Effective Strategies for Teaching Political Advocacy Marie Lindsey, PhD, APN/CNP
ISAPN Midwest Conference October 9, 2014
U.S. Capitol
• Independent practice for APNs is a reality in only 20 states (3 of
these just passed such laws this year) and Washington, D. C.
• Despite recent successes APNs in other states struggle to
achieve independent authority—and APNs in some states do not even attempt this goal.
The Goal for APNs– Full Practice Authority
Stated Barrier #1 to Full Practice Authority
•“The medical society has a
Stated Barrier #2 to Full Practice Authority
“APNs are apathetic” and unwilling to
advocate for full practice authority.
Let me tell you a little story…
More Likely Reasons
• APNs, like most nurses, are unaware of their potential political
power and how to use it.
• APNs do not know the basics of government and lawmaking;
They do not understand their right to personally advocate for APN and other issues that they feel would make our country better.
Root of the Problem
• Many APN faculty are no more informed about politicaladvocacy than other APNs—or even the general public.
• As a result, they avoid teaching advocacy essentials and
students graduate without being prepared to influence health care policy for the benefit of patients and the profession.
Policy Courses Developed at University of St. Francis (USF) Joliet, IL
• For MSN-FNP, MSN-nursing administration, MSN-nursing education, and DNP (post-master’s nurses, not limited to APNs)
• Graduate nursing courses delivered online; Joliet is main campus, but also campus in Albuquerque, NM
• In process of limiting out-of-state students to IL, IN, IA, WI, and NM & AZ (many states have restrictions regarding out-of-state APN programs).
“Policy” Courses at University of St. Francis
• Content is similar for MSN or doctoral students.
• MSN course teaches concepts of advanced practice nursing and basics of U.S. health care system.
• Required course for all MSN students—FNP, nursing administration, or nursing education.
• Required DNP course focuses on U.S. health care system and health policy in more depth.
• Both courses – 4 semester hours; all graduate courses at USF are at least 4 SH (helps students with financial aid).
Course Assignments
• APN interviews (MSN students)• Coding assignment (MSN students)
• Nurse practice act comparison (MSN & DNP) • Visit to legislator’s office (MSN & DNP)
• Class discussions and final paper (MSN & DNP, but different topics for paper)
APN Interviews - MSN
• Interview one APN whose practice is similar to the type they are studying to become (at USF only FNP). • And one “different” APN (CNM or CRNA or CNS, not
just a different type of NP).
• Purpose: Make them aware of the range of APN practice to foster collegial relationships with all types of APNs and better explain other roles to policy makers.
Interview Questions
• Ask both APNs same questions: Why they became an APN, type of setting where they work, “typical” day, type of certification, if they have Rx authority, including controlled substances, if need supervisory or collaborative relationship with physician, if credentialed/privileged, job satisfaction, if member of any professional organization, understanding of DNP.
Coding Assignment
• Provides initial exposure to E/M-CPT coding of patient encounters. • Initiates student into the reality of being a provider rather than a staff
nurse.
• Coding site: emuniversity.com
• Tutorial (about 1 hour) & download a certificate of completion; used to be free, now is $21.99.
• Submit certificate to faculty for 5% of course grade—faculty does NOT have to grade!!!
• Reinforces “equal pay for equal work” concept as a provider.
Nurse Practice Act Comparison
• Comparison done in PowerPoint (important skill) • Compare the nurse practice act (NPA) of the statewhere they live/work with NPA of another state (faculty assigns other state).
• States should be practice “opposites” (i.e., if home state has full practice authority, compare to more restrictive state and vice versa).
NPA Assignment Value
• This assignment is often the most enlighteninginformation in the course.
• Overwhelming majority of nurses have no idea of the huge variation of APN practice across the nation. • Forces students to read their own NPA (as EVERY
nurse should do) and not rely on others in their institutions to interpret the law for them.
More About NPA Assignment Value
• Shows those in restrictive states what the goal shouldbe for all states—don’t accept the status quo. • Highlights the good fortune of those in full practice
authority states but:
– What has been giveth, could be taketh away in one way or another.
– They should aspire to help their less fortunate colleagues in other states.
NPA PowerPoint Critique
• Students randomly assigned another students’ NPA PowerPoint to critique; critique elements very simple. • Evaluate to what extent:
--Other student addressed elements of rubric --Content on slides was clear and understandable --Aesthetics enhanced delivery of content
--Presentation conformed to proper writing mechanics
Value of NPA PowerPoint Critique
• Introduce students to idea that peer review process isinherent in collegial scholarship and professional growth—that doing so is to actually HELP a colleague. • Exposes them to a third state’s NPA.
