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Public policy has a major impact on your practice and your patients. Advocacy is an expectation of the advanced practice nurse. Elected officials care about what their constituents have to say. To make a difference, you need to be informed and engaged. Contacting your legislator and discussing issues is an important attribute of nurse leaders. In your interactions with lawmakers you want to be positive and nonpartisan, personal, persistent, patient, focused on your message, and provide accurate information. 


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  1. Determine the issue or message (e.g., telehealth impact on your practice) you wish to discuss with your legislator(s). Resource: The American Nurses Association Federal Legislative Priorities for 2019.
  2. Identify your legislator and contact information from his or her website and/or search here.
  3. Method of Advocacy: Letter/ Email. 
  • Letter or Email: The student must write three (3) letters or emails or a combination of letters/emails to their identified legislators (State of California and/or Federal). The letters/emails may be the same topic to three different legislators or three different topics to three different legislators. Legislators read correspondence, especially when it is personalized and clearly from a constituent. The following guidelines should be used when writing to your representative:
    1. Be brief (one page or less), and use your own words.
    2. Begin with the appropriate heading and address.
    3. Be specific: State the specific bill number and issue and state your opinion in the first sentence.
    4. Relate your experience with the issue. Use personal examples when possible. Your interest and concern about the issue is important. 
    5. Ask the legislator to specifically commit to supporting or opposing the legislation you are writing about.
    6. Ask for specific reasons they are supporting or opposing the proposal. 
    7. Sign and print your name and include your address and other contact information.
    8. If you have pertinent materials and/or editorials from local papers, include them.
    9. Cite any references at the end of the letter or email usingAPA format.
    10. Avoid form letters/emails if possible. If you are using a sample or form letter, be sure to adapt it, especially in the first sentence and paragraph.  Legislators and their aides recognize form letters and are less likely to be influenced by them.
    11. Thank him or her for considering your opinion.
    12. Submit the three letters and/or emails in Word docs in the D2L assignment link along with a separate one-page reflection on your experience.

see attachment for sample

April 23, 2018

The Honorable Richard Burr

217 Russell Senate Office Building

Washington, DC 20510

Dear Senator Burr,

My Name is John Doe, I am a Registered Nurse in Winston-Salem, North Carolina. I am writing in regard to the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2017 [S.1063], that is pending approval by the Senate of the United States of America. “Establishing safe staffing standards for direct care registered nurses is a critical component of assuring that there is adequate hospital staffing at all levels to improve the delivery of quality care and protect patient safety” (U.S. Senate, 2017).

Establishing safe staffing standards is important because, in the United States, approximately 250,000 deaths per year are related to medical errors (John Hopkins, 2016, para. 1). According to this number it makes medical errors the third highest cause of death in the United States “Most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability” (John Hopkins, 2016, par.10). Mandated nurse-patient ratios can help decrease deaths due to medical errors. A study by Eunhee, et al. (2015) found, “Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality. These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments” (p. 535). Another study by West, et al. (2014) found “a statistically significant interaction between the number of nurses and patient’s risk of mortality, suggesting that nursing staff availability has the greatest impact on those at greatest risk of death”.

As a member of the Committee on Health, Education, Labor, and Pensions you have the opportunity to help with this issue. I ask that you support the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 [S.1063]. In supporting this bill, it will guarantee the improvement of quality of care and protect patient safety. It will guarantee the decrease of medical errors as well as decrease the rate of patient mortality.

Thank you for your time and efforts to protect and serve North Carolina!


John Doe, RN

2055 Country Club Rd.

Winston-Salem, NC 27005

[email protected]



Eunhee, C., Sloane, D. M., Eun-Young, K., Sera, K., Miyoung, C., Il Young, Y., & … Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies, 52(2), 535-542. doi:10.1016/j.ijnurstu.2014.08.006

Johns Hopkins. (2016, May 3). Study suggests medical errors now third leading cause of death in the U.S. Retrieved from https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

U.S. Senate. 115th Congress, 1st Session. S. 1063, Nurse Staffing Standards for Patient Safety and Quality Care Act of 2017. Edition statement. Washington, DC: Government Printing Office, 2017.

West, E., Barron, D. N., Harrison, D., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in intensive care: An observational study. International Journal of Nursing Studies51(5), 781-794. doi:10.1016/j.ijnurstu.2014.02.007

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