How to Get Started as a Nurse Advocate Around Key Issues Like Scope of Practice

National Council of State Boards of Nursing map of Nurse Licensure Compact states. Click to expand.

Have you ever been frustrated by a professional issue and wondered if new legislation could fix it? This happened to me as a nurse practitioner after moving to a new state.

I was young and newly married, wanting to be closer to family. I didn’t realize how drastically different each states’ Nurse Practice Act could be in terms of advanced practice registered nurse (APRN) scope of practice. My work as a psychiatric NP had been focused on child and adolescent psychiatry, but moving to Florida in 2013 hindered my ability to continue this practice. State laws did not allow advanced practice nurses to prescribe controlled substances, and the majority of attention-deficit/hyperactivity disorder medications are considered Schedule II.

Getting started as an advocate.

Ultimately, this legal restriction led to two things: my transition to adult-only practice, and learning how to be a nurse advocate. This overview was developed as an introduction to the process of impacting legislative change as an advocate for your patients and your profession.

• First, identify the level of government responsible for the changes you want. State laws, like those for APRN scope of practice or Nurse Licensure Compact, are decided by each state’s legislature. Some current examples of issues that nurse advocates are working on through federal legislative change are workplace violence, mandatory overtime, faculty shortages, workforce development, and modernizing Centers for Medicare and Medicaid Services payment systems for nursing care.
• Second, reach out to professional nursing organizations by location or by specialty to see if they are already advocating for your issue. These groups may have legislative champions who have drafted and sponsored bills. Some organizations hire lobbyists or have political action committees (PACs) to influence legislation. Nursing groups will often work together to address more complex legislative efforts; in Florida, I had joined the Coalition of Advanced Practice Nurses, which is comprised of 15 organizations to speak with “one voice” in Tallahassee. You don’t have to make changes alone! It’s likely that many nurses share your frustration and want to work together to advocate for our patients and our profession.
• Next, figure out if your elected officials can make a difference on your specific issue within the all-important committee process. To find your elected officials, visit USA.gov and enter your address. This site provides key information such as political party affiliation, contact information, and a link to your representative’s website. Visit their website to learn more about their personal histories, committee assignments, and if they hold a leadership position. Committees are where legislation is introduced, debated, and voted on before reaching the full legislative body. Support from these smaller groups is essential. Check to see if your elected officials are members of an important health care committee.
• Then begin your advocacy work by contacting your elected official. Their websites list various ways to speak with their offices, including addresses, phone numbers, fax numbers, and email addresses. Staffers respond to constituent concerns and communicate them to the elected official. Many professional nursing organizations draft forms letters and schedule a “Hill Day” in which they meet with elected officials’ staff through advocating in person. Personalized letters detailing your expertise and how a particular issue affects your/their community tend to receive more attention than form letters.
• Lastly, get to know your legislators as individuals. This often happens during campaign season by volunteering your time to help them out. Some examples of volunteer work include making phone calls (“phone banking”) or walking through neighborhoods in their district talking to constituents (“door knocking”) about the positions of this elected official as well as fundraiser events.  Being familiar with your elected official will make it easier to speak with them directly about your specific issue. They will already know your expertise as a nurse and how you provide nursing care for constituents in the district.

My experience as a nurse advocate for the last 10 years has been very positive. In Florida, it took years working together in a coalition to begin legislative change, but before I moved back to the DC metro area in 2019 we accomplished a lot: controlled substance prescribing for APRNs and physician assistants, title change from advanced registered nurse practitioner to APRN, changes to the Mental Health Act recognizing the expertise of psychiatric NPs, and movement towards “autonomous practice,” which later passed in March 2020.

Legislative change is challenging and slow, but with perseverance and collaboration, significant improvements can be made, as we did in improving access to care for an entire state.

(To listen to a podcast interview with the author of this post that was conducted by AJN senior clinical editor Christine Moffa, click here and scroll down.)

Emily Bell, MSN, RN, APRN, PMHNP-BC, been a registered nurse for 19 years and a psychiatric-mental health nurse practitioner (PMHNP) for 15 years. She has worked across the continuum of mental health care services, including inpatient, outpatient, day hospital programs, emergency department, mental health triage, and primary-care mental health integration. She has a passion for suicide prevention, teaching the next generation of mental health providers, and legislative advocacy to attain full practice authority for advanced practice nurses. Currently, she provides outpatient telepsychiatry services in Washington, D.C. and Virginia. Her most recent advocacy efforts have been moving forward legislation to recognize the expertise of PMHNPs in the District of Columbia to care for individuals suffering from a mental health crisis.

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