Nurses who regularly peruse this column may have noticed that I changed employment earlier this year. While health policy remains the focus of my work, I left Capitol Hill after almost 9 years to return to a university. During my tenure on 'the Hill,' I frequently found myself wishing for time to just think. It didn't even have to be much time. Now, after 7 months away from the high stress, high stakes legislative world of policy and politics, aspects of the experience merit sharing because they address the questions nurses most frequently asked me about working on Capitol Hill.
For nurses who like the idea of working in policy, at the local, state, or federal level, but think they are too removed from the policy environment in terms of their education and experience, my story highlights the ability of nurses to move from the worlds of nursing practice and education to policy and politics. I came to the Hill from a teaching position in the College of Nursing at the University of North Dakota and, after less than 2 years, was promoted to the chief of staff position to a U.S. Senator. Prior to accepting the Capitol Hill position, I'd been to Washington, DC only once--for less than 24 hours.
A View of Life on Capitol Hill
Every congressional office has a legislative assistant responsible for handling health policy. This person is the contact for nurses and any other group or individual interested in communicating with their congressional member on a health issue. I started my work on the Hill as a legislative assistant and was responsible for health, education, and welfare issues. In contrast, typical responsibilities of a chief of staff involve overseeing the office budget, personnel, press and public relations, political and legislative operations, and the offices located in the home state, in addition to the Capitol Hill office. These legislative assistants interact with a wide range of individuals including constituents, lobbyists, representatives of the administration and other senate offices, state government officials, and sometimes officials from other countries. While I also chose to continue my involvement with health policy, the nature of the chief of staff position requires breadth across an array of policy issues. For example, working for a North Dakota Senator required familiarity with issues as diverse as the role of the two Air Force bases located in the state to changes in farm crop subsidies. The legislative assistants responsible for these issues have in-depth expertise.
I used a number of sources to stay informed on issues, including briefing materials, daily summaries of congressional activity, political information from the Democratic party, and newspapers which I read cover-to-cover looking for emerging policy issues, political slants, economic and other developments both here and abroad. Given the range of issues and individuals one interacts with in this job, being even minimally conversant is essential. 'I don't know' is rarely an acceptable response from anyone working on Capitol Hill. It would be akin to a nurse giving a report at shifts' end and responding similarly on the status of a patient in her/his care.
At first glance, working in this environment might seem an ill-fitting career move for a nurse. Just the opposite is true. While a political science major knows the legislative process, a nurse knows the content to which that process is applied. Consequently, once the language and the process of the legislative arena are mastered, a nurse's education and experience are excellent starting points for legislative and policy work. Aspects of nursing education that were most helpful to me are easily identifiable.
First, working in health care facilities provides experience with consumer and provider issues. For example, if the focus of a legislative proposal is the practice and reimbursement of nurse anesthetists or the care provided in nursing homes, nurses have firsthand knowledge on which to draw. This background stands in stark contrast to most legislative assistants for health who generally bring a liberal arts education to their work. Also, as a nurse meeting with lobbyists or constituents, a working knowledge of health issues allows for more complex discussions. When hospital CEOs, biomedical researchers, or advocacy groups came to the office to encourage support for their issue, our discussions probably began where others may have ended. For example, it isn't necessary for a lobbyist seeking additional research funds for interstitial cystitis to explain the illness or describe the population it typically affects.
Nursing research, too, provides skills for activities ranging from interpreting polling data during an election year to determining whether a research finding presented by a special-interest group really supports a recommended position. The emphasis on communication skills in nursing programs is critically important. Just as a nurse's assessment includes observations that go far beyond listening to a patient describe symptoms, sensitivity to nonverbal communication and using specific strategies such as open-ended questions are important tools on Capitol Hill. These skills are applied in situations as diverse as negotiating sessions with other congressional staff to discussions with a constituent distressed about Medicare coverage for an elderly parent.
The nursing process also found its way into my work by providing a pragmatic approach to virtually every decision making process, whether it was ensuring the success of a press conference or organizing the Senate Rural Health Caucus staff. Finally, in my specific situation, working in critical care was sound preparation for the crisis management and priority setting needed every day and sometimes every hour in a congressional office. Unanticipated developments in both critical care nursing and on the Hill demand an ability to accommodate fast moving change.
Opportunities for Growth
While nurses bring a rich background to the policy arena, they can also experience exciting opportunities and tremendous professional growth. Even nurses who spend short internships or fellowships on Capitol Hill are often captivated by the excitement of witnessing the legislative process and working with policymakers firsthand. Their enthusiasm and heightened interest in health policy is refreshing. I received a number of professional gifts from my Capitol Hill experience.
First, in spite of the generally accepted view that the past 2 years of congressional activity have been marked by gridlock and hostility between political parties, negotiation and compromise characterized much of my Hill experience. Members and staff recognized that moving legislation generally required 51 votes and that an inflexible position often resulted in a losing battle. Capitol Hill, as with state legislatures, is prime training ground for honing negotiating skills. Similarly, in spite of firmly held views that are often polar opposites, one learns that respectful engagement of interest groups and other congressional staff should be the rule. While a congressional office may not choose to be on your team on one issue, they may be essential to achieving success on another. While disagreement frequently characterized legislative work, it was almost always done courteously and orchestrated carefully.
Capitol Hill also provides ample experience in developing working relationships with individuals from varied professional backgrounds, be they bankers, corporate executives, or veterans. While working with nursing groups was most comfortable, learning the language of their interest groups and the significance of their issues is a true growth experience. Over time, I developed a much stronger interest in policy with an interdisciplinary focus.
