Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. And today, I am pleased to have with me Rosanne Raso, Editor-in- Chief of Nursing Management, and At Large Director at AONL, as we dive into the topic of advocacy. Rosanne, welcome.

Rosanne Raso: Well, thank you, Bill. This is such a great topic, and I am thrilled to be here with you.

Host: Well, thank you so much. It is a great topic and I know that I and our listeners are interested in learning more from you, Rosanne. So, thank you so much for your time. So first off, why is advocacy so important?

Rosanne Raso: Honestly, I think it's important because, when nurses hear the word advocacy, their brains tend to go towards lobbying, and high level things that make them nervous. And that advocacy goes much deeper than that. We do it at every level. I mean, this is our professional responsibility. Clinical nurses in direct care are advocating for patients and families every single day. Unit leaders are advocating for their teams and their patients every single day. As a chief nurse, I advocated for my teams and for the patients and families every single day. And it doesn't matter if you win or not. And I've used win with like quotes around it, because it's not about winning and losing. It's about influencing policy. That's what advocacy is about.

Host: Influencing policy. I like how you said that, and I think there is a perception issue. People think of advocacy as lobbying. And as you said, it goes much deeper than that. Very important across all levels. And I know you wrote an editorial in Nursing Management last year entitled Advocacy: Peeling Back the Layers. Can you explain to us what was the main message you hoped to convey?

Rosanne Raso: Well, there were a couple of messages in there. The title is one of them, peeling back the layers, which was my point just before, that this is happening at every level. And I was inspired to write it because I attended the AONL Advocacy Academy and Advocacy Day in June of last year. And I had never lobbied at the federal level before. I had lobbied at the state level and the local level, and I certainly lobbied within organizations I worked for issues that I felt strongly about, but I had not done that before. And once again, it was all demystified. It was not scary. It's doable. And I wanted to convey that we advocated every level, at every level of leadership. And that lobbying for legislation at state and federal levels is not scary. And it doesn't have to be scary. So, that was really the main messages in there.

Host: Yeah, it's important to have your voice heard, you said. Of course, you want to win, but it's not necessarily about winning. You want to make sure that you have a seat at the table and you're advancing the policies or the things that you think that will help the organization. Is that right?

Rosanne Raso: Correct. And by helping the organization, it could be helping workforce, helping patients, helping each other. It could be through legislative work that helps the organization. There's many different ways this goes with different stakeholders.

Host: Yeah. And as you said, this involves every level or affects every level. So, that's why it's important to get out there and advocate and have your voice heard. So, Rosanne, in terms of policy work, you've mentioned Big P and Little P policies. Could you explain the difference between the two?

Rosanne Raso: I did put that in my editorial, which by the way, was published last October if anybody wants to look for it. And I did not invent Big P, Little P, and I'm not sure who did and who to give credit for. It might have been Stacey Chappell, who was the Senior Director of Advocacy at AONL, or it might have been somebody else I met at that Advocacy Academy.

But Big P is this legislative work. It is our elected legislators, creating policy that becomes law or regulation. So, that's the Big P work. And the one that usually is more mysterious to people. The Little P work is the work you do in your organization on your unit as a clinical nurse or for organizational policy. At the unit level, it could be policy about scheduling, it could be policy organizationally about visitation. I've advocated I don't know how many times for my thoughts on what visitation should look like.

One of the advocacy stories that I love around my own practice was as a chief nurse, nurses or any workforce was not allowed to have any food or drink at the nurses station. Now, that all sounds fine, except they weren't even allowed to have water, and this is a basic thing people need. So, I looked up OSHA policy, I looked up the hospital policy, I spoke to infection control, and basically discovered that there's no regulation that prevents having liquids that are covered in a public place. So, I was able to successfully advocate that any staff could have bottles of water, either at the nurse's station or in their pockets, and that it would not be a policy violation. And that's one of my favorite stories about Little P work.

Host: Yeah, that's a great example. So, a great example of a Little P. As you said, Little P is the work you do in your own organization, hence in that example that you just gave us. And the Big P is the legislative work. That's where creating policy, think of legislators in those things. So, thank you for explaining that to us. So, Rosanne, when speaking with legislators, Big P, what are the key points our listeners need to know to effectively communicate their message?

