How to Get Started as a Nurse Advocate on Key Issues Like Scope of Practice AJN Beyond the Scale

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

Have you ever been frustrated by knowledgeable issue and wondered if recent laws could fix it? This happened to me as a nurse after moving to a brand new state.

I used to be young and recently married, and I desired to be closer to my family. I didn’t realize how drastically different Nurse Practice Act laws might be from state to state regarding the scope of practice for an Advanced Practice Nurse (APRN). My work as a psychiatric nurse focused on child and adolescent psychiatry, but moving to Florida in 2013 made it difficult for me to proceed practicing. State law didn’t allow APRNs to prescribe controlled substances, and most medications for attention deficit hyperactivity disorder are considered Schedule II drugs.

First steps as an advocate.

Ultimately, this legal restriction led to 2 things: my transition to adult-only practice and learning learn how to advocate for nursing. This review is designed to supply an introduction to the means of influencing legislative change as an advocate on your patients and your career.

• State laws, similar to those regarding APRN scope of practice or the Nurse Licensure Compact, are established by each state legislature. Some current examples of issues that nursing advocates are working to handle through changes in federal laws include workplace violence, mandatory extra time, staffing shortages, workforce development, and modernizing the Centers for Medicare and Medicaid Services payment systems for nursing care.
• These groups can have legislative advocates who’ve written and sponsored bills. Some organizations hire lobbyists or have political motion committees (PACs) to influence laws. Nurse groups often work together to handle more complex legislative actions; in Florida, I joined the Advanced Practice Nurses Coalition, which consists of 15 organizations, to talk with “one voice” in Tallahassee. You don’t must make change alone! Chances are, many nurses share your frustration and wish to work together to represent our patients and our career.
• To find your elected officials, visit USA.gov and enter your address. This page includes key information, similar to political party affiliation, contact information, and a link to your representative’s website. Visit their website to learn more about their personal stories, committee assignments, and whether or not they hold a leadership position. Committees are where laws is introduced, debated, and voted on before it reaches the total legislature. Support from these smaller groups is important. Check to see in case your elected officials are on a crucial health care committee.
• Their web sites list a wide range of ways to contact their offices, including addresses, phone numbers, fax numbers, and email addresses. Staff reply to constituent concerns and forward them to the elected official. Many nursing organizations develop forms and hold “Days on the Hill,” where they meet with staff elected officials to personally advocate on behalf of others. Personalized letters that detail your expertise and the way a specific issue affects your/their community are inclined to be more popular than form letters.
• This often happens during campaign season while you volunteer your time to assist them. Some examples of volunteer work include making phone calls (“phone banking”) or walking through neighborhoods in your district and talking to voters (“door knocking”) in regards to the elected official’s positions and fundraising events. Knowing your elected official will make it easier to confer with them directly about a particular issue. They will already be acquainted with your experience as a nurse and the way you provide nursing care to voters in your district.

My experience as a nurse advocate over the past 10 years has been very positive. In Florida, it took years of working together in a coalition to start legislative change, but by the point I returned to the DC metro area in 2019, we had completed rather a lot: prescribing controlled substances for APRNs and physician assistants, changing the title from advanced practice nurse to APRN, changes to the Mental Health Act recognizing the expertise of psychiatric nurses, and the move to “autonomous practice,” which was later passed in March 2020.

Legislative change is difficult and slow, but with persistence and collaboration, significant progress will be made, as now we have done to enhance access to health care across the state.

Emily Bell, MSN, RN, APRN, PMHNP-BC, has been a registered nurse for 19 years and a psychiatric health nurse practitioner (PMHNP) for 15 years. She has worked in a wide range of mental health care settings, including inpatient, outpatient, day care, emergency department, mental health triage, and first care integration. She is keen about suicide prevention, educating the following generation of mental health providers, and advocating for full practice licensure for advanced practice nurses. She currently provides outpatient telepsychiatry services in Washington, DC, and Virginia. Her most up-to-date advocacy efforts include introducing laws to acknowledge PMHNP competencies within the District of Columbia for the care of people experiencing a mental health crisis.