Brennan Lewis (Host 1): Welcome to Nurses Connect, a podcast from Children's Health dedicated to exploring critical issues and dynamic topics that shape the nursing profession today. I'm Brennan Lewis, Senior Vice President of Nursing Excellence, Innovation, and Patient Experience.

Kristy Welter (Host 2): And I'm Kristy Welter, Program Manager of Nursing Communications. We are your co-hosts for Nurses Connect, and we're so happy you've joined us today. On this episode, we're discussing the importance of nurses involvement in professional advocacy.

Host 1: We have two guests today, Senior Director of Nursing Excellence and Professional Practice, Tish Key, and Sally Derek, a clinical nurse in our Food Allergy Center. Welcome to Nurses Connect, Tish and Sally.

Sally Derrick: Hello. Thanks for having us today.

Lateia Key: Glad to be here.

Host 2: Can you start us off by telling us what nurse advocacy is?

Lateia Key: I think nurse advocacy is being able to use your voice to stand up and speak for the things that need to happen within your profession, within your practice for your patients, within your community. It is being able to use your voice to make change and advocate for the things that need to be changed.

Sally Derrick: I would agree with Tish. I think it's really important as a nurse to recognize that your voice matters. And as a nurse, you really do bring a great perspective to the table that a lot of times it is missing. And so, it's important for nurses to spread their advocacy in lots of different directions because that voice does matter.

What settings should nurses bring their voice to the table? Well, for me, I served on a school board locally where they did not have anyone else on the board that was a healthcare provider. And so, when we experienced things like COVID-19, having that nurse voice really made a difference when it came to decisions that were being made that truly impacted the children. But also, we needed to make sure they were safe, teachers were safe, all practices that were going into place made sense. And really, there wasn't anybody else at that table at that time that could bring the health perspective that really needed to be included in the discussion.

So, I think, for me, I served on a school board here in the Metroplex for six years. And at that time, I was, the only healthcare person on the board. And that was really important because we experienced things like COVID-19, and a lot of decisions were being made about safety, but also health of our students and staff. And I think it was important for a perspective like a nurse to be at that table to really help drive those conversations and decisions that were made.

Lateia Key: So for me, advocacy, one of the most important places to start is actually at the state level. And when I think about that, like Nurse Day at the Capitol, nurses bring a wealth of knowledge and clinical matter that legislators don't have and all of our practice is driven by law. So, it's important for us to have our voice present on that stage.

And also, when we think about that, we also have the local laws. So just like Sally said, in your school board, in your city, wherever you can impact, you can, but it even goes even deeper. We work in hospitals or we work in clinics or maybe we work in the community so wherever you're at, I think you have to say, "How do I advocate in this space?"

Host 1: You brought up that nurses stay at the capitol. So, about a year ago, we took 30 nurses, really the largest group of nurses that we organized to take down to Austin. So, tell us a little bit about that and what role did our nurses play.

Lateia Key: That was an extremely exciting experience. So when we went down there, we had several nurses who had never engaged in advocacy before, they had never even thought of having their voice on that stage. And when we went down to nurse day at the Capitol, the first thing they do is they help provide you the education of what are you going to do? What does it look like to sit down with the legislator? What are some of the issues that we're facing? And they're going to come up this cycle.

The role that our nurses played was not to go in with judgment or criticism for the legislators, but to work as teachers to help them to understand it. If you look at professional development books, we're knowledge workers. And that's the role that all of our clinicians played. We were able to share how does this impact nurses? How does this impact the patients we serve? What would this mean when you actually pass it for the communities that you're passing it for? So, that's what we shared, but it was extremely exciting to be able to do that.

Sally Derrick: I agree, very eyeopening. It was a lot of fun, but also I think, super eye-opening. I also think it was really great for the nurses that attended that had never spoken with a legislature. Remember before to realize they're just regular people just like you and I. And that was something I think that was very eye-opening for them. And then, they were able to leave the experience, recognizing how easy it, and then with the hopes that they would go back to the local level now and talk to your city council members, your school board members, or your state-elected when they're in your area. And that you could use your voice to just speak to them like normal people and let them know what's important to you.

