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Nurses as Advocates for Improvements in Community Health Care Bethany Hall-Long, Ph. D, RNC, Nurses as Advocates for Improvements in Community Health Care Bethany Hall-Long, Ph. D, RNC, FAAN DE State Senator, District 10 Professor, School of Nursing University of Delaware

Overview Introduction & Historical Overview Driving Forces & Legislative/Regulatory Structures, Health Policy & Politics Overview Introduction & Historical Overview Driving Forces & Legislative/Regulatory Structures, Health Policy & Politics Highlights Professional & Advocacy Issues Summary, Call to Action, & Q & A

Questions? When you hear the words “Health Care” what one word comes to mind? Questions? When you hear the words “Health Care” what one word comes to mind? When you hear the word “Politics” what comes to mind? When you hear the word “Nursing” what word comes to mind? When you hear “Advocacy” what word comes to mind?

Background/Historic Leaders Pushed for improvements in community health Lillian Wald— Pioneered the field of Background/Historic Leaders Pushed for improvements in community health Lillian Wald— Pioneered the field of Public Health Nursing

Mary Breckenridge —Brought the specialty of Nursemidwifery to the U. S. and started the Mary Breckenridge —Brought the specialty of Nursemidwifery to the U. S. and started the Frontier Nursing Service to serve rural Appalachian families.

Florence Wald Mother of the American Hospice Movement Started the first US hospice in Florence Wald Mother of the American Hospice Movement Started the first US hospice in Connecticut

Local, State, National & International Policy Forces Influencing Community Care Fiscal Constraints (16% GDP Local, State, National & International Policy Forces Influencing Community Care Fiscal Constraints (16% GDP Health Care) Health Professions Resources/Shortages Technology & Informatics Gaps/Demands Ethics (i. e. , HIPPA, DNR Orders)

Local, State, National & International Policy Forces (Continued) Surge in Chronic Disease & Aging Local, State, National & International Policy Forces (Continued) Surge in Chronic Disease & Aging Bio-Terrorism, War & Global Disaster Risks Scope of Practice 4 th Branch of Government: Media

Health System Actors & Government Actors: Consumers Providers Employers Government Insurers Interest Groups Other Health System Actors & Government Actors: Consumers Providers Employers Government Insurers Interest Groups Other FUNCTIONS • Funding • Regulations • Service • Delivery • Research & Development • Other

Central Driving Policy Issues Impacting Current Community Care Quality Access Cost Central Driving Policy Issues Impacting Current Community Care Quality Access Cost

Current Problems Estimates show 30% of hospitalizations are related to medication misuse/errors/noncompliance at home Current Problems Estimates show 30% of hospitalizations are related to medication misuse/errors/noncompliance at home *By the year 2030, the number of Americans aged 65 and older will more than double to 71 million older Americans, comprising roughly 20 percent of the U. S. population. Shortage of nurses/lack of funding for community-based care *Source: The State of Aging and Health in America 2007. This report was released by the Centers for Disease Control and Prevention (CDC) and The Merck Company Foundation at the 2007 Joint Conference of the American Society on Aging and the National Council on Aging in March 2007.

Health Policy: Course of action or inaction by the government regarding the public’s health Health Policy: Course of action or inaction by the government regarding the public’s health and welfare Impact on the Nursing Profession?

Government and Areas for Nursing Advocacy Regulations Funding Service Delivery/Clinical Research & Development Other Government and Areas for Nursing Advocacy Regulations Funding Service Delivery/Clinical Research & Development Other

Title 24 of the Delaware Administrative Code section 7. 7. 4. 6 Delaware’s Nurse Title 24 of the Delaware Administrative Code section 7. 7. 4. 6 Delaware’s Nurse Practice Act says CNA’s may not administer medications. Is there a way to allow a nurse to delegate giving routine meds to an aide with experience and special training?

Medication Administration In the Community: Questions Do we really need nurses to give medications Medication Administration In the Community: Questions Do we really need nurses to give medications at home? Is there funding to pay for nurses to give meds around the clock in a home setting? Even if there were funding, are there enough nurses to give every adult in the community their medications at home?

