Stay Nonpartisan in a Partisan World

“Flo” and Resistance

Since Florence Nightingale became an advocate for defining and implementing exceptional nursing standards, physicians have been opposed to nursing carving out a distinct role. While Nightingale spoke with firm conviction of the need to provide nursing care of the highest quality to soldiers, others, including some physicians and administrators, wanted to exploit inexpensive and often free nursing labor, which in their opinion was to be under the control and direction of physicians.

Flash forward to health reform 2009. The same political dynamic is still in play as some physician groups seek to control the reformed health care marketplace and diminish the contribution of APNs. As we position ourselves for a reformed health care system, let’s reflect on partisanship and how we as a provider group may want to posture ourselves as nonpartisan patient advocates. I maintain that aligning as a profession with one party is not a politically competent strategy.  

Partisan Electoral Endorsements

Historically, the American Nurses Association (ANA) endorses Democratic presidential candidates, a tradition dating back to a time when labor unions were a far more powerful political force. But does the ANA endorsement of a candidate influence the votes actually cast by 3.5 million nurses? The sheer diversity of nursing makes organizational endorsement of a single candidate a sketchy practice at best. It also diminishes the idea that nurses are an informed citizenry and professionals who will vote independently.

The consequences of endorsing candidates are great. If the nonendorsed candidate wins, nurses in policy circles may have less access to decision makers. Read Obama 2008! Early in the primaries, the ANA endorsed Hillary Clinton.

Professional nursing organizations must evolve from endorsement, an outdated political strategy. A more forward-thinking posture is to have nurses in each presidential campaign serve as advisors. APN groups in particular must operate with a spirit of bipartisanship, so tough policy challenges can be addressed in a pragmatic and politically viable manner.

It is time to take the poison out of partisanship and support candidates from both sides of the aisle. Although electoral politics are partisan, APN policy should not be.

Striking a Nonpartisan Tone

Too often, partisanship destroys our national dialogue. Respectful discourse across party lines has become the exception, not the norm. The recent devolution of the health reform dialogue to “death panels” and “granny killing” was shocking. The screaming matches on cable TV are another disturbing sign that very little listening is occurring. This sharpening political dialogue moves us away from the central idea that our big, creaky health care system needs to be reformed. When the conversation shifts to barbed, mean-spirited attacks, the truth gets lost.

Advanced practice nurses must stay above this and work to elevate the conversation by bringing the experiences of patients to the fore. We have a responsibility, a social covenant, to engage policymakers on sensible reform. We need to stay out of partisan politics, because health care is a bipartisan issue.

As long as we hold patients—not ourselves—as our first priority, NPs could become a strong bipartisan force. One strategy to confront the sharp partisanship, which shuts down meaningful engagement, is to develop policy solutions that make sense for the nation and can be embraced by both sides of the aisle. Ideas whose time has come include mandating health insurance just as we do auto insurance, robust health care homes, meaningful disease management strategies such as a Medicare benefit that includes care transition services, group visits, and intensive wellness services to reverse pathology. These ideas are grounded in changes that benefit patients, are not self-serving, and do not fall into political ideology silos.

We must bring to the table our emancipatory knowing—our ability to recognize injustices that are unnoticed or invisible and to articulate structural changes required to right systems’ wrongs. For example, members of both parties would be interested in addressing the issue of an insurance company in Wisconsin that markets “free” colonoscopies for those over 50. What is not visible is that the patient is charged $5,000 if the colonoscopy identifies any pathology. We can help decision makers understand perverse marketing practices such as this by bringing our experiences, absent partisanship, into the discussion.

PAC Giving May Strain Bipartisanship

A quick glance at some of the more politically competent organizations shows that they have made a strategic decision to do business in Washington in a bipartisan manner. These organizations engage with, build relationships with, and make donations through political action committees (PACs) to both political parties. 

As we gear up for the 2010 election cycle, we should pause and reflect on the size, scope, and manner in which we distribute PAC dollars. Notable is the overwhelming APN support for Democrats via PAC dollars (see table on page 8). On the other hand, anesthesiologists and physical therapists have organizations with robust PACs that donate equally to Democrats and Republicans. They therefore may enjoy more dialogue or access to lawmakers on both sides of the aisle. 

Having a Say in Health Care Reform

A new level of emancipation may occur among APNs if we adhere to our deepest patient-centered principles and maintain an aura of civility and bipartisanship. APNs need to boldly express what we think are sensible reforms that will expand coverage, rein in costs, increase competition in the insurance marketplace, and provide Americans with more choices in their health coverage. Over time, such reforms will come to enjoy strong backing from the voting public, special interest groups, and Republicans and Democrats alike.

As this issue of NPWN goes to press, the story of health care reform circa 2009 remains unfinished. The Affordable Health Care for America Act (HR 3962), passed by the House of Representatives in November, is a massively ambitious plan with measures that will be good for patients as well as advanced practice nursing (generally, these  groups are aligned). The provisions that enhance patient care are numerous and include extending

coverage to millions, eliminating exclusions for preexisting conditions, boosting comparative effectiveness research, enhancing school-based health clinics, expanding nursing workforce development, and including providers other than physicians in all studies on primary care, care coordination, and health care homes.

The classic Greek philosophers were the first to discover that from the strife between conflicting ideas could come higher truths. Let’s help write the story of health reform circa 2010 by becoming a sought-after knowledge source. This is not an invitation to sugarcoat, water down, or support anemic ideals. Rather, taking a nonpartisan posture is a strategic decision that may sharpen our political competence and ability to influence policy.