“All Politics Is Local”

Abstract

Marilyn W. Edmunds PhD, NP I have recently spent some time talking with nurse practitioners (NPs) in Australia, Wales, England, and Canada about the NP role and how it is being implemented abroad. Some of these are NPs from the United States who have moved overseas; others are nurses in the United Kingdom who are growing into the role. Sometimes they face barriers and problems that NPs in the US never faced. Often they can look at solutions that American NPs have found and adapt them to their own settings. Whatever the situation, I continue to be impressed with the clinical competence, compassionate care, creativity, and ingenuity of our NP colleagues everywhere. How they deal with political and professional issues grows out of the solutions they find to barriers in their own practices. Some challenges to NP role development and implementation seem universal. How can NP educational curriculum be strengthened? How do NPs work to the full potential of their education and skills? How do NPs gain legitimate access to patients? How do NPs find reimbursement for work commensurate with their professional service? How can professional practice risks be minimized? How can NPs socialize new colleagues within the role and, as professionals, police NPs who practice on the fringe? While there may be universal challenges to the NP role, there are no universal answers. What works in 1 state or country may not work within another. But the answers often come down to local politics: how decisions get made; who has the power, the connections, the contacts, the network; who will support NPs and advocate for them when the challenge is something that NPs cannot do for themselves. As an old Washington, DC adage says, “All politics is local.” Our country has been embroiled in divisive battles over how to jolt the stagnant economy and get people back to work. There is a need to reinvent government for the future to avoid the problems that led to the quagmire in which we now find ourselves. Many NPs rejoiced that health care reform legislation recognized NPs as essential players in a new health care system. There is evidence now that health care reform legislation may be pulled up by the roots to see whether it is viable. Whether it will be replanted and allowed to grow or will be discarded with the weeds remains to be seen. Even whether Medicare, Medicaid, and Social Security are on the same weed heap is also unclear. If health care reform continues to be debated, NPs need to be politically active now more than ever before to make sure legislative gains supporting NP practice are not reversed. There is strength and protection in being part of strong state NP organizations that are monitoring local change. There is protection in large membership numbers in the American College of Nurse Practitioners, which represent NPs politically in Washington, DC. NPs may yet be in for the legislative fights of their lives.