Las Vegas – Despite the many advances and accomplishments nurse practitioners have achieved since the profession’s inception, NPs rank just sixth in perceived stakeholder influence on healthcare reform, according to a speaker at the AANP 2013 National Conference.

“Developing a sustainable, effective, efficient healthcare delivery system that works for our patients, healthcare providers and payers is the NP vision,” Tay Kopanos, DNP, FNP, vice president of state government affairs at AANP said.

Yet government officials (75%), insurance executives (56%), pharmaceutical executives (46%), healthcare executives (46%) and physicians (37%), came out ahead of nurses (14%) in terms of perceived influence on healthcare reform, results of a 2010 Gallup Poll indicate.

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With several vital goals set forth for healthcare reform era – gaining full practice authority in all 50 states, establishing NPs as a voice in the healthcare delivery system and informing the public health agenda — it is time NPs learn “the art of the ask,” Kopanos said.

Exlpaining what NPs want and why it is needed will require NPs to take several steps: understand the broader conversation around healthcare reform, build relationships with legislators, have a thorough knowledge of the issues at hand, critically assess policies and be able to propose solutions.

So how can NPs do this?

Kopanos suggested following the “Rule of 5” for building relationships with state legislators:

  • Attend a “Meet the Candidate” or “Open House
  • Donate time and money to support a candidate that is running for office
  • Write a note of congratulations to the winning candidate and offer to serve as a consultant on health issues or other areas within your realm of expertise
  • Send “thank you” letters to your elected representatives when they vote to support non-healthcare issues that are important to you
  • Forward representatives information, such as news articles, on healthcare areas of interest

After establishing a relationship with elected representatives, it’s time to explain your issue and why it’s a problem that needs immediate attention. Then, provide a solution.

Knowing the issues inside and out is key, according to Kopanos. She suggested several titles as required reading for NP advocates, including the IOM report, “Future of Nursing: Leading Change, Advancing Health” and the Macy Foundation publication “Who will provide primary care and how will they be trained?”.

Also familiarize yourself AANP policy statements, federal trade commission position rulings, and the National Council of State Boards of Nursing Model APRN Nurse Practice Act.

But it doesn’t stop there. Understand opposing stakeholder view points, too, including stances on NP scope of practice from the American Medical Association, the Physicians Foundations and the American Academy of Family Physicians.

Critically assess policies by developing a system to screen proposed legislation and regulation, Kopanos suggested. Key questions to answer when reading a piece of legislation include “who, what, why and why now.”

She also emphasized the importance of engaging with elected officials on proposed legislation as soon as possible. Share your concerns and contextualize the impact of a bill at the individual patient level and the healthcare level. “If parts of the bill are positive, point it out,” Kopanos said. Last, but not least, “be nice,” when dealing with elected representatives.


  1. Kopanos T. #13.4.112. “Policy Advocacy: Enhancing Your Game.” Presented at: American Association of Nurse Practitioners 2013 National Conference. June 19-23, 2013; Las Vegas.