Politics, public policy, and advocacy are similar but have unique definitions. Politics are activities that relate to influencing the actions and polices of a government and keeping power in the government.1 Public policy refers to laws and actions of the government including regulations, while advocacy is defined as the act or process of supporting a cause or proposal: the act or process of advocating something.2 Public policy and advocacy literacy is the awareness and understanding of legislative regulatory and quality efforts that are being conducted by policy makers, insurers, and quality assessment organizations.
WOC nurse specialists frequently participate in discussions around advocacy. Every day we provide expert WOC and foot care to our patients across the health care continuum and are faced daily with multiple conundrums related to access to care. Focusing on patient-centered care is easy for us due the intimate nature of our specialty practice.
Do any of these situations sound familiar? (1) Your patient has an insurance carrier that will not cover the payment of the same number of barrier rings as the allotted number of barrier wafers that are covered in the insurance plan. (2) You find the new insurance requirements for obtaining a pressure redistribution support surface for your patient with a pressure injury has slowed the process so much that it takes 3 to 6 weeks to get the appropriate surface to maximize healing and treatment. (3) You find that patients treated for chronic venous insufficiency (CVI) and lymphedema return to your outpatient or home care service because they cannot obtain or afford replacement stockings in a timely manner, resulting in recurrent ulcers or cellulitis. (4) You find that your management team has identified limited payment for patients with an ostomy who are beyond the 30- to 90-day postsurgical window. (5) You note a trend in your patients who suffer from constipation that they are not following their bowel medication regimen because insurance no longer covers over-the-counter medication. Describing and defining gaps in care such as illustrated in these scenarios bring power to our voice when combined with those of colleagues and patients. This coalition of stakeholders forms the basis for public policy dialogue and the true definition of advocacy.
WHERE HAVE WE BEEN, AND WHERE DO WE NEED TO GO?
The patron of WOC practice, Norma Gill, was a patient advocate through and through. With the wisdom of the lived experience coupled with political-savvy and the intuitive entrepreneurial spirit, Norma started a practice focused on ostomy care that spurred the development of a professional nursing specialty, educational programs dedicated to the specialty, and an organized nursing specialty organization. The passion that energized Norma Gill continues to be the passion that has fueled the continued growth of WOC nursing and ignited our advocacy efforts.
The Wound Ostomy and Continence Nurses Society (WOCN Society) has engaged in public policy and advocacy for decades. Currently, the Society is focusing resources on efforts that are more proactive and less reactive, as well as strategically building an effective structure to facilitate rapid response, communications, and engagement. These efforts include (1) maintaining a clear up-to-date health care agenda that guides the direction of the Society in policy and advocacy affairs; (2) improving environmental scanning of the Federal Register and other government Web sites using key words that reflect the clinical realm of WOC nursing practice; (3) conducting monthly public policy and advocacy calls with Society leadership and director of governmental relations; (4) assigning active liaisons to important groups such as the National Quality Forum, the Wound Care Alliance, and the American Nurses Association; (5) investing in CQ Engage software (CQ Engage, Washington, District of Columbia) to facilitate membership advocacy efforts with elected officials; and (6) regularly refreshing the Public Policy and Advocacy tab on the WOCN Society home page.
The WOCN Society has identified additional strategic goals that have yet to be completed. They include development of templates for information sharing for public policy and advocacy issues to communicate complex issues identified in the regions and affiliates and by membership at large to the Society and creation of an organized pool of WOC clinicians with interest in public policy and advocacy work with specific attention to identifying clinical expertise, practice location, regional influence, and particular area of specific advocacy interest. We also plan to explore Medicare fistula policy and gaps in supply and care coverage and revise Society tools that focus on coding and billing information.
FROM INFORMATION COMES ACTION
Action comes from both the influential collective voice of many such as the public policy and advocacy efforts represented by the WOCN Society and the individual voice that is singular but powerful when combined with others that articulate the same message with the same vigor. Our public policy and advocacy efforts profoundly influenced the Lymphedema Treatment Act that has been proposed in both the United States House and Senate. This bill would legislate provision of compression garments to those with lymphedema. The WOCN Society has stood by this legislation with the understanding of the close relationship of lymphedema and edema of CVI and the awareness that such legislation would certainly influence future policy for compression coverage for treatment of edema due to CVI. We have impacted the Competitive Bidding program that uses a bidding process to select durable medical equipment (DME) providers as regional distributers for select DME items. Although the program is currently stalled, it emphasizes the need to be proactive in access to supplies and specialty care such as WOC nursing services.
We are addressing the needs of the ostomy patient by building on our Guiding Principles for Sustainable Access to Ostomy Services, Technology and Innovation.3 A review of the literature is underway to gather the evidence around effect and outcomes of WOC nursing care with the ostomy population and the influences of access to service and supplies on quality of life with the patient who has a bowel or bladder diversion. Coupled with true patient stories and working with the United Ostomy Association of America, this information will inform future policy papers and white papers. In addition, we routinely comment on legislative and regulatory policy changes relevant to our practice. This occurs in close collaboration with like-minded specialty nursing groups, physician groups, specialty organizations, and health care consumer groups. We also nominate WOC nurses to technical expert panels, expert testimony opportunities, and specialty practice workgroups.
POWER COMES FROM UNITY
There is a saying that is attributed to an African proverb, "If you want to go fast go alone. If you want to go far go together." There is so much to do as we drive forward our health care agenda, and each clinician is an important part of this larger collaborative. Being savvy in public policy and advocacy requires investment, but the overall benefit is substantial. In order to participate with less trepidation in calls for public policy and advocacy action, I ask you to consider the following strategies: Remain abreast of public policy and advocacy news. The WOCN Society sends out information regarding policy and advocacy activities via e-mail through specific publications such as Public Policy/Advocacy News as well as the WOC Now. What can you do? Open your e-mail and check your spam folder for missed things that are of interest to all.
Review the Public Policy and Advocacy tab on the WOCN Society Web page. Start by viewing the Health Care Agenda. There are 4 areas of focus: access to supplies; payment reform; workforce and education; and quality. Under each area are supporting documents that are resources for anyone interested in the work of the WOCN Society or have need to implement public policy/advocacy activities at the local level and need reference material. Look for hot topics located here; they are updated routinely. In addition, look for federal and state advocacy initiatives, tools for taking action, and templates for medical necessity.
I strongly encourage you to actively review what is happening in your local area and region. I have found that policy decisions that impact patient access to care or supplies in your community are likely to influence others in your region. Communicate to the WOCN Society Public Policy Liaisons (e-mails on tab) any public policy issues that you deem relevant. This helps the team look for trends and possible areas for action. Be prepared to contribute; by committing just a few minutes of time is essential when there is a call to action. In turn, the Society is striving to provide you with resources to make this process easy and effective.
As Public Policy and Advocacy Coordinator for the WOCN Society and as task force chair of the WOC Nurse Scope and Standards, I am convinced that when WOC nurses engage in advocating for access to better care delivery with our patients, we contribute to the sustainability of the profession. By keeping our eye on patient-centered care, we will continue to demonstrate the influence of our expertise in provision of highly complex care with quality and positive outcomes that influence efficiency and cost containment in the provision of care for the populations that we serve. As Winston Churchill once stated, "A pessimist sees the difficulty in every opportunity: an optimist sees opportunity in every difficulty."
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