Advanced Civics

As the United States braces for what promises to be another intense election season, the potential for nurses to advocate for patients and populations as policymakers, politicians, and voters is being highlighted as never before.

Globally, nurses have been hailed as health care heroes for their bravery and commitment to their patients during the COVID-19 pandemic. This respect is long-standing: Americans have rated nursing the most ethical profession in an annual Gallup Poll for over two decades running. But at the same time, nurses, health, and health care are at the heart of some of the most contentious issues facing voters today, including abortion access, gun violence, the opioid crisis, and gender-affirming health care (now banned or restricted, or soon to be, in 22 U.S. states). A recent NPR/PBS NewsHour/Marist poll of likely voters in the 2024 presidential election found that health care ranked third among their top concerns.

It’s no surprise that many people today are looking to the policymaking and political spheres as places where such thorny health related issues can and should be discussed and sorted out. At the same time, nurses are increasingly seen as the kind of bridge-building leaders the U.S. needs in the current polarized environment.

At a recent webinar on nurses, politics, and policy hosted by Columbia Nursing’s Center on Health Policy, former Maine state legislator (and nurse) Darlene Curley, EdD, said: “Nurses make excellent legislators. We can assess data quickly, set priorities, collaborate, and solve problems.” Yet Curley’s research shows that representation of nurses in state legislatures has declined over the past two decades. There are currently only three nurses in the U.S. House of Representatives and none in the U.S. Senate.

“Nurses build consensus every day. . . . We really need nurses at every level of government,” agreed Curley’s fellow panelist, and fellow nurse, Delaware Lieutenant Governor Bethany Hall-Long, PhD.

Using health as a compass

Based on their sheer numbers—there are 4.2 million nurses in the U.S.—the profession represents a significant slice of the country’s voting-age citizens.

“We don’t usually vote as a group, but if we did and we had health as our compass, then we could really make a difference,” notes Elizabeth Cohn, PhD ’09, vice president for health equity research at

Northwell Health’s Feinstein Institutes for Medical Research. Politically, she notes, nurses are fairly evenly split, with one-third identifying as Republican, one-third as Independent, and one-third as Democratic.

In 2018, Cohn launched Nurses Who Vote, a nonprofit that promotes civic engagement among nurses. At the time, she was a distinguished professor at the City University of New York, teaching health policy to doctoral nursing students, who themselves were working on the front lines of the medical care system. “We were talking about the impact of Medicaid expansion, vaccine rates, policies and practices,” Cohn says. “I started to realize that we advocate for our patients, we advocate for our communities, and we needed to advocate for policies and those we elect.”

Cohn and her students observed that many health issues—climate change or vaccine safety, for example—have become political footballs. “It occurred to really all of us that electing people with a health-oriented lens would probably result in a more open engagement process.”

Cohn adds: “As a class, we decided that the best thing that we could do is to register ourselves and our patients to vote.” Nurses Who Vote began running voting drives around the school of nursing and soon formed a partnership with another nonprofit, nonpartisan group, the League of Women Voters.

Linking civic engagement and health

Nurses Who Vote also connected with Vot-ER, yet another nonpartisan nonprofit that promotes civic participation—by encouraging clinicians to help their patients register to vote. Cohn wears a badge, developed by Vot-ER, that allows people to check their voter registration status, and to register to vote, just by scanning a QR code. “On one side, you can register people to vote, and on the other side, you can read about how voting affects community health,” Cohn explains. Across the U.S., she notes, about 700 hospitals and health systems are working with Vot-ER to make civic engagement part of the health care conversation.

There’s solid evidence that civic engagement is healthy for individuals and communities, Cohn adds. Nurses Who Vote, Vot-ER, and other partners successfully lobbied the Department of Health and Human Services to recognize this connection by adding civic participation and voting as a health-related behavior in its Healthy People 2030 guidelines.

When anyone questions whether the health care setting is an appropriate place to register people to vote, Cohn points out that most people register to vote at their local department of motor vehicles— which is certainly no more appropriate than a clinic or medical office, especially given the connection between civic engagement and health.

“Where should people register to vote?” Cohn asks. “Well, wherever they are. And if that’s where they are, then that’s where we should register them. So we want to just make the voting and registering to vote available where people are and where we can speak to them about it, since it is a factor in improving their health and the health of their communities.”

Fighting for full practice authority

Columbia Nursing’s associate dean of clinical affairs, Stephen Ferrara, DNP, says the movement to promote civic engagement among nurses—up to and including running for office—is gathering steam. “I believe that’s a good thing. I think we need to have more nurse practitioners [NPs] and nurses representing constituents across the country.”

Ferrara has worked diligently through the political system to advocate for what many see as the top objective for NPs: full practice authority. 

As executive director of the Nurse Practitioner Association of New York State (NPANY), Ferrara helped push through the 2014 Nurse Practitioner Modernization Act, which allows NPs with more than 3,600 hours of clinical experience to work at their full scope of practice, without statutory collaboration. Previously, New York’s NPs needed a written practice agreement with a physician to practice, regardless of their clinical experience. New York is now one of 27 states, along with the District of Columbia, that grants full practice authority to NPs.