Lateia Key: I think in being able also to hear the questions they asked, it really made it hit home how much they want and need the information you have. Like they would ask questions that we wouldn't even think to ask as a nurse because it's part of what we do and we know . They will be passing a law over something they really have limited knowledge on. So, I was able to feel their gratitude. I agree. And then it came, it actually felt like a general conversation,

Host 1: You know, remembering these are elected officials and they are elected to represent on behalf of their constituents. And so, understanding and hearing the healthcare perspective is so important, because they are not experts in healthcare. So, I think the voice of the nurse is important. What are some of the policies that have been pretty critical over the last year that professional nurses can really influence and have influenced?

Lateia Key: I can tell you one of the ones that really stands out for me that we influenced, it was House Bill 2187, which is the nurse staffing statute. And what this is at home in Texas, we have really some solid laws around staffing and how you keep it safe. But there were gaps we didn't even know were present until COVID-19 came out. And that really highlighted some of the gaps in our staffing laws that made it easy for nurses to be put in situations where it was impossible for them to practice safely. So with this bill, all of the nurses were able to speak to the gaps in that bill, and a lot of those issues were closed up. They actually did pass that bill, and that has helped to reinforce safe staffing in healthcare.

Host 1: And one of the key aspects for that particular bill was around—not only in Texas is it required to report your staffing, and we have a staffing committee, statutes, et cetera—but that healthcare systems were not held accountable to following through with their staffing plans. So, that was one of the significant things that kind of resonated for me as a nurse for that particular bill.

Lateia Key: Nobody was held accountable, but even when people were held accountable, the accountability cost less than the cost of a nurse. So even if I had to pay the fine at that point, it still was cheaper than having to fix the problem. And so, really being able to shore up who is going to monitor who's going to make sure that we're being accountable to it. How are we going to reinforce those penalties? What is the penalty? A lot of those things had to be rectified. And so, that went through.

Sally Derrick: I think this just highlights that elected officials can't be experts on everything. And so when you get into specifics on certain bills, they aren't the expert and they rely on their teams heavily to fill in that knowledge gap for them. But they may not be getting correct information. So, for this especially, having nurses there to speak to them with experience on the front line of staffing concerns, I think makes a huge difference, which goes back to why the nurse's voice is so important. We don't need just a staffer being the one to educate the elected official on what the needs are. We need a nurse providing that information.

Host 2: So as I'm listening to you, you both sound really passionate and knowledgeable about what you've been doing for advocacy. I'm curious what kind of prompted both of you to get involved with nurse advocacy?

Sally Derrick: Well, I started as a PTA mom. I tell everyone that. I just started as a PTA mom involved in our schools. And then, as my kids got older and the more experience I had within the schools, I realized that my voice could be larger, could be magnified if I was on a school board. So, I ran for our local school board in 2018. At that time, I will tell you it wasn't because I was a nurse, it was because I was a mom. But once I got there, I recognized how important being a nurse mattered. So, that wasn't my initial why, but it quickly became really important and relevant in my story and probably ended up driving a lot of the decisions I made, even maybe more so than just being the mom.

One of my very first experiences on the school board was that the district was deciding whether or not to keep registered nurses on every campus. And they had made the decision, it was too expensive, so we were going to get rid of all of them. And I was the nurse on the school board who got wind of this and sat down with our superintendent and said, "Absolutely not. That is a bad idea." I know from working in pediatrics that we're having to send kids home sooner than ever before because of insurance restraints, which means sick kids are going home sooner than ever before and parents have to go back to work, which means the kids going back to school. So, you're putting kids in schools that are not a hundred percent necessarily, and you're going to take away the one medical person on the campus.

