HealthAugust 14, 2023

Why more nurse leaders are needed at the public policy table

Nurses are uniquely qualified to influence public policy issues, helping to remove barriers that impact community health locally and nationally.

Lisa Bonsall, MSN, RN, CRNP, clinical editor for Lippincott’s, interviews Susan C. Reinhard, PhD, RN, FAAN, in a podcast on the importance of including the voice of nursing in public policy. Senior Vice President and Director of AARP Public Policy Institute and Chief Strategist for the Center to Champion Nursing in America (CCNA) and Family Caregiving Initiatives, Reinhard has deep knowledge and experience serving on local and national boards that impact community health nationwide.

As a visiting nurse early in her career, Reinhard says she saw firsthand the crucial role nurses could play in helping to shape public policy. As a relatively new graduate, she questioned why care options differed between similar patients and was advised to “look at the bottom of the chart and see the payment source.”

“I started to realize that I couldn’t treat all people the same,” Reinhard explains. “It was quite stunning to me that so much had to do with what insurance you had and who the payer was. When you are in nursing school, you are learning how to take care of people, but you don’t worry about the payment source. That’s how I started getting involved in policy.”

Once Reinhard began to explore what public policy was all about, she says it also became clear how much she didn’t know. She turned to the American Nurses Association and her local New Jersey State Nurses Association (NJSNA) chapter to fill in the gaps. “This is how I got into understanding how bills were made into law,” she explains. Upon earning her doctorate in sociology and health policy, she became a part-time lobbyist for NJSNA, which opened the door to innumerable contacts and led to her being named Deputy Commissioner of Health and Senior Services in New Jersey.

Ultimately, this led to forging a partnership between the American Academy of Nursing (AAN) and the Robert Wood Johnson Foundation (RWF), based in Princeton, New Jersey, encouraging more AAN fellows to get involved. “The AAN is about policy,” she explains, as it examines “what’s going on in the state and within the nation.” Her next step was being named co-director of the Center for State Health Policy at Rutgers University before being recruited to AARP.

Reinhard describes the AARP Public Policy Institute as a “Think and Do Tank,” with its CCNA, in collaboration with RWF, as key “in disseminating work to engage nurses and nurse champions, who care about nursing and the work that we do.” She calls the collective efforts “nursing intervention at the community health level,” noting that while nursing “takes care of people one at a time, public policy helps you care for many people across time.”

When the CCNA was formed in 2007, the initial focus was on the nursing shortage and recruitment. However, Reinhard says that has since been expanded to address today’s nursing faculty shortage. “How can we get more nurses to pursue their baccalaureate degree and higher so they could become faculty?” she posits. Another effort is to get more nurses on boards. “We’ve brought this into our action coalitions,” which she says are aimed at positioning “nurse leaders and champions in every state to focus initially on education progression and leadership,” adding that this has “brought together 19 national organizations,” placing nurses on coalition boards and other initiatives.

Created in response to the 2010 Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health,” one of the key strategies was to get 10,000 nurses on boards by 2020, which the coalition achieved, placing nurse leaders in pivotal decision-making roles to improve the health of every American.

Today Reinhard says much of the focus is on a new report, “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity,” which addresses 50+ recommendations and related action plans. Hospitals and healthcare organizations are being challenged to determine what they can do in the immediate future and longer range. In addition, AARP has created the Center for Health Equity through Nursing to align nursing leadership with consumer voices to end structural racism. “These are basically structural barriers to health and well-being,” she explains, adding, “Our focus is on scalable system changes that advance health equity nationwide.”

Having nursing representation on healthcare-related boards is especially critical, says Reinhard. “I have found that many board members don’t really know health very well. When nurses speak up, we tend to represent the patient and the family members because we have direct experience working with them in a hospital or community setting.” However, she cautions nurses pursuing a board appointment should be aware of the possible perception of only being interested in how issues affect nurses. “Our role isn’t only about how this affects nurses,” she emphasizes, “but how nurses provide care to people and what that means to the decision-making that’s going on in the hospitals.”

“When nurses speak up, we tend to represent the patient and the family members because we have direct experience working with them in a hospital or community setting… Our role isn’t only about how this affects nurses, but how nurses provide care to people and what that means to the decision-making that’s going on in the hospitals.” 
Susan C. Reinhard, PhD, RN, FAAN

Reinhart also believes that nurses can serve as a bridge to drive policy from acute to post-acute care. “Patients and families really need support once they leave the hospital. We have a better understanding of what it will be like when you get home from the hospital, and we can bring that insight into committees within the hospital,” she explains.

Having nurses on non-medical boards that affect the community can also be very beneficial. “It doesn’t have to be a hospital board,” says Reinhard. “It can and should also be local boards where you live that affect the people you know in your community. I find that nurses who serve on boards feel supported and want to contribute in ways that go beyond direct care to change the life course for people in their communities.”

When considering a board opportunity, Reinhard encourages nurses to follow their passions. “My passion is family caregiving from my early days as a visiting nurse,” she explains, which has led to a board appointment for the National Alliance for Caregiving. “What sings to you in your soul?” she challenges. “Start there and get to know people outside of your comfort zone. It’s not who you know, it’s who knows you and what interests you. Once you have an opportunity to show up, really listen carefully. If there is something you can add, please add it.”

Reinhard also recommends sending a simplified resume if asked for background information. “Strive to have a very short resume because this has to be included when the board votes on adding a new board member.” She says it can also be a turn-off to include a long list of credential abbreviations. “I will generally use RN and PhD because that is my terminal degree, but I don’t use MSN or certifications,” which can be perceived as pretentious.

In the aftermath of COVID, Reinhard also stresses the importance of self-care for nurses to guard against burnout. “We need to take care of ourselves and support our frontline workers so they can support the well-being of others. That’s number one, along with taking every opportunity to celebrate and elevate the nursing profession. I invite you to join us in our work for The Future of Nursing Campaign for Action. There are many ways for nurses to participate.”

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