For people with no policy experience, the political arena is intimidating. Reasons not to get involved abound: The issues seem confusing, you're too busy, you don't believe one person can really make a difference, or you're uncertain about whom to contact and what to say.

But not participating has repercussions. Inaction affects policy, and the bills passed are often detrimental to the people who didn't make their views known.

"We see and live with the consequences of the policies that are enacted," said Rep. Maria Rudd, NP, a legislator in Minnesota. "If you're not there advocating for your position, who is? Sometimes what happens in policy making is there are unintended consequences. The more engaged you are in the process, the better chance you have of picking up on some of those unintended consequences and preventing them from happening in the first place."

Fortunately, a variety of levels for political action exist, and many state nurse practitioner organizations stand ready to get you involved and educate you about what's going on in your state and on Capitol Hill. Believe it or not, you can get politics to work for you - in a way that will suit your schedule, communication style and special interests.

"We understand that not everybody can come down to the legislature or write a letter - but how about a phone call or an e-mail?" Rudd said. "Just do something."

Go Ahead, Introduce Yourself

One of the first steps to maneuvering through the political road map is getting to know your local legislators. Many states have helpful Web sites that allow you to find your legislators with a quick search. For example, in Pennsylvania, log on to www.legis.state.pa.us, and type in your zip code or county in the upper right-hand corner of the home page to get a list of your senators and representatives, with links to their contact information.

Figuring out which method to use to contact your legislator is a bit more complicated. If a vote is coming up soon, a brief phone call expressing whether you are for or against the bill might be best. If you have some time and want to give an explanation of why you feel the way you do, you might want to write an e-mail or letter.

"How you get in touch with your legislators depends on their personal preference ... I like e-mail," said Rep. Linda Upmeyer, NP, a state representative in Iowa. "I can handle it quickly wherever I am."

Rudd prefers a brief, handwritten note over e-mail or form letters.

"The handwritten note always has a lot of impact because it's something you can touch and feel," she said. "We get hundreds of e-mails, so they can be overwhelming. Form letters and post cards are okay, but they don't have the same impact as the personalized letter."

A face-to-face meeting is the most beneficial point of contact, according to most legislators and advocacy groups. This can promote an extended relationship with the legislator and allow him or her to process your information on a more personal level.

"We've had the most positive impact with phone calls and personally meeting with legislators," said Karen Schwartz, NP, chairwoman of the Georgia Advanced Practice Registered Nurses Grassroots Committee, which last spring aided the passage of a long-awaited prescriptive authority law. "Your legislators should know your face and your name if you want them to trust the information you're giving them and support your cause. E-mails are easy, but do legislators read them? According to the Atlanta Journal Constitution, most Georgia legislators admit they do not. Letters are only useful for keeping a count of who opposes and who supports a piece of legislation. Phone calls are often counted this way as well, so content can be lost. Meeting with your legislators and having a personal conversation with them gives time for interaction and questions that could help persuade someone who might not understand the issue."

Get Your Information Straight

When meeting with legislators, present yourself in a professional manner, and have strong data to back up your views.

"It is kind of like a job interview, in that if you are 'hired,' you will likely become a resource to that legislator, and he or she will call on you for opinions and information on matters concerning your issue," Upmeyer explained.

A clear and concise argument about one specific bill or issue will serve your purpose well, whether or not the legislator agrees with you. Don't make the person guess what your issue is: After a brief introduction of who you are and who you are representing, explain what you want.

"Use your personal stories to flesh out the conversation," Upmeyer said. "Be sure you leave time for questions. Don't assume the legislator understands everything about the issue."

If you haven't personally been affected by the issue at hand, feel free to bring someone with you who can tell how he or she has been affected by it (best is a constituent of the legislator you're meeting).

Know your opposition and why they oppose it, so you can defuse the potential problems yourself as you discuss it with the legislator.

"Even if a legislator does not agree with your argument, you must keep a positive relationship with him or her. Saying negative things will not only taint the platform you're working on, but also possible future encounters you might have," Schwartz explained. "Rep. Sharon Cooper, a psychiatric nurse, never forgot being heckled at a dinner by nurses after she stated that she did not support prescriptive authority for advanced practice nurses in Georgia."

