Week 6 - Assignment: Explore Methods to Meet Public Demands for Quality Services and Week 7 - Assignment: Compare Statewide Programs for Efficiency

ADVOCACY & H EA LTH POLICY By Alec Stone, MA, MPA, H ealth Policy Director

States Have a Role in Creating Public Health Policies

The federal government structure in Washington, DC, is hard

to ignore. U.S. children are taught about it in schools, and we hear about it regularly as elections, legislation, appointments, and the like are discussed in the news.

Less recognized, though, is that each state has a similar legislative structure. The governor is the highest elected officer, with constitutional powers that include budgetary authority, emergency resources, and even a state militia. State representatives meet in bicameral (two houses) chambers, a House and a Senate, and full agencies regulate in cabinet-level departments.

W ithin the boundaries of each state, based in a rich history of sovereign rights that have been dedicated to states for more than 240 years, are principles that allow the people to direct their leaders to govern as the people indicate. Hence, California passes laws that Alabama would not consider. The U.S. Constitution's 10th amendment, often cited by states rights

advocates, plainly affirms, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people” (Library of Congress, 2017).

W hen dealing with issues that affect all people, such as sweeping laws about the national defense, transportation, the interior, and health care, the federal government takes jurisdictional authority. And in more recent years, the U.S. Supreme Court has weighed in on civil rights cases, nationalizing laws for every citizen, regardless of state laws.

But it is at the state level that public policy shifts can occur. Although the U.S. Congress grabs all the headlines with its rancor and outrageous behavior, state legislatures often go unnoticed and accomplish a great deal of legislative efficiency. More and more, national advocacy groups are finding a successful tactic in taking complex, and sometimes controversial, topics to state legislatures. Viewed as incubators for future, broader legislation, states tackle social and economic issues

in a more targeted environment. If it can work at the state level, perhaps the same law can work at the federal level? Three such topics have found their way through state legislatures with some success and are important to oncology nurses.

Medicinal Cannabis In January 2018, U.S. Attorney

General Jeff Sessions announced a new federal policy regarding marijuana (U.S. Department of Justice, 2018). The Department ofjustice reasserted the federal government’s prohibition of marijuana, overriding 29 states and the District of Columbia that have passed laws legalizing the use of marijuana, including medicinal cannabis (Savage & Healy, 2018). Until recently, it was thought that a single, federal law

More and more, national advocacy groups are finding a successful tactic in taking

complex, and sometimes controversial, topics to state

legislatures.

FACTOIDS A N D OTHER SHO RT R EADS

U.S. cancer death rates continue to decline: as of 2015, the cancer death rate for men and women combined had fallen 26% from its peak in 1991, translating to nearly 2.4 million deaths averted. American Cancer Society. (2018). Cancer facts and figures, 2018. https://www.cancer.org/latest-news/facts-and-

figures-2018-rate-of-deaths-from-cancer-continues-decline.html

might be introduced to encompass the spreading support for medicinal cannabis. Next steps could be to expand the effort to more states, forcing Congress to review the subject.

Scope of Practice Nurse licensure is handled through each state. It’s a complex

regiment of 50 different bodies that generally have the same level of regulations but some very important and defining differences (American Nurses Association, n.d.). Most noteably, this includes codifying nurses’ scope of practice for each state: when, where, and how nurses are allowed to legally practice to the full extent of their education and experience is often up to state legislatures, with elected officials who have limited to no understanding of nurses’ abilities. Laws are passed with broad strokes and unknown implications. Nurses must be a vocal part of these discussions with their state legislators. Find out more about how you can get involved at www.ons.org/advocacy- policy/get-involved.

Workforce Safety The day-to-day work environment for a nurse is constantly

changing. Treatment and cures have advanced, but often those who administer the lifesaving drugs are themselves in harm’s way, if the drugs are handled incorrectly (Polovich & Olsen, 2017). The safe disposal of hazardous drugs is an issue that oncology nurses regularly face. Unknown to those outside of this environment, the National Institute for Occupational Safety and Health is promoting standards at the federal level as well as in individual states. Some state laws about hazardous drug safety have been on the books for more than 25 years but are inconsistent between states (Eisenberg, 2012). The more rigorously healthcare workers advocate for safety, the better state elected officials understand the underlying points of the issue.

Breast cancer death rates declined 39% from 1989- 2015 among women, mostly attributed to improvements in early detection. American Cancer Society. (2018). Cancer facts and figures, 2018. h ttps://

www.cancer.org/latest-news/facts-and-figures-2018-rate-of-deaths- from-cancer-continues-decline.html

How these topics are developed and the approach with which patient advocates and healthcare providers, particularly nurses, attempt to advance the dialogue are lessons for creating a motivated and mobilized army of supporters. Unique leadership opportunities exist to make real changes in health care, and oncology nurses are at the center of these discussions. W hether at the federal or state level, as the most trusted healthcare

professionals, nurses continue to make a real difference with decision makers who implement policy.

American Nurses Association, (n.d.). Scope of practice. http://w w w . nursingworld.org/MainMenuCategories/Policy-Advocacy/State/ Legislative-Agenda-Reports/Scope-of-Practice

Eisenberg, S. (2012). NIOSH safe handling of hazardous drugs guidelines becomes state law .Jo u rn a l o f In fu sio n N ursin g , 35, 316-319. https://doi. o rg /10.1097/NAN.0b013e31826596c4

Library of Congress. (2017). United States Constitution, https://www.loc. gov/ rr/program/bib/ourdocs/Constitution.html

Polovich, M., & Olsen, M.M. (2017). S a fe h a n dling o f h azardous d rugs (3rd ed.). Pittsburgh, PA: ONS. https://www.ons.org/store/books/safe- handling-hazardous-drugs-third-edition

Savage, C., & Healy, J. (2018). Trump administration takes step that could threaten marijuana legalization movement. https://www. nytimes.com/2018/01/04/us/politics/marijuana-legalization-justice- department-prosecutions.html

U.S. Department of Justice. (2018). Justice department issues memo on marijuana enforcement, https://www.justice.gov/opa/pr/justice- department-issues-memo-marijuana-enforcement

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American Cancer Society. (2018). Cancer facts and figures, 2018.

https://www.cancer.org/latest-news/facts-and-figures-2018-rate- of-deaths-from-cancer-continues-decline.html

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American Cancer Society. (2018). Cancer facts and figures, 2018. h ttps:// www.cancer.org/latest-news/facts-and-figures-2018-rate-of-deaths- from-cancer-continues-decline.html

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