Capitol Clout
Nurse lobbyists make the most of their position as trusted health care professionals to bend the ear of lawmakers, advocating for both RNs and patients

By Gerilyn Herold, MSN, RN
November 11, 2003

Rose Gonzalez, MPS, RN, director of government affairs for the American Nurses Association, was stunned by being ushered to the front of a line that stretched down a hallway in Washington, D.C. Awaiting their turn to enter a small room, Gonzalez and other health care lobbyists were hoping to gain access to "markups" on an appropriations bill. During a break, a congressman spied Gonzalez in line and escorted her past the jealous eyes of her colleagues.

"A markup is when the legislators take a bill and are making changes in committee," Gonzalez said. "You try to see if your little piece is in or out."

Once the bill is marked up, it goes forward to be voted on. "This particular bill incorporated funding for [nursing] education," Gonzalez said. "I was very interested to hear whether they were going to change it or give nursing some special emphasis."

Gonzalez, who said she was "pleasantly surprised" to be given first-class treatment, was reaping the fruits of her labor. Her good fortune that day was a result of many hours of just doing her job.

"I had been working very closely with the legislator and his staff, so he just spotted me in the crowd and said, 'Why don't you come with me?' she said. "My job as a lobbyist is really about educating people and building relationships."

How respected are nurses on Capitol Hill? "Our word is what makes the difference," Gonzalez said. "We know that nurses are trusted. We take that with us when we lobby. We're committed to the issues that we move on and we're truly respected on Capitol Hill."

Gonzalez said recently in The Hill newspaper that legislators ranked the ANA No.17 out of 171 influential groups on health policy, a prestigious ranking, especially when compared to organizations with much greater resources, such as the American Medical Association.

Legislation education

Tricia Hunter, MN, RN, executive director and lobbyist for the American Nurses Association\ California, expanded on the need for educating political leaders.

"A bill can impact whether our patients have access to their practitioner or get a certain medication. A bill impacts whether a patient gets a cardiac cath, dental hygiene or a hearing aid. It becomes imperative that we're talking to legislators because they often don't know much about health care," Hunter said.

Hunter knows firsthand the importance of educating legislators. Twelve years ago, she was elected and served as an assemblywoman for California.

While serving in the Assembly, Hunter introduced legislation that licensed perfusionists, who run heart-lung bypass machines during cardiac surgery. Because Hunter, a former operating room nurse, led the legislation, the bill flew through both houses with consent. After the bill passed, "13 legislators came back and asked me what a perfusionist was and one even asked why we were licensing percussionists," Hunter said, laughing.

"My point is," Hunter said, "there's no way a legislator can be informed on all the issues that come into the Assembly and Senate. You're only going to know as much about the bill you're voting on as someone who cares about that legislation takes the time to let you know," Hunter said.

That all-important "someone" could be a nurse lobbyist, or nurses who have contacted their legislators. "When we go up on the Hill and talk to legislators, it helps us [the ANA] a lot when the legislators say we've heard from the nurses," Gonzalez said, because legislators are entrusted to respect the wishes of their constituents.

To encourage nurses to participate in the legislative process, Gonzalez said that the ANA keeps its Web site up to date with federal bill information. The state associations also track pending legislation on their sites.

For ANA members who would like to be even more involved, they can join N-STAT (Nurses Strategic Action Team) and receive weekly in-depth reports for the purpose of contacting legislators.

Building bridges

Although educating legislators and nurses is a major part of the lobbyist's job, it's also about "relationships and information," said Lydia Bourne, MA, RN, legislative advocate for the ANA\ C. "Strong relationships with the legislators, their staff and other lobbyists are really the key," she said. "This is how you share information, this is how you stay on top of things."

Gaining and sharing information provide muscle to the work of a lobbyist. To stay up to date, lobbyists have to keep their ear to the ground and "watch, look and listen," said Nancy Sharp, MSN, RN, legislative consultant for the American Nephrology Nurses'Association.

Sharp said some days she feels a little like Columbo, the TV detective from the '70s. "He'd be asking a witness questions, then get to the door and come back and say, now, what about this, what about that ... He had a nice way about trying to get more information."

In politics, information equals power. "You've got to get your network going," Sharp said. In her job, colleagues are expected to call colleagues and say, "Hey, I was on the Hill today, did you hear about …?"

