My patients invited me into their homes, where I observed the forces that shaped their lives and health — things like stress, neighborhood safety, access to food, social support, education level and whether they had health insurance. I witnessed, as nurses do every day, how people’s environment tremendously affected their health, and how the kind of insurance my patients had, or lacked, played a significant role in the care that I could — or couldn’t — provide.
Nursing is a challenging profession, yet even as I got caught up in the details of the many things nurses do, I wondered about the powerful social and environmental factors that contributed to the health of the people I saw. I realized that as a nurse if I could influence those factors through policy — the regulations created as solutions to problems — I could affect thousands of people or more.
My career since then as a nurse involved in public policy has been rich and varied. I’ve held leadership positions in state government and co-lead a center for state health policy. I’ve taught, and conducted research. I lead AARP’s Public Policy Institute and serve as the chief strategist at its Center to Champion Nursing in America, where I help lead the Future of Nursing: Campaign for Action, a national initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation that is working to build healthier communities through nursing. CCNA is an initiative of those same three organizations.
While my curiosity drove me to shift direction in my nursing career, such a change isn’t for everyone. Nurses are needed in direct care and in communities more than ever. But I believe this: What makes for more powerful nursing is at least being aware of how policy rulings can affect you and the people you care for.
Public policy’s impact
Public policy can mean the difference between someone having health insurance or not. It affects the type of care that a person can get and whether or not the care they receive is covered by their insurance. It affects the cost of prescription drugs, copays, deductibles and covered services. And as nurses, it has a tremendous influence on our working environment.
Public policy affects how and where nurses can practice and what we can do. In 29 states, nurse practitioners cannot practice to the full extent of their education and training because of outdated legal hurdles. Nurse practitioners in these states face barriers such as being required to find a physician to supervise them (often at great cost) in order to diagnose, treat and prescribe medications to their patients, even though nurses in other states can practice without these restrictions. At CCNA, we are working to remove these barriers. Since 2010, we’ve helped to change laws in nine states so that these advanced practice nurses can provide full care.
All of us were drawn to nursing because we want to help people. And because policy affects us all, knowing what’s happening in the world around you is one way to get involved. Being an informed nurse and citizen gives you insight and understanding of the world, and how and why decisions are made. It allows you to make connections and have conversations you might not ordinarily have. It also makes you knowledgeable in work and life.
So how do you get there? Pay attention to current events — especially the politics of healthcare, vote attend professional conferences, join a state or national nursing organization, and consider joining your state’s Campaign for Action state affiliate. These experiences might even lead you to a leadership position.
As nurses, we understand the healthcare needs of individuals, families and communities. But when nurses take a broad view and understand the greater influences at work, it helps us as a profession be a more effective force in improving the health of our nation.