• Helps them learn to give and receive criticism graciously. • Faculty grades the quality of their critique (is it sufficiently
Visit to Legislator’s Office
• Cornerstone of empowering legislative advocacy. • Must actually visit a legislator’s office—phone calls,letters not sufficient.
• May be a state legislator or federal legislator (if you have online, out-of-state students, federal legislation is easier).
First Concept --Federal vs State
• Must learn difference between Congressional/federallegislators (ones who work in Washington) vs those who work in General Assembly (state capital). • Must learn which legislators to approach based on
type of issues (e.g. Medicare is federal law, so contact Congressional members; practice acts are state law, so contact General Assembly members).
Visit Legislator’s Office
• Apprised that they may have to meet with the legislator’s assistant (especially if federal legislator) – that’s OK. • Apprised that making an appointment might be time-consuming (especially if federal legislator), so need to start appointment-making process early in course. • Students in same legislative district may go together. • Urged to NOT say they are students and this is a course
Topics for Legislative Visit
• Faculty assigns the topic to discuss with lots ofbackground information.
• Usually limit to one topic and visit only one legislator:
– If there is a current “hot’ state issue (e.g., practice act), that should be the topic.
– If no hot state topic or if program is online with students from several states, the home health issue works for everyone.
Post-Visit Assignments
• Write a simple summary and thank-you note (even if visited withother students, must write own summary and note). • Summary questions: Was legislator/assistant:
-- knowledgeable about APN pratice and topic or at least willing to become informed
-- willing to express legislator’s support or opposition -- cordial vs merely civil; helpful vs confrontational; informative about political process
Final Paper – Summary of Course Content
• MSN Course– Beginning of course: Students describe their own hypothetical (imaginery) health system that will be adding APNs to its workforce for the first time. Student is the “project manager” for this system initiative.
– Each week: They discuss topics learned in readings, videos, etc.,in terms of what the health system must consider when hiring APNs.
• DNP Course
– Beginning of course: Students envision “ideal” health care system for U.S. and revise it as they learn more about the realities of the current system, as well as systems in other countries.
Final Paper Elements - MSN
• Each week of class students learn about and discuss APN practice (effective use of each type of APN [and possiblyPAs], laws/regulations, ethical issues, quality/performance assessment, liability/risk management, certification, marketing strategies, credentialing/privileging, reimbursement, future in terms of Affordable Care Act, etc.)—as would apply to their
hypothetical health system (this makes topics “come alive”). • End of course: They write a paper that succinctly summarizes the weekly
discussion topics/assignments; is formatted as a proposal for senior leadership outlining the issues related to incorporating APN practice into the organization.
Final Paper - MSN
• Helps reinforce and pull together course concepts. • Is appropriate for all students regardless of area of
concentration so that as graduates they will understand and can market the APN role whether they are clinicians or administrators or educators.
Final Discussion Topic - DNP
• Students re-state and summarize their vision of the idealhealth care system for the United States, incorporating what they have read, media they have viewed, and information learned from faculty and fellow students. • Again, this course-long effort is appropriate regardless of
the student’s prior preparation as an APN, administrator, or educator.
References for MSN Course
• Buppert, C. (2015). Nurse practitioner’s business practice and legal guide (5th ed.). Burlington, MA: Jones and Bartlett.
• Jansen, M. P. & Zywgart-Stauffacher, M. (Eds.). (2010). Advanced practice
nursing: Core concepts for professional role development. New York, NY: Springer.
• Kovner, A. R. & Knickman, J.R. (Eds.). Jonas’& Kovner’s health care
delivery in the United States(10thed.). New York, NY: Springer.
• Nagelkerk, J. (Ed.). (2006). Starting your practice: A survival guide for
nurse practitioners.St. Louis, MO: Mosby Elsevier.
• Articles: Barbara Safriet, IOM, NCSBN, Josiah Macy, Newhouse et al.
Textbooks for DNP Course
• Kovner, A. R. & Knickman, J.R. (Eds.). Jonas’& Kovner’s health care delivery in the United States(10thed.). New York, NY: Springer. (Same
as MSN, DNP students read more chapters) • Milstead, J. A. (2013). Health policy and politics: A
nurse’s guide (4thed.). Burlington, MA: Jones &
Bartlett. (2016 edition coming out in December)
Final Plea
Our profession is completely dependent on our political advocacy. We ALL must know who our Congressional (federal) and state legislators are and visit them often. We must know which issues to take to which legislators. And we must impel our students to do the same. Our profession can go backwards—yes, it really can—if we abdicate our individual professional responsibility.
