The Nurse as Advocate

The Nurse as Advocate

My Journey to the Delaware General Assembly

Bethany Hall-Long

“I have come to the conclusion that politics are too serious a matter to be left to the politicians.”

General Charles de Gaulle

My Political Roots

I am a nurse and I became the first health care professional elected into the Delaware General Assembly, as well as the first registered nurse elected. The roots of my public service began in a farming community where I volunteered to help others in my church and at neighborhood organizations. At the age of 12, I was a candy-striper in a local hospital and continued my civic work during my teen years. When I entered college I joined a political party. Though my parents were not politically active, my great-grandfather was a member of the Delaware House of Representatives in the 1920s and I am a descendent of Delaware’s 16th governor. The Nurse as Advocate

My interest in politics began while working with underserved residents at the same time I was completing my master’s degree in community health nursing in the late 1980s. I used an earlier edition of this book in my graduate program and vividly recall reading the chapters about becoming involved in politics. I began working with my local city government, the League of Women Voters, and a federal health clinic that served the homeless. Before these experiences, I had thought that public policy was remote to nursing and somewhat dry. These experiences changed my perspective.

Volunteering and Campaigning

I went on to volunteer with nonprofit and civic organizations, join professional associations, and to complete my doctoral degree in nursing administration andpublic policy. During this time, I served as a United States Senate Fellow and as a U.S. Department of Health and Human Services policy analyst for the Secretary’s Commission on Nursing. These experiences exposed me to national policy work, federal officials, leaders in the nation’s health associations, and international researchers. I became actively involved with veteran’s organizations because my husband was on active duty in the military. I also became a volunteer on political campaigns with the Democratic Party. I had excellent mentors to assist me with both my nursing and political career paths. All of these experiences helped me to understand the policy process and the importance of building relationships. The Nurse as Advocate

I began my work in politics to make a difference in the lives of many citizens who lack life’s necessary resources. As a public health nurse, I had an interest in improving the services available to vulnerable populations. I continue to work to advance issues important to the residents I represent. These include health care, the environment, land preservation, education, and economic development.


There’s a Reason It is Called “Running” for Office

A number of factors influenced my decision to run for public office in 2000, including my desire to make a significant contribution to the public’s health. As a university faculty member, I assigned students to various public health and health policy assignments. During these experiences, I witnessed the need for expert health knowledge in the Delaware General Assembly. The time was ripe within the political party and within my district to run for the Delaware legislature. I ran for office for the first time in 2000 and lost by a mere 1%. I had run against a long-term, male incumbent and learned some important political lessons. In 2002, political redistricting left a vacant seat and I ran again. This time I won in a tough election against the president of the local school board. After serving 6 years in the House, I campaigned for, and won, a state senate race in 2008 (Figure 55-1).

FIGURE 55-1 Dr. Hall-Long’s campaign literature identifies her as a nurse and educator. The Nurse as Advocate

A Day in the Life of a Nurse-Legislator

No two days in politics are alike. Each elected official’s experiences and perceptions are linked to his or her beliefs, the district’s beliefs, the state’s legislative rules, and external economic or social pressures. In Delaware, serving as a legislator is a part-time job. Delaware’s bicameral legislative session is active for a total of 45 days per year. Session convenes each January, and the legislature must pass the budget bill and recess by July 1. We meet three days a week: Tuesday, Wednesday, and Thursday. I spend the remaining days on 467constituent work, in meetings, delivering speeches, and conducting my job as a nursing faculty member. Between July and January, my days are filled with at least 8 to 12 hours of meetings, community work, and, in election years, campaign activities. On occasion, there are Special Sessions in the fall when the senate convenes.

Much of a state legislator’s time is spent on the capital and operating budgets of the state, as well as handling senate confirmations. These activities need to be completed by the end of the state’s fiscal year: July 1. My most important role is to represent my constituents at committee meetings, public hearings, on task forces, and as a sponsor or cosponsor of relevant bills. My district is both rural and suburban and has numerous policy needs: smart growth, transportation, education, health care, and economic development. The Nurse as Advocate

I juggle caring for my family, legislative work, and nursing education. I’m up at 5 AM to exercise and then I have breakfast meetings with constituents or campaign committee members. Following the meetings, I usually put on my other hat and spend time with my nursing students. I return phone calls in my car as I head into the state capital. When I arrive in my office, I’m greeted with phone messages, e-mail, and the pressing issues of the day. I share one staff member with another senator. Session begins around 2 PM when we enter caucus for 30 to 45 minutes to discuss the legislative agenda and bills to be voted upon. One day a week there are committee hearings. In the afternoons, I squeeze in more phone calls, RSVPs, research with the lawyers, and then head back to the floor for votes.