"It's so important to never antagonize the person you're speaking with," Upmeyer agreed. "You can politely disagree and still make your point. But if you come across as rude or unreasonable, you will be unsuccessful. Smile, and be rational. Speak with logic and reason. Back up your assertions with data."

And be sure to check your state or national NP association's stance on the issue. Unintentional misrepresentation can be damaging.

"Unfortunately, I received an e-mail from one NP who wrote, 'I can't believe MAG won't give us schedule I and II drugs,'" Schwartz recalled. "I quickly responded with 'please do your research on what schedule I drugs are. No NP in the country can sign for schedule I drugs.' Other NPs had discussions with legislators about how they wanted 'independent practice' and said they were 'indeed practicing medicine.' These statements can really hurt a campaign for change."

Work Well With Others

Groups who show up to important votes or collectively make calls for or against an upcoming vote can have an impact. When Rudd had an important vote going against her caucus one day, she felt bolstered by the community presence that came to stand behind her.

"Occasionally there is pressure to vote with your caucus. I had a whole group of people from my district present that day, so I was confident that what we were voting on wasn't in the best interest of the people I represent, and I felt very comfortable taking that vote," she said. "I could stand up and say, 'I have a room full of people here today against this,' and I was able to articulate why I couldn't vote for it."

Group efforts also help get bills hashed out before they even make it to the drafting table.

"Building coalitions with other groups on your issue is very effective," Rudd said. "If you know you have something that you might run into a problem with another group over, try to work it out ahead of time. If you work through the anticipated roadblocks, it is more likely to pass."

When Georgia NPs looked back at the past 12 years of failed efforts for prescriptive authority, they realized working with other people hadn't been enough of a focus.

"The No. 1 failure in the past for us was trying to do this ourselves! We had to mobilize other APRNs to help," Schwartz said. "We decided to do phone-a-thons and call the thousands of APRNs registered in Georgia. We obtained a list from the board of nursing and did a mailing to everyone listed. We developed a rally that was like no other we had organized before. The United Advanced Practice Nurses of Georgia joined forces with the Georgia Nurses Association and put $25,000 into a CE program, rally and legislative reception - it was attended by over 500 people and got great media coverage."

Working with committee chairs is another relationship that shouldn't be forgotten. One of the best approaches to paving the way for a proposed bill is figuring out which committee it will be referred to and getting the committee chair behind it (or at least not opposed to it).

"Bills typically have to go through several committees. You want to know who the committee chairs are because they pick and choose which bills they will call for hearing," Rudd explained. "Find out if you know any constituents in the chairperson's district. Knowing who is in power is also important. For example, in the Minnesota House of Representatives, I'm in the minority - it's very difficult for minority members to get a bill heard, so you may want to collaborate with a member of the majority party. It's really effective to have coauthors from both parties. Then you can work on getting buy-ins from both sides."

Negotiations, Wrangling and Debate

Before negotiating with opposing groups, try to figure out what you might be able to compromise on, as well as what areas are nonnegotiable.

"We had pretty intense negotiations with lobbyists from the Medical Association of Georgia (MAG), Rep. Sharon Cooper, a MAG supporter, Rep. Sue Burmeister, our original bill sponsor and supporter, and Demetrius Mazacoufa, the lobbyist for the Georgia Nurses Association," Schwartz said. "Our original bill was almost two pages. The final version was 19 pages, with 10 pages relating to APRN prescribing, so a lot had to be added to give MAG enough peace of mind to agree to the final version and for the nurses to say 'Ok, if that's what it takes!'"

One concession Georgia NPs made was sacrificing schedule II prescribing rights. They did so in response to a proposal from MAG about a formulary of legend drugs that would be acceptable. "We wanted to prevent having a short list of legend drugs limiting what we could prescribe," Schwartz explained.

MAG attempted to add language stating that NPs must be supervised on site 25% of the time and that the physician must see certain patients at regular intervals.

