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Take your legislator to lunch: the nurse leader's role in political advocacy.

Nurse leaders have a responsibility to impact the legislative process through advocacy efforts that support health care bills that affect positive change for patients. Advocacy Day and Pink Ribbon Luncheon, an advocacy project supported by a local non profit affiliate of breast cancer funding and research, was presented to the 2009 Maryland General Assembly. The purpose of the luncheon was to formally introduce the non profit local affiliate to the General Assembly, and to educate the members of the General Assembly of the urgency of not cutting funds already budgeted to FY10 Breast and Cervical Cancer Screening Program (BCCP) and The Breast and Cervical Cancer Diagnosis and Treatment Program (BCCDTP). The nurse leader, having expert knowledge, was able to both increase the legislators' knowledge, and advocate for the uninsured, low income women statewide. The stages of policy process, according to Milstead (2008) were adapted in the development and implementation of the Advocacy Day Pink Ribbon Luncheon, which included agenda setting, legislation and regulation, implementation, and evaluation. Political advocacy does lead to legislative enactment.

At A Glance

* Nurse leaders have vast knowledge and information to present to legislators which can lead to more informed legislative decision making.

* Nurse leaders are important constituents of the legislators, and legislators are more interested in hearing from their local constituents.

* By continuing advocacy efforts nurse leaders are making an important contribution towards ensuring a favorable legislative and regulatory health care environment in the state.


The advanced practice nurse of today must be technically competent, use critical thinking and decision models, possess vision that is shared by colleagues and consumers, and function in a vast array of roles (Mistead, 2008). One such role is the emergence of nurse leaders in the legislative arena of advocacy and health policy. Legislative advocacy efforts by nurse leaders is a way of impacting local, regional and national decision making bodies that affect individual lives and addresses community issues. Nurse leaders, through advocacy efforts, are able to educate and influence legislators, with resulting policies and laws that insure the health and wellbeing of the citizens.

This report summarizes an advocacy and public policy practicum project developed and implemented by a nurse leader in a practicum course as part of the requirements for obtaining an MSN degree. The project was conducted on behalf of a local non profit affiliate for breast cancer funding and research. This advocacy project was entitled the Advocacy Day Pink Ribbon Luncheon and was presented to the Maryland General Assembly in January 2009.

The purpose of the Advocacy Day Pink Ribbon Luncheon was twofold: to formally introduce a local non profit affiliate to the General Assembly, in order to begin to build a strong statewide advocacy coalition; and, to strongly request to not cut those funds already budgeted to FY10 Breast and Cervical Cancer Screening Program (BCCP) and The Breast and Cervical Cancer Diagnosis and Treatment Program (BCCDTP). The purpose of these programs is to increase breast and cervical cancer screening levels among uninsured, low income women statewide, to provide follow-up to diagnosis, to carry out public and professional education, to assure the quality of screening services, to monitor the cancer problem in Maryland, and to carry out evaluation of these programs.

If members of the General Assembly are not informed by qualified, professional experts when debating a particular bill, then ultimately, decisions are made based on very little knowledge about the actual problem or the need for specific solutions. Nurses have the power of great knowledge and expertise. Through the Pink Ribbon Luncheon, the nurse leader spoke before the General Assembly, and distributed literature packets for informational exchange, which impacted legislative decision making on the women's health care and screening programs facing budget cuts.

Breast cancer, when detected early, can be cured. Women whose breast cancer is detected early have a 98% chance of surviving 5 years or more. (ACS Breast Cancer Facts and Figures). Mammograms are a very significant part in early detection. But for women who are uninsured or underinsured, a mammogram may not be available. In these uncertain and difficult economic times, it is expected that this population will increase. In Maryland, while over 65,000 women were eligible for the BCCP, the program was only able to screen 20% of eligible women in 2006 and 2007. Only 1 in 5 of the uninsured eligible women in Maryland was seen through BCCP in 2006 and 2007 (Susan G. Komen for the Cure, 2008).

When the need for health cares services is critical, it is imperative that nurse leaders advocate politically by speaking out on issues that concern those in need. The purpose of this article is to describe an example on nursing advocacy that impacts legislative decision making regarding health care delivery.