After each legislative day, there are usually receptions sponsored by interest groups. These provide time for lobbyists and members to review issues and concerns and highlight state funding efforts or programs. Typically, I attend several civic or association meetings each evening after the session in my district (I balance these with my son’s sporting and school events.). These meetings are important for gathering community input, staying current on issues, and letting my constituents know that I am concerned about their issues. It all takes a lot of time, energy, and a few cups of coffee. The Nurse as Advocate

What I’ve Been Able to Accomplish as a Nurse-Legislator

I have sponsored or cosponsored a range of legislation as a member of the house and senate: health, education, transportation, veteran’s affairs, agriculture, natural resources and the environment, homeland security, community and county affairs, and insurance committees. As the only health care professional in the Delaware General Assembly, I have been the prime sponsor of some important health bills and on task forces such as the necessary code changes for the state’s Health Exchange as a result of the federal Affordable Care Act (www., Governor’s Cancer Council, and the Health Fund Advisory (Master Tobacco Settlement Committee). I have worked on many licensure/scope of practice and public health and environmental policies. These policy issues have included occupational health, substance abuse prevention and treatment, cancer, minority health, dental care access, health professions, environmental justice, chronic illness, mercury removal from the environment, school health, early childhood education, prescription assistance, and end-of-life care decisions. I have found that having a nursing background is extremely valuable in influencing a wide variety of policy issues. The Nurse as Advocate

I have worked very closely with the farmers in my district. I myself was raised on a farm, and my knowledge of farming has proved vital. I was pleased to sponsor, as my first piece of legislation, the farmland preservation license tag. In addition, I have sponsored land use legislation that helps with county, municipal, and state communication. Only 1% of the U.S. population consumes more than 20% of all health care expenditures, and 5% of the population accounts for more than 50% of the total expenditure (The National Institute for Health Care Management [NIHCM] Research and Educational Foundation Data Brief, 2012). Chronic illness is a major issue for Delaware, as it is for the nation. I sponsored legislation to establish a blue ribbon task force to analyze the problem of chronic illness in Delaware and to develop policy recommendations. The task force identified strategies including 468disease standards of care for health professions, improved communication between insurers and providers, outreach to the at-risk, and the use of a disease management approach with Medicaid patients and among the business community.

I was the prime sponsor of legislation creating a cancer consortium for Delaware. This group has completed a comprehensive assessment and plans to tackle our high cancer mortality rates. I am pleased to say that the cancer incidence and cancer rates have dropped since the creation of this body. The state has implemented the consortium’s many recommendations, including establishing a free treatment program for cancer patients who lack insurance, adding statewide caseworkers, and creating screening programs. Recently, I was pleased to update the state’s Indoor Tanning Laws to prohibit children under age 14 years from using tanning beds and for those aged 14 to 18 years to require parental consent. The Nurse as Advocate


HIV infection rates in Delaware are among the highest in the nation. Several years ago I cosponsored needle exchange legislation, and it has shown a positive impact on HIV infection rates. I was pleased to sponsor the legislation to create a state Office of Health and Safety for public programs. All these examples of sponsored legislation involve a team effort with other officials, individuals, lobbyists, and organizations or advocates.

Tips for Influencing Elected Officials’ Health Policy Decisions

What have I learned as a legislator who can help other nurses who are seeking to influence policy? You must communicate well to influence policy, and nurses are naturally gifted communicators and problem solvers. In a study of nurse leaders in federal politics, I found that the political strategies used most frequently by nursing organizations are direct contacts, grassroots efforts, and coalition formation (Hall-Long, 1995). Nurses should not be intimidated by the need to call, write, or visit their elected officials. It is important when meeting with elected officials that you are prepared. Have a one-page fact sheet to leave behind (as opposed to a binder of information), and be prepared to summarize your issue and offer solutions in less than 5 minutes.

If nurses don’t speak up on health care issues, who will? Physicians? Hospital associations? Insurers? If nurses don’t speak up, legislators will only hear from other groups. Given health reform and a push for a nursing consensus model, advanced practice nurses are expected to take on a broader scope of practice and must be engaged in state-level policy discussions. You have heard the expression, “It’s not whether you win or lose but how you play the game.” Well, in politics, how you play the game can determine whether you win or lose an issue. Increasing your influence by working in a group or coalition is an extremely effective strategy. The Nurse as Advocate

Is It Worth It?

Life as an elected official has been better than I could have imagined. Though it has taken some time away from my family and my scholarship, it has been worthwhile. I encourage other nurses to consider how they might serve the public, including running for elected office.


Hall-Long B. Nursing education at political crossroads. Journal of Professional Nursing. 1995;11(3):139–146.

The National Institute for Health Care Management [NIHCM] Research and Educational Foundation Data Brief. The concentration of health care spending. [Retrieved from] 2012 The Nurse as Advocate

Also check: Nursing and Midwifery Board of Australia