That was something that I very quickly used my nurse voice to advocate for and was really thankful that the decision was reversed and they did not get rid of nurses on our campuses. And then, you fast forward six months later and we were in COVID. And I look back and think what could have happened had that decision gone through, if there hadn't been someone to advocate as a voice of healthcare to say, that was a very, very bad idea.

So, my story didn't start as a nurse, but it very quickly became obvious that being a nurse really is what mattered and could be really valuable.

Lateia Key: So impactful. I think for me it started a little differently. I was at the TNA conference. And I'd always like appreciated being a part of TNA, but they were sharing a story about a piece of legislation they had passed. About 60 kids the year prior to this legislation had died from asthma attacks in schools. And I could not imagine being a nurse. These were rural schools where healthcare was not local, and it was difficult for the nurse to have access to albuterol. And I could not imagine being a nurse at the school having to watch a child struggle with asthma and know that if I just had access to give albuterol, I could rescue this kid, because albuterol is something we give out like cotton candy in the ERs. So, why do we not have access to this medication? So, they had passed legislation that year to allow nurses to be able to administer albuterol in these situations. And I'm like, "Wait a minute. Why is this not already a thing? Why?" And then, that was when I started gaining information on legislation, what are the bills that are out there, and who do they impact. I've never worked at a school, but I would hate to be that nurse. I couldn't imagine.

Host 1: I think one of the things, we are professional nurses. And I think we maybe don't do a good enough job encouraging early career nurses to get involved early. So for me certainly was a late start , and I see such an impact in value in doing it. And so now, mentoring others and saying get involved early with your professional organizations, your state organizations, et cetera, so that you know what's going on. So, you can influence policy. But I don't think we see our roles as nurses often the impact that we should be making through advocacy.

Lateia Key: I don't know that I connected how important being a part of your state organization is with advocacy. I remember as a nursing student—and you're completely right, Brennan—because as a nursing student I was very active in Texas Student Nurse Association. But I never connected that with the fact that our practice is driven by law and healthcare has so many factors driven by law. And they play an impact in that. And then, you look at Texas Nurses Association and the history of that. And I commonly will tell nurses like I understand you may not have time to sit down in Austin, and you may not know every bill that comes up, but it's 15 bucks a month. It's $15 a month. And that helps pay for the attorneys and all of the other people who are researching the bills and bringing them to your public so you can find the things that are coming up that you need to advocate for. So, I think that was something I didn't learn until way late in my career. And I wish I would've been able to connect the dots earlier.

Host 1: What are some basic early, like, advice that you would give early career nurses, but even those that are seasoned that have been in the profession for a while that maybe have not engaged? What are some things they could do now around advocacy and how to get involved. So, we talked a little bit about engaging your professional organization, but what are other ways they could do advocacy?

Sally Derrick: Yeah. An idea that I had thought of, as Tish was talking was, every school district has a SHAC, which is the Student Health Advisory Council. And that is a state-mandated council that school districts must have in place that helps to make decisions based on key items in a school district that impact health. And that is a great first step. You could use your nurse voice. It's advocacy. It's a way to know what's going on in your child's school district. And those are decisions being made in those committees that are then forwarded on to school boards for approval. But it's a great place to start, because it's easy. It's once a month usually. And that doesn't really require you to have any knowledge ahead of time going into it. I really think that If you have especially small children, I get it. Like when you're in the trenches of raising kids and trying to be a nurse and working full time and all the things, this is a way that you could still be involved in your child's school district, feel like you're giving back, but also you're using your nursing knowledge, nursing skills, all those things to help others.

Lateia Key: I think, foundationally, the first thing I would say is register to vote. I think a lot of nurses don't pay attention to voting days. And whether it is your local elections, your state elections, your council, your cities, your schools, your PTA, wherever they're voting, I think we have to get comfortable using our own voice and forming an opinion based on evidence that we see, and then advocating for whatever is needed to support our profession and our patients. But I think registering to vote's the first thing.

