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Political Activism by the Nurses of FNA A Sample of Outcomes from History

Political Activism by the Nurses of FNA A Sample of Outcomes from History . PRESENTED BY: Willa Fuller Compiled by Janice Hess, ARNP, DNP . Historical Political Activism Perspective: On the Shoulders of Giants.

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Political Activism by the Nurses of FNA A Sample of Outcomes from History

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  1. Political Activism by the Nurses of FNAA Sample of Outcomes from History PRESENTED BY: Willa Fuller Compiled by Janice Hess, ARNP, DNP

  2. Historical Political Activism Perspective: On the Shoulders of Giants • Fundamental Ideologies: Nursing is a moral endeavor based in caring and advocacy (Ballou, 2000) • Visionary leaders: On the Shoulders of Social and Political Activists Nursing Giants: Nightingale Wald Dock Mahoney

  3. Common threads or lessons learned from these political activist nursing giants: • A passion and desire to make a difference • A belief that nursing has a moral and professional obligation to get involved • Dedication and perseverance • Involvement of others in their political activism efforts-forming grassroots efforts

  4. So what is so different today? Factors that may act as barriers to political involvement: • Oppression or stereotyping of nursing profession based on medical and administrative hierarchies in health care. • Nursing’s heterogeneity as a group • Lack of membership in professional organization

  5. Factors: (continued) • Political-ethical dilemma • Lack of political science education • Too much to do, too little time

  6. How do we move from apathy to political involvement: • Register and get out the vote • Get involved through professional organization membership and networking • Contribute to your Political Action Committee • Find Political Mentors

  7. Strategies for Revitalizing Nursing Political Activism • Education: nursing curriculum, professional organizations • At work : Talk with • peers

  8. Model for change: How do we reach the desired outcome? Moving Florida Nurses from Apathy to Political Activism

  9. Outcomes 1913 First legislative committee formed by FNA First bill passed by FNA and signed into law on June 7, 1913 was a bill for State Registration of nurses. 1919 FNA went on record to support the Jones-Raker Bill giving female RNs rank in the military. ANA lobbied for this bill. 1922 FNA lobbied for a bill classifying nurses as professional. This was passed by the House and the Senate.

  10. A cursory review of the outcomes of 100 years of advocacy by FNA

  11. Outcomes (continued) 1939 First nurse practice act was passed. 1950-1951 Practice act revised. LPN included and RN and LPN practice was differentiated. LPN educational standards increased. 1954 FNA developed recommendations for employment standards

  12. Outcomes (Continued) 1955 National Bolton Bill passed providing military service commissions for male nurses. Note of Interest: Minimum wage was raised from 75 cents to $1.00 1956 FNA sued and the Florida Supreme Court unanimously agreed that RN’s were not subject to occupational license tax. 1959 FNA opposed a bill that would lower standards for LPN Education. Bill was killed in committee after the FNA Legislative Chair testified before the committee.

  13. Outcomes 1960 FNA recommends employment practices and standards for the workplace including no discrimination, hours of work, salaries, on call service, vacation, termination, etc. The Florida Board of Nursing, along with the Florida League for Nursing and the Florida Association of the Development of Jr. Colleges formed a group to educate hospitals about this new RN educational option.

  14. Outcomes 1963 FNA creates minimum employment practices for Public Health nurses on the basis of higher quality of patient care. Supports Kerr-Mills bill which was legislation regarding care for the elderly, but only if it includes, home care and nursing home care services. Bill was passed with FNA’s requests included but there were no appropriations.

  15. Outcomes 1964 FNA, FHA and FMA met for two days to discuss common issues. 1965 ANA begins a public campaign to work on the economic plight of professional nurses. Note of interest: In 1955, FNA conducted a survey that revealed Florida nurses made $500 less than nurses nationwide.

  16. Outcomes 1966 FNA Legislative Committee Issues • Eliminate Practical Exams with written exams for LPNs • Increase licensing fees • Change requirements for RN to include BSN • Limit consecutive terms of the Board of Nursing to 2 • Increase travel perdiem (BON?) • Employ an Executive Director • Allow BON to license a non-citizen as long as they become a citizen within 6 years.