Rosanne Raso: Well, there's a lot in answer to that question, but it's not hard. The main thing is they want to hear your story. They are not in healthcare. They need to know the perspective of a nurse leader and how that affects whatever policy is in draft or is being considered. So, they need to hear your story. They want to hear your story, and they will listen to you. You may not get the legislator, you may get an aid. And that's still important, because they have influence.

And important is to keep it short and powerful. So, you want to know your headline, like come in with right away with what you're there for. So, that's very clear. You want to use data if you can. So, for example, let's say you're advocating for some kind of policy on workplace violence. You can use data from your organization such as just last year, we had a hundred incidents, and that's probably an example that is much lower than what the real story is of workplace violence that were reported and many are unreported. Just yesterday in the emergency room, one of the emergency room nurses was punched in the stomach. So, use data, use anecdotes, use examples, and practice it. So, be prepared to tell that story.

You do want to know what the position is of that legislator, what committees they're on. So, maybe you're lucky the legislator in your district is on the health committee or on the committee that has the purse strings for funding something that you really want to advocate for. So, be prepared. Keep it short and powerful. Use examples, use data, use stories, and do your homework.

Host: I think that's great advice. Because you probably don't have a lot of time when you sit down with an aid or a legislator. Is that right?

Rosanne Raso: That's right. You probably have a 15-minute slot the most.

Host: Okay. So, that's when you say be prepared. Short and powerful is good. Know your headline. I think that's excellent. The world thirsts for great headlines. Use data if you can and then make sure you practice it right. You want to have that speech down, is that right?

Rosanne Raso: Correct. Right.

Host: Yeah. Great, great tips. I love that. Well, this is all really good information, Rosanne. So, thank you for sharing this with us. So for someone listening who may be asking, "Hey, I want to get involved in this," what advice do you have for someone new to advocacy? What can they do to get involved?

Rosanne Raso: Well, I'm thinking first about the Big P level, which is with that legislative advocacy. And I think the best way to start getting involved is when you partner with a professional organization. It could be AONL regional that you are a member of. It could be another professional organization you're a member of. It could be the hospital association in your area. All of those will probably be lobbying definitely locally. You could get involved in that or, and you could talk to your internal government affairs folks who are those people get to know them what's on their radar screen. You might be able to put something on their radar screen as well, and you may be able to help them and they'll be able to help you. So, that's another way.

I'm also thinking of community advocacy as well, which is kind of in between Big P and little P. So for example, if you have kids that are school age and there's PTAs, they have influence on policy within the school that may be related to health or what's served in the cafeteria or anything. Even, you know, bullying work would be in that realm. There may be other community work that you might want to advocate for so you can be active within a group or even just write a letter to your local paper. That is a way to get involved.

So, there's a couple of ways to do that. I think you want to really know what's important to you. So if you stick to your values, like what you're passionate about, it makes this work easier. And I mentioned workplace violence earlier. If that's something you're passionate about helping with, then stick with that. If reducing healthcare disparities is your jam, then that's the thing you work on.

Maybe it's work environment issues, maybe it's mental health, maybe it's staffing, maybe it's scope of practice for advanced nurse practitioners. So whatever your passion is, there's going to be a policy issue related to that. And it could be at the Big P level or the Little P level, local or legislative. So, sticking to what you're passionate about that go down that path, I would definitely advise that.

Host: Or the medium P level, which is the community work you talked about.

Rosanne Raso: Yes. Yes, exactly.

Host: All kinds of different entry points for you to enter the world of advocacy. And I think it's so important when you said, Rosanne, know what's important to you. So, I think that's really great advice. And then, as you said, generally what's important to you, there's probably a policy initiative or directive that's related to that. So, really good advice. So, let's take that one step further, Rosanne, could you suggest some resources then, or maybe there's some upcoming opportunities for nurse leaders to learn more and get involved in advocacy?

