How can you move a policy forward? What strategies need to be implemented, evidence compiled, or resources utilized? What is the plan for the legislative process? 

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For this Assignment, you will create a Personal Legislative Agenda in which you will detail your strategy for moving your policy through the legislative process. 

Begin working in Week 5, it is not due until Week 7. 


  • Review the Personal Legislative Agenda and Action Plan Exemplar to demonstrate how you will construct your Personal Legislative Agenda for the state and federal proposed legislation.  
  • Review the Personal Legislative Agenda and Action Plan Exemplar to determine which approach might work best for advancing your policy initiatives at various stages of the legislative process. 


Submit a Personal Legislative Agenda detailing your strategy for moving your policy through the legislative process, using the Personal Legislative and Agenda and Action Plan Exemplar as your template. 

In your Personal Legislative Agenda, choose from the strategies provided in Advocacy Toolkit resource that best suite moving your policies forward. Be sure to connect the strategies to the appropriate sections of the policy model you selected in Module 2.

Agenda: Nursing Shortage 

See attachment for the form that needs to be used


Personal Legislative Agenda & Action Plan

(Student’s Name)

Context: I am a Family Nurse Practitioner and volunteer two afternoons a week at a free primary healthcare clinic in South Florida. The majority of our families are Latino or Haitian immigrants, and most of the children have at least one undocumented immigrant parent. None of the families have health insurance, many suffer chronic conditions (such as, asthma, diabetes, and HTN), and their only source for medication is from the clinic.

Problem: The fear of deportation, incarceration, and/or family separation discourages undocumented immigrant families from seeking healthcare until the symptoms are so severe, they can no longer be ignored. There are very few specialists who will accept our referrals; those who do have long wait times for appointments or are too far away for most of our families. Access to affordable health insurance and comprehensive healthcare services are desperately needed for undocumented immigrant families in South Florida and across America.

Proposed State Legislation: HB 135/SB 640: Florida Kidcare Program Eligibility

My position: Support Oppose Amend Watch

Proposed Federal Legislation: H.R.3149/S.1660: HEAL for Immigrant Families Act of 2021

My position: Support Oppose Amend Watch

Proposed Legislation



Process &


My Advocacy Actions



of Proposed Legislation

Next Steps

State: HB 135/SB 640: Florida Kidcare Program Eligibility

Increases income eligibility threshold for coverage under Florida Kidcare program; excludes undocumented immigrant children from eligibility

9/20/21: HB Filed
10/26/21: SB Filed

9/29/21: HB
referred to Finance & Facilities Subcommittee;
Healthcare Appropriations Subcommittee; and
Health & Human Services Committee.

11/16/21: S 640 referred to Health Policy; Appropriations Subcommittee on Health; and Human Services; Appropriations.

Sent email thanking Representative Bartleman and Senator Hooper for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the Florida Association of Nurse Practitioners (FANP).

After reviewing the bill co-sponsors, I saw that my elected officials were not listed. Sent an email to my district legislators, Representative Joseph and Senator Pizzo to encourage them to co-sponsor the bill.

Signed up with Florida Senate Tracker to receive legislative updates on the status of the House and Senate bills.

Wrote a 250-word editorial for the
Miami Herald praising the bill and pointing out the need to include undocumented children. It was published on 11/10/21.

I talked with co-workers at the clinic about the legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.

I’m a member of the county’s Women’s Democratic Club and talked about the legislation at our monthly meeting.

Neither of my elected legislators sit on any of these committees. I worked with FANP and Catholic Charities Immigration & Refugee Services to develop testimony about my experiences with undocumented immigrant families and children in South Florida; and worked collaboratively to develop a fact sheet comparing the health of immigrant and nonimmigrant children in Florida. Both were presented by organization lobbyists at the Health Policy Committee hearing for the Senate bill, with a request to amend the legislation to include undocumented immigrant children.

