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

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

University of DelawareUniversity of Delaware

Nurses as Advocates for Improvements in Community Health Care

OverviewOverview

Introduction & Historical OverviewIntroduction & Historical Overview

Driving Forces & Legislative/Regulatory Driving Forces & Legislative/Regulatory Structures, Health Policy & Politics HighlightsStructures, Health Policy & Politics Highlights

Professional & Advocacy IssuesProfessional & Advocacy Issues

Summary, Call to Action, & Q & ASummary, Call to Action, & Q & A

Questions?Questions?

When you hear the words “Health Care” When you hear the words “Health Care” what one word comes to mind?what one word comes to mind?

When you hear the word “Politics” what When you hear the word “Politics” what comes to mind?comes to mind?

When you hear the word “Nursing” what When you hear the word “Nursing” what word comes to mind?word comes to mind?

When you hear “Advocacy” what word When you hear “Advocacy” what word comes to mind? comes to mind?

Background/Historic LeadersBackground/Historic LeadersPushed for improvements in community healthPushed for improvements in community health

Lillian Wald—Lillian Wald—Pioneered the Pioneered the field of Public field of Public Health NursingHealth Nursing

Mary BreckenridgeMary Breckenridge

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

Florence WaldFlorence Wald

Mother of the Mother of the American Hospice American Hospice MovementMovement

Started the first US Started the first US hospice in hospice in ConnecticutConnecticut

Local, State, National & International Policy Local, State, National & International Policy Forces Influencing Community CareForces Influencing Community Care

Fiscal Constraints (16% GDP Fiscal Constraints (16% GDP Health Care)Health Care)

Health Professions Health Professions Resources/ShortagesResources/Shortages

Technology & Informatics Technology & Informatics Gaps/DemandsGaps/Demands

Ethics (i.e., HIPPA, DNR Ethics (i.e., HIPPA, DNR Orders)Orders)

Local, State, National & International Local, State, National & International Policy Forces (Continued)Policy Forces (Continued)

Surge in Chronic Surge in Chronic Disease & AgingDisease & Aging

Bio-Terrorism, War & Bio-Terrorism, War & Global Disaster RisksGlobal Disaster Risks

Scope of PracticeScope of Practice

44thth Branch of Branch of Government: Government: MediaMedia

Health System Actors & GovernmentHealth System Actors & Government

Actors:Actors:

ConsumersConsumers

ProvidersProviders

EmployersEmployers

GovernmentGovernment

InsurersInsurers

Interest GroupsInterest Groups

OtherOther

FUNCTIONSFUNCTIONS•FundingFunding•RegulationsRegulations•Service Service •DeliveryDelivery•Research & Research & DevelopmentDevelopment•OtherOther

Central Driving Policy Issues Central Driving Policy Issues Impacting Current Community CareImpacting Current Community Care

QualityQuality

AccessAccess

CostCost

Current ProblemsCurrent Problems

Estimates show 30% of hospitalizations are Estimates show 30% of hospitalizations are related to medication misuse/errors/non-related to medication misuse/errors/non-compliance at homecompliance at home*By the year 2030, the number of Americans *By the year 2030, the number of Americans aged 65 and older will more than double to 71 aged 65 and older will more than double to 71 million older Americans, comprising roughly 20 million older Americans, comprising roughly 20 percent of the U.S. population.percent of the U.S. population. Shortage of nurses/lack of funding for Shortage of nurses/lack of funding for community-based carecommunity-based care

*Source: The State of Aging and Health in America 2007*Source: The State of Aging and Health in America 2007. This report was . This report was released by the Centers for Disease Control and Prevention (CDC) and released by the Centers for Disease Control and Prevention (CDC) and The Merck Company Foundation at the 2007 Joint Conference of the The Merck Company Foundation at the 2007 Joint Conference of the American Society on Aging and the National Council on Aging in March American Society on Aging and the National Council on Aging in March 2007.2007.

Health Policy:Health Policy:

Course of Course of actionaction or or inactioninaction by the by the government regarding the public’s government regarding the public’s health and welfarehealth and welfare

Impact on the Nursing Profession?Impact on the Nursing Profession?

Government and Areas for Nursing Government and Areas for Nursing AdvocacyAdvocacy

RegulationsRegulations

FundingFunding

Service Service Delivery/ClinicalDelivery/Clinical

Research & Research & DevelopmentDevelopment

OtherOther

Title 24 of the Delaware Administrative Title 24 of the Delaware Administrative CodeCode section 7.7.4.6section 7.7.4.6

Delaware’s Nurse Practice Act says Delaware’s Nurse Practice Act says CNA’s may not administer medications. CNA’s may not administer medications.

Is there a way to allow a nurse to delegate Is there a way to allow a nurse to delegate giving routine meds to an aide with giving routine meds to an aide with experience and special training?experience and special training?

Medication Administration In the Medication Administration In the Community: QuestionsCommunity: Questions

Do we really need nurses to give Do we really need nurses to give medications at home?medications at home?

Is there funding to pay for nurses to give Is there funding to pay for nurses to give meds around the clock in a home meds around the clock in a home setting?setting?

Even if there Even if there werewere funding, are there funding, are there enough nurses to give every adult in the enough nurses to give every adult in the community their medications at home?community their medications at home?