Theoretical Framework

Sieloff's (1997) Theory of Group Power within Organizations, was used as a theoretical basis for assessing this nursing leadership practicum experience. In today's health care environment and economic times, organizations much like local non profit affiliates face many hurdles and challenges as they strive to obtain their goals. All resources must be recognized and effectively utilized (Sieloff, 2004). Nurse leaders become excellent resources to affect change. According to Sieloff (1997) it is critical that nurses, within groups, understand how best to achieve their goals within the current and future health care environment.

According to Sieloff (1997), power is very abstract which makes it difficult to define and study. Power has also been viewed negatively and, as a result, is not something that nurses routinely consider. However, when defined as the capacity of a group to achieve its goals, power becomes a crucial resource to any group of nurses wishing to improve their ability to attain their goals.

A nurse leader must routinely assess how to achieve the goals of an organization within the current and future healthcare environment. By engaging in advocacy and lobbying efforts such as the Advocacy Day Pink Ribbon Luncheon, nurse leaders are able to use power and resources as an effective means of achieving set goals. In addition, it is very important for nurse leaders to bring their vast knowledge, expertise and power to the political arena, where they can impact and influence decision making of the legislators who pass laws that pertain to healthcare.

Nurses cannot ignore the political aspects of any issue. Speaking before the members of the Maryland General Assembly, as well as Directors and Deputy Directors of Maryland health care agencies, and honored guests, was an enormously powerful experience. Leadership in nursing is defined as the process whereby a person, who is a nurse, facilitates the actions of others in goal determination and achievement (Milstead, 2008).

Agenda Setting

Agenda setting in the process of policy refers to the identification of a societal problem and bringing it to the attention of the government (Milstead, 2008). Accordingly, the first step in agenda setting was to identify and state clearly the goals and purpose of Advocacy Day Pink Ribbon Luncheon. Leadership in nursing is defined as the process whereby a person, who is a nurse, facilitates the actions of others in goal determination and achievement (Milstead, 2008).

The first goal was to formally introduce the legislators to the local non profit affiliate and the valuable work they do throughout the State. Next and foremost was to present to the attending legislators the need to not cut those funds already budgeted by the State to the Breast and Cervical Cancer Screening Program (BCCP) and the Breast and Cervical Cancer Diagnosis and Treatment Program (BCCDTP). Successful programs such as the BCCP and the BCCDTP must be fully funded to allow all women access to the screening and treatment services they deserve. But in order to convey to the legislators the importance of not cutting these key budgets, they needed to be educated with an overview of the impact of breast cancer in the state, the programs that exist, and how the programs help those in need. The nurse leader is the expert in presenting this information clearly and concisely to the legislators.

Legislation and Regulation

According to Milstead, legislation and regulation are formal responses to a problem. The Breast and Cervical Cancer Diagnosis and Treatment Program was established in 1992 to provide breast cancer and cervical cancer diagnosis and treatment services to program eligible Maryland residents. In 1992, the Maryland Department of Health and Mental Hygiene received a grant from the Federal Centers for Disease Control and Prevention to provide breast and cervical cancer screening services to low income, uninsured or underinsured women (COMAR 10.14.02).

In 1997, the grant was renewed for an additional five years. In 1998, the Maryland legislature made State funds available to supplement the CDC grant. The BCCDTP reimburses the following providers throughout the State to provide diagnosis and treatment services to program participants: hospitals, physicians, pharmacies, medical laboratories, medical suppliers, nurse practitioners, nurse anesthetists, physical and occupational therapists, and home health agencies.

Government regulations and laws have a significant and powerful impact on every nonprofit organization and the people it serves. This makes it imperative for non profit organizations to become involved with policymakers at the city, county, state and national levels who affect their organizations and constituencies. No social service agency can ignore the rules that affect those it serves and still be effective. While services are critical, so is speaking out on the issues that concern those in need. Nurse leaders have an excellent opportunity, via advocacy events such as The Advocacy Day Pink Ribbon Luncheon, to communicate to the members of the General Assembly, with the ultimate goal of influencing decision making. The government response (voting yea or nay), as part of the policy process, often time hinges on the knowledgeable nurse leader who contributes or intervenes prior to final decision making. The Pink Ribbon Luncheon is a stellar example of an intervention by nurse leader in order to bring about a formal response to a problem in the form of legislative change.