1/5/22: HB 135 was withdrawn.

3/14/22: SB 640 died in Health Policy.

Send thank you emails (as a member of FANP) to all sponsors and co-sponsors of the House and Senate bill.

I am on the Legislative Action Committee for FANP. Plan to attend meeting at the end of the session with our lobbyist to determine why the bill failed in two committees.

Work with FANP, Catholic Charities, and the bill’s legislative sponsors to research opposition to the bill and determine future plans to reintroduce a revised version.

Suggest to FANP that, moving forward, we consider forming a coalition with other nursing organizations, safety-net providers, and immigrant advocacy organizations. This would give us more resources, broader support across the state, and a more developed grassroots presence.

Federal: H.R.3149/S.1660: HEAL for Immigrant Families Act of 2021

Eliminates the 5-year wait for immigrants to enroll in Medicaid and Children’s Health Insurance Program coverage; excludes undocumented children and families from eligibility

5/12/21: HR filed 5/13/21: HR referred to Subcommittee on Health
5/17/21: S filed and referred to Committee on Finance.

Sent email thanking Representative Jayapal and Senator Booker for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the ANA and the American Association of Nurse Practitioners (AANP).

After reviewing the 90 co-sponsors in the House and 11 co-sponsors in the Senate, I saw that my elected officials were not listed. I used to send an email to my congressmen, Representative Salazar and Senator Rubio encouraging them to co-sponsor the bill; there are no Republican co-sponsors in the House or the Senate.

Signed up with the tracking service to receive legislative updates on the status of the House and Senate bills.

Posted my support of the legislation, a link to a fact sheet on
HEAL, and a “Contact your Legislator” link on my Facebook page. I also tweeted my support of the legislation to my Twitter account.

I talked with co-workers at the clinic about the federal legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.

I’m a member of the county’s Women’s Democratic Club and talked about the federal legislation at our monthly meeting. They were able to refer me to other local and regional groups that may be interested in learning more about and supporting the bill.

Pending: Still in the Subcommittee on Health and Ways and Means Committee in the House and the Committee on Finance in the Senate.

The ANA and AANP have not published positions on this legislation; legislation is not listed as a specific priority on the website.

I researched 19 advocacy groups supporting the legislation. I decided to join and financially donate to two—First Focus: Campaign for Children, and National Partnership for New Americans.
Both have legislative alert services and a national grassroots activism initiative.

Since neither of my congressmen serve on the committees that will be hearing the bill, working through an advocacy coalition complements my individual activism.
I will contact them to see how I can best support their efforts to advance this bill.

Connecting Kingdon’s Theory of Policy Change to My Personal Legislative Agenda & Action Plan

Kingdon’s Three Streams

Relevance to My Personal Legislative Agenda & Action Plan


The problem is that many immigrants do not have access to health insurance in South Florida and other parts of the country. The problem is further complicated by the fact that all immigrants are not seen as equally important or of value. They are separated into two groups—those who are here lawfully and those who are undocumented. It is important to my Personal Legislative Agenda & Action Plan that the problem definition be inclusive of all immigrants so that the most vulnerable among them—the undocumented—are included in the proposed policy solutions. Unfortunately, inclusivity creates divisiveness in how the problem is defined.


Nationally, there is no consensus across party lines regarding the provision of healthcare services or health insurance to undocumented immigrants. In Florida, the legislative and executive branches of government are controlled by the party that is unsupportive of undocumented immigrants. Also, healthcare is not seen as a basic human right in the U.S. Non-citizens cannot vote and therefore have no voice in the legislative processes. As a citizen and as a nurse, I have a moral and ethical responsibility to advocate for vulnerable populations who are denied the opportunity to speak for themselves.


