Are you a nurse or nurse practitioner looking to enter a public health leadership role at the local, state, or federal level? Illinois Representative Lauren Underwood (IL-14), a registered nurse, implores you to try.

“It is my expectation that you will try. It is your professional responsibility to lead and public service is an excellent way to have an impact,” said Rep Underwood during a fireside chat with Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, FAAN, who is dean and professor of the Duke University School of Nursing and Vice Chancellor for Nursing Affairs.

Rep Underwood was first elected to Congress in 2019, representing the 14th District in Illinois, and already has made her mark. Her Healthcare Affordability Act, which lowers the cost of health care premiums, was included in President Biden’s American Rescue Plan. In Congress, Rep Underwood co-founded the Black Maternal Health Caucus to combat the historic health inequities and high death rates among Black mothers. The caucus introduced 13 bills collectively known as the Black Maternal Health Momnibus Act (H.R. 3305/S. 1606). Rep Underwood’s Protecting Moms Who Served Act (P.L.117-69) became the first of the Momnibus Act bills signed into law on November. 30, 2021. On June 27, 2023, The Pregnant Workers Fitness Act 2023 (Pub. L. 117-328), which guarantees pregnant and postpartum workers the right to reasonable accommodations, also became law.

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These are just some of the ways health care providers can make a difference in Congress. From serving in local health departments to working for policy change on a federal level, Rep Underwood said that nurses have the skills to enact change. “I believe that nurses should be running local health departments as well as serve on the oversight board of every community health department in this country,” she said.

Nursing Skills That Apply to Leadership Roles

One innovative way that Rep Underwood applies her nursing background to policymaking is by taking the time to adequately assess the scope of a problem and evaluating data before deciding on a specific intervention. She cited her experience conducting nursing assessments as key to her ability for critical thinking when problem-solving in her current role in Congress. “I’m a data-driven, evidence-based policymaker,” she said.

And while this approach may not seem novel among health care providers, “it’s pretty innovative on Capitol Hill to make that kind of assertion” as many of her colleagues approach discussion of policy questions with a preferred solution already developed, Rep Underwood said.

How Nurses Can Run for Elected Office

While self-doubt might creep in when considering public health roles, including concerns about the cost of running for office, Rep Underwood said that it isn’t as hard as one might think. She estimated the cost to run for a county board at approximately $2000 to $3000 and said even nurses without public health experience have the expertise for these leadership positions.

“We need to change the culture in nursing to reframe it,” Rep Underwood said. “Part of this change is building nurses’ confidence that indeed they are qualified for leadership roles and it is their professional obligation to advocate for their colleagues, patients, and communities,” she explained.

Promoting Leadership Roles for Nursing Students

When asked how nursing schools might best prepare students for leadership roles, Rep Underwood was ready with a list in hand:

  1. Introduce policy courses early in nursing education programs
  2. Create space in clinical pacing to allow nurses to go and be advocates at the US Capitol, rather than requiring nurses to take a vacation day to do so.
  3. Encourage students and recent graduates to join large nursing professional organizations that have government affairs offices that engage in federal lobbying so that nurses’ voices are reflected in decision-making.

Rep Underwood said she took a stand-alone policy course second semester of her freshman year at the University of Michigan. “How powerful is it to have that student nurse feeling like she or he has agency as a health care provider to not only take care of that patient in front of them but also drive transformative change? That’s a mindset,” she said.

An example of this type of innovative change is found at Duke University School of Nursing where Dr Guilamo-Ramos and colleagues “are developing, implementing, evaluating, and promoting a nurse-led model of care that can be applied across settings for health promotion, for prevention, and for restorative treatment to innovate health care systems and policy,” he explained. “Our model …. envisions nurses as leaders in transforming health care.”

Other advice for students from Rep Underwood is to find online courses on campaigning for office and contacting professional associations to pair with a nurse champion to shadow for a day or volunteer for campaigns. The American Nurses Association endorses candidates and can help pair students with advocacy work.

Using Legislation to Increase Nursing Numbers in the US

To leverage the nursing workforce to address the health care shortages nationwide, Rep Underwood wrote a bill to increase resources for educating nurses. The Future Advancement of Academic Nursing (FAAN) Act (H.R. 851) would address the crisis of nurse staffing through a $1 billion investment to create funding pathways for schools of nursing to grow the workforce.

“A $1 billion investment may sound bold …. We need to lean in and be bold because this can be a game changer for our profession,” she said. The bill, unfortunately, passed through the House but not the Senate; Rep Underwood will continue to champion this bill.

Among the many other bills she is working on is the Educating Future Nurses Act to expand clinical education and training opportunities for future advanced practice registered nurses (APRNs). The legislation creates a permanent federal funding stream for hospitals to partner with schools of nursing, community-based care settings, and other hospitals to address clinical training costs for graduate nursing students.

The bill builds on a similar program created under the Affordable Care Act known as the Graduate Nurse Education Demonstration Program, which provided federal funding to hospitals to pay for the clinical training costs of APRNs. Rep Underwood’s legislation expands and makes permanent this program, creating a federal funding stream for educating APRN students.

Fueling the Fire for Full Practice Authority

Dr Guilamo-Ramos asked what nurses can do when faced with interprofessional partners who are not supportive of full practice authority for APRNs. Rep Underwood said to continue discussing the “undeniable quality metrics” showing that clinical outcomes from care provide by APRNs in most settings are good or better than those of clinical partners.

“We have to have a long-range advocacy view,” she added. “But continue to do this work year after year to advance this mission. I know it’s hard, and it’s really frustrating, and it can be very uncomfortable to have these conversations.”

“Power through, because we will win,” Rep Underwood said. “They’re counting on us being fatigued and giving up. But there’s more of us than anybody else, and we’re very good at what we do, and I believe in us. And I believe we’re going to win. I’m here to have your back.”


Bridging the gap in health equity through a nurse-led model of care. Duke School of Nursing. April 25, 2023.