http://nwh.awhonn.org © 2009, AWHONN 191

w“We in America do not have government by the

majority. We have government by the majority

that participate.” —Thomas Jefferson, 1787

So often, nurses touch the lives of individu-

als and families through direct patient care.

But they also touch millions of people’s

lives through advocacy. In the mid-1980s,

AWHONN member Carola Bruflat began a

journey of grassroots advocacy that she says

has not only enriched her career, but has

advanced the nursing profession and has led to

many improvements in patient care. Here, she

tells her story.

Getting Started by Telling StoriesMy path as a nursing advocate began when a

fellow AWHONN member asked me to serve

on the Virginia section’s newly formed legisla-

tive committee. I’d never been involved in any

advocacy issues before, but I was intrigued to

find that I could make a difference by telling my

story and the stories of my patients to legisla-

tors. My participation in AWHONN’s legislative

committee included advocacy efforts to expand

Medicaid eligibility for pregnant women and

their newborns, as well as work toward the

provision of family medical leave on the state

and federal levels. These initiatives prepared me

to participate in an even greater capacity several

years later when I would advocate for expanded

So often, nurses touch

the lives of individuals

and families through

direct patient care.

But they also touch

millions of people’s

lives through advocacy

Making a Difference

Carola Bruflat, WHNP/FNP, MSN, RNC

Kerri Wade, MPA

One Nurse’s Journey in Health Care Advocacy

192 Nursing for Women’s Health Volume 13 Issue 3

prescriptive authority for nurse practitioners

(NPs) in my state.

Grassroots EffortsAs a new NP in 1998, I joined the local chapter

of the Virginia Council of Nurse Practitioners

just as it was beginning its next significant

statewide legislative effort—a two-year plan to

address prescriptive authority for NPs. In the

first year, the Council helped to create a bill that

would maintain the current supervisory ratio

at the time, but would remove the restriction

of how many NPs were supervised by a physi-

cian. The bill was unanimously passed by the

Virginia General Assembly and became law on

July 1, 1999.

The second phase of the Council’s plan, ex-

panding NPs’ prescriptive authority to include

Schedule III, IV and V drugs, proved to be a

bit more challenging. We began an extensive

campaign to educate members of the state leg-

islature about the benefits of this change in the

law. Our efforts included placing a minimum

of 30 calls, letters and emails to each office.

We attended town hall meetings, developed

information packets and visited members of the

General Assembly to pass out the packets to ev-

ery office. Our patients, nursing and physician

colleagues, our families, and friends were all

recruited to write and call about this legislation.

We reached out to other likeminded groups,

such as the Legislative Coalition of Virginia

Nurses, AWHONN, March of Dimes, Virginia

Perinatal Association and the Virginia Women’s

Network, to form a coalition and strengthen

our numbers. The Council mobilized each

advocate and empowered them with tools,

which were prepared by our lobbyist, to educate

legislators about the benefits of our bill.

All our hard work achieved a resounding

success in the House with a vote of 79 to 19.

The Senate proved to be more complicated,

when our bill was blocked in the Senate Sub-

committee. Rather than give up, the Council

continued negotiations. Quickly, then state

Senator Emily Couric offered a compromise—

to “roll in” schedules one at a time, as well as

pursue additional continuing education, and

report to the General Assembly about our

expanded authority after “roll in” was complete.

After success in the Senate, the bill returned to

the House and it passed by a vote of 88 to 9. We

were astounded and exhilarated by our success.

This is one of many nursing advocacy success

stories. As trusted health care experts, nurses

can make a difference in the future of our pro-

fession and our patients’ care through advocacy.

Groundbreaking LegislationSince 2000, the Virginia Council of Nurse

Practitioners has successfully advocated for the

Omnibus Signature bill, which gives NPs the

ability to sign, certify and attest to the health

of workers, the need for handicapped parking

and any other form that was previously signed

by a physician only. This was the first such bill

in the United States and many other states have

followed suit since then, using the law in Vir-

ginia as a model. In 2006, the Council sought

additional prescriptive authority to be able to

prescribe Schedule II medications, which passed

by unanimous votes in the both the Virginia

House and Senate.