  17. Outcomes 1969 FNA filed a bill requiring an RN to be on duty each shift at nursing homes. Bill did not make it out of committee. 1971 Reporting of child abuse by nurses, teachers etc Immunizations required before children enter school Mandatory PKU testing Comprehensive alcoholism prevention

  18. Outcomes 1975 Nurse Training Act • Note of interest: Previously there had been minimal emphasis on enlisting nurses and educating them about legislative advocacy. This activity began to increase in the 70’s. • FNA submitted changes to the Nurse Practice Act to redefine the expanding role of nurses. Legislation passed 112-1 in the Senate and 38-0 in the House. Signed by Governor Reuben Askew in July of 1975. ( Bill included mandatory CE’s for licensure to go into effect by 1980 and to be regulated by the Board of Nursing.

  19. 1976-Senator Bob Graham • Advice to nurses on limited NP reimbursement by state Medicaid program: • Be specific when presenting your position. Give details and FACTS. Avoid cliches. • Establish one on one relationship: nurse to legislator • Establish continuity of contact-call or visit your legislator regularly. Note of interest 1: During this time there was a bill to rescind the right of public employees to represented by collective bargaining. Note of interest 2: FNA Lobbyist worked to get the funds appropriated to fund the administration of continuing education by the Board of Nursing.

  20. Outcomes 1979 Baker Act Bill allowing NP and CNS’s in mental health to initiate proceedings considered 1980 Nurse Day in Tallahassee- Beginnings of Political Action Days and later FNA Lobby Days 1981 Lobbyist in Tallahassee year round Members will be alerted to pertinent bills Struggle to get nurses engaged continues. Nurse Action Day in Tallahasee ARNP Advanced Practice Committee working on issues. FNA ARNP’s and FANA joined forces. FNA supports ratification of the ERA

  21. Outcomes 1982 Negotiation with FMA to protect NP Scope of Practice Successful FN-PAC formed. Legislative Committee disbanded. ANA- Medicaid reimbursement for CNM’s was passed. 1983 LDC Network formed with the goal of having a nurse assigned to every legislator. ARNP’s can apply for and receive Medicaid numbers for reimbursement purposes. Nurse Anesthetists included in health insurance coverage.

  22. Outcomes 1984 FNA successfully lobbied for funding of the Impaired Professionals Program ( later IPN) Living Will Legislation passed with FNA lobbying. Toxic Substances bill passed, protecting nurses. Lay Midwives grandfathered in but no new training would be allowed. This was later repealed by Governor Chiles but more stringent standards were applied as negotiated by FNA.

  23. Outcomes 1985 First newsletter report by Barbara Lumpkin. Irma Rochlin, RN elected to the House. Nurse Practice Act to undergo Sunset Review. FNA uses this to encourage nurses to get involved. 240 nurses attend Political Action Days Continued lobbying for banning smoking in public buildings. After two years of lobbying by ANA and the states, President Reagan signs Nurse Training Act with decreased funding.

  24. Outcomes 1985 Bill that would transfer approval of nursing educations programs to DOE rather than BON. FNA thwarted this attempt. Continue to work on 24 hour RN coverage for nursing homes. 1986 Sunset review of Nurse Practice Act closely monitored by FNA. Complete. Mandatory seat belts signed into law. FNA major funder of Florida Pay Equity Coalition. Study showed that females and minorities are “subtantially undervalued”

  25. Outcomes 1986 Governor Bob Graham speaks at FNA Convention. 90% of FNA endorsed candidates won elections. Commission on the Future of Nursing formed. Swift intervention by FNA attaches an amendment to another bill requiring Occupational Health Nurses to be notified of toxic substances in the workplace.