While there have been some initiatives to expand Medicaid or offer the opportunity to purchase health insurance for immigrants who are here lawfully, undocumented immigrants are excluded from these proposals. While I support all policies that address the unmet needs of immigrants, I also must ask that policies excluding the undocumented be amended to include them. Policies that separate families, defund sanctuary cities, or unduly limit immigration exacerbate the problem and contribute to ongoing poor health outcomes and health disparities among immigrants. Part of my Personal Legislative Agenda & Action Plan is to monitor health policies that negatively impact (or exclude) this population as well as be aware of—and challenge—other immigration policies and regulations that indirectly contribute to the problem.

Likelihood of Policy Change

It is unlikely that the state and federal immigration and health reforms, I support, will be approved any time soon. There are deeply ingrained challenges in both the politics and policy streams at both levels of government, and the “legal” vs. “Illegal” differentiation prevents a single definition of the problem. My Personal Legislative Agenda & Action Plan, however, reflects my long-term commitment to raising awareness on this issue and advancing these policy priorities.

Next Steps

It is important for me to remain aware of issues and public/political opinion that frame the issue of immigration reform. To that end, my Personal Legislative Agenda & Action Plan includes subscriptions to legislative alert services at the state and federal levels. I also belong to two organizations that advocate for immigrants at the state and federal levels, which send alerts when state or federal proposals or regulations are introduced that impact the immigrant population. I already participated in one online campaign on this issue.

I am learning to carefully read and analyze proposed legislation, so I can engage with my elected officials in an informed manner.

As a Catholic, I have also financially contributed to and become a grassroots member of Catholic Charities-Immigration and Refugee Services, which has allowed me the opportunity to raise awareness and discuss my experiences with immigrants to congregations in my area.

I was recently asked to prepare committee hearing testimony that could be adapted and submitted at some future point, when needed.

I am also a member of the Florida Association of Nurse Practitioners, and I serve on the organization’s Legislative Action Committee. In that role, I have been able to raise awareness of immigrant health issues in the organization and in our “Policy Watch” endeavors at the national level. I am a member of the American Association of Nurse Practitioners and the American Nurses Association (ANA). (The ANA has an
Issue Brief

supporting healthcare for undocumented immigrants.)

Although I am not a “single issue” voter, I am mindful of candidate positions on immigration reform and plan to contribute financially to—and vote for—those who most align with my values and priorities as a nurse and citizen.

I need to learn more about the opposition to these reforms, so I am better prepared to address their arguments. I plan to listen to media sources more aligned with the opposition and to search the literature to separate fact from hype and opinion. I have learned that the key to policy advocacy is to be informed and prepared, so when engagement with my elected officials is needed (on an issue I am passionate about), I’m ready to engage.

Public Health
Policy Advocacy
Guidebook and
APHN Public Health Policy

Updated Toolkit:




Original Toolkit:




What is Advocacy?
Why is it Important to be an Effective Public Health Advocate?
Advocacy as a Strategy
Advocacy vs. Lobbying


Are Professional Organizations like APHN Allowed to Advocate or Lobby?
Why Should Professional Organizations Participate in Advocacy Efforts?
Why Should Public Health Professionals Participate in Advocacy Efforts?

How Does a Bill Become a Law?
The Federal Budget

Federal Budget Impact on Public Health
The Federal Budget Process

How a Legislator’s Office Works

The Development of APHN Policy Positions
What Constitutes APHN Policy?
APHN’s Policy Analysis Steps
APHN’s Public Policy and Advocacy Process

Goals of the Advocacy Guidebook and Toolkit –


Part 1: Advocacy as a Tool and Strategy –


Part 2: Understanding the Public Policy Process –




: Organizational Advocacy –




Being an Effective Policy Advocate
Policy Advocacy Methods

Inside vs. Outside Advocacy Strategies
Advocacy through Social Media
Coalition Building
Identifying Legislators/Decision-Makers to Contact

Letter Writing
Tips for Effective Letter Writing
Addressing the Letter

Sending an Email
Personal Appointments or Visits
Making a Phone Call
Advocacy Tips to Remember

Part 4: Individual Advocacy – 1


Part 5: Advocacy Tips and Tools – 2


Toolkit Acknowledgements –


References –





Provide an overview of advocacy and the policy making

Strengthen the ability of organizations and individuals to advocate
for policy change using a variety of effective advocacy strategies.