How Advocacy Improves Patient CareThese new laws have allowed me to care for my

patients in an appropriate, timely and cost effec-

tive way. Without the advocacy efforts of nurses

to push for their passage, the laws would not

be in existence today. The Council continues to

educate our General Assembly members about

the role of the NP and the use of advanced prac-

tice nurses to fill the gaps in the looming health

care provider shortage, and to advocate for the

ability to practice to our fullest capacity based

on our education and scope of practice.

Being a citizen advocate has been one of the

most rewarding aspects of my nursing career. I

now attend town hall meetings, contribute to

and work on election campaigns and write or

call my state and federal legislators about issues

that affect my patients and my role as an NP.

It’s easy to start by writing a letter. What do you

see in everyday practice that concerns you as

Carola Bruflat, WHNP/

FNP, MSN, RNC, is a

women’s health nurse prac-

titioner in a private OB/

GYN practice in Fairfax,

VA, and is past president

of the Virginia Council of

Nurse Practitioners. Kerri

Wade, MPA, is associate

director for Government

and Media Affairs at

AWHONN in Washington,

DC. Address correspon-

dence to: cbruflat@cox.net.

DOI: 10.1111/j.1751-486X.2009.01418.x

I’d never been involved in any advocacy issues

before, but I was intrigued to find that I

could make a difference by telling my story

and the stories of my patients to legislators

June | July 2009 Nursing for Women’s Health 193

a nurse? Start there and use a letter or

phone call to educate your legislators

or their staff about the issue. Take the

continued stigma and lack of aware-

ness about postpartum depression, as

an example. Beyond your compassion

for an individual mother, you might

ask yourself, “What more can I do as a

nurse to ensure that all new moms and

their families are made aware of this

condition, screened for it, and treated

appropriately?” One way to answer

this question is through advocacy ef-

forts aimed at passage of The Melanie

Blocker Stokes MOTHERS Act (H.R.

20/S. 324). This is federal legislation

that would expand research, services

and education related to postpartum

depression and psychosis. Named after

Melanie Blocker Stokes, a Chicago

woman who committed suicide after

the birth of her daughter, the legisla-

tion is an important step in making

postpartum depression treatments

and services more accessible across the

United States. As nurses, we can

advocate for this legislation by calling

our representatives and senators and

asking that they support it. As trusted

experts, we must let our elected officials

know what issues are important to us

and our patients.

Tips for Getting StartedLegislative success requires careful

planning and persistence. Here are

some practical tips to help you get

started:

• Identify your federal, state and local

officials using Project Vote Smart.

Visit www.votesmart.org, and enter

your Zip code to generate a list of

your legislators, their key votes, and

positions on issues.

• Subscribe to MegaVote. Visit http://

capwiz.com/awhonn/megavote/ to

sign up to receive a weekly email

detailing how each of your federal

legislators voted.

• Write letters to your members of

Congress. Visit http://www.capwiz.

com/awhonn and enter your Zip

code. This site will generate a

prewritten letter to your elected of-

ficials on issues that are important

to nursing.

• Call your members of Congress to

voice your opinion on issues that

matter to you. Call the Capitol

Switchboard (202) 224-3121 and

ask to be connected to your legisla-

tor’s office. For more information,

please visit the “Capitol Hill Basics”

section of the AWHONN Legisla-

tive Action Center at http://www.

capwiz.com/awhonn.

• Strike while the iron is hot. Reach

out to local chapters of nursing or-

ganizations, such as AWHONN or

the American Nursing Association

(ANA), to learn about the activities

happening right now in your state

legislatures.

ConclusionThe “health care crisis” is a hot topic

these days. Nurses on the frontlines of

patient care are in a unique position

to educate our lawmakers on what the

issues are and what can be done about

them. Remember, there is strength in

numbers—the more nurses who get

involved, the bigger their impact. The

sky is the limit! NWH

Our patients, nursing and physician

colleagues, our families, and friends

were all recruited to write and call

about this legislation

http://nwhTalk.awhonn.org