Informing Policy, Driving Change: No Longer Optional for Nurses

Nurses have the knowledge, skills, and obligation.

The American Academy of Nursing (AAN) kicked off its annual policy conference last week by honoring Rep. Eddie Bernice Johnson, (D-TX), the first registered nurse elected to Congress, and hearing from the nurse most recently elected to the House, Rep. Lauren Underwood, (D-IL). Their presence underscored a viewpoint that is gaining traction in prominent circles, from the World Health Organization to the National Academy of Medicine: Nurses have the knowledge, skills, and obligation to inform policy and drive change.

During her talk, Underwood laid out her policy priorities and expressed her fervent belief that for nurses, “engaging in policy is not optional.”

Underwood serves on three House committees—Veterans’ Affairs, Homeland Security, and Education and Labor—and within those on subcommittees dealing with emergency preparedness, disability assistance, and other topics where she uses her health expertise to influence policy on a range of issues. These include gun violence prevention, black maternal health, infant mortality, drug pricing, and suicide among veterans.

A data-driven approach.

Underwood’s approach to policymaking is data driven. Prompted by research on medication adherence, she sponsored a bill to allow veterans to receive a full-year’s supply of contraceptives rather than having to refill their prescriptions every three months.

When asked about her vision for the future of nursing, she named two priorities.

“We continue to struggle to get the level of federal investment that’s needed to grow our nursing workforce,” she said, lamenting the cyclical struggles all health professions face to keep workforce programs funded. “Quarter after quarter, health care is the sector that is really driving economic growth and progress in communities across our country,” she pointed out, arguing that this is reason enough to make, “sustained investments in growing our health care workforce and doing so in a way that promotes innovation.”

Underwood also stressed the need to make access to health care available to all in order to reduce health disparities. Ten years after the enactment of the Affordable Care Act, many communities remain chronically underserved, she said. “We’re at this point where . . . we’ve just got to solve it. And I think that the electorate is with us.”

The youngest black American to serve in Congress, Underwood was sworn in during a federal government shutdown. When established lawmakers offered no solution to that impasse, it became clear to the freshman lawmaker “that the American people had elected us to lead. . . . I could not sit back and wait [for] a coach [who] was going to draw a play on a clipboard and give it to me.”

‘Do not wait for someone to invite you in.’

As Underwood observed, nurses in influential positions in the clinical and research sectors are leading and driving change every day, but few nurses have stepped into the political or even policy arenas.

“Do not wait for someone to invite you in,” she told Academy members. “We have the solution, and we have the evidence to back it up, and the only thing that’s missing is asserting ourselves.”

A ‘fragile’ public health system, under enormous pressure.

Whether that means running for office or lobbying for change at the local, state, or federal level, Underwood emphasized the urgency of nurses leaning in to the advocacy role. The public health system is “very fragile, and on the precipice of collapse,” she said, placing vulnerable communities at “catastrophic” risk.

While her words were aimed at an American audience, they found echoes in a global context. While accepting the Academy’s inaugural Legacy Award, Rep. Johnson mentioned that a nurse from Taiwan had stopped by her office that very morning on route to the Academy meeting. The reason? That nurse had just been elected to public office and wanted to meet the first nurse to serve in Congress.

Johnson and Underwood are compelling role models for political and policy engagement, but solving the health problems facing the nation will require many more such committed individuals from nursing’s ranks. As Underwood put it, nurses cannot “continue to allow this next generation of nurses to hang back.”

By freelance writer/editor Nicole Fauteux