Legislative and administrative policy makers at both state and federal levels make decisions every day that impact practitioners. These decisions limit or expand your practice, delineate your titles, set your level and source of reimbursement, define your ability to deliver certain levels of care, and create or tear down barriers to patient access to services. As we say in Kentucky: "Frankfort (where our legislators meet) will happen-whether you are there or not. You can choose to be a victim of the system or you can choose to be an influencer of the system." I strongly encourage you to be a player and not a victim!!

Tricks of the Trade

Here are a few tips to help you be a more effective advocate:

* No one has more influence with a legislator than a voting constituent!! Be sure to register and to vote; legislators often use these factors to gauge your level of involvement.

* Remember that personal communications with your legislator are the most effective. Stay in touch with your legislator-not just during the session.

* Be sure your legislator knows you are a practitioner when you contact him/her about an issue. This is particularly important when contacting a legislator from a district other than your own.

* Be polite, be brief, and be specific (using the bill number) in your communications. Offer to answer questions or to get more information if you are asked a question.

* Be a good listener and hear the legislator out on the issue. Be prepared to discuss the issue and to "put a face on it" in terms of your patients and the possible impact the legislation would have on them.

* Know how the process works: the committee system, the timetable, how bills come for a vote. Let the legislator know that you have done your homework.

* Be persistent, but not pushy; clear and assertive, but not critical or threatening. Understand that it is important not to burn any bridges, even with a legislator who votes against your issue.

* Understand that the legislative process is recurring and ongoing; positive change may take a long time. Never give up[horizontal ellipsis]there's always the next session!!

* Be sure to say "Thank you!!" to the legislator or policymaker and to the staff. Follow up with a handwritten thank-you note.

A Success Story

I have had the pleasure of working with the Kentucky Nurse Midwives and Nurse Practitioners for the past 5 years, culminating in our successful legislative expansion of prescriptive authority to include controlled substances despite the very strong opposition of the Kentucky Medical Association. We were ultimately successful because we had a strong group of committed practitioners who took on their advocacy role over a number of legislative sessions. They were knowledgeable about the issues, they galvanized support from their collaborating physicians and patients, and they worked together to make their voices heard.

These hard-working advocates learned the legislative process, followed the advice of their lobbyist and legislative task force, and developed an effective internal communication system (listserv) and communication network with key legislators and policymakers. They understood that compromise was necessary, while opting to "hold the line" to achieve the most positive change possible. They were visible in their communities and visible in Frankfort. They remained positive, even in the face of heartbreaking defeats, and they were persistent because they cared passionately about their patients and about their profession.