MARCH 1996, VOL 63, NO 3

I, E (4 I f4 I. A ’I’ I 0 N

Legislation Independent Study The article “Becoming knowledgeable in the legislative process can help nurses shape their own future” is the basis for this AORN Journal inde- pendent study. The objectives and examination for this program were prepared by Jody Porter, RN, BSN, CNOR; Rosemarie Schroeder, RN, BNS, CNOR; and Becky Armstrong, RN, BSN, CNOR, Region 1-B representatives to the AORN Legislative Committee, with consultation from Susan Bakewell, RN, MS(N), professional education specialist, Center for Perioperative Education.

A minimum score of 70% on the multiple-choice examination is necessary to earn 1.0 contact hour for this independent study. Each applicant who successfully completes this study will receive a certifi- cate of completion. The deadline for submitting this study is Aug 31, 1996.

Send the completed application form, multiple-choice examina- tion, learner evaluation, and appropriate fee to

AORN Customer Service c/o Legislation Independent Study 2 170 S Parker Rd, Suite 300 Denver, CO 8023 1-57 1 1

BEHAVIORAL OBJECTIVES After reading and studying the article on the legislative process,

the nurse will be able to (1) describe how a bill becomes a federal law, (2) describe the process by which federal regulations are created, and (3) list four steps to becoming an effective lobbyist.

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1, E G I S L A T I 0 N

Becoming knowledgeable in the legislative process can help

nurses shape their own future ach day members of the US Congress and state legislatures E debate laws that affect our

profession. When you join AORN, you have the opportunity to influence this process. The leg- islative network of AORN begins with you as a member. Politics are part of your daily life-in your workplace, professional organiza- tions, community, and the govem- ment. Historically, physicians have told nurses what to do and not to do. Today, legislators have that power. We must become active in the political process and have input in the policy-making decisions that define our practice; otherwise, the government will have the power to dictate our prac- tice and our future as nurses.

LEGISLATIVE RESOURCES Many organizations and other

sources have information on pend- ing bills that affect nursing. Fol- lowing is a partial list of suggested contacts for legislative issues. rn League of Women Voters

State nurses association rn State board of nursing H State hospital association rn State organization of nurse

H Chamber of commerce m AORN Headquarters H AORN Legislative Committee

executives

I

I HOWA BILL BECOMES FEDERAL LAW

Any senator or representative may introduce federal legislation (Figure 1). Private interest groups, organizations, or individuals can

initiate legislation by asking a sen- ator or representative to introduce a bill. All bills must pass both the House of Representatives and the Senate before being signed into law by the president.

After a bill is introduced in either the House or Senate, it is referred to the standing committee that has jurisdiction over that issue. The sponsor of the bill typically writes to other legislators seeking support or cosponsorship of the bill. Asking for support on a bill does not guarantee that other legis- lators ultimately will vote for the bill, but it does give the bill more visibility and helps the public know which legislators favor the bill. Support for a bill from mem- bers of the committee to which it has been referred increases the probability for action on the issue.

Subcommlttee. The committee chair then assigns the bill to a sub- committee. If the bill is not placed on the subcommittee’s agenda or is not approved, the bill usually does not proceed further. The chair of the subcommittee intro- duces the bill at his or her discre- tion. The chair may seek support- ers and other interested individu- als from his or her state to testify at a hearing to gauge interest in the bill. Organizations or individu- als interested in seeing the bill move forward contact their legis- lators on the subcommittee (eg, by writing letters, sending faxes, making telephone calls, visiting legislators in person) to solicit support on the bill. If an interested organization is not invited to par-

ticipate in the hearing, its repre- sentatives can provide written tes- timony for or against the bill. Nurses in legislative roles often are called on at this point in the legislative process to present testi- mony that will educate subcom- mittee members about the issues presented in the bill. After a bill passes out of the subcommittee proceedings, it is forwarded to the full committee to undergo a simi- lar process.

Congress. The sponsor of the bill then “marks it up” and takes it to the floor of the Congress for unlimited debate. In the Senate, a filibuster (ie, when one or more senators speak until a two thirds majority of senators vote to end discussion) may be used as a delay tactic.

Rules in the House of Repre- sentatives are more elaborate. A legislative calendar (ie, schedule) lists bills in the order in which they come out of committees. The rules committee determines the flow of bills to the House floor. The rules committee decides how long debate will last; who monitors this time; how many, if any, amend- ments will be considered; and when a vote on final passage of the bill will occur. Sponsors of bills and committee members appear before the rules committee to determine when and how their bills will be considered by the full House. The House and the Senate can introduce a companion bill (ie, simultaneous bills with similar lan- guage). Senators also may make amendments to a bill at any time.

