1. Natal, Erica MHA, MBA, BSN

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In recent years, attention to healthcare legislation has gained momentum. The COVID-19 pandemic, staffing shortages, and patient disparities in access have put a spotlight on healthcare. Improving healthcare toward a system that is fair and maintainable remains a priority in national public policy. If we are to serve the best interest of patients, and achieve healthcare coverage that is adequate and accessible for everyone, foundational modifications are required.


Nursing is the nation's largest healthcare profession, with more than 3.8 million registered nurses nationwide (Smiley et al., 2018). As such, nurses have the potential to profoundly affect policy. In recent decades, even though nursing is one of the most respected professions and nurses have become increasingly knowledgeable, involvement in the policy-making process that affects delivery of health services has been limited (Juma, Edwards, & Spitzer, 2014; Salvage & White, 2019).


This is troubling to say the least when you consider the proximity that healthcare workers have to all aspects of healthcare. No one is more qualified to help guide legislators determine healthcare funding priorities and create healthcare legislation than those who deliver patient care every day.


To encourage more nurses and healthcare workers to participate in healthcare policy initiatives, this article describes how ideas become laws and lists selected resources to help the reader get started. Healthcare policy begins as an idea. When a State Representative or a State Senator decides to sponsor an idea, he/she will guide it through the State Legislature. The idea will be drafted into proper legal language and is now called a bill. All states use a similar process, but there can be unique differences. The exact process for passing a bill into law can be found on the state's legislative website. The following steps outline the basic process for moving a bill through the State Legislature (, 2019):


* The bill is assigned a number by the Chief Clerk of the House and then is sent back to the Legislative Counsel's office to verify that the language style is correct.


* The State Printing Division prints the bill and returns it to the House of Representatives for its first reading.


* The Speaker will refer the bill to a committee and send it to the Legislative Fiscal Officer and the Legislative Revenue Officer to determine fiscal or revenue impact.


* The committee holds open forums and work groups.


* The committee chair will deliver a signed report to the Chief Clerk. This step needs to happen for the bill to go to the House floor for a final vote or be reported out of the committee.


* The original bill and the amended bill are compared to ensure accuracy. (Engrossed bill)


* The bill is now read for the second time in the house of origin (House).


* The bill will have a third and final reading before the vote.


* If the bill is passed by the House members, it is sent to the Senate.


* The bill has its initial reading in the Senate and is assigned to a committee. The first and second readings allow for amending the bill. During the third reading, debate happens.


* If the bill is passed in the Senate devoid of changes, it is sent back to the House for enrolling. Enrolling is the final printed version of the bill.


* If the bill is amended in the Senate by even one word, it must be sent back to the House for agreement.


* Once the bill has passed both houses in the identical form, three officers sign it: the Speaker of the House, the Senate President, and the Chief Clerk of the House or Secretary of the Senate, depending on where the bill originated.


* The enrolled bill is then sent to the Governor.


* If the Governor signs the bill, it will become law. The Governor's veto may be overridden by a two-thirds vote of both houses.


The House and Senate each have three committees with authority over legislation affecting healthcare and healthcare professionals. The House committees and their corresponding subcommittees are as follows:


* Appropriations Committee-Subcommittees are Labor; Health and Human Services; and Education.


* Energy and Commerce (Medicare Part B and Medicaid)-Subcommittees are Health; and Environment and Hazardous Materials.


* Ways and Means Committee (Medicare Part A)-Subcommittee is Health.


The Senate committees directing healthcare are as follows:


* Appropriations Committee-Subcommittees are Labor; Health and Human Services; and Education.


* Finance (Medicare)-Subcommittee is Health Care.


* Health, Education, Labor, and Pensions Committee (H.E.L.P)-Subcommittees are Aging; Children and Families; Employment Safety and Training; and Substance Abuse and Mental Health Services.


Knowledge on how you are represented at the nation's capital, Washington, DC, is critical in navigating a bill's passage through these committees. Every state in the country is represented on Capitol Hill by two Senators. Each state also has Representatives in the House. A state's population will dictate the number of Representatives it has. There are several ways to find your elected government officials. A list of U.S. Senators by state can be found at The U.S. House of Representatives website,, contains a list of the Representatives by state.


Advocacy means taking steps to create change. There are a variety of strategies healthcare advocates can utilize to carry their message. Using multiple modalities such as webinars, newsletters, flyers, and podcasts can work to engage a large audience and provide needed education on public health matters. Utilize the tools provided by professional societies to engage in healthcare initiatives you are passionate about. For example, the Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Health Care Policy Committee or Patient Advocacy web page. Opportunities abound for advocating for nurses, patients, and the nursing profession. Healthcare worker must come together and work to influence policy, making healthcare safer for those who render it and those who receive it.




Juma P. A., Edwards N., Spitzer D. (2014). Kenyan nurses involvement in national policy development processes. Nursing Research and Practice, 2014, 236573. [Context Link]


Salvage J., White J. (2019). Nursing leadership and health policy: Everybody's business. International Nursing Review, 66(2), 147-150. doi:10.1111/inr.12523 [Context Link]


Smiley R. A., Lauer P., Bienemy C., Berg J. G., Shireman E., Reneau K. A., Alexander M. (2018). The 2017 National Nursing Workforce Survey. Journal of Nursing Regulation, 9(3), S1-S54. [Context Link] (2019). How laws are made. Retrieved from website:[Context Link]