“To stay experimentation in things social and economic is a grave responsibility. Denial of the right to experiment may be fraught with serious consequences to the nation. It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory and try novel social and economic experiments without risk to the rest of the country.” 

U.S. Supreme Court Justice Louis Brandeis 

Since the founding fathers drafted the tenets of freedom from authoritarian rule, the merits of a centralized federal government or a defused structure that provides great power to individual states’ rights have been debated. The United States eventually fought a civil war over the argument, but even today, as controversial policy issues are discussed, the point remains: Where is the best policy formulated?  

The Transition to State Rights 

For the nation’s first 200 years, the federal government typically held sway as the final arbiter for policy resolutions. But as states moved closer to becoming what former Justice Brandeis termed “laboratories of democracy,” bolder legislation was introduced in the 1930s that resounded in regional territories. To fortify their resolve, state legislators formalized certain principles to substantiate their authority.  

Any implementation at the federal level should require state action to comply and must allow a reasonable amount of time for state legislatures to debate and enact any necessary legislation for their constituents. Where states already have similar legislation in place, a process for declaring substantial compliance should also be developed.” 

Then in the late 1960s, President Richard Nixon began to halt the expansion of federal power. Ronald Reagan’s 1980 election brought forward a new philosophy suggesting that Capitol Hill was limiting individual freedoms and that the states should have more control over their own policy decisions

Thus began a time when public policy initiatives were introduced in state capitals as a way of gauging response on a controversial issue. If the measure passed the rigorous debate and myriad challenges of parochial interests, other states would be more likely to replicate similar laws and eventually a federal law could pass to supersede the different state versions.  

Why It’s Important to Advocate at the State Level 

Because of their physical proximity to constituents, state representatives and senators understand that voters demand laws that closely align with their desires. Additionally, those legislators gain experience that they take with them into other policymaking roles—49% of U.S. representatives now serving in Congress were once members of their state houses. During those terms, many leaders met with experts, such as nurses, to learn more about the health policy issues that they’re now discussing in Washington. 

ONS’s Work in the States 

Recently, ONS has been taking some of its advocacy to the state level through concentrated state policy education. Working with several chapters in targeted states, ONS member advocates have met with their state elected leaders and provided real-life context about patients with cancer, quality care, and the nurse’s role in health care. During those conversations, oncology nurse advocates formed deeper connections because of a shared background—several general assembly members are nurses themselves.  

In Maryland, State Senator Shirley Nathan Pulliam (D-44) regaled 30 ONS members in January 2017 with how she’s used her nursing experience to navigate the complex personalities of politics. She almost would not let the ONS advocates leave her office as she excitedly share a litany of legislation planned to improve access to breast cancer care, screenings, and coverage for more Marylanders.  

Similarly in Texas in August 2019, State House Representative Stephanie Klick (R-91) spoke to almost 100 of her nurse colleagues about the legislative process. In particular, Klick was promoting a bill with the Texas Nurses Association that would allow nurses to alert authorities in dangerous situations, specifically focusing on the work environment and ensuring safe harbor. Because she is a nurse, she said her colleagues relied on her to explain and advance the bill through the committee. 

Finally, North Carolina State Representative Gale Adcock (D-41) was the keynote speaker in April 2017 to 40 oncology nurses in Durham. Her advice was that nurses need to stand up and be counted. Nurses cannot allow other professions to dictate scope-of-practice issues. Adcock said that she was relegated to the back bench when first elected, but as the legislative session progressed, she earned the respect of her colleagues by explaining patient-centered care issues—and treating other legislators’ ailments herself! 

ONS Perspective 

More nurses are represented in state legislatures than in the U.S. Congress, and throughout the country, they are having a greater impact on health policy than ever before. Nurse advocates must find new and unique opportunities to help influence public policy. For more information, listen to “How Nurses Will Affect Health Policy in 2020” on the Oncology Nursing Podcast.