Nursing, Advocacy and Health Policy

Publication of the revised American Nurses Association's "Code of Ethics for Nurses" coincided with a new administration taking office in January 2025 and the start of a new session of Congress. In addition to describing the values and obligations in the nurse-patient relationship, the code describes the role of nurses in influencing health policy through advocacy. So what steps can nurses take to improve patient care through engagement in public policy? As a member of AACN's Strategic Advocacy Team, I'm sharing a few ideas!

Applying the Nursing Process to Nursing Advocacy

I learned the nursing process in nursing school and later, as a clinical instructor, I used it to teach nursing students. As we move from novice to competent to expert in our nursing careers, the nursing process often becomes intuitive. We organize our patient care through this process without noticing the individual steps. Because this process is one we share as a profession, I will offer a framework for nursing advocacy that uses the five steps of the nursing process: Assess, diagnose, plan, intervene and evaluate. I'll give examples of how these steps apply to our work at AACN and how individual nurses might use these steps in their own policy and advocacy work.

Assess: 'What data do I need and how do I get it?'

In clinical practice, when a patient's condition changes, we ask about new symptoms and new exposures, we listen and look for new physical exam findings, and we check their meds and what labs have been drawn. We look for anything else that could be different and may have caused that change. Similarly, the first step in advocacy is gathering information. Fortunately, information about policy changes is not difficult to find thanks to online search engines, electronic news publications and social media. One tip, though, is to understand the reliability of the sources where policy news is shared. Just as we might want to double-check a piece of clinical data that is out of range, we want to be sure we have accurate information to inform decisions and actions on health policy.

How we do this at AACN:

Our Strategic Advocacy Team at AACN has a vetting process where we explore public policy issues using a variety of sources of information. Primary sources are key to this process. If we are looking at proposed regulation or legislative action, we go to the .gov site where it is publicly posted and read the actual wording. The White House similarly posts all executive orders on open access pages. This access allows us to interpret the rule or law for ourselves, directly applying an AACN lens, and consider the consequences for patients and nurses. When the proposed rule or law is controversial or highly relevant to our community, we often use multiple sources to understand a range of opinions on its impact.

What individual nurses can do:

Government sites that post regulatory and legislative language are open access, so anyone can read those primary sources. In addition, consider checking a website that evaluates the political slant and reliability of different media outlets, such as Ad Fontes or AllSides Media. If your regular sources tend to lean one way on the political spectrum, consider also seeking information from a source that leans the other way to get the full scoop. You may not agree with everything you read or watch, but moving outside your usual channels promotes a broader understanding of health policy issues.

Social media can be a helpful way to learn about policy changes. As you scroll through your feed, if something seems interesting or important, take the time to click through to the source. Sometimes the headline is designed to attract attention rather than reflect the perhaps mundane and accurate details of the situation. When you click through, check to see if the posted content is a news story or an opinion piece. If it's an editorial or opinion, consider going to primary sources to verify the accuracy of the information. Social media algorithms are designed to show you content that matches your interests, so you may miss advocacy opportunities if social media is your only source for news. Consider making it a habit to check other online news websites for policy information. Another AACN blog, Do's and Don'ts of Social Media Use for Nursing Professionals, offers tips for engaging on social media channels, including assessing the accuracy and intention of a post before engaging (e.g., liking, sharing, commenting, etc.) to avoid amplifying misleading or exaggerated information.

Diagnose: 'What is the problem?'

Once you've gathered key facts, it's time to interpret the situation. Similar to patient care, this part involves analyzing all pieces of data into a single coherent picture. Sometimes that's a high-resolution, crystal-clear picture of what is happening, and other times, it's blurry or missing a few pieces. In both clinical practice and advocacy work, it's tempting to move seamlessly to different options for addressing a situation, but a clear and shared understanding of the problem is essential.

How we do this at AACN:

At AACN, we articulate the diagnosis of a policy issue based on its potential impact on acute, progressive and critical care delivery, and the health of the clinical work environment. We ask, "How might this proposed rule/law/order impact our community of nurses and the patients and families they care for?" Because we focus on federal policy, sometimes a fair bit of distance exists between the proposed rules, laws and orders that we review and the individual nurses providing patient care. Nursing practice is directly influenced by unit and organizational policies, which are also driven by county and state policies, so we need to consider how the proposed rule/law/order will impact those different layers.

How the individual nurse can do this:

One question that nurses engaging in policy can ask for the diagnosis is, "What does this mean for my patients and colleagues?" As an acute, progressive or critical care nurse, you have unique insight about illness and care delivery because your proximity allows you to share that experience with your patients. Use that lens as you analyze the data, so you can clearly articulate the issue that needs your advocacy.

Planning: 'What are my options?'