The multiple benefits of full practice authority for NPs, their patients, and the health care system include streamlining care, reducing costs, and helping to address racial disparities in health and health care by improving access to clinicians, particularly in underserved rural and urban areas.

Recently elected president of the American Association of Nurse Practitioners (AANP), the nation’s largest professional organization for NPs, Ferrara aims during his two-year term to clear the way to full practice authority for NPs nationwide by addressing state laws and federal regulations that restrict or reduce their scope of practice.

“The goal is to reduce barriers and eliminate the barriers for the remaining states,” Ferrara explains. For example, he notes, current Medicare regulations allow only physicians to prescribe diabetic shoes for patients with diabetes—not NPs. “People are at risk of losing a toe or their entire foot with a bad infection. This is a really simple intervention that needs to be implemented. It’s just archaic to have nurse practitioners not be allowed to do that.”

The ICAN (Improving Care and Access to Nurses) Act, introduced in the U.S. House of Representatives in 2022 and in the U.S. Senate this year, would lift some restrictions on the types of care that NPs can provide, including prescribing diabetic shoes. Ferrara is a firm proponent of the ICAN Act. “We encourage patients to contact their legislators to eliminate these barriers that prevent them from receiving the care that they need,” he says.

There are more opportunities than ever, he notes, for nurses to get involved in politics, to help shape policy, and to advocate for patients, including reaching out to their elected representatives to support legislation and campaigning for candidates. “You may only have an hour,” he says, but “there’s phone banking you can do for candidates, there’s text banking that you can do as well.”

Busy nurses can rely on AANP, NPANY, and other advocacy and professional groups to identify their local representatives and candidates and their positions on important issues, Ferrara points out. Nurses Who Vote also provides such information.

Health policy and advocacy

Ferrara brings his health policy students to Albany to visit New York’s state legislature every year. Some also attend the AANP’s Health Policy Conference, held every January in Washington, D.C. During the conference, students and NPs can pick up tips and pointers on lobbying Congress, followed by the chance to put these skills into action during Capitol Hill Day.

Terilyn Ma, MS, a DNP student in Columbia Nursing’s Adult Gerontology Acute Care Nurse Practitioner Program, attended the conference this year. “It was amazing meeting fellow nurse practitioners from all around the U.S. who were all fighting for the same cause, which is to improve patient access to care and advocate for full practice authority for all nurse practitioners,” recalls Ma, a board-certified adult-gerontology acute care NP who served as Student Council Executive Board University Senator for 2021-2023 and is the lateral representative of her DNP group for 2022-2024.

Ma plans to continue to advocate for full practice authority for NPs when she returns to the nursing workforce. While she couldn’t attend Capitol Hill Day in 2023, she plans to go in 2024. “There is so much more to do in order to improve our health care system, and advocating for nurse practitioners to have full practice authority is something I hope I can help achieve by getting involved.”

Serving community in government

Nurses and NPs can also support their communities by joining local, county, and state health boards, notes Maryelena Vargas, PhD ’08, who has served on the Englewood, N.J., Board of Health for many years and previously worked as a public health nurse for Englewood’s Health Department, starting in 1991.

Vargas’s colleagues on the Board of Health elected her the board’s president this year. While this has brought new responsibilities to her already full days, Vargas says working for her community energizes her. She is also a professor of nursing at the Henry P. Becton School of Nursing and Allied Health at Fairleigh Dickinson University in Teaneck, N.J., and a board-certified family nurse practitioner with the North Hudson Community Action Corporation, which operates several federally qualified health centers in northern New Jersey.

“Being involved in policy-making is very rewarding to me, especially since I have always felt a responsibility to represent members of the Latino community, who may not have had the opportunities I had to influence public health decisions,” Vargas says, noting that despite representing 27% of Englewood’s population, Latinos remain unrepresented among the city’s elected officials.

Vargas and her fellow Board of Health members collaborate with colleagues in Englewood’s Health Department to direct the administrative division and program divisions in Environmental Health, Health Education, Public Health Nursing, and Vital Statistics and Licensing. The Health Department inspects restaurants, pools, and other facilities to ensure proper sanitation; investigates public health nuisance complaints; issues birth, death, and marriage/civil union certificates and licenses; and provides retail food and pet licenses.

The Englewood Board of Health and Health Department have also made a real difference in population health, Vargas notes, by educating restaurants and food preparers on food allergies and by holding health fairs that offer HIV testing, hepatitis C testing, COVID shots, flu shots, and hypertension screening.

“Many nurses live in communities like mine,” Vargas says. “If they decide to become involved in local, county, and/or state boards, they can make a big difference in health and social policy. It’s easy; nurses have the skills, the knowledge, the compassion, the common sense. With a collaborative approach, they can partner with legislators and leaders in their communities to promote health and social justice for all.”

Illustration by James Steinberg, Photographs by Jörg Meyer

This article originally appeared in the Fall 2023 issue of Columbia Nursing Magazine.