Strategies for Building a Coalition

1. Strategies for Building a Coalition Maryann Alexander, PhD, RN Michelle Buck, APN, CNS

2. 2008

3. 2007 and 2010 • Illinois • Hawaii, Kentucky and Maryland

4. 2011 Uniformity to APRN Regulation

5. Outline • Preparation for Grassroots Campaign • Building a Coalition • Taking Action • Getting the Bill Passed • Using Data Effectively and Other Strategies

6. John Kingdon (2000) • 247 detailed interviews (133 specifically related to health care) • 1/5th congressional staff • 1/3rd executive branch • Remaining: outside government

7. #1: Cohesion Speaking with one voice and convincing legislators that the policy truly represents the preferences of the entire group. 84% of the respondents thought this was the most influential factor in the political agenda.

8. Grassroots Grassroots Campaign

9. Astroturfing

10. Step 1: Preparation

11. What Changes Need to Be Made and Where Will They Be Made? • Statutory • Rules/Regulations • Policy

12. Begin Informal Discussions/Ensure Awareness of Issues • Board of Nursing • Major Nursing Organizations • Other Health Care Organizations • Umbrella Agency for Professional Regulation

13. Other influences • National organizations • State Medical Board • State Medical Association • Consumer Groups

14. Professional Organization • Talk with Executive Board • Discuss with Government Relations Committee • Inform Membership Ensure Cooperation and Support

15. Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world. Joel Barker

16. Step 2: Taking Action/Building the Coalition

17. Formal Meeting • Key representatives from all APRN groups • Explain changes and how will affect APRNs in state • Outline a plan for building a consensus • Get their input • Give the coalition a name/Develop a mission statement

18. Formal Meeting • Ask for them to submit names/CVs of their members wiling to participate • Date of the meeting with the entire coalition • Pledge support for the effort and everyone stands united

19. Professional Organization • Present the proposed changes to the Members • Get feedback from members • Provide feedback to BON • Educate the membership • Build support within the organization • Select representatives for the coalition

20. Representatives for The Coalition • Executive Board • GR Committee • Key Members

21. Choose State/Team Captains • Divide state into regions • One captain for every region • Assign team members to captains • Strategically choose co-captains

22. Building the Coalition Team If possible-one member of every organization represented on every team in the coalition

23. The Coalition Meeting • Vision Statement • Consensus Model for APRN Regulation • Changes to be Made/How they will affect APRNs in state-focus on positive • Resource Materials • Show how the state is divided up/introduce captains

24. Kick-off Meeting • Strategies • Opposition • Most important! Everyone must speak the same language, use the same terms • Communication plan/website/dates of future meetings • Everyone agrees to work together and pledges support

25. Responsibilities of the State Captains • Primary Communicator • Establish a means of communication with team members • Strategize as to how you will educate the APRNs in your region • Distribute resource materials

26. Responsibilities • Represent the region at coalition meetings • Meet with legislators/coordinate legislative activities

27. Step 3: Getting the Bill Passed

28. Prior to the Opening of the Legislative Session and Ongoing… • Educate the APRNs in the state: • Post information and toolkit on BON and Professional Organization website • State Captains • Distribute materials to APRNs • Give presentations at Hospitals/Nurses Week • Get on agenda of local chapter meetings • Coach team on how to talk with legislators

29. Choose Sponsors for the Bill • Supportive of Nursing/Knowledgeable about health care • Experienced in successfully passing legislation • Influential in both parties

30. Preparing for the bill to be Introduced • Legislative handbook • Data/Talking Points • Language for the bill • Decide who will lead the lobbying efforts

31. Bill is introduced and in committee • Target the committee members-explain why the changes are important and how they will positively affect the health care provided to the citizens of your state. • Constituents contact committee members • Fact sheets • Data • State Captains

32. Bill is in Committee • Address Opposition • Provide Testimony • Gather Consumer Support

33. Bill is out of committee and goes to House or Senate floor • All out effort is needed for APRNs to contact their legislators • Bill number is important • Encourage all supporters of the bill to NCSBN website for resource materials they may need

34. Addressing the Opposition Board of Nursing Professional Organization • Board of Medicine • State Medical Association Other opposition

35. Negotiations • Have data ready • Be prepared for all questions/have counter-arguments prepared • Use personal contacts/capitalize on existing relationships

36. Using Data Effectively and Other Strategies

37. Florence Nightingale Florence Nightingale's Visual Rhetoric in the Rose Diagrams Lee Brasseur Technical Communication Quarterly; Spring 2005; 14, 2; ABI/INFORM Global pg. 161-182

38. The Rose Diagrams/Evidenced Based Policy The Model • Scientific data to identify a problem • Framed within the context of the political environment • Anticipated questions/opposing argument • Proposed a solution and provided data supporting the effectiveness of the solution

39. Statistics are not merely numbers; they reveal patterns that allow human beings to control destiny. Florence Nightingale

40. John Kingdon (2000) Second most important influence on the policy process…

41. #2: Academicians, Researchers, Consultants 66% rated these as the second most important influence in the policy process. Data and expert opinion

42. Resources • NCSBN Member Board Profiles • NCSBN data • Other States/Other Professions Within Your State • Statistics • Other data sources

43. One Board of Nursing • Problem • Two boards of nursing places an undue burden on the IL Dept of Professional Regulation in terms of budget and staff. • A high number of disciplinary cases on the RN/LPN board. (Public Safety)

44. Board of Nursing Proposed solution • Combine the boards and create one board of nursing with 13 members.

45. Board of Nursing Anticipated opposition • Removing the physicians from the APRN board will endanger the public.

46. Board of Nursing Data to support the proposed solution • The APRN Board has not met over the past two years. There has been no increased in discipline cases or any other indication of a threat to the public. • Prior to the past two years the attendance record indicates only one out of the 3 physicians on the board ever attended the board meetings.

47. Additional data to support the proposed solution • Illinois is only one of 2 states to have an APN board • Illinois has no voice at the national level in APN regulatory issues since the APN board is not a member of NCSBN. • Combining the boards will provide substantial savings for the dept.

48. Additional Lessons

49. Elimination of Collaborative Practice Agreements Problem • APNs that work in collaborative practice agreements with MDs that • They don’t know • Don’t know what their role is/what the collaborative agreement is for • Physicians uncomfortable with the process • APRNs in rural settings are having difficulty finding physicians to collaborate with and APRNs are avoiding working in those areas. • They are redundant

50. Elimination of CPA Proposed change: • Elimination of collaborative practice agreements