Legislative Process: Application of Evidenced Based Practice Bill to Law Idea, Drafted Legislation, Assigned Legislative Process: Application of Evidenced Based Practice Bill to Law Idea, Drafted Legislation, Assigned a # (HB, SB. . ), Introduced, Assigned to Committee, Hearings (mark-up), Voted on - Other Chamber (Same Process), Vote…

Executive Branch Role To Executive Branch: law or veto Obama Administration’s Health Care Reform Executive Branch Role To Executive Branch: law or veto Obama Administration’s Health Care Reform Debate **Regulation, if Override as needed passed. Know DE Regulations (i. e. , medication management in home)

Questions List 2 -4 key public policy or political issues for nursing or allied Questions List 2 -4 key public policy or political issues for nursing or allied health professions related to the management of medications in the community Identify 2 -4 clinical issues you feel must be addressed to improve patient care, outcomes, costs, including medication administration etc. . . Other

Delaware Considerations How do other states regulate caregivers helping with medication administration in the Delaware Considerations How do other states regulate caregivers helping with medication administration in the community setting? Med. Techs with certification and an RN to delegate and be available for guidance and supervision? CNA’s with special experience/training/certification?

DE General Assembly Action DE General Assembly Action

Money Committees **Authorized versus Appropriated State Budget—Operating & Capital (Bond) & Rainy Day Fund, Money Committees **Authorized versus Appropriated State Budget—Operating & Capital (Bond) & Rainy Day Fund, Special Funds (i. e. Tobacco) Bill with a Fiscal Note over 50 K Joint Finance Committee Appropriations

DE Health Related Committees “THINK OUTSIDE THE HEALTH BOX” Senate & House Committees- Examples DE Health Related Committees “THINK OUTSIDE THE HEALTH BOX” Senate & House Committees- Examples to consider Senate Health, Agriculture, Insurance & Elections, Veterans Affairs, Highways, Small Business, Banking, etc. House Health & Human Development, Homeland Security, Labor, Natural Resources and Environment, Education, Public Safety, Judiciary, etc. .

Federal Policy Examples Policy Politics Policy Politics etc. Multiple biological, socio-cultural, mental, physical, economic Federal Policy Examples Policy Politics Policy Politics etc. Multiple biological, socio-cultural, mental, physical, economic issues impacting individuals, professionals, workplaces, schools, communities, governments etc Domestic & Global Other- Nursing, medicine, Allied Health. Specific US Senate & US House www. thomas. gov www. nursingworld. com

Political Strategies To Influence Policymakers Use of media Testimony Direct & Indirect contacts PACS Political Strategies To Influence Policymakers Use of media Testimony Direct & Indirect contacts PACS Drafting Policy Coalition building - Grassroots efforts - Shaping implementation Others

How To’s: Interacting With Elected Officials Face-to-face meetings E-mail Letter writing Unified Approach Do’s How To’s: Interacting With Elected Officials Face-to-face meetings E-mail Letter writing Unified Approach Do’s and Don’ts

Nursing: ALL Areas of Public Policy Nursing: ALL Areas of Public Policy

Federal & State Resources www. delaware. gov Governor Markell 302 -744 -4101, 1 -800 Federal & State Resources www. delaware. gov Governor Markell 302 -744 -4101, 1 -800 -292 -9570 Lt Governor Denn 302 -744 -4333 DE House *302 -744 -4351 or 302 -744 -4171 DE Senate 302 -744 - 4286 or 302 -744 - 4048 County & Local Governments –Visit as needed www. thomas. gov US Capitol 1 -2 -2 -224 -3121 Senator Carper 202 -224 -2441 Senator Kaufmann 202 -224 -5042 Representative Castle 202 -225 -4165

Contact Information General Policy Information. DE League of Women Voters’ American Nurses/DE Nurses Association Contact Information General Policy Information. DE League of Women Voters’ American Nurses/DE Nurses Association Other Specialty Organizations Senator Bethany Hall-Long 302 -744 -4054/4286 bethany. hall-long@state. de. us

“Closing Thoughts” “The further back we look, the further ahead we see” (Churchill) “It’s “Closing Thoughts” “The further back we look, the further ahead we see” (Churchill) “It’s always darkest before the dawn” “Great opportunities are disguised as unsolvable problems”