Here we want to consider all the possible responses to the identified problem and pick the best one or ones (sometimes more than one action is needed). Keep in mind that if the diagnosis stage demonstrates a lot of uncertainty, gathering more data might be the best response.

How we do this at AACN:

We first coalesce the gathered data and identified issues into an SBAR (Situation, Background, Assessment, Recommendation). As a team, we find the SBAR generates a shared understanding of the situation and becomes a foundation for team discussion. As a member of that team, I find that writing an SBAR helps me clarify my understanding of the public policy issue and its impact on patient care. Some of the options we consider in the recommendation section of the SBAR are reaching out to the coalitions we belong to to see if they plan any action, composing and sending letters to policymakers, using AACN e-newsletters to communicate the policy issue to our members, or monitoring the proposed policy for further developments.

How the individual nurse can do this:

You can consider several options when responding to health policy issues that you assess and diagnose as relevant and important to your practice:

• Reach out to peers, share what you've learned and invite input.
• Contribute to shared governance processes, and unit or organizational committees that create and revise hospital policy. Since hospital and health system policies can have a profound effect on nursing practice, nurses should be at the table to contribute to their development.
• Do an online search and see if other grassroots efforts or professional organizations are addressing the policy or issue.
• Consider checking the RNAction website to view and engage with priorities identified by the American Nurses Association.
• Identify your state and federal representatives and notify them of your concern.
• Watch for townhalls where congressional representatives and other policymakers return to their home districts and offer forums for their constituents.
• Consider joining a "Hill Day" event at the state or federal level. Professional organizations, including the American Nurses Association, arrange these events, where groups of nurses meet with legislators to describe their nursing experiences and priorities.

Intervention: 'Let's go!'

This is when we take our planned action. Be aware of the following considerations that apply to AACN and to all nurses in our community:

1. As you begin conversations about policy issues, avoid amplifying inaccurate, exaggerated or emotional information. Similarly, consider correcting misinformation and disinformation when you see it. (In the "assess" stage, you collected primary source information to help you do this.) If you see an online post or comment that doesn't quite have the full story, politely provide the information you have.
2. With policymakers, consider messages that leverage both data and narrative examples. While data and evidence are crucial to making sound policy choices, stories that bring that evidence to life can be powerful in political circles. Take for example Dr. Lorna Breen Heroes' Foundation, which advocates for the support of healthcare workers' well-being. The foundation uses a specific provider's story combined with data showing their experience is relevant to other healthcare roles. The result is a sound message, grounded in truth and also emotionally resonant.
3. Along the same lines, be sure that communication with policymakers has a professional tone, so that your expertise as a nurse shines through. Whether you are meeting in person or composing a written message, formulate your thoughts into clear and concise key points.
4. At AACN, when we compose a message for our nursing community or for policymakers, we always have multiple team members check for errors and completeness. Consider inviting a colleague, a mentor, a friend or a family member to review and optimize your messaging.
5. It's a good idea to thank policymakers when their actions align with our values and expectations. As a member of the Nursing Community Coalition, AACN routinely signs on to letters of appreciation when policymakers introduce legislation such as the ICAN Act or the PRECEPT Nurses Act that support our profession.

Evaluation - 'So how did it go?'

Just as we take lessons from patient and family care experiences and apply them to our future care, advocacy work offers us a learning opportunity that we can apply forward. In addition to feeling proud that you took action on an important issue, consider evaluating the experience. Identify - and maybe even write down -- what you learned and how you might apply those lessons.

Unlike clinical practice, advocacy work seldom has immediate results. That's difficult. We work in a profession where adjusting the rate of a vasopressor changes a patient's blood pressure within minutes. Engaging in policy advocacy is incredibly slow in comparison. There are some bills that have been reintroduced many times without making progress. So when you decide to engage in policy and advocacy, be ready for a marathon, not a sprint.

To learn more about AACN's advocacy work, check our webpage. You can also reach out with questions to advocacy@aacn.org.

Here are a few more resources to learn how you can engage with health policy issues:

• National Coalition of Ethnic Minority Nursing Organizations holds an annual health policy conference and also offers resources related to their member organizations' shared goal to achieve health equity.
• RNAction: The American Nurses Association offers draft letters to send to congressional representatives.
• Congress.gov: You can find names of your congressional representatives on this page and read proposed legislation and track its progress.
• The American Academy of Nursing has an annual health policy conference, offers open access webinars on policy issues and creates policy statements.
• State legislation and regulation impact nursing practice. Review these two websites to connect to your state websites.

Do you use additional resources to learn about health policy? Let us know in the comments below.

Special Acknowledgement

I acknowledge and thank my co-author, Lisa Bonsall (she/her), strategic advocacy editor, for her valuable contributions to this blog.