Implementation, the third stage of the policy making process according to Milstead, involves the execution of policies or programs toward the achievement of goals. To begin the implementation of the Advocacy Day Pink Ribbon Luncheon, the preferences of the legislators and their schedules were reviewed and considered. It was decided that a blanket approach via a luncheon would facilitate interaction and informational exchange addressing dozens of legislators and staff, and would be more effective than scheduling individual appointments with only a few select legislators. The Pink Ribbon Luncheon would ensure reaching a much larger audience at one time, encourage an open venue for discussion and informational exchange between the legislators and staff, and ensure that valuable information would disseminate out to the greatest number of stakeholders.

The Maryland State Senate Building Miller West Room #1 was then reserved for Wednesday, January 28, 2009. The Pink Ribbon Luncheon was scheduled from 11:30 AM until 1:30 PM, catching legislators and staff as they broke from morning session, allowing time to arrive, mingle, and eat as their schedules allowed. A brief presentation was planned for 11:45 AM, and then was repeated at 12:30 PM since the legislators would begin their committee meetings at 1:30 PM.

Next, a checklist was developed to organize and coordinate implementation of the Pink Ribbon Luncheon. A spreadsheet was then compiled containing the names of each Senator and Delegate of the 2009 Maryland General Assembly, along with their e-mail address, their respective party affiliation and specific district(s) served, that would serve as both the invitation and response list. This contact information was retrieved from the Maryland General Assembly website.

E-mail invitations were sent out to all invitees on Monday, January 13, 2009 prior to the legislative start date of January 21, 2009. A second reminder e-mail went out January 19, 2009. In addition, attached to each e-mail invite was a poster invitation that could be printed and distributed to help publicize the event. Hard copies of the invitational poster were also color printed and mailed to a legislative contact for personal distribution to the legislators. Once a response was received, either by e-mail or telephone, a thank you e-mail was sent out acknowledging receipt of the response and appreciation for their time and interest. The response spread sheet was continually updated and kept on a share drive at the local non profit affiliate office.

Finally, after the Pink Ribbon Luncheon, thank you e-mails were sent to all those invited, thanking those that were able to attend, and inviting future informational exchange for those who were unable to attend. Individual typed letters were composed and mailed to several key legislative contacts that aided in facilitating the luncheon thanking them personally for their help, dedication and commitment. Included were pink ribbon decals and key chains.

During the luncheon, an interactive, educational presentation was scheduled for 11:45 AM, and repeated at 12:30 PM. The presentation included an introduction and welcome by the MSN degree candidate and nurse leader, followed by remarks from the Executive Director of the non-profit, providing an overview of the local affiliate, followed then by the Grants and Education Manager addressing the various grants and services provided to Maryland by the nonprofit. The presentations concluded with a presentation by an Oncology Social Worker, LCSW-C, of a Baltimore Metropolitan Cancer Center, with personal stories of breast cancer patients benefiting from the Breast and Cervical Cancer Programs, as well as from the funds and services provided to the State by the local affiliate. The presentations concluded with a summation of the goals for advocacy event, a question and answer period, and a thank you to all attendees.

Each attendee received a packet of information that included: an agenda of the presentation, a welcome letter, the local non profit 2007-2008 annual report and informational brochure, a map of the statewide grant recipients, and a flyer describing breast cancer data in Maryland. Informational packets were also distributed after the luncheon to those members of the General Assembly unable to attend.

Catering service was finalized after careful review, based on comparison of cost per person, and menu offerings. The luncheon was self serve, buffet style, and the room was decorated with pink tablecloths, rink ribbons and poster displays highlighting the local non profit affiliate.


Forty seven Maryland State Senators, 141 Maryland State Delegates, and 29 honored guests were invited. Honored guests included the Director of the Breast and Cervical Cancer Program/Center for Cancer Surveillance and Control, the Deputy Secretary for Public Health Services, the Director Family Health Administration, the Director Center for Cancer Surveillance & Control, RN's from the Diagnosis and Treatment Program, and the Program Manager, MD BCCP. Also invited were the Accelerated Masters in Nursing Administration Professors and cohort members from the College of Notre Dame of Maryland. Governor Martin O'Malley, Lt. Governor Anthony Brown, and other members of the State Executive Branch were personally invited by the Director of Development at the local non profit affiliate.

