Nurses as advocates: 4 big health policy issues you can impact now

In this webinar, Mandi Cafasso, DNP, APRN, CNP, assistant professor and interim director of UC's Doctor of Nursing Practice programs, discusses the role of the nurse advocate, how nurses can influence health policy issues, and why nurses should be more involved in these efforts.

Advocacy is "the act of defending or arguing in favor of something such as a cause, idea, or policy and is therefore a way to train citizens and professionals to be agents of change and nurture the desire of making a difference."

The concept of health care advocacy has been part of the nursing profession for nearly a century. The American Nurses Association first included advocacy recommendations in its 1926 version of the Code of Ethics. Today, the code stipulates, in part, that nurses take action to influence leaders, legislators, governmental and non-governmental agencies, and all areas related to health affairs that impact social determinants of health. It also discusses the important role nurses play in advocating for the profession as policies are developed.

In addition, the American Academy of Colleges of Nursing’s Essentials, which define the expected curriculum and competencies for nursing education at all levels, include domains, or subject areas, many of which speak to nurses’ role as advocates.

Across the U.S., nursing is the largest segment of health care providers, with over three million registered nurses actively employed. If only 10% of those nurses were actively involved in policy, their impact would be enormous, says Cafasso.

The health care landscape continuously changes, but three big issues persist:

• Health care access
• Scope of practice
• Health care cost

A fourth issue, the opioid epidemic, is another problem lawmakers, especially those in Ohio, have continuously targeted with new legislation.

Health care access

In the past few years, Ohio lawmakers introduced legislation tied to care access, including House Bill 221 or the Better Access, Better Care Act; House Bill 45, related to COVID relief; and Senate Bill 3, related to the nationwide Nurse Licensure Compact.

The Better Access, Better Care Act would, in part, allow a certified nurse practitioner, clinical nurse specialist or certified nurse midwife the option to practice without a standard care arrangement and collaborating practitioner if the advanced practice registered nurse (APRN) has practiced in a clinical setting for the longer of 2,000 hours or 12 months.

House Bill 45 was signed into law and designated funds for nursing homes, rural hospitals, Medicaid providers, crisis care infrastructure and much more. Sentate Bill 3 was also signed into law and made Ohio the 39th state to enter the Nurse Licensure Compact, which standardizes licensure requirements across states so nurses can practice in multiple states without the need to obtain licensure in each.

Scope of practice

Ohio lawmakers have also introduced bills that would expand health professionals' scope of practice, or the services those professionals are authorized to perform under their license, registration or certification. Two examples:

• House Bill 318 would allow supervised anesthesiology assistants to develop and implement anesthesia care plans, including induction, maintenance and emergence care; perform epidurals; clear for surgery; and consent for procedures.
• House Bill 496 would expand certified professional midwife practice scope to allow delivery of breached twins and vaginal birth after c-section at home and permit these practitioners to care for families for six to eight weeks after child delivery.

Cafasso says these bills raise concerns about patient safety, especially among Certified Registered Nurse Anesthetists (CRNAs) and Certified Nurse Midwives.

A boost for nurses, House Bill 138 was signed into law and included a provision to allow emergency medical service personnel to follow do not resuscitate (DNR) orders written by APRNs.

"There are many restrictions in health care policy regarding who can sign forms or authorize certain things to be done," Cafasso says, so legislators hope to introduce a bill during this general assembly term for global signature authority to allow APRNs to sign or complete forms for patient care within their practice scope.

Health care cost

A couple examples of bills introduced in Ohio that would impact health care cost:

• House Bill 135 would require all co-payments made by patients to count toward their insurance deductable.
• House Bill 608 would require insurance plans and Medicaid to cover biomarker testing as a means of preventative screening for certain cancers.
  

"A significant number of people are avoiding health care based on cost, which is another thing we need to develop policies for to help people access care when they need it," Cafasso says.

Opioid epidemic

In addition, the opioid epidemic continues to impact care delivery in Ohio, and health care advocacy played a role in recent progress toward preventing overdose deaths.

In 2022, the Ohio Department of Mental Health and Addiction Services, in collaboration with Recovery Ohio and the Ohio Department of Health, announced they would rapidly deploy 60,000 doses of naloxone to targeted communities in Ohio, which has the second-highest rate of opioid-related overdose deaths in the U.S.

"This was a result of grassroots advocacy by those passionate about the need to change and correct the care that was provided to these patients," Cafasso says.

In December 2022, Ohio's governor signed into law Senate Bill 288, which legalized fentanyl test strips and expanded protections for persons with drug use or abuse disorders who call 9-1-1.

Ohio's 135th General Assembly began in January, and we are likely to see more bills related to scope of practice, access to care and health care cost, Cafasso says. In addition, the rapid health policy changes made in the early days of the pandemic have served as a trial for what could become more permanent changes in the future.

Ready to get involved in health care policy? Here are ways you can get started:

• Look up and track legislation on LegiScan.com (free).
  
• Join a national nursing organization, such as the American Association of Nurses, American Association of Nurse Practitioners or the American Academy of Nursing.
• Attend Ohio Nurses Day at the Statehouse (NDASH), organized by the Ohio Nurses Association.
  
• Contribute to a political action committee.