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Figure 1 Executive office. The bill, if it LEGlSIATlVE AND REGUIATORY PROCESS

passes both the House and the Senate, is sent immediately to the president. If the versions of the bill passed by the House and Senate dif- fer greatly, a conference Committee attempts to resolve the differences. This committee's goal is to work out a compromise that is acceptable to both houses. The conference committee is composed of senior members from other congressional committees and congressional members appointed by the Speaker of the House and the presiding offi- cer of the Senate. Bills often are altered significantly by the confer- ence committee members. Lobby- ists, political action committees (PACs), constituents, and the presi- dent usually voice their opinions strongly at this stage. If the compro- mise bill is not accepted, it dies.

If the bill does not go to a con- ference committee, the president

w approve the bill by signing it, w approve the bill by not acting

on it (ie, the bill becomes law in 10 days if not signed), perform a pocket veto (ie, the bill dies because the congres- sional session is over and the president does not have 10 days to return the bill to Con- gress), or

w veto the bill (ie, before the 10- day period has expired, the president returns the bill to Congress without signing it to indicate his displeasure with the bill). Congress may over- ride the president's veto by a two thirds majority vote in both houses.

C a n

THE REGULATORYARENA Rules that supplement and

clarify laws passed by state and federal legislators are called regu- lations. Regulations define a

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bill’s issues in specific terms. The president delegates responsi- bility for implementing rules and regulations to regulatory agencies (eg, US Department of Health and Human Services [the largest feder- al agency regulating health care], US Food and Drug Administra- tion). Regulatory agencies are composed of people who are experts in the complex issues involved in a particular law.

Federal regulation. When a fed- eral law has been passed, a general notice of the proposed regulation related to that law is published in the Federal Register. This daily publication lists the time, place, and topic of scheduled hearings, which allows interested parties to express their opinions on the pro- posed rule and provides feedback to the regulatory agency. The com- ments made at the hearing are sum- marized and published with other pertinent information in the final form of the regulation. These are published at least 30 days before the regulation goes into effect.

State regulation. A state’s department of health and public service commissions regulate prac- tice at the state level. A state’s board of nursing specifies the scope of nursing practice and addresses such issues as RNs’ roles as first assistants in surgery, advanced practice nurses administering or prescribing medications, and licen- sure of nurses. State boards of nurs- ing and state nurses associations monitor regulatory activities.

THE ROLE OF LOBBYING Lobbyists are, in many cases,

experts capable of explaining com- plex and difficult subjects in a clear, understandable fashion. They engage in personal discussions with members of Congress in which they can explain why they are advocates for a certain position.

Direct lobbying is direct com- munication, either written or oral, with legislative officials or persons

who may take part in the develop- ment of legislative issues. This includes letter writing and visits with legislators or their aides.

Nurses are respected and recog- nized as a powerful group of con- stituents by our legislators. Lobby- ing is a test of communication skills, and our ability to react to threatening legislation is of great importance to our profession. We are a valuable resource to our legis- lators in formulating future health care policy.

ican Nurses Association to provide legislative and regulatory monitor- ing and lobbying services for our top priorities. AORN’s lobbyist, Rose Gonzalez, RN, MPS, sends Headquarters monthly updates of key health care legislation.

Lobbying activities, direct or grassroots, by nonprofit organiza- tions are permissible in influencing legislation; however, law prohibits a membership nonprofit organiza- tion such as AORN from support- ing or opposing any candidate for elective office. Nonprofit organiza- tions often form PACs to raise and distribute funds to candidates who advance a special interest group’s agenda. If AORN members wish to participate in a political campaign activity, we must do so as individu- als and not as representatives on behalf of AORN. We can attend nurses day at our state legislatures, schedule appointments, and give testimony on bills in committee as a means of establishing our influence.

AORN contracts with the Amer-

HOW To BE AN EFFECTIVE LOBBYIST

The first step in becoming an effective lobbyist is to know your legislator, which can be accom- plished by adopting the following guidelines.

Background. Knowing your leg- islator’s level of knowledge on an issue can determine what level of detail you should use when talking with him or her. Reviewing a legis-

lator’s background also will help you decide who will approach the legislator (ie, choosing a person with a background similar to that of the legislator’s).

Voting reCOrd. Knowing legis- lators’ voting records helps you decide which legislator is appro- priate to approach.

Constltuency. Determine how a legislator’s constituents would react to your position. Keep in mind that the constituents’ opinions may be more important than yours.

Meetlngs. Schedule a discus- sion with a legislator, allowing time to discuss complex subjects. Confirm the appointment 24 hours in advance.

Posltlon. Target members of the committees that will handle the bill, especially the committee chairs.

The second step in becoming an effective lobbyist is to know your material.

Why. Some bill supporters never actually discuss why a pro- posal is good, but assume that everyone will recognize a good bill when they see it.

Personalize. HOW would this bill personally affect you?

