A CNO Guide to Participating in Policy and Advocacy

Legislators play a key role in nursing practice, from scope of practice to workplace violence prevention to patient care delivery. But right now, most of the elected officials making decisions about nursing policy are not nurses.

According to a 2023 study, the number of nurses serving as legislators has declined from 2013. In 2023, there were only 72 nurse legislators in 36 states. According to the American Nurses Association, there are only three nurses currently serving in the United States Congress.

As this year progresses under a new administration with new ideas about legislation and policy, it’s more important than ever that CNOs and other nurse leaders get involved so that nurses can be the ones leading the way for legislative change.

The Winning Edge for Advancing Nursing Advocacy and Legislation webinar included three experts on the subject: Rudy Jackson, SVP and CNE of UW Health and HealthLeaders Exchange member, Claire Zangerle, CEO of the American Organization for Nursing Leadership and SVP and CNE of the American Hospital Association, and Natalie Nicholson, CNO of Denver Health.

The panel included three key points about nursing policy and legislation.

There are several critical areas of focus for nursing legislation, the first being workplace violence. Nurses experience some of the highest rates of workplace violence out of any profession. According to a National Nurses United report, eight in 10 nurses experienced at least one type of workplace violence between 2023 and 2024. The panelists emphasized that nurse leaders should be aware of the SAVE Act, which would make it a crime to knowingly assault or intimidate healthcare employees at work.

Additionally, the passage of the One Big Beautiful Bill Act (OBBBA) will mean dire things for rural hospitals and health systems, and many patients previously enrolled in Medicaid will lose access to coverage. The panelists emphasized that nurse leaders must speak up about the impact of this bill on the most vulnerable patients and communities, and the downstream effect that it will have on nursing practice and care delivery.

CNOs also need to pay attention to legislation regarding rules around telehealth, advanced practice nurses, and mandated staffing ratios. Additionally, leaders must keep tabs on legislation that might have a secondary effect on nursing, even if it seems like there won’t be a direct impact. That includes any piece of legislation regarding childcare or other things that impact a nurse’s ability to participate in the workforce.

Ways to get involved

When it comes to participation in the legislative process, the panelists recommended identifying and building relationships with local, state, and federal policymakers. CNOs should know who the decision-makers are and what committees they are on and try to become their subject matter experts who they can call upon to discuss nursing-related issues.

CNOs should also build pipelines for newer generations of nurses who are inspired and want to get involved in advocacy. It’s critical that nurse leaders foster a sense of confidence among nurses to stand up and have a voice.

Driving home the point

Lastly, there are two key strategies to use when speaking to legislators: data and storytelling. The panelists recommended presenting the data from a policymaker’s constituency and the health system’s community. Metrics to keep in mind include turnover rates, workplace violence numbers, patient outcomes and experience, nurse vacancies, and nurse sensitive indicators.

Storytelling is also a powerful tool, especially when combined with data, the panelists explained. Policymakers often don’t understand the nuances and intricacies of being a nurse, and storytelling conveys the passion and the importance of why these issues matter. CNOs should also consider doing their advocacy work in person, when possible, to further communicate the subject’s importance and to build better relationships with lawmakers.

G Hatfield is the CNO editor for HealthLeaders.