Bethany Hall-Long, PhD, RNC, FAAN DE State Senator, District 10 Professor, School of Nursing

1. Nurses as Advocates for Improvements in Community Health Care Bethany Hall-Long, PhD, RNC, FAAN DE State Senator, District 10 Professor, School of Nursing University of Delaware

3. Overview • Introduction & Historical Overview • Driving Forces & Legislative/Regulatory Structures, Health Policy & Politics Highlights • Professional & Advocacy Issues • Summary, Call to Action, & Q & A

4. Questions? • When you hear the words “Health Care” what one word comes to mind? • When you hear the word “Politics” what comes to mind? • When you hear the word “Nursing” what word comes to mind? • When you hear “Advocacy” what word comes to mind?

5. Background/Historic LeadersPushed for improvements in community health • Lillian Wald—Pioneered the field of Public Health Nursing

6. Mary Breckenridge • Mary Breckenridge—Brought the specialty of Nurse-midwifery to the U.S. and started the Frontier Nursing Service to serve rural Appalachian families.

7. Florence Wald • Mother of the American Hospice Movement • Started the first US hospice in Connecticut

8. Local, State, National & International Policy Forces Influencing Community Care • Fiscal Constraints (16% GDP Health Care) • Health Professions Resources/Shortages • Technology & Informatics Gaps/Demands • Ethics (i.e., HIPPA, DNR Orders)

9. Local, State, National & International Policy Forces (Continued) • Surge in Chronic Disease & Aging • Bio-Terrorism, War & Global Disaster Risks • Scope of Practice 4th Branch of Government: Media

10. Health System Actors & Government Actors: • Consumers • Providers • Employers • Government • Insurers • Interest Groups • Other • FUNCTIONS • Funding • Regulations • Service • Delivery • Research & Development • Other

11. Central Driving Policy Issues Impacting Current Community Care • Quality • Access • Cost

12. Current Problems • Estimates show 30% of hospitalizations are related to medication misuse/errors/non-compliance at home • *By the year 2030, the number of Americans aged 65 and older will more than double to 71 million older Americans, comprising roughly 20 percent of the U.S. population. • Shortage of nurses/lack of funding for community-based care *Source: The State of Aging and Health in America 2007. This report was released by the Centers for Disease Control and Prevention (CDC) and The Merck Company Foundation at the 2007 Joint Conference of the American Society on Aging and the National Council on Aging in March 2007.

13. Health Policy: • Course of action or inaction by the government regarding the public’s health and welfare • Impact on the Nursing Profession?

14. Government and Areas for Nursing Advocacy • Regulations • Funding • Service Delivery/Clinical • Research & Development • Other

15. Title 24 of the Delaware Administrative Codesection 7.7.4.6 • Delaware’s Nurse Practice Act says CNA’s may not administer medications. • Is there a way to allow a nurse to delegate giving routine meds to an aide with experience and special training?

16. Medication Administration In the Community: Questions • Do we really need nurses to give medications at home? • Is there funding to pay for nurses to give meds around the clock in a home setting? • Even if there were funding, are there enough nurses to give every adult in the community their medications at home?

17. Legislative Process: Application of Evidenced Based Practice Bill to Law • Idea, Drafted Legislation, Assigned a # (HB,SB..), Introduced, Assigned to Committee, Hearings (mark-up), Voted on - Other Chamber (Same Process), Vote…

18. Executive Branch Role • To Executive Branch: law or veto • Obama Administration’s Health Care Reform Debate • **Regulation, if Override as needed passed. • Know DE Regulations (i.e., medication management in home)

19. Questions • List 2-4 key public policy or political issues for nursing or allied health professions related to the management of medications in the community • Identify 2-4 clinical issues you feel must be addressed to improve patient care, outcomes, costs, including medication administration etc. . . • Other

20. Delaware Considerations • How do other states regulate caregivers helping with medication administration in the community setting? • Med. Techs with certification and an RN to delegate and be available for guidance and supervision? • CNA’s with special experience/training/certification?

21. DE General Assembly Action

22. Money Committees **Authorized versus Appropriated State Budget—Operating & Capital (Bond) & Rainy Day Fund, Special Funds (i.e. Tobacco) Bill with a Fiscal Note over 50K • Joint Finance Committee • Appropriations

23. DE Health Related Committees “THINK OUTSIDE THE HEALTH BOX” • Senate & House Committees- - Examples to consider Senate Health, Agriculture, Insurance & Elections, Veterans Affairs, Highways, Small Business, Banking, etc. House Health & Human Development, Homeland Security, Labor, Natural Resources and Environment, Education, Public Safety, Judiciary, etc..

24. Federal Policy Examples Policy  Politics  Policy Politics etc. • Multiple biological, socio-cultural, mental, physical, economic issues impacting individuals, professionals, workplaces, schools, communities, governments etc • Domestic & Global • Other- Nursing, medicine, Allied HealthSpecific US Senate & US House www.thomas.gov www.nursingworld.com

25. Political Strategies To Influence Policymakers • Use of media • Testimony • Direct & Indirect contacts • PACS • Drafting Policy • Coalition building - Grassroots efforts- Shaping implementation • Others

26. How To’s: Interacting With Elected Officials • Face-to-face meetings • E-mail • Letter writing • Unified Approach • Do’s and Don’ts

27. Nursing: ALL Areas ofPublic Policy

28. Federal & State Resources www.delaware.gov Governor Markell 302-744-4101, 1-800-292-9570 Lt Governor Denn 302-744-4333 DE House *302-744-4351 or 302-744-4171 DE Senate302-744- 4286 or 302-744- 4048 County & Local Governments –Visit as needed www.thomas.gov US Capitol 1-2-2-224-3121 Senator Carper 202-224-2441 Senator Kaufmann 202-224-5042 Representative Castle 202-225-4165

30. Contact Information General Policy Information- DE League of Women Voters’ American Nurses/DE Nurses Association Other Specialty Organizations Senator Bethany Hall-Long 302-744-4054/4286 bethany.hall-long@state.de.us

31. “Closing Thoughts” • “The further back we look, the further ahead we see”(Churchill) • “It’s always darkest before the dawn” • “Great opportunities are disguised as unsolvable problems”