1. Alexander, Mary BS, CRNI

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When you decided to become a nurse, you probably didn't think of your profession as a political endeavor. For many of us, nursing was about serving our patients, delivering a plan of care, ensuring quality, and avoiding adverse events. But as the business of healthcare has grown and changed, and as nurses who deliver the care have become more highly specialized, the atmosphere in which we practice has become an arena of competing interests. By our sheer numbers, nurses represent a large special interest group, and it is important for us to understand and work for issues that affect our profession.


The Nurse Reinvestment Act of 2002 has been one of the most widely publicized pieces of legislation affecting nurses, but many other issues are now on the table that either support or limit nursing care. Earlier this year, Congressman John W. Olver (D-MA) introduced legislation that would give Medicaid patients greater access to quality healthcare by requiring states to offer coverage for those who select an advanced practice registered nurse (APRN) as their primary healthcare provider. Known as the Medicaid Nursing Incentive Act of 2003, this piece of legislation recognizes the vital role that nurses play in the delivery of quality healthcare. Still, there are recent proposals that could limit nursing pay as a measure to control the spiraling cost of healthcare. The Labor Department has introduced a regulation that would stop nurses from earning overtime pay if they are in an administrative role or earn too much, while lower paid nurses might still be eligible. Many nursing organizations have warned that such a regulation will exacerbate the already dangerous shortage of nurses if they are not compensated for overtime hours.


There is little doubt that the nursing profession has become more politicized in recent history, but many nurses need encouragement to get involved in issues that affect their practices and their careers. It can be intimidating-even a little overwhelming-when we look at the array of regulations, legislation, and budget changes that need our attention. But participating in a group that can lobby on your behalf or making individual efforts to influence policy, are some of the most valuable things you can do to support present and future nurses. The Nurse in Washington Internship (NIWI), sponsored by the Nursing Organizations Alliance (NOA), is a mechanism for helping nurses learn to communicate with legislators and develop policies and agendas for nurses. If you want to get involved on a more grass roots level, consider writing or visiting your local Congressional Representative. You can always call or write for an appointment to discuss issues that affect your practice, and if you have extensive expertise, you might consider seeking an appointment to a government committee or task force.


Even if you are not ready to make the leap into a political committee, it is worth your time to read up on current changes in government regulations and legislation that affect you and your patients. Educating those around you is also crucial. By sharing your knowledge with colleagues, you will be able to work collectively toward your goals. As nurses, we need to remember that the public sector is a place where we can make a difference. But active participation is the key to progress. Whether you choose to become part of an organization, lobby as an individual, or seek a position in public service, your voice will not go unheard.