Succinct. Identify all of the strongest arguments supporting the bill briefly, providing details only if needed.

Supporters. What people or groups support the proposal?

Opposers. Determine who opposes the bill and what his or her arguments and your effective rebut- tals might be. Are there any politi- cal consequences for the legislator if he or she endorses your position?

Resources. Who can the legisla- tor contact for more details? Prepare a one-page sheet with phone num- bers of at least two contact persons.

The third facet of being a suc- cessful lobbyist is to know your strengths, weaknesses, and goals.

Small delegation. No more than three or four knowledgeable people should approach a legisla- tor at one time. Each member of

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your lobbying organization should be assigned a role in or segment of the presentation.

Rehearse. Rehearsing your presentation can help identify weak arguments, difficulties in conveying ideas, and disagree- ments among the participants.

Allles. Discuss the issue with other groups of supporters to add strength to your argument, to avoid potential conflicts, and to find additional ways of influenc- ing the legislator.

The fourth, and perhaps most important, quality of a successful lobbyist is to know the political system.

Committees. What subjects usually are handled by each com- mittee? Who are the powerful members?

Tlme. How much time do you have to develop your strategy and present your arguments at each legislative stage?

Tactics. Be prepared for parlia- mentary techniques (eg, amend- ments, objections) to either facili- tate or hinder the passage of a bill.

Compromlse. Know when to compromise with legislators or other supporters and when not to. Amendments can gather support for a bill or clarify its language, but they also can delay a bill or completely change its intent.

tion to a legislator, use the follow- ing strategies.

Be prompt. Never keep a legis- lator waiting.

identify yourself. Do not pre- sent yourself as the spokesperson for an organization if you are not. Use only the title or credentials that relate directly to the advance- ment of your issue. Be sure to identify yourself as a constituent of the legislator.

Be pleasant. Start conversa- tions in a nonadversarial manner, pointing out areas of agreement first. Do not lecture. Thank the legislator for previous good votes.

If you are to make a presenta-

Do not scold him or her for voting in a manner that opposes your stand. Avoid taking opposition as a personal affront. Never threaten.

Be self-confident. DO not grov- el or be intimidated by your sur- roundings or your legislator. It might help you to remember that legislators cannot know every detail of every issue. They often welcome additional information about a complicated field such as health care.

The legislator may have to leave or may lose interest before you make your winning argument. Address only one issue at a time.

Avoid jargon. Legislators are generalists on most subjects and do not necessarily speak the bureaucratese or technical lan- guage in which you may be fluent.

Be honest. Be forthright in dis- cussing the downside of your position. Do not try to bluff. If you do not know an answer, offer to obtain the desired information and relay it to the legislator in a timely manner. Do not lie. Getting caught in a lie will ruin your credibility permanently.

PrOmiSeS. Ask for and ensure a definite commitment for a spe- cific course of action from your legislator. Keep your promises to the legislator (eg, confidential comments, bargains, notification of changes in position).

FOllOW Up. Send a letter of thanks for the meeting, even to those who disagreed with your position. Mention supporters in your letter.

Evaluate the effectiveness of the lobbying effort and fine-tune the process. Provide ongoing con- tact between legislative sessions.

If you are undertaking a letter- writing campaign (ie, in addition to or in lieu of meeting your legis- lator in person), incorporate the guidelines for meeting your legis- lator in person with the following guidelines.

Be SUCClnct. Time is important.

s The letter should never be longer than one page.

R Handwrite the letter legibly. R Write your retum address and

phone number on the letter. Do not demand or expect an immediate reply. Grassroots lobbying generates

legislative influence at the public level. Annual OR Nurse Week activities and the “You Need and Deserve a Perioperative Nurse” brochure exemplify effective cam- paign strategies. Publicity and human interest stories present opportunities for free professional publicity. You should prepare a clear, concise message; know your interviewer; avoid off-the-record comments; take control; dress appropriately; and, if you are unsure of a particular position, do not com- mit either way to it (eg, “That is an important dilemma.”).

CONCLUSION Perioperative nurses must unite

with our colleagues to make an impact on nursing’s future. Nurses involved in the political process are involved in the ultimate patient advocacy. The opportunity for involvement in the legislative process is there for everyone.

tee is organized as a network of 52 state coordinators. Each state coor- dinator contacts chapters in his or her state. To find out who your state coordinator is, call AORN Head- quarters at (303) 755-6304 x 219. Any member interested in serving a two-year term as a state coordinator to the AORN Legislative Commit- tee should complete a willingness- to-serve form and submit it to AORN Headquarters.

The AORN Legislative Commit-

JODY PORTER RN, BSN, CNOR

ROSEMARIE SCHROEDER RN, BSN, CNOR

BECKY ARMSTRONG RN, BSN, CNOR

LEQISUTIVE COMMIITEE REQION 1-B

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