Legislative Process: Application of Legislative Process: Application of Evidenced Based PracticeEvidenced Based Practice

Bill to LawBill to LawIdea, Drafted Idea, Drafted Legislation, Assigned Legislation, Assigned a # (HB,SB..), a # (HB,SB..), Introduced, Assigned Introduced, Assigned to Committee, to Committee, Hearings (mark-up), Hearings (mark-up), Voted on -Voted on - Other Other Chamber (Same Chamber (Same Process), Vote…Process), Vote…

Executive Branch RoleExecutive Branch Role

To Executive Branch: law To Executive Branch: law or vetoor vetoObama Administration’s Obama Administration’s Health Care Reform Health Care Reform DebateDebate

**Regulation**Regulation,, if if Override as needed Override as needed passed.passed.Know DE Regulations Know DE Regulations (i.e., medication (i.e., medication management in home)management in home)

QuestionsQuestions

List 2-4 key public policy or political issues List 2-4 key public policy or political issues for nursing or allied health professions for nursing or allied health professions related to the management of medications related to the management of medications in the community in the community

Identify 2-4 clinical issues you feel must be Identify 2-4 clinical issues you feel must be addressed to improve patient care, addressed to improve patient care, outcomes, costs, including medication outcomes, costs, including medication administration etc. . .administration etc. . .

OtherOther

Delaware ConsiderationsDelaware Considerations

How do other states regulate caregivers How do other states regulate caregivers helping with medication administration in helping with medication administration in the community setting?the community setting?

Med. Techs with certification and an RN Med. Techs with certification and an RN to delegate and be available for guidance to delegate and be available for guidance and supervision? and supervision?

CNA’s with special CNA’s with special experience/training/certification?experience/training/certification?

DE General Assembly ActionDE General Assembly Action

Money CommitteesMoney Committees

**Authorized versus Appropriated**Authorized versus Appropriated

State Budget—Operating & Capital State Budget—Operating & Capital (Bond) & Rainy Day Fund, (Bond) & Rainy Day Fund, Special Funds (i.e. Tobacco)Special Funds (i.e. Tobacco)

Bill with a Fiscal Note over 50KBill with a Fiscal Note over 50K

Joint Finance CommitteeJoint Finance Committee

AppropriationsAppropriations

DE Health Related CommitteesDE Health Related Committees

““THINK OUTSIDE THE THINK OUTSIDE THE HEALTH HEALTH BOX”BOX”

Senate & House Committees- Senate & House Committees- - Examples to consider- Examples to consider SenateSenate Health, Agriculture, Insurance & Health, Agriculture, Insurance &

Elections, Veterans Affairs, Highways, Small Elections, Veterans Affairs, Highways, Small Business, Banking, etc.Business, Banking, etc.

HouseHouse Health & Human Development, Health & Human Development, Homeland Security, Labor, Natural Resources Homeland Security, Labor, Natural Resources and Environment, Education, Public Safety, and Environment, Education, Public Safety, Judiciary, etc.. Judiciary, etc..

Federal Policy ExamplesFederal Policy Examples

Policy Policy Politics Politics Policy Policy Politics Politics etc. etc.

Multiple biological, socio-cultural, mental, Multiple biological, socio-cultural, mental, physical, economic issues impacting individuals, physical, economic issues impacting individuals, professionals, workplaces, schools, professionals, workplaces, schools, communities, governments etccommunities, governments etc

Domestic & GlobalDomestic & Global

Other- Nursing, medicine, Allied HealthSpecificOther- Nursing, medicine, Allied HealthSpecific

US Senate & US HouseUS Senate & US House

www.thomas.gov www.nursingworld.com www.nursingworld.com

Political Strategies To Influence Political Strategies To Influence PolicymakersPolicymakers

Use of mediaUse of mediaTestimonyTestimonyDirect & Indirect contactsDirect & Indirect contactsPACSPACSDrafting Policy Drafting Policy Coalition building Coalition building - Grassroots efforts- Grassroots efforts- Shaping implementation- Shaping implementationOthersOthers

How To’s: Interacting With How To’s: Interacting With Elected OfficialsElected Officials

Face-to-face meetingsFace-to-face meetings

E-mailE-mail

Letter writingLetter writing

Unified ApproachUnified Approach

Do’s and Don’tsDo’s and Don’ts

Nursing: Nursing: ALLALL Areas of Areas of Public PolicyPublic Policy

Federal & State ResourcesFederal & State Resources

www.delaware.govGovernor Markell 302-744-4101, 1-800-292-9570Governor Markell 302-744-4101, 1-800-292-9570Lt Governor Denn 302-744-4333Lt Governor Denn 302-744-4333DE House *302-744-4351 or 302-744-4171DE House *302-744-4351 or 302-744-4171DE Senate302-744- 4286 or 302-744- 4048DE Senate302-744- 4286 or 302-744- 4048County & Local Governments –Visit as neededCounty & Local Governments –Visit as needed

www.thomas.govUS Capitol 1-2-2-224-3121US Capitol 1-2-2-224-3121Senator Carper 202-224-2441Senator Carper 202-224-2441Senator Kaufmann 202-224-5042Senator Kaufmann 202-224-5042Representative Castle 202-225-4165Representative Castle 202-225-4165

Contact InformationContact Information

General Policy Information- General Policy Information- DE League of Women Voters’ DE League of Women Voters’ American Nurses/DE Nurses American Nurses/DE Nurses

AssociationAssociation Other Specialty OrganizationsOther Specialty Organizations

Senator Bethany Hall-LongSenator Bethany Hall-Long 302-744-4054/4286302-744-4054/4286 [email protected]@state.de.us

““Closing Thoughts”Closing Thoughts”

““The further back we The further back we look, the further ahead look, the further ahead we see”we see” (Churchill)(Churchill)

““It’s always darkest It’s always darkest before the dawn”before the dawn”

““Great opportunities are Great opportunities are disguised as unsolvable disguised as unsolvable problems”problems”