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June 26, 2017/Nursing/Quality

Nurses See Advocacy as an Integral Part of Their Professional Responsibility

Tackling issues that matter


Michelle Cockrell, MSN, RN, is a clinical nurse in the Emergency Department at Cleveland Clinic’s main campus. Though she works the night shift, Cockrell’s concern for her patients doesn’t end when the sun rises. She is a passionate advocate for quality patient care and the nursing profession, serving as the Government Affairs Liaison for the Ohio Emergency Nurses Association (Ohio ENA).


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“Public policy sets the tone for healthcare and affects everything we do as a profession,” says Cockrell. “I don’t think people understand that the choices legislators make ultimately trickle down to front-line staff and affect our ability to provide quality patient care.”

Michelle Cockrell, MSN, RN

Cockrell is one of many nurses at Cleveland Clinic who is actively interested in shaping public policy. The Stanley Shalom Zielony Institute for Nursing Excellence’s Legislative and Health Policy Council, formed in 2014, has approximately 80 members. Council leadership focuses on the role of nurses as advocates and encourages advocacy in the local community, statewide and nationally.


“Nurses can influence community health, public policy and the nursing profession on many levels,” says Nancy Kaser, MSN, BS, RN, ACNS-BC, NEA-BC, a clinical nurse specialist and co-chair of Cleveland Clinic’s Legislative and Health Policy Council. “Advocacy can be displayed in many ways, such as writing a letter to your representative, providing a presentation at a community event, or sharing stories told by patients about the barriers to healthcare they encounter regularly. Advocacy is integrally tied to what nurses do. We care about the profession, patients and families and can help influence decisions to improve outcomes.”

Educating nurses on public policy

Many nurses echo Kaser’s sentiment. When the Legislative and Health Policy Council surveyed more than 650 Cleveland Clinic nurses last October, greater than 96 percent agreed or strongly agreed that nursing advocacy was an integral part of their professional responsibility. In addition, more than 93 percent agreed or strongly agreed that nurses had the ability to influence the nursing profession. But how? That’s the guidance that the Legislative and Health Policy Council hopes to provide during monthly meetings.

During the past couple of years, the council’s main focus has been on educating nurses about health policy and encouraging involvement. Some topics covered were quite basic: branches and responsibilities of our federal government, how bills become laws, and local, regional and state topics affecting nurses, healthcare or our communities.

“We partner regularly with our government relations colleagues for learning about current issues,” says Meredith Lahl, MSN, MBA, APRN, PCNS-BC, PPCNP-BC, CPON, Executive Director and ACNO of Advanced Practice Nursing at Cleveland Clinic. For instance, last summer a representative from Cleveland Clinic’s Government and Community Relations Department spoke about the impact of hosting the Republican National Convention in the city of Cleveland.

To provide further education, the council held its first Legislative & Health Policy Conference in October 2016. The one-day event attracted 125 attendees, who learned about the role of nurses in public policy and received an update on current health policies and how they impact practice. A highlight of the day was the keynote address by Rebecca M. Patton, DNP, MSN, RN, CNOR, FAAN, from Case Western Reserve University’s Frances Payne Bolton School of Nursing. Dr. Patton served as president of the American Nurses Association during the Obama Administration and had been invited to watch the president sign the Affordable Care Act into law.


“The take-home message for all attendees was to join professional nursing organizations,” says Lahl. “You don’t have to lobby on Capitol Hill, write letters to your legislator or run for city council. But it’s very important to join your professional organization and get involved with the issues you care about.”

In addition, the Legislative and Health Policy Council organized trips to the Ohio Statehouse, the seat of government in the state capital of Columbus. Each year, a group of Cleveland Clinic nurses attends Nurses Day at the Statehouse, sponsored by the Ohio Nurses Association. More than 400 nurses from across the state attend the event, which typically includes a panel discussion on nursing issues and meetings with legislators. “It’s a great opportunity to hear about what legislators are doing in our state,” says Cockrell.

Members of the council also traveled south to the Ohio Statehouse in 2016 to witness testimony to House Bill 216. Signed into law by Governor John Kasich on Jan. 4, 2017, H.B. 216 removed unnecessary rules and regulations surrounding APRN practice and is a step toward greater practice autonomy in the state of Ohio. “Many of our nurses did not know they could witness expert testimony at the Statehouse,” says Kaser. “Hearing experts telling our story was amazing!”

As leaders of Cleveland Clinic’s Legislative and Health Policy Council, Kaser and Lahl were actively involved in promoting passage of this bill. For more about House Bill 216, read this CQD article.

Moving from education to action

Some nurses go beyond witnesses and become outspoken proponents for public policies related to healthcare. Lahl, who serves alongside Kaser as co-chair of the Legislative and Health Policy Council, has been an outspoken advocate for full and independent practice for APRNs.


“Cleveland Clinic has the largest number of advanced practice nurses in Ohio and nationally,” says Lahl. “It’s important for our organization to be at the table discussing what legislation should look like and how it impacts our healthcare providers and patients.”

Cockrell’s decision to roll up her sleeves and get involved stemmed from her work in the ED. “I was interested in what was going on in the ED, and I knew I had a voice as a frontline nurse,” she says. “We are one of the largest professions nationwide, so why not use our voice to speak up for how we practice?”

Cockrell, who has been a member of the Emergency Nurses Association since 2009, contacted the Ohio ENA Government Affairs Liaison in 2013 and asked to attend committee meetings. A year later, she attended her first ENA Day on the Hill, joining nurses from across the country to meet with legislators and advocate for the association’s public policy agenda in Washington, D.C.

In 2016, Cockrell was named Government Affairs Liaison for the Ohio ENA and led a delegation to Day on the Hill to urge elected officials to consider key issues, including psychiatric health reform. When at the Hill, she met with several legislators, including Ohio Senators Sherrod Brown and Rob Portman. “It was amazing to give our input as nurses on Capitol Hill and tell our legislators what we feel strongly about,” says Cockrell.

The collective voice of the ENA made a difference: Less than two months after Day on the Hill 2016, the U.S. House of Representatives overwhelmingly passed H.R. 2646, the Helping Families in Mental Health Crisis Act. In December, President Obama signed the 21st Century Cures Act into law, eliminating prohibition on same-day billing for mental health and primary care services, providing resources for suicide prevention programs, and expanding crisis intervention training for first responders.


Tackling issues that matter to the community

With the groundwork laid in the past few years, the Legislative and Health Policy Council now hopes to move more nurses like Cockrell to action. One of its goals for 2017 is to encourage more involvement locally. “We are partnering with colleagues from Cleveland Clinic’s Government and Community Relations to explore how nurses can become involved at the community level,” says Kaser. This may include everything from taking blood pressures at local wellness fairs to serving on boards of directors.

The council also plans to tackle local health issues and informally polled its members, asking for input. “Rather than trying to learn all about A, B and C, we’re going to spend time on a particular issue and see how we can impact it,” says Lahl. One possible topic is Ohio’s opioid crisis.

“Education and outreach are important, and we will continue that,” says Kaser. “But our active members are ready to take the next step, and we’re trying to provide opportunities for everyone.” She hopes that nursing leaders in healthcare organizations across the country are inspired too.

Kaser concludes: “With all the changes taking place in healthcare, somebody needs to talk to legislators and decision-makers. Who better than nurses?”

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