Troubled and unhappy nurses cannot be wished away and they will not go away because they are ignored ... the increasingly complex role of the nurse, the alarming ratio of supportive personnel to nurses, the growing realization that nurses have subsidized the cost of health care for too long a time - all these factors make it imperative that all members of the health team involve themselves in finding solutions to the problem of growing unrest in health facilities (Sept. 1966, Ohio Nurses Review).

Registered nurses have not found solutions to these major problems in the thirty-two years since this article was published. The replacement of registered nurses by unlicensed assistive personnel, the increasing complexity of the role of the registered nurse, and the lack of adequate compensation for registered nurses remain pressing issues for the nursing profession. A national survey of 7000 registered nurses by Judith Shindul-Rothchild (1996) revealed: 1) 60% reported a reduction in the number of RNs providing direct patient care; 2) 57% reported that the quality of care in their institutions doesn't meet their professional standards; 3) 65% are being asked to care for more patients; and 4) 78% are dealing with increased patient acuity.

The only group with any incentive to change our historic and current problems is ourselves. In fact, other groups, who believe that they have much to lose if nursing gains power, lobby against our progress. A case in point is the Ohio State Medical Association legislative priorities for 1997 which include "limiting allied practitioner's scope of practice: nurses prescriptive authority" as one of their five priorities. This situation certainly exists in all 50 states.

The best way for registered nurses in the United States to find solutions to these problems at the national level is to become involved in the lobbying efforts of the American Nurses Association (ANA). Birnbaum, in a recent issue of Fortune magazine, named ANA's lobbying team the 78th most powerful lobbying group in Washington, D.C.; more powerful than the American Association of Medical Colleges, American Academy of Family Physicians, American Association of Health Plans, American Dental Association, and the United Mine Workers. (Note that the American Medical Association is rated higher than ANA so the help of each nurse is most definitely needed.) ANA was included in the list of powerful lobbying groups in large part due to its legislative successes in 1997 which include:

• achievement of direct Medicare reimbursement for ALL nurse practitioners and clinical nurse specialists
• introduction of legislation in both chambers to provide direct Medicaid reimbursement for all nurse practitioners and clinical nurse specialists
• drafting and introducing the "Patient Safety Act" (HR 1165) that would require health care institutions to make public specific information on staffing mix and levels, and patient outcomes; complaints to be filed with accrediting or regulatory agencies; health care mergers and acquisitions to be subject to the approval of the Secretary of Health and Human Services based on their impact on the safety and health of the community; and proposed legislation to include "whistleblower" protections for health care workers
• securement of increased funding for the Nurse Education Act ($65.6 million, an increase of $300,000 over 1997), National Institute of Nursing Research ($63.6 million, an increase of $4 million over 1997), Occupational Safety and Health Administration ($336 million, an increase of $12 million over 1997), and the National Institute for Occupational Safety and Health ($152 million, an increase of $11.5 million over 1997)
• reauthorization of the Community Nursing Organization Demonstration Project through December 31, 1999 (these projects have offered a package of Medicare benefits to the elderly in non-institutional settings by nurse coordinators and managers in Arizona, Illinois, Minnesota and New York since 1994)
• inclusion of three nurses -- ANA President Beverly Malone, PhD, RN, FAAN; Martin Prado, RN, of Florida; and Mary Wakefield, PhD, RN, FAAN, of Maryland -- on President Clinton's 34-member Advisory Commission on Consumer Protection and Quality in the Health Care Industry.

ANA's successes are a result of the outstanding work done by the staff of the ANA Department of Federal Government Relations, the ANA Political Action Committee, and the grassroots lobbying network (N-STAT). Nurses can have a direct impact on each of these efforts.

The ANA Political Action Committee raises and contributes funds to support candidates who support ANA's legislative agenda, involves nurses in electoral campaigns, and increases ANA's visibility in the Washington political arena. Last year ANA PAC raised over $1 million and plans to exceed $1 million during 1998. The 1998 election is an excellent opportunity to support candidates who are "friends" of nursing, elect more nurses to Congress and involve more nurses in Congressional campaigns. Nurses can volunteer to work on a "friend" of nursing's campaign. The personal relationship that develops between you and the candidate, as well as the staff, will be invaluable when lobbying for legislation if the candidate is elected. You can call your State Nurses Association to ask which candidates would be best to work for and to inform them of your work. Some candidates need your help now as they are running in difficult primary elections. Others will appreciate your help immediately following the primary election which differs in every state (call your state nurses association for this information too).

N-STAT is the grassroots lobbying force consisting of thousands of nurses who are members of their State Nurses Associations. N-STAT participants commit to write or call when notified by ANA about impending federal legislation. A synopsis of the legislation as well as a sample letter to the member of Congress are provided by ANA to N-STAT members. Last year N-STAT members were asked to contact their legislators approximately 4-6 times. Signing up for N-STAT is a good way to get timely information and it is an easy and effective way to really make a difference. N-STAT made a major contribution to ANA's legislative successes in 1997. Virginia Trotter Betts (the originator of the N-STAT concept) remarked at a public policy conference in Washington in October, 1997, that legislators had told ANA staff to "call off the nurses" because they were getting hundreds of letters and calls related to a piece of legislation. This is a good example of nurses involving themselves in finding solutions to problems. If you live in the United States, you can become an N-STAT member by writing or calling your State Nurses Association. If you live outside of the United States, call your national nursing association and see what you can do to promote nursing in your country.

I'd like to write a new ending to the issues that have plagued us for too many years. It will appear in OJIN in the year 2000 as follows:

Untroubled and happy registered nurses could not be wished away and they did not go away because they were not ignored ... the increasingly complex role of the registered nurse, the appropriate ratio of supportive personnel to registered nurses, and the public's realization that registered nurses have subsidized the cost of health care for too long a time--all these factors made it imperative that all members of the health team involved themselves in finding solutions to the problem of growing unrest in health facilities ... Registered nurses joined their State Nurses Associations in record numbers, contributed over $1.75 million to the ANA political action committee, worked on key Congressional races across the country, and became active members of N-STAT (Glazer, 2000).

THE AUTHOR

Greer Glazer, PhD, RN, FAAN
Director, Parent Child Nursing
College of Nursing
Kent State University
Kent, OH 44202
E-mail Address: GGlazer@kent.edu

Dr. Glazer is Professor and Director of Parent Child Nursing at Kent State University College of Nursing. Besides her many research activities in the field of women's health and stress, Dr. Glazer is chairman of the Ohio Nurses' Association Government Affairs Committee, a combination legislation committee and PAC. She is currently the legislative liaison to congressman Steve LaTourette and has previously been on health care committees at the state and national level. Locally she serves on the Board of the Cuyahoga County (Ohio) Children's Trust Fund and recently completed four years on the Health Care Committee allocation panel for United Way in Cuyahoga County.