"This was a deal breaker. We were not willing to put into the statute what interval the patient had to be seen by the MD. We argued that this takes [away] the patient's right to choose a provider," Schwartz said. "We were also not willing to agree to 'direct' supervision when we do not have to practice that way now. The final version says that the 'nurse protocol' agreement must specify how the MD will reevaluate the patients and must see the patients every 3 months when they are receiving controlled substances on schedules III through V."

Flexibility and patience can come in handy when a bill seems to have lost all its positive aspects. When MAG changed the original prescriptive authority bill to a version that was essentially disagreeable for nurses, Georgia NPs had to react.

"We initially said that we had to stop SB 603. But after a few days passed, we realized that SB 603 was our only avenue for continued progress with a prescriptive authority bill," Schwartz said. "We calmed down, took a few breaths, regrouped and said, 'what in this bill can we, and can we not, live with?' We then approached our senators with the new position that we support SB 603, with some necessary changes. I believe that MAG was shocked, and had hoped that we would give up."

Don't Be Apathetic

People often get politically active when they feel their back is against the wall, but sometimes it's good to work on minor details to promote the NP profession during calm political times. Or, even when a case seems to have little hope, such as Georgia's prolonged battle, support your peers even at a distance, with donations or phone calls to your legislators.

"We had to continually develop new ideas to get and keep NPs interested in the fight. We also had a high turnover rate, because leaders would get burned out with the struggle that we had to endure," Schwartz said. "It was frustrating to hear the apathy in the nursing community regarding this issue. In the fall when we were making our phone calls to educate NPs about the new movement for 2006, we were hung up on, told they were not interested in helping because 'it will never pass,' and we left messages to more than 1,000 APRNs who never called back."

Personal interest can often be sparked by simply looking at problems in your current practice.

"Bring forward your ideas to solve problems you see in your state. We have a shortage of mental health care providers in Iowa. We are working on ways to increase numbers of NPs, PAs and psychologists and psychiatrists in the state. During crisis times, the person who steps up with good ideas will be viewed as very helpful," Upmeyer said. "Is your state ready for a pandemic? What are your ideas for providing elder services? . . . How do we get people to address personal choice and responsibility? Try to bring policy ideas, not just money ideas. No one has solved any of these problems, no matter how much money they spent. NPs are educated in a nursing model, not a medical model, which strengthens our problem solving and critical thinking skills."

Staying Power

Keep your relationships with legislators moving by contacting them after the votes are cast. Be sure to send them thank-you notes and financial help during elections. The ultimate goal is to develop relationships in which legislators see you as an expert on health-related topics.

"I continue to be the only health care provider in the Iowa House or Senate. My colleagues openly say they value my insight," Upmeyer said. "As health care providers, your legislator needs to know what you do, the similarities and differences among an NP, PA, RN, MD, etc. What can you do, and what can you not do? You have an opportunity to be the expert for your legislator. Don't be shy about it."

For those not comfortable with such a high level of involvement, even going through the motions of making a quick phone call is enough. Don't be afraid to break into this arena, even in small ways.

"Half of life is just showing up. Just the fact that somebody makes an effort speaks volumes," Rudd said.

Sarah Lebo is the associate editor. To report news about your state, contact her at slebo@merion.com.

Top 5 Dos and Don'ts to Engaging in the Legislative Process

Do try multiple avenues for getting in touch with legislators. Don't simply copy a form letter and send it without including your personal practice information.

Do find time to introduce yourself to your legislators when they are less busy, such as in between legislative sessions. Don't get complacent and assume it's not necessary to be involved in politics if there's not an NP-specific threat.

Do take advantage of your state NP association to understand the legislative process or ask questions. Don't ignore your opposition. Try to understand why people might have a problem with what you're advocating.

Do think the issue through, and back up your arguments with research (and information from a credible source, such as your NP organization). Don't try to address too many concerns or get off track. Pick your battle - a specific bill or issue - and focus on that.

Do schedule personal meetings with your legislators, or invite them to your practice or your association's meeting. They might be flattered by being asked to speak on a panel or being included in the program. Don't alienate the legislator in any way. Be professional. If you must disagree, do so politely, and always leave exchanges open for more dialogue in the future.