Adams: Dr Miyamoto, thank you so much for speaking with me. Can you share with us your career trajectory?
Miyamoto: Jeff, thank you. I can say that my path is one less traveled. It was in my master's program that I became interested in policy and advocacy. I had mentors at the University of Michigan, Drs Beatrice Kalisch and Ada Sue Hinshaw, who supported my pursuit of a career in this arena. It was through their encouragement that I came to Washington, DC, after my master's program. Later, they called me back to Ann Arbor when I was accepted into the PhD program. After 2 years of doctoral course work, I literally packed up my life in a U-Haul and moved to DC. It was not an easy road at first; I had no job. I applied for countless policy and advocacy positions. In DC, education helps, but experience matters, and I quickly learned that networking was priceless. As a nurse with just a few policy experiences during my graduate education, I was not the most sought-after candidate, however; I had a powerful network. Dr Hinshaw introduced me to Dr Suzanne Feetham, who had relationships at the National Institutes of Health. There I landed my 1st opportunity in the Office of Extramural Research. While I enjoyed the work immensely, my passion for advocacy was still at the forefront. A position opened at the American Association of Colleges of Nursing (AACN) for a Government Affairs Manager. I was up against candidates with much more experience, but Dr Polly Bednash, then chief executive officer (CEO) of AACN, saw a future for me. She hired me, made me promise I would finish my PhD, and assured me it would be a steep learning curve, but one I was ready for. I finally had the position I dreamed of, and I was committed to showing Dr Bednash her instincts were correct. I remember working around the clock, 7 days a week, to become the expert I needed to be. There were days when I left the office at 10 or 11 PM and came back the next morning at 7 AM. Professionally, it was exhilarating to be part of the policy change occurring at the federal level. Within a year and a half at AACN, I was promoted to the Director of Government Affairs and ran the association's advocacy and policy portfolio. I have been at AACN for 9 years and have tremendously supportive leaders. From our CEO (current and past), to every president and our board of directors, they have embraced my suggestions for expansion and innovation in our advocacy work.
Adams: Can you speak of your proudest professional accomplishment?
Miyamoto: I think the professional work that I've had in contributing to the development and adoption of the Commitment to Quality Health Reform: A Consensus Statement from the Nursing Community.1 It was designed as a blueprint for Congressional staff outlining the priorities nursing envisioned for America's patients in health reform. This document was signed by 41 national nursing organizations, a rare display of unanimity in nursing. These national nursing organizations used the document in Congressional meetings because of the broad-based consensus. The process was rewarding on multiple levels. First, having worked at AACN for 2 years, our policy portfolio was focused on nursing education and research, and our advocacy issues fell in that scope. Through the process of collaborating with other nursing organizations, I was able to learn the federal barriers to practice for Advanced Practice Registered Nurses, and health information technology advances, among others. I was working with remarkable nursing lobbyists at the federal level. I was the "new kid" on the block, and they embraced me. I remember receiving e-mails from Congressional staff thanking us, for coming together as a community and sharing a common message. We had made an impact. Most importantly, we were successful. After the Affordable Care Act passed in March 2010, I remember convening and going through the consensus statement as a group and counting all of our wins. We did not achieve every goal, but made tremendous progress.
Adams: What is something that the readers of JONA might benefit from knowing that they might not be aware of?
Miyamoto: I've learned that politics and policy can never be separated. Many nurses I know want to engage in policy, but politics is what is off-putting to them. We cannot escape the fact that donating to a political action committee or supporting Members of Congress is the reality of politics. We want to see our champions get reelected, and so we have to support them with tangible resources including time and money. Vice President Biden has a quote that I love. "Don't tell me what you value, show me your budget, and I will tell you what you value."2 If seeing real change is what we value, we must invest. Members of Congress have grass tops (as opposed to grass roots) advocates, who are big donors or individuals who knock on doors and volunteer as strong supporters of their campaign. Americans must be informed voters, and we have to know where our Members of Congress stand on the important issues. National nursing organizations can help. Those that actively engage in federal advocacy work can share with you legislation that a Member might have supported, which is congruent with your policy positions. Another quote comes to mind as we discuss politics, and it comes from Florence Nightingale. She said, "I attribute my success to this-I never gave or took any excuse."3
Adams: So you are saying one way nurses can be more influential in policy is through financial contributions?
Miyamoto: Absolutely. Our political system is constructed such that certain voices have a more robust presence in the halls of Congress. These voices often belong to the affluent, the intense, those who would be considered institutions, and those with strong leaders. If every voice had equal say and equal impact, then we wouldn't have to worry about how much money we gave or how engaged we were in the political process. I often get the question, how can nurses make an impact financially when other providers make more money? I always reply, consider our numbers. For comparison, there are more than 3,000,000 nurses and a little over 900,000 physicians in the United States. If each nurse were to contribute just $5 to a campaign or political action committee, nurses would be investing more than $15 million. These are simple numbers, and there is much more complexity that goes into the equation, but the numbers do influence impact.
Adams: Aside from financial contributions, how might someone become more involved in federal or state policy?
Miyamoto: Time is another resource. As with money, it doesn't have to be in significant amounts, but developing relationships with Members of Congress and their staff is critical. Phone calls, mailings, and so on. You can't underestimate what a giant impact those efforts have. Again, I must commend our national and state nursing organizations. If you want to be involved, they are looking for help.
I believe messaging is critical. As nurses, we must clearly articulate the role we play in delivering high-quality, cost-effective care. There is a science to messaging, but we must remember that the take-away should always be the patient and not any single profession. Mastering the art of messaging will translate in all sectors of your career. Whether it be with Members of Congress, at the federal or state level, within our own institutions, at dinner parties or parent/teacher meetings, how we communicate is noticed. The more nurses are familiar with how to engage and articulate, the better we are at some of the higher-stake politics.
Adams: So how would to recommend preparing the next generation to be increasingly engaged and to make a contribution?
Miyamoto: The AACN has developed baccalaureate, master's, and doctorate of nursing practice essentials, which guides the educational curriculum. Each educational level requires that policy be taught. That said, it is one thing to teach it, it's another thing to embrace it. Professors need to challenge their students to embrace policy for the profession and their patients. This topic is not one that nursing students are often excited about, but if a professor can make it real to the student, the difference in the level of interest can be sustainable. I attribute my passion for policy to my 1st course in my master's program.
Adams: Any closing thoughts?
Miyamoto: I think that we (nursing) are making significant strides. In the decade that I have been doing this work, I feel that there has been a difference. Policy makers have a better sense of the truly miraculous care and contributions that nurses provide. Sometimes I feel like the seemingly few of us nurses dedicated to policy are anomalies. But the truth is, I know that there are many more like me out there. We are all striving for ways to improve the health of our nation by bringing to light the solutions that come from the nursing profession. We have much work to do, but we are coming closer.
Adams: Dr Miyamoto, I really appreciate your insights and sharing today.
Miyamoto: It was my pleasure, I and thank you and the readers of JONA for continually seeking knowledge to optimize our impact and lead our profession.
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