Rosanne Raso: Well, AONL has a couple of things coming up in June, which are terrific. So, one is the advocacy academy where you learn these communication techniques and how this all works. And then, there is the actual advocacy day, which is lobby day, and you would be put with a group in your state because the work is done. You go to people in your district. That's how you make influence. You're going to people in your district. You're voters, so your opinion matters to them. And they prep you on what are we advocating for? How would you make your case? It's really incredible experience. So, the AONL Advocacy Academy and Advocacy Day are terrific, and that's coming up soon.

There's also a professional governance conference coming up for AONL in early August, and we will have an advocacy tracked at that. And honestly. As nurse leaders supporting professional governance structures is one way for Little P work to empower staff to be involved in policy. Very important. Not only involved, but they should be driving policy honestly.

Host: Yeah, that's great advice and good information on how people can jump in and get involved. And if you want more information, you can always visit aonl.org. And before we wrap up, I do want to ask you though, I heard you advocated for government recognition for the Black Angels. Can you explain to us who the Black Angels are and what did that involve?

Rosanne Raso: Oh, thank you for mentioning that. So, the Black Angels were a group of nurses that came up from the Jim Crow South back in the '40s to staff Seaview Hospital on Staten Island in New York, which was a TB sanatorium. Most of the white nurses had all quit. They did not want to be infected. They were afraid. And I'm not sure how this exactly happened, but the Health Department of New York City needed help. So, they put in ads to bring nurses up and they were affectionately called the Black Angels by the patients in Seaview. And how I know about this is I read the book by Maria Smilios called The Black Angels, and it is the untold story of this group of nurses who faced all kinds of odds, including racism here at that time, and ended up being involved in the cure for TB. The cure for TB was found at Seaview Hospital in Staten Island, New York, and they were involved in the trial. So, that's the Black Angels. There's two living Black Angels left.

So, I met Maria Smilios, the author at an event, and she was very interested in trying to get the Presidential Medal of Freedom for the Black Angels. And I was like, "I'll help you. I'm involved in so many organizations. We can all get behind this." And then, we found out there's also a gold medal that's a congressional gold medal.

So, first of all, before we started writing to legislators, we wrote to-- I don't know how many organizations and individuals to get support so that when we started writing letters to get legislators to be behind us to do this, we had literally three pages of nursing organizations, doctors who were involved in TB up until this day, who knew the story and understood the importance. And so then, we wrote letters to pretty much anybody in New York, because this was a New York-based story. We wrote letters to the nurse caucus members, the Black caucus members, like anybody we could think of to help us.

I thought this was a slam dunk, but it goes to show you, you have to do your homework because not everybody's interested in the same thing. But we did find Congresswoman Nicole Malliotakis. It was her district on Staten Island, New York. And her staff believed in doing something helped us understand that getting the gold medal was like way too much, like it wasn't going to happen. So, what she did was created a congressional record for the Black Angels, which I thought was just a proclamation, but it's much bigger than that. She read it in Congress and it is now officially part of the history of the United States of America. We had a celebration in her office. The two living Black Angels were there. And now, she has also arranged for a street naming, which we are actually having later this week. So, it's a story of collaboration and perseverance.

Host: That's amazing. And that's what advocacy can do. So, that was great that you did that. And these women are remembered and honored. And as you say, it is now a part of American history, which is really important. So, great example of advocating for something important. So, thank you for sharing that story. And congrats and great work to you on that.

Rosanne Raso: Thank you.

Host: Yeah, really cool. Well, Rosanne, thank you so much. This has really been interesting. Thank you for talking with us today. Before we wrap up, is there anything else you want to add

Rosanne Raso: Just to summarize, like the most important thing or things, number one, it's not scary. It's not mysterious, like you can do this. Number two is whether it's Little P or Big P, don't wait until it's too late and something happens that you don't want to happen. This is our professional responsibility and you can do this and there's resources to help you.

Host: Don't wait, it is your professional responsibility. So well said, Rosanne. Thank you so much. Really important topic. Thank you for spending some time with us today. I appreciate it.

Rosanne Raso: Oh, it was my pleasure. I could go on for, you know, another hour, but I know you won't let me.

Host: I love it. Rosanne, thank you again. Really appreciate it. Again, that is Rosanne Raso. AONL Advocacy provides important public policy information on the issues relevant to nursing and healthcare. So if you want to learn more about that or get involved, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.