  26. Outcomes 1988- Joint Committee of Board of Nursing and the Medical Examiner. FNA Recommendations • Permit ARNP’s to prescribe under protocol signed by both NP and physician. • File protocal annual with DPR (now BON) • Amendments to protocol be submitted within 30 days Other issues: Limit insurance companies ability to deny insurance based on HIV testing. Insurance companies must protect confidentiality. • Mandatory CE for HIV- this was supported by the membership. • AMA proposal of the Registered Care Technician (RCT). After a lot of nurse involvment and collaboration with FMA, this was defeated.

  27. Outcomes 1988 NPs allowed to prescribe all medications other than controlled substances. • “Snitch” bill requiring professionals to tattle on one another was defeated ( supported by FMA). • Support for Teen Moms and a bill regarding the patient’s right to refuse sustenance( supported by FNA) were defeated. 1990 FNA-FMA joint task force collaborates on common issues. 1991 Opposed healthcare workers report their HIV status.

  28. Outcomes 1991 Pharmacists refusing to fill prescriptions by ARNP’s. FNA worked with FNA attorney to address these issues. 1992 ANA- Safe Needles Initiatives 1991-92 FNA encourages local legislative forums to engage legislators on their home turf. 1993 QUIN Council organized FNA invited by Gov. Chiles to speak at a press conference regarding his Florida Health Plan.

  29. Outcomes 1992 350 nurses at Political Action Days Clinical Laboratories Bill ( ARNP’s can now order) 1993 Coalition of FNA ARNP’s, FANA and the Florida College of Nurse Midwives formed resulting in the ARNP Legislative Task Force. 1994 ARNP Independent Practice/DEA numbers: Failed Support for school nurses who are asked to do more with less. 1994 President Ann-Lynn Denker and Barbara Lumpkin met with President Clinton at the White House re: • healthcare issues.

  30. Outcomes 1976 Failed to pass: A bill supported by FNA banning smoking in public places. 1978 FNA opposed institutional licensure for nurses. Supported individual licensure. 1978 Florida Midwife Bill Passed: Governor Askew signed into law a bill that required HRS to make available services of nurse midwives who are certified as ARNP’s

  31. Outcomes 1994 MSN required for certification as an advanced practice nurse. ( APN’s prior to 1997 grandfathered in). 1995 Foundation Nurses in Need approved by IRS 1996 Supreme Court rules that all RN’s are supervisors and cannot be represented by collective bargaining. NLRB agrees with ANA/FNA that this is not true. 1996 Defeated bill that would allow only nurses employed by home health agencies to work in Home Health. 1997 ANA testified at NIOSH about the effect of downsizing on the work environment of nurses.

  32. Outcomes 1997 JaneGale Boyd, FNA Member elected to the House. FNA supports RN Identification on name badges Political Action Days- Over 300 attended. Marta Prado-FNA Member appointed to Clinton’s Health Care Quality Commission RN in Every School Campaign 1998 Jeb Bush visits FNA Headquarters prior to election 1999Term limits go into effect Protect the title of Nurse to include RN’s and LPN’s only

  33. Outcomes 1999 Nursing home reform Propaganda campaign by FMA against Nurse Practitioner controlled substance prescribing QUACK QUACK QUACK! Regulation of Certified Nursing Assistants 2000 Campaign -1 in 44 voters is a registered nurse FNA and nurse attorney Cynthia Mikos go to Tallahassee to submit a legal challenge to the direct supervision of CRNA’s by an MD or DO.

  34. Conclusion: • Nurses cannot afford to be spectators in the political arena. We must embrace political activism in order to become a part of the discussion and decision making related to needed healthcare change. • Moving from an invisible role to a prominent part of political advocacy will require that nurses look backwards for inspiration of past nursing political activist while looking forward as to how to “engage” the nursing profession in a new grassroots effort of political activism.

