Whether shepherding legislation they sponsored, collaborating on a strategic workforce plan or educating their peers about healthcare issues, nurses elected to their state legislatures continually draw on their past clinical experiences to promote the profession and get things done.

Rep. Donna Howard, D-48th District, a former RN who has served in the Texas House of Representatives for six years and is up for reelection, calls nursing "invaluable" to her legislative career. She said it was helpful, particularly in learning to work with a multidisciplinary team and see the bigger picture. "I credit my educational preparation for the way that I approach issues," Howard said.

Nursing education and patient care experience have helped legislators better serve their constituents. "The nursing background gives me the ability to listen to people to try and understand their issues, which has made me a more effective legislator," said Rep. Denise Grimsley, RN, R-77th District, who has served in the Florida House of Representatives for eight years and is running for the Florida Senate.

Grismley considers her greatest accomplishment in the House the revamping of the Board of Nursing and nursing education system, "trying to get rid of bureaucratic procedures and open up more opportunities in nursing." She was the prime sponsor of HB 1209 in 2009, which removed the board’s rulemaking authority, provided standards for approval of nursing programs and specifies programs are deemed approved if the board does not act within prescribed timeframes. In the three years since the bill passed, the board of nursing has approved 111 nursing education programs, increasing the number of available spots for students by 47% and the number of students graduating from Florida nursing schools by 14%, according to the Florida Legislature’s Office of Program Policy Analysis and Government Accoutability’s report 12-4. She also led a Medicaid reform bill.

After being named the first female chairperson of the Florida House of Representatives appropriation committee, Grimsley never lost her cool even in the most contentious meetings. The speaker remarked that the more spirited debates got, the calmer she became. "I told them it’s my trauma nursing background," Grimsley said.

Although Howard is not practicing, she still identifies herself as a nurse. She is committed to nursing workforce issues and co-authored "Texas Nursing: Our Future Depends on It — A Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013."

"We built a coalition of stakeholders to look at workforce issues, and that allowed us to be successful in what we achieved," Howard said. "We were able to increase funding significantly to increase opportunities to get nurses into the pipeline and graduate nurses, not only at the entry level but at the master’s level, to help address the nursing faculty shortage."

According to a report from the Texas Education Coordinating Board, the Nursing Shortage Reduction Program awarded $7.3 million to nursing programs in fiscal year 2009, increasing the number of graduates by 1,055.

In addition to the funding for nursing education, Howard helped pass legislation to provide greater protections to nurses who report unsafe patient care. Howard works collaboratively with fellow nurse Rep. Susan King, R-71st District, to advance nursing priorities and advise other legislators about nursing and healthcare issues.

Former Florida Rep. Yolly Roberson, RN, D-104th District, who served from 2002-10, (term-limit rules prevented her from continuing in that role), also found working across the partisan aisle helped her achieve results in passing legislation, including sponsoring HB 411, which went into effect in July 2006 and redefined the term "psychotherapist" to include certain advanced practice registered nurse practitioners for purposes of the psychotherapist-patient privilege of the Florida Evidence Code. She also sponsored legislation that prohibited selling weight-loss pills to minors and legislation that required law enforcement to assist victims of sexual battery in obtaining necessary medical treatment and other services.

Roberson is forming a nonprofit organization to address healthcare disparities in South Florida. She finds nurses in general are not involved in advocating their positions on policy issues, such as the cost of healthcare. "Nurses can change the face of healthcare in America," Roberson said. "They can change the everyday lives of Americans."

Legislators want to hear from their constituents, Grimsley said. She encourages nurses to write letters and ask questions. Grimsley decided to run for office after observing many of the legislators and regulators she met did not seem engaged in their work. After winning the election, she continued to work in the ED and as a house supervisor at Florida Hospital Sebring for a time.

Howard encourages nurses to stay abreast of issues concerning healthcare delivery and know where the candidates stand. Participation in nursing organizations can boost one’s influence and work on the nurse’s behalf, she said. "Nurses should be engaged and make sure their voice is heard," Howard said.

Nurses also can volunteer with advocacy groups and perhaps take part in a campaign to network and learn strategizing and marketing techniques. "It’s great to have insight into how the process works and network connections to reach a broader audience," Howard said.