representatives. Find a local representative and

discover legislative activity.
Official political advocacy website for the
American Nurses Association. Learn about how to

RNaction.org
get involved in politics, relevant issues affecting
nurses, and information on the ANA-PAC.
Provides suggestions and tips on how to enter
nursetogether.com

politics, on any scale, and how to make a

difference on any level (Morales, 2012).

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Official website for The White House. Features

Whitehouse.gov

information and education on relevant issues

including healthcare reform.

Conclusion
The legislative arena provides nurses a unique setting to advocate for safe and quality
patient care on the local, state, national, or even global level. Currently there are a lack of nurses
involved in the legislative process and this could be attributed to political apathy, dedication and
time restraints related to their family, or fear of the unknown setting. An assessment of the
healthcare environment, in this case, the legislative arena, includes learning about how bills are
introduced and the outcome of making them a law. Relevant nursing organizations such as the
ANA or NSNA were discussed and analyzed to discover opportunities within each organization
to join and get involved in politics. With this knowledge and resources at their disposal, nurses
throughout the world can impact policy and advocate for equal, safe, and quality patient care.

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References
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Philidelphia, PA: Lippincott Williams & Wilkins
American Academy of Nurses. (2015). About the academy. Retrieved April 19, 2015 from
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American Nurses Association. (2015). NursingWorld. Available: www.nursingworld.org/.
American Nurses Association. (2010). Scopes and standards of practice: second edition. Silver
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Benton, D. (2012). Advocating globally to shape policy and strengthen nursings influence. The
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Gonzalez, R.I., Maryland, M.A. (2012). Patient advocacy in the community and legislative
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10.3912/OJIN.Vol17No01Man02
International Council of Nurses. (2010). Promoting health: an advocacy guide for healthcare
professionals. Geneva, CH: World Health Communication Associates Ltd.
International Council of Nurses. (2015) About ICN. Retrieved April 19, 2015 from
www.icn.ch/about-icn/about-icn/.

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Matthews, J. H. (2012). Role of professional organizations in advocating for the nursing

profession. The Online Journal of Issues in Nursing, 17(1). doi:
10.3912/OJIN.Vol17No01Man03
Morales, K. (2012). Politics and nursing: Get involved. Retrieved from
http://www.nursetogether.com/politics-and-nursing-get-involved
National Student Nurses Association. (2015). About us. Retrieved April 19, 2015 from
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Patient Protection and Affordable Care Act, 42 U.S.C. 18801 (2010)
QSEN Institute. (2015). Pre-licensure KSAs. Retrieved April 20, 2015 from
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Social Choice Theory. (n.d.). In Stanford Encyclopedia of Philosophy online. Retrieved from
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Nursing, 17(1). doi: 10.3912/OJIN.Vol17No01Man04
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