  35. Outcomes 2000 National Needlestick Prevention law signed by President Clinton. 2001 FNA purchases subscription to Capital Wiz so members can have access to legislators at their fingertips. Funding for staffing study in Governor Bush’s budget Note of Interest: at this point we are only one of 6 states that did not allow NP’s to prescribe controlled substances

  36. Outcomes 2002 Anesthesia Assistant Bill- defeated ANA- Nursing Shortage Bill passed NP’s can sign for for disabled Parking Permits for VA patients Nursing Shortage Solutions Act Yolly Roberson, RN and Attorney, elected to the House. Funding for the Florida Center of Nursing 2004 CE Broker – very controversial issue ARNP name can be on prescription bottle passed. ARNPs/PAs can perform physicals on corrections officers

  37. Outcomes 2005 NP can perform physicals on firefighters and security personnel NP can sign disabled parking permits. Blocked two bills that would limit practice. 10 million dollars in the budget for nursing education Dermatology Bill proposing that patient must see a dermatologist first. FNA Opposed. Seek $5.00 from licensure fee to fund the FCN. Bill limiting Domestic Violence and HIV education. (enough is enough)

  38. Outcomes 2006 3 nurses re-elected to the legislature FNA reaches out to Gov. Crist to included nurses in the transition team. Barbara Lumpkin retires, Anna Small is the new FNA lobbyist. 2007 Paula Massey retires CNS’s defined in the practice act. ARNP’s granted civil immunity when obtaining informed consent. Florida Center for Nursing named in honor of Barbara Lumpkin

  39. Outcomes 2007 Safe Lift bill failed ARNP’s signing death certificate failed Florida Coalition of Advanced Practice Nurses formed. Glitch bill to fix unintended consequences of the CNS bill Barbara Lumpkin Institute Conference 2008 Florida Center for Nursing threatened but remained in the budget

  40. Outcomes 2008 Interim study ordered by the President of the Senate on nurse practitioner prescribing of controlled substances (for the 2nd time with a favorable conclusion) 2009 Safe Staffing Bill based on ANA Principles-opposed by several groups-failed Clinical labs bill mandates labs to take ARNP orders- passed Bill to add donation to the FCN to the BON renewal process passed. Medicare fraud bill (1986) passed.

  41. Outcomes 2010 Glitch bill to 1986 –passed Funding cut for FCN- ( removed from budget this year) Attempted the $5 licensure fee. Legislators see this as a “tax” Tried new strategy on prescribing with Mike Bennett ARNP’s removed before bill moves forward. Authority for the Board of Nursing to approve educational programs severely compromised. Over 100 nursing programs in the state at the present time. BON recently put 12 schools on probation

  42. Outcomes 2011 Session in full swing Reapportionment is key focus Baker Act Bill on track to pass. ( Must be signed by Governor.) Further fixes to the Medicare Fraud Bill. ( FNA had a current student to testify. ) Head injury and high school athletes. Supervision of surgical techs in the OR (FNA partnering with AORN on this bill.)

  43. References: • Ballou, K. (2001). A historical-philosophical analysis of the professional nurse obligation to participate in sociopolitical activities. Policy, Politics & Nursing Practice, 1(3), 172-184. • Boswell, C., Cannon, S. and Miller, J.(2005). Nurses’ political involvement: Responsibility versus privilege. Journal of Professional Nursing, 21 (1), 5-8. • Conger, C. & Johnson, P. (2000). Integrating political involvement and nursing education. Nurse Educator, (25 (2), 99-103 • Cramer, M. (2002). Factors influencing organized political participation in nursing. Policy, Politics & Nursing Practice, 3 (2), 97-107. • DesJardin, K. (2001). Political involvement in nursing AORN Journal, 74(5), 614-615 • Dunphy, L. Florence Nightingale’s legacy of caring and its application. In M. Parker (Ed.), Nursing theories & Nursing Practice (2nd ed.). Philadelphia, PA: F.A. Davis Company.

  44. References: Continued • Rains, J.; Barton-Kriese, P. (2001). Developing political competence: A comparative study across disciplines. Public Health Nursing, 18(4), 219-224. • Roberts, J. and Group, T. (1995). Feminism and nursing. Westpoint, Connecticut: Praeger.

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