It’s 10:30 p.m. and you’re getting ready to go home after a very busy shift in a medical unit. You spot your supervisor heading over to you with that dreaded clipboard. The nurse on the next shift has called in sick again and you’re being mandated to work overtime for the third time this week! “I’m so tired!” you think, “How can they do this to me again?” You know that you cannot safely practice for another shift. You tell your supervisor that you heard a law that prohibits mandatory overtime was passed last year and you thought that you couldn’t be mandated. Your supervisor states “This is an emergency and you’ll have to stay.” She also tells you that you’ll be charged with patient abandonment if you leave.

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Last year, at a staff meeting, you spoke out against the understaffing and the skill mix of the staff on your unit, complaining that patients weren't getting the care they deserve and you feel nervous that you'll make a mistake because of hurrying so much all the time. Your supervisor had some difficulty providing sound justifications for the facility's staffing policies; then she attacked you directly about your time management skills. Since then, you've had your days off denied and you have had to float to other units. You just know you're being targeted because you spoke out.

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You've just moved from Oregon, back to your hometown in New York State, to care for aging and ill parents. As a nurse practitioner in Oregon, you had your own thriving practice, authorized by that state to provide health care without collaboration or supervision from a physician. You've just reviewed information from the New York State Education Department Web site and you're worried now that you won't be able to establish a practice here, since you do not know any physicians with whom to collaborate.

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You are a home care nurse who has to discharge a patient today because she is no longer covered by insurance and the family cannot afford to pay for the care out of pocket. You think she might do fairly well, with the help of family, but you know that she could benefit from several more visits. As you walk back to your car, you feel helpless and angry.

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Have you or your colleagues experienced these or similar circumstances? What do these scenarios have in common? Would you guess that what is common among the scenarios is the opportunity for political action and legislative activity?

Does the mandatory overtime law, effective July 2009 in New York State, cover the nurse in the first scenario? What are the emergent situations that the Department of Labor has determined an employer can mandate for? What can the nurse do in this situation? Could she really be charged with patient abandonment in that situation?

Would staffing ratio legislation help the nurse in the second scenario? Does this nurse know that the New York State Nurses Association helped to enact Whistleblower Protection legislation in 2003? What recourse does she have right now?

The Nurse Practice Act defines the profession of nursing, including nurse practitioners. In New York State, according to Education Law 140, nurse practitioners must have a collaborative agreement with a physician in order to practice. This may not be the case in other states. In some states, nurse practitioners can practice entirely independently; in others, they must have a supervisory relationship with a physician. Does knowing the details of the Nurse Practice Act in New York State have an impact on the nurse practitioner who has just moved from Oregon?

In the last scenario, would that nurse feel any less helpless if she began advocating for universal health coverage?

Ok, so you see the connection. As nurses, our practice is set by the laws and regulations of the state in which we are licensed. Furthermore, health care is impacted—continuously—by the legislative process. Changes in funding, among other factors, directly impact the quality and availability of health care. The legislative process is directly impacted by those who are elected into those roles. So clearly, political processes impact on legislative processes, and as stated previously, legislative processes impact on health care. All of the changes that occur in health care will impact on the profession of nursing and thus the lives of nurses in that state, or country in the case of a federal law.

This course will help the nurse to learn about the process of lobbying, that is, the process of influencing decision makers who impact our professional lives, as well as our personal lives as consumers of health care. Nurses can increase their power first by adding to what we know about healthcare policies and proposals, and then by communicating our knowledge, concerns and stories to lawmakers in an effort to impact the legislative process. Examples throughout this course will be based on New York State.

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