Participation in advocacy efforts to build, support, and promote patient access and resources for trauma care is a perfect fit for trauma nurses! We naturally work to educate and improve care for our patients, families, and communities—It is in our DNA. Nurses have been the most trusted professional for 20 consecutive years according to a Gallup poll (Saad, 2022), which positions us to share our expertise in the areas of health, illness, injury prevention, and health care to help effect change.

DEFINING ADVOCACY VERSUS LOBBYING

Nurses and health professionals often wonder whether the advocate role is the same as lobbying; how can we tell the difference? In the public policy sphere, it is important to know both how advocacy is defined and how lobbying and advocacy differ. Nurses seeking to get involved in public policy, action, and influence will need a clear understanding of how their work aligns with both legal and governmental frameworks. This discussion is intended to give a brief outline of advocacy and lobbying to help you promote trauma care, injury prevention, or other topics.

ADVOCACY

The general definition of advocacy is educating on a topic; how it impacts your program, patients, community, or individuals; and showing the impact of an issue, idea, or action. For a nonprofit organization, there is no limitation on this activity (National Council of Nonprofits [NCN], 2019). Advocacy is the process of stakeholders making their voice heard on an issue that affects lives locally, at the national level. Advocacy involves identifying an issue, embracing it, and promoting it as a cause that needs attention. The advocacy process encompasses a range of activities that seek to influence knowledge, perception, or policy; these actions ultimately seek to effect change. Examples of advocacy include educating the public by discussing an issue (social media, radio, news, or other platform), publicizing results of studies or analyses, or providing a point of view on an issue. A nurse advocate could write an editorial; educate patients, citizens, and legislators about an issue; build an advocacy group; or attend and speak at a public hearing.

LOBBYING

On the other hand, lobbying is understood as actions that influence a politician or public official on an issue. This might be direct communication of any kind with a legislator or other elected official to support a specific piece of legislation. It could also be asking the public, family, friends, or patients to take action on a specific bill or proposal for a bill (NCN, 2019). Lobbying is a specific form of advocacy with a narrow definition and strict parameters. The Internal Revenue Service defines lobbying as “an attempt to influence specific legislation” (NCN, 2019). Legislation is defined as an action by legislating bodies (U.S. Congress, state legislature, local councils, or similar governing bodies) relating to bills, acts, resolutions, referenda, and so on (Prevent Coalition, n.d.). Examples of lobbying may include meeting with an elected official to ask them to support a specific bill or asking a member of Congress to vote in favor of or against a piece of legislation. Direct lobbying involves interfacing with a legislator or group of legislators about a specific bill. Grassroots lobbying involves informing and motivating individuals to promote a specific action, usually for or against a piece of legislation (Prevent Coalition, n.d.).

A trauma nurse holds incredible potential for advocacy and can engage in lobbying under the correct circumstances. Trauma nurses can champion trauma-related causes within their unit, hospital, or organization; they can broaden this to public awareness, education of policy makers, and speaking on behalf of patients and populations. A trauma nurse in any setting may see injury patterns that indicate a need for public awareness or action to promote policy change. That change may require advocacy work to inform lawmakers on the impacts an issue has on population health. Formal lobbying to push for the passage of legislation to make the change may be appropriate. In some cases, the final policy change may require both. Examples of trauma nurses' advocacy versus lobbying actions are shown in Table 1.

Table 1. - Trauma Nurses Advocacy Versus Lobbying Examples Advocacy Lobbying A group of trauma nurses meet with state legislators to provide Stop the Bleed Training Trauma professionals meet with key lawmakers to urge support for a bill to mandate Stop the Bleed kits in high schools A trauma nurse provides a patient story about recovery from a traumatic brain injury A nonprofit group of trauma nurses spends 50% of their annual budget on public campaigns to prevent the repeal of a helmet law in their state A group of trauma nurses gives a violence prevention talk about the benefits of violence interruption programs to lawmakers and public advocates A trauma nurse is featured in a mass media ad to urge the public to call their representative to vote no on planned funding cuts to state violence prevention programs Trauma nurses sign a petition to encourage the continued funding for statewide trauma centers Trauma nurses meet with a legislative sponsor of a bill to urge the inclusion of grants for trauma center injury prevention programming
FINDING RESOURCES TO GET INVOLVED

Nurses intuitively advocate for their patients in the clinical arena as they identify clinical changes in conditions and provide intervention. Our responsibility is to advocate for our patients and families to ensure the best outcome possible. Formal advocacy, however, is not instinctive, but it is necessary to advance our profession and improve care for our patients. Expanding our role from bedside to policy arenas can accelerate the process of change. How can trauma nurses advocate for our profession and our patients at all levels?

One of the easiest paths to advocacy is joining and becoming active in professional nursing organizations such as the Society of Trauma Nurses (STN). Professional organizations are conduits for their members to express concerns to governing bodies at the state and national levels. Many national organizations have mechanisms on their websites to facilitate communication with legislators. The trauma nurse can personalize these communications to ensure that the legislators hear their concerns and comments. Our professional organizations understand the complex nature of policy making and can navigate various strategies to optimize input on important issues for our patients and profession. Many of our national organizations have advocacy tool kits, with many resources available for both new and experienced nursing advocates. These tool kits offer resources to guide nurses in various stages of their advocacy journey, from beginners to experienced advocates. Templates and samples for communication are often available.

BRINGING IT ALL TOGETHER

Understanding the differences between advocacy versus lobbying is just the start of forging your role in the nurse advocacy process. Growing relationships with professional organizations, lawmakers, and colleagues can help build your personal success as a trauma policy and resource advocate. Active participation in professional organizations and collaboration with legislators at all levels of government can help seat trauma nurses at the decision-making table to promote the general health and safety of our communities.

As nurse experts, we are poised to serve as a resource for policy makers. Your knowledge as a trauma nurse can help provide education about injury care resources, types and severity of injury, mechanisms of injury, and the overall path to recovery for the trauma patient. Local, state, or national participation in policy advocacy can help promote health policy decision making to improve public safety and trauma care resources. As trauma nurses, we need to go beyond the bedside to ensure access to care, limit inequities in health care, influence health policy, and create system changes to improve care to our patients.

Find more information and resources on the STN Government Affairs and Advocacy page, watch for our committee alerts, or contact Adam Haley, STN Government Affairs Legislative Affairs Director, or Chair Cristy Meyer, MSN, RN, CEN, TCRN.

REFERENCES National Council of Nonprofits (NCN). (2019, September 12). Advocacy vs. lobbying. Retrieved February 16, 2022, from https://www.councilofnonprofits.org/advocacy-vs-lobbying Prevent Coalition. (n.d.). All lobbying is advocacy, but not all advocacy is lobbying! Retrieved February 16, 2022, from https://www.preventcoalition.org/resources/advocacy