Nurses Shape Policy with Eye on the Bedside

March 12, 2015

Leading Change: How Nursing Can Shape Health Care Policy

Think nurses can’t influence health policy, or that laws passed in Albany or Washington don’t profoundly impact what nurses do at the bedside? Think again.

It may be tempting for many nurses to focus exclusively on the job at hand, whether it’s patient care, research, or education. But the knowledge and experience nurses gain from their day-to-day work also makes them experts who are uniquely qualified to shape debate on health policy and public health.

“When nurses talk about what it really means to practice and what it really means to be at the bedside and the legislators start hearing those stories, it becomes real, it becomes potent, and it becomes something they want to work for as well,” said Sally Dreslin `94, Executive Deputy Commissioner at the New York State Department of Health.

Dreslin spoke last month at a forum sponsored by the Center for Health Policy, directed by Patricia Stone, PhD, RN, FAAN, the Centennial Professor of Health Policy at Columbia Nursing, and the Columbia University School of Nursing Alumni Association.  The forum brought together senior nursing leaders at the state and federal level to talk about what it takes for nurses to make their voices heard, and to discuss the sweeping influence laws and regulations have over the way that nurses are able to care for patients, families, and communities.

In New York State, many laws and regulations have had a significant impact on the practice environment at the bedside, Dreslin said. There is the Nurse Practitioner Modernization Act, passed last year as part of the budget, which gives experienced NPs the ability to practice independently without direct supervision from a physician. Also last year, the state passed the Safe Patient Handling Act, which will reduce injuries by helping to implement best practices for using equipment to lift, transfer, and reposition patients. Other recent state laws have banned mandatory overtime, increased penalties for violence against nurses, and encouraged innovation in the delivery of care in the commercial insurance market.

While the Affordable Care Act may come to mind as the most influential health law ever passed at the federal level, Sheila Burke, adjunct lecturer at the John F. Kennedy School of Government at Harvard University and senior public policy advisor at Baker Donelson in Washington, D.C., offered another contender: Medicare. President Lyndon B. Johnson signed Medicare into law in 1965, creating a national health insurance program for seniors that has used its role as the biggest payer of medical bills to exert far-reaching influence over how care is delivered and paid for in the U.S.

“Medicare was our first attempt to step into setting quality standards in a very dramatic way,” Burke said at the forum. “As part of that, Medicare has also had an enormous impact on nursing from the very beginning in terms of making provisions for the slow and steady and sure increase in the use of nurse practitioners.”

In the early days, Medicare forced racial desegregation at hospitals by refusing to pay for care provided at segregated hospitals, Burke said. Later on, Medicare played an instrumental role in helping to create the hospice movement by paying for palliative care. And more recently, Medicare has motivated hospitals to lower infection rates and curb readmissions – again by tying payment to improvements on these quality measures.

Many policy changes at the federal, state, and local level can be influenced for the better by nurses and other clinicians who run for public office and get directly involved in the legislative process, Burke and Dreslin said.

Stephen Ferrara, DNP, FAANP, FNP-BC, associate dean of Clinical Affairs at Columbia Nursing, offered a real-life example of how nurses can directly shape policy. As Executive Director for the Nurse Practitioner Association of New York State, he described the many years of work and compromise that went into ultimately winning passage last year of the state's NP Modernization Act.

He began by pushing what many NPs saw as the perfect bill, one with as little regulation as possible. But that languished in the legislature for about five years because there wasn't enough support to get it passed. Then Ferrara said he had to figure out a compromise. The one that passed as part of the state budget last year wasn't as sweeping as some NPs wanted, but it was something that could get through the legislature. And it worked in part because so many nurses went directly to their legislators to make the case for change, Ferrara said. The passage shows what nurses can accomplish in the policy arena when they work to make their voices heard, he added.

"Nurses make up the largest part of the health care workforce, but we are very underrepresented when it comes to Congress and the state legislatures," Ferrara said. "What boggles my mind is that almost every year the Gallup poll comes out and nurses come out on top as the most ethical and honest profession out there. We need to do more to leverage this power."