Sharp said that as a lobbyist, "You're just moving and jiving and going around and keeping up."

In her "lobbying shop" at the ANA, Gonzalez said she and her staff have C-SPAN, cable television where they can view the proceedings of the day. "If we can't be on the Hill, we can monitor what's happening," she said.

One day while Gonzalez and her staff were working at the office writing letters of support, the ANA was misquoted by a legislator on the House floor. "We heard it," Gonzales said, "so we faxed something to someone else who was going to speak."

When the next legislator got up, he corrected the error and said, "This is what the ANA believes. I have a letter right here in my hand."

Gonzalez emphasizes that such quick turnaround of information rarely happens, but it resulted in plenty of high-fives among the staff.

In Washington, lobbyists frequently work in coalitions to move legislation. Sharp said when she visits legislators "on the Hill," most will ask who else is for or against a piece of legislation. "If you say these 30 or 40 organizations have signed on, they're relieved. It saves them time rather than hearing from each individual group."

Gonzalez said that the federal level, compared to the state level, can be more challenging because there are many more stakeholders, making the work more complex.

At the state level, some of the work is done in coalitions, but not as often. "It's friendlier," Sharp said. "When you [lobby in] Washington, you have to have an appointment and then it's usually with the health staff for that legislator. Lots of other people are calling, too."

Sharp said when she wants to speak to her own state legislator in Maryland, she can sometimes just knock on the door and go in. "It's more casual," she said.

When lobbyists aren't speaking with legislators or networking, they often are busy with giving testimony or arranging testimony for hearings. Both on the federal and state level, hearings occur when a proposed bill is passing through legislative committees. Hearings also can be used to gather in-depth information about an issue.

For hearings, "you think about who you want as your witnesses," Sharp said. "Sometimes, you write the verbal testimony for your witness" because in a bill hearing they have only two minutes to speak. "They have to talk succinctly, everything moves really fast."

The testimony has to build to make critical points and each new witness needs to say something that hasn't been said, Bourne said.

Human face

The opinion of experts is welcome in hearings. But sometimes the greatest power to persuade comes from the stories of the nurses themselves.

Gonzalez spoke proudly of Karen Daley, MPH, RN, who gave compelling testimony to get the Needlestick Safety and Prevention Act passed.

The bill advocated the use of safe needle devices in institutions so nurses would not be inadvertently stuck and contract a bloodborne disease. The ANA worked closely with its state partners to gain momentum and move the issue to the federal level.

"We were working the bill [in Washington]," Gonzalez said. "We felt it was a cost-effective mechanism and would reduce injuries among nurses."

One of the major opponents of the bill was effectively blocking it until Daley came forward with her story. She was working in an emergency department and, while cleaning up after an emergency situation, was stuck by a dirty needle that was in the disposal box.

"She did nothing wrong. She had a gloved hand, was using good technique and adhering to universal precautions," Gonzalez said.

The needle deeply punctured Daley. When she contracted HIV and hepatitis C, she had to leave her job and her livelihood. The legislators, upon hearing Daley's story, were so moved that they pledged not to let a similar situation happen to another nurse.

The bill easily passed.

"Integrity and respect" are the key elements all four nurse lobbyists agree are critical to their job.

They garner it by virtue of the profession. They strive to maintain it in their relationships with legislators and their staff, nurses, their parent organizations and the public.

"We're not going to pull the wool over anyone's eyes," Gonzalez said. "We'll always give the good, the bad and the ugly."

If they could have their dream, what would any of these lobbyists wish for? "I'd love to see 41 nurses in the state Assembly," Hunter said, jokingly. "That's half the number of seats in the California Assembly, plus one-the number needed for a majority."

Gonzalez said she would like to "demystify" the process of legislation and see more nurses involved at the federal and state levels. She also wishes nurses would band together. "We have 2.7 million nurses in this country. Imagine the power if we all joined on a single cause," she said.

What do the lobbyists enjoy most about their work? "I enjoy the diversity of the job," Gonzalez said. "The very best aspect of the job, however, is advocating for nurses and the improvement of health care for all."

"Until you join in, you don't realize to what extent legislation affects practice," Hunter said. "Sixty percent of health care is provided by the government. Legislation and regulations affect the type and amount of health care provided.

"I've learned just by getting involved that I can impact the quality of care our patients receive. It's empowering."

Contact Gerilyn Herold at geriherold@earthlink.net