I think the other thing we don't do as well as we should, if you look around your community, you're going to see events from local legislators, local community people. You can find meet and greet, you can find a social, you can find a town hall. Find those things and just go, just show up, because then you're going to start hearing the conversations. You're going to start seeing the problems that affect your community and that 80% of healthcare happens in the community. So, we need to start there. If you are a member of your professional organization, they're going to make it easy for you. They're going to show you the bills that are coming out. Look at them. They even put them on a one-pager. Figure out what it is. Educate yourself. And then, use your voice, because you've got a beautiful one.

Host 1: And not only do they list out and educate us on the different bills, but also they prepare templates for us to be able to use to email and message our legislators, which I think is huge. And we always want to personalize those to make sure that it resonates with them. But that is an easy way to get involved without even having to sit in a council or committee meeting, but just making sure your voice is heard.

Lateia Key: They're not different than us. Legislators are not. And if you think about how we learn, we learn through stories just as much. I can learn so much more when I hear about a case or a condition where someone came in, they are very much the same. So, what story do you have that you could share?

Host 2: Is there anything that we have not talked about today that you would like to touch on regarding advocacy?

Lateia Key: Yeah. I think when people think of politics, there's a lot of emotion that can come around it. And people can sometimes get caught up in a lot of the negativity that has touched our society. But when we are working in advocacy, we're not looking at it from a party line's perspective. We're looking at it from what's best for the patient, what are the facts of the bill? How would this help serve our profession? How would this help serve our community? And it's not about negativity or about getting caught up in that. When you have a practice that is foundational, when you have a practice that is grounded in law, if you don't get involved in advocacy, then other people are going to make decisions that impact your practice and your voice will never be heard. They're going to make the decision. You just won't be a part of it. So, it's really important to use your voice so that you can be heard and be a part of the decisions that impact your practice.

Sally Derrick: I also think Nurses Day at the Capitol, the quote that we all walked away with was, "If you're not at the table, you're on the table." And I think nurses have to remember that, that we want to be seated at the table so we're not being served up on the table for changes and decisions being made. We want to be the ones at the table helping to make those changes and drive those conversations. Take that first step. Just get involved in anything. That's your way to advocacy, is to take the first step.

Host 1: You know, I was even thinking just now as you all were talking, what was resonating is that as professional nurses, we first and foremost advocate for our patients. And helping ourselves have a voice in being advocates on their behalf, which is a duty and responsibility to us as licensed professional nurses. Sometimes nurses don't advocate, like they're scared. There's a lot of fear mongering, you know? And that's almost the first step as a professional nurses, finding your voice to be able to do what's right on behalf of your patient.

Lateia Key: One of the main pillars of our profession is advocacy. And it comes from being able to speak up for your patient.

Sally Derrick: We're doing it, we're already doing it every day. And now you're just taking that work and you're stepping outside of your role in the hospital and doing something outside.

Host 1: Locally, regionally, nationally, I mean, absolutely.

Lateia Key: And when you think of it, it's all to serve the patient. When we're doing things that improve our ability to do our jobs well and to do the work we do well, that is for the patient when we are advocating for the schools to keep their RNs. Yes, it's going to help the RNs. Why? Because it's going to help the patients. So, everything we do comes back to who we are as professional nurses, and we are advocates.

Host 1: All right. Well, it's time to wrap up this episode of Nurses Connect. Thank you both for joining us today.

Sally Derrick: Thank you so much for having me. This has been a really great conversation.

Lateia Key: Thank you for letting us share a little bit of our passion for advocacy.

Host 2: Well, thank you for sharing it with us. If you want to know more about nursing at Children's Health, we encourage you to visit childrens.com/nursingannualreport. Here, you'll find the information that summarizes a variety of our nursing initiatives. Thank you to our listeners for joining us today. We'll talk to you next time on Nurses Connect.