A total of 99 invitees responded as attending. On the day of the luncheon, 56% of those, or 55 guests, were counted through the registration process as attending. It was noted that some attendees bypassed the registration desk and thus were not included in the count of total number attended. In addition, on the day of the advocacy luncheon there was a severe ice storm that closed schools, businesses and made traveling treacherous. It is unknown what effect the weather played in attendance. Overall however, a 56% attendance rate was considered excellent.

Response from legislators attending the Pink Ribbon Luncheon was sincere and overwhelmingly positive. The legislators were appreciative of the relaxing, casual setting of the luncheon that allowed them to mingle and converse with clinical experts. In addition, the opportunity that the Pink Ribbon Luncheon afforded the nurse leader to speak personally with the legislators and guests, resulted in contacts from several Senators and Delegates requesting the nurse leader's participation in future legislative projects regarding breast cancer, mammograms and women's health issues.


The recommendation would be to continue to build upon the advocacy effort of the 2009 Advocacy Day Pink Ribbon Luncheon in Annapolis. First, the local non profit affiliate has data documenting what they are doing to favorably strengthen and impact the citizens and communities in each legislator's district, through grant funding, and educational outreaches, that must be disseminated out to the legislators. This knowledge will ultimately lead to more informed legislative decisions. In addition, the non profit local affiliate, its Board, its staff and the multitudes of volunteers, supporters, and contributors are important constituents of each and every legislator. Legislators are always more interested in hearing from their local constituents, particularly in lieu of the funding and leadership role the local non profit affiliate plays in the State of Maryland. By continuing its advocacy efforts in Annapolis, the local non profit affiliate is making an important contribution towards ensuring a favorable health care legislative and regulatory environment in the State. In addition, nurse leaders are constituents as well, and are recognized as such by their legislators. Nurse leaders also possess the professionalism, knowledge and power to affect policy change in the legislative arena, and are viewed with respect as experts in their field. As both constituents and clinical health care experts, the presence and testimony by nurse leaders before the General Assembly is powerful. Well known as patient advocates, nurses can no longer be spectators in the political process. Legislative advocacy does lead to enactment. At the conclusion of the 2009 General Assembly, the FY10 budget was left unharmed for the Breast and Cervical Cancer Programs. In addition, the additional supplemental funding which had been submitted to the General Assembly for FY 2009 funding of the Breast and Cervical Cancer Programs was approved.

By continuing advocacy efforts nurse leaders are making an important contribution towards ensuring a favorable legislative and regulatory health care environment in the state.


American Cancer Society (ACS), Breast Cancer Facts and Figures, 2007-2008. Atlanta: American Cancer Society, Inc.

Maryland Department of Health and Mental Hygiene, Family Administration: Breast and Cervical Cancer Screening Program. Retrieved March 16, 2009, from

Milstead, J. A. (2008). Health policy and politics: A nurse's guide. (3rd ed., p19). Sudbury, MA: Jones & Bartlett Publishers.

Sieloff, C. L. (2004). Leadership behaviors that foster nursing group power. Journal of Nursing Management, 12, 246-251.

Sieloff, C. L. (1997). Instrument measures nursing goal achievements: Assessment of departmental power within organizations. Michigan Nurse, 70(4), 1-4.

Susan G. Komen for the Cure Maryland. (2009). Close the gap: Breast cancer in Maryland. Handout presented at Maryland Rally October 29, 2008 in Annapolis, MD.

by Mary M. Capano, MSN, RN

College of Notre Dame of Maryland

Table 1: 2009 Pink Ribbon Luncheon Invitees, RSVP's, and Attendees
Table 2: 2009 Pink Ribbon Luncheon Graph
Invitees, RSVP's and Attendees

 Legislators Guests Total

Actual # Invitees 188 29 217

Actual # RSVPs 76 14 90

Actual # Registered 41 14 55
as Attended

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Title Annotation:MNA Journal: Political Advocacy
Author:Capano, Mary M.
Publication:Maryland Nurse
Geographic Code:1USA
Date:Jan 1, 2010
Previous Article:MNA's Nursing Student Legislative Day in Annapolis.
Next Article:Feb 1: save the date for Nurses' Lobby Day in Annapolis.

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