Another strength that I derived was far greater confidence when interacting with people who, in other circumstances, might seem intimidating. Whether staffing a congressional hearing or facilitating a political fundraising event, comfort and fine-tuned conversational skills are prerequisite to conversing with people whose background and experiences were markedly different from my own. While I often found myself wrestling with a primordial 'flight' response, there were numerous experiences that helped overcome the unease. Activities as diverse as a political dinner at the home of Senator John D. Rockefeller (whose tree house for his children wasn't much smaller than the home in which I was raised); to participating in a small group meeting with the Dali Lama, whose monastery home in Tibet I'd toured weeks earlier--a home he's been prevented from returning to by the Chinese government; to being one of two passengers on a German military jet--with the other passenger being a member of Chancellor Kohl's cabinet; to a White House reception during the Bush era for large Republican Party campaign donors (The latter would be an atypical activity for a Democratic staff member; however, I'd been invited by a donor who had friends in both political parties). With each new challenge, interpersonal skills were honed.
Capitol Hill also provided an in-depth education in the legislative and political process. My first year promoted feelings similar to those I experienced in graduate school--much to learn and not enough time to learn it. However, just as a new nurse takes great pride in making a difference to a patient, so too successful health legislation incorporating one's contributions is a cause for celebration. Nurses in both environments affect health care--the difference is how.
Finally, my Hill experience was highlighted with opportunities to travel stateside to places like Prince William Sound, Alaska, to view from a helicopter the devastation of the Valdez oil spill, and to places abroad like Prague, Taipei, Bonn, Beijing, Hong Kong, and Lhasa, Tibet. From these visits, my perspective became much more global and far better informed. The opportunity to learn about economic, political, trade, and health issues facing other countries underscores the nature of our global community and its significance to each of us. Even today, I find myself reading news of these and other regions that I would certainly have glossed over in years past. And, unexpected byproducts of these travels are some lasting friendships with my counterparts in other governments.
People Who Make it Possible
Regardless of where a nurse practices, the opportunity to both contribute to people's health and grow professionally are rich rewards. My chance to do both in the legislative arena was possible only because of others who, unasked, were committed to helping me succeed. The individuals who assisted me are terrific models for others who are willing to make a difference in a nurse's career. The person most responsible for my being interviewed and subsequently hired for a position on the Hill was Betty Maher, the executive director of the North Dakota State Nurses Association. Prior to moving to Washington, DC I was very involved with the political and government relations activities of the state nurses association and my interaction with the executive director grew. Betty Maher recognized the value of nurses' involvement in the political process early in her own career and her political involvement paved the way for my employment. She was on a first-name basis with the first senator who hired me. She placed a number of calls to him and drew on all the rationale she could muster about why it was important to have a nurse in a U.S. Senate office. It was years later that I learned that in her armament of reasons, she noted that since the senator would soon stand for re-election, he needed to know that 1 in 44 voters is a nurse. She opined that hiring one would increase the likelihood that he could capture much of this voting block.
After I interviewed and was offered the position of legislative assistant, the decision to accept it was still a difficult one. Moving into very unfamiliar territory carried a much higher perceived risk of failure.
While encouragement came from many quarters, the strongest and most positive encouragement came from a voice on the phone belonging to an individual I had never met and with whom I shared only one characteristic that I knew of with certainty--we were both nurses. The conversations I had with Polly Bednash, the executive director of the American Association of Colleges of Nursing, were pivotal to my accepting the position. Without knowing me, she told me all of the reasons she thought it was important for me to accept the position and for nursing to have one more nurse on the Hill.
Her encouragement and support continued during my 9 years of policy work. When I reached out for counsel or information, Polly Bednash always reached back; with insight, political savvy, and wisdom.
Once I arrived in Washington, long work days left minimal time for professional networking after hours. Nevertheless, I made a point of attending an informal dinner meeting of at least 75 nurses from the government, local academic institutions, and nursing organizations. To my good fortune, one of the first individuals I met was Nancy Sharp who provided individual introductions to seemingly every individual in the room. She continues to do it to this day, helping other nurses new to Washington build important connections and making each of them feel like they have something to offer. Nancy Sharp has unparalleled commitment to helping neophytes in the policy arena get the information and make the contacts they need to achieve success. She is selfless in her work--an uncommon attribute in Washington--and her commitment to nursing success in the policy arena defies adequate adjectives.
Pat DeLeon, a non-nurse, has in fact received numerous honorary nursing awards. A psychologist and lawyer, Pat serves as Senator Daniel Inouye's (DHI) chief of staff. While he was on Capitol Hill a decade before I arrived, he treated me as a peer from our first meeting and painstakingly included me in a range of legislative initiatives. His counsel on strategy and his willingness to share his expertise helped a nurse new to the policymaking arena position legislative proposals to achieve legislative success. Where quid pro quo almost always underlies interactions on Capitol Hill, Pat accrued little in return for his investment in my professional growth. On reflection, I couldn't have asked for a better mentor on the Hill and nursing couldn't ask for a better friend.
For nurses new to the policy arena in local communities, state capitals, or the nation's capital, guidance and support can come from a lot of people. Now that I'm back in an academic environment, I've had time to think about the difference the work of individual nurses (and non-nurses) make as well as the contributions of nursing associations like the American Nurses Association and the American Association of Nurse Anesthetists. Just as we take pride in nursing's accomplishments, we can certainly be proud of its people.
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* Project LPNs had a 100% pass rate on the RN national licensing exams on the first attempt.
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MARY K. WAKEFIELD, PhD, RN, FAAN, is Director, Center for Health Policy, School of Nursing, George Mason University, Fairfax, VA.
