Transcript Bethany Hall-Long, PhD, RNC, FAAN DE State Senator, District 10

Nurses as Advocates
for Improvements in
Community Health Care
Bethany Hall-Long, PhD, RNC, FAAN
DE State Senator, District 10
Professor, School of Nursing
University of Delaware
Overview
Introduction & Historical Overview
Driving Forces & Legislative/Regulatory
Structures, Health Policy & Politics Highlights
Professional & Advocacy Issues
Summary, Call to Action, & Q & A
Questions?
When you hear the words “Health Care”
what one word comes to mind?
When you hear the word “Politics” what
comes to mind?
When you hear the word “Nursing” what
word comes to mind?
When you hear “Advocacy” what word
comes to mind?
Background/Historic Leaders
Pushed for improvements in community health
Lillian Wald—
Pioneered the
field of Public
Health Nursing
Mary Breckenridge
Mary
Breckenridge—
Brought the
specialty of Nursemidwifery to the
U.S. and started
the Frontier
Nursing Service to
serve rural
Appalachian
families.
Florence Wald
Mother of the
American Hospice
Movement
Started the first US
hospice in
Connecticut
Local, State, National & International Policy
Forces Influencing Community Care
Fiscal Constraints (16% GDP
Health Care)
Health Professions
Resources/Shortages
Technology & Informatics
Gaps/Demands
Ethics (i.e., HIPPA, DNR
Orders)
Local, State, National & International
Policy Forces (Continued)
Surge in Chronic
Disease & Aging
Bio-Terrorism, War &
Global Disaster Risks
Scope of Practice
4th Branch of
Government:
Media
Health System Actors & Government
Actors:
Consumers
Providers
Employers
Government
Insurers
Interest Groups
Other
FUNCTIONS
•Funding
•Regulations
•Service
•Delivery
•Research &
Development
•Other
Central Driving Policy Issues
Impacting Current Community Care
Quality
Access
Cost
Current Problems
Estimates show 30% of hospitalizations are
related to medication misuse/errors/noncompliance at home
*By the year 2030, the number of Americans
aged 65 and older will more than double to 71
million older Americans, comprising roughly 20
percent of the U.S. population.
Shortage of nurses/lack of funding for
community-based care
*Source: The State of Aging and Health in America 2007. This report was
released by the Centers for Disease Control and Prevention (CDC) and
The Merck Company Foundation at the 2007 Joint Conference of the
American Society on Aging and the National Council on Aging in March
2007.
Health Policy:
Course of action or inaction by the
government regarding the public’s
health and welfare
Impact on the Nursing Profession?
Government and Areas for Nursing
Advocacy
Regulations
Funding
Service
Delivery/Clinical
Research &
Development
Other
Title 24 of the Delaware Administrative
Code section 7.7.4.6
Delaware’s Nurse Practice Act says CNA’s
may not administer medications.
Is there a way to allow a nurse to delegate
giving routine meds to an aide with
experience and special training?
Medication Administration In the
Community: Questions
Do we really need nurses to give
medications at home?
Is there funding to pay for nurses to give
meds around the clock in a home
setting?
Even if there were funding, are there
enough nurses to give every adult in the
community their medications at home?
Legislative Process: Application of
Evidenced Based Practice
Bill to Law
Idea, Drafted
Legislation, Assigned
a # (HB,SB..),
Introduced, Assigned
to Committee,
Hearings (mark-up),
Voted on - Other
Chamber (Same
Process), Vote…
Executive Branch Role
To Executive Branch: law
or veto
Obama Administration’s
Health Care Reform
Debate
**Regulation, if
Override as needed
passed.
Know DE Regulations
(i.e., medication
management in home)
Questions
List 2-4 key public policy or political issues
for nursing or allied health professions
related to the management of medications
in the community
Identify 2-4 clinical issues you feel must be
addressed to improve patient care,
outcomes, costs, including medication
administration etc. . .
Other
Delaware Considerations
How do other states regulate caregivers
helping with medication administration in
the community setting?
Med. Techs with certification and an RN
to delegate and be available for guidance
and supervision?
CNA’s with special
experience/training/certification?
DE General Assembly Action
Money Committees
**Authorized versus Appropriated
State Budget—Operating & Capital
(Bond) & Rainy Day Fund,
Special Funds (i.e. Tobacco)
Bill with a Fiscal Note over 50K
Joint Finance Committee
Appropriations
DE Health Related Committees
“THINK OUTSIDE THE HEALTH BOX”
Senate & House Committees- Examples to consider
Senate Health, Agriculture, Insurance &
Elections, Veterans Affairs, Highways, Small
Business, Banking, etc.
House Health & Human Development,
Homeland Security, Labor, Natural Resources
and Environment, Education, Public Safety,
Judiciary, etc..
Federal Policy Examples
Policy  Politics  Policy Politics etc.
Multiple biological, socio-cultural, mental,
physical, economic issues impacting individuals,
professionals, workplaces, schools,
communities, governments etc
Domestic & Global
Other- Nursing, medicine, Allied HealthSpecific
US Senate & US House
www.thomas.gov www.nursingworld.com
Political Strategies To Influence
Policymakers
Use of media
Testimony
Direct & Indirect contacts
PACS
Drafting Policy
Coalition building
- Grassroots efforts
- Shaping implementation
Others
How To’s: Interacting With
Elected Officials
Face-to-face meetings
E-mail
Letter writing
Unified Approach
Do’s and Don’ts
Nursing: ALL Areas of Public Policy
Federal & State Resources
www.delaware.gov
Governor Markell 302-744-4101, 1-800-292-9570
Lt Governor Denn 302-744-4333
DE House *302-744-4351 or 302-744-4171
DE Senate302-744- 4286 or 302-744- 4048
County & Local Governments –Visit as needed
www.thomas.gov
US Capitol 1-2-2-224-3121
Senator Carper 202-224-2441
Senator Kaufmann 202-224-5042
Representative Castle 202-225-4165
Contact Information
General Policy InformationDE League of Women Voters’
American Nurses/DE Nurses
Association
Other Specialty Organizations
Senator Bethany Hall-Long
302-744-4054/4286
[email protected]
“Closing Thoughts”
“The further back we
look, the further ahead
we see” (Churchill)
“It’s always darkest
before the dawn”
“Great opportunities are
disguised as unsolvable
problems”