Share tools and resources for public health nurses and other
public health professionals engaging in advocacy.

Establish a framework for identifying policy goals, creating a
plan of action, and effectively building the case for change.


Advocacy is participating in the democratic process by taking
action in support of a particular issue or cause. Advocacy is the
active support for policies and programs that can improve
health in families and communities.



Public health nurses and other public health professionals are
on the front lines of responding to public health needs related
to communicable and chronic disease, natural disasters, and
preventive health services. Members of the Association of Public
Health Nurses (APHN) and other public health organizations are
in a great position to advocate for what is known to be effective
in promoting health and preventing disease.

In order to create effective public policy, it is very important for
public health professionals who are knowledgeable about
factors that influence health within our communities, including
social determinants of health, to be involved in the policy
formation process. As constituents and members of the public
health community, public health professionals are often asked
to provide educational information and advice to decision-
makers, such as policy makers and other public representatives.


As public health professionals, our acquired knowledge and
diverse experiences can provide the basis for strong and
effective public health policy and the achievement of health
equity. Consistent with our standards of practice, it is our
obligation and ethical responsibility to incorporate the identified
needs of populations in policy development and
implementation. It is also our professional duty to develop the
skills needed to advocate for public health and the public health
workforce before decision-makers.


Creating needed policies when none exist.
Reforming harmful or ineffective policies.
Ensuring good policies are implemented and enforced.

Advocacy is also a strategy to influence decision-makers when
drafting laws and regulations, distributing resources, and
making other decisions that affect public health issues,
infrastructure, and the workforce. The purpose of utilizing
advocacy as a strategy is essentially about three things:




The goal of advocacy is policy change.

One important question is, “How is advocacy different from
lobbying?” Although most people use the two terms
interchangeably, it is important to understand the difference
between advocacy and lobbying.


By advocating for systems change, public health professionals
can encourage changes that help large sectors or populations
and set the context in which individual decisions and actions are
made. Public health advocacy is taking a stance about laws and
regulations that can impact individual and community health.
For example, advocacy has been effective in recent years in
reducing exposure to tobacco smoke and improving nutrition in

Advocacy includes activities such as participating in a town hall
meeting or demonstration, conducting a public forum or press
activity, or developing an issue brief for your state or local
policymakers on a particular public health issue. These types of
activities do not constitute lobbying as long as you are not
urging a policymaker to take a position or action on specific
legislation. Public health professionals should know their
organization’s expectations around advocacy and whether they
are advocating with their organization or as a private citizen.

What then, is lobbying? To be considered lobbying, a
communication must refer to and express a view on a specific
legislative proposal that has been introduced before a
legislative body (local, state, or federal). This means working to
influence the outcome of specific legislation—trying to get a bill
passed or defeated—by communicating your organization’s
views or position to those who participate in the formulation of
the specific legislation—your members of Congress, your state
legislators, your local elected officials, or the staff of


APHN has been granted tax-exempt status by the Internal
Revenue Service (IRS), and must follow specific laws pertaining
to advocacy and participation in political campaigns. Tax-exempt
organizations are allowed to engage in lobbying and advocacy
activities related to specific issues, legislation, and regulations
but are not allowed to intervene in a political campaign for or in
opposition of a certain candidate or policymaker. As an
organization, APHN is involved in advocacy around improving
public health. When you are participating in advocacy activities
as a member or leader of APHN, it is critical to understand
these advocacy and lobbying guidelines. Members of other
public health organizations should learn more from their
organization’s leadership.

Larger organizations like the American Public Health Association
(APHA) and the American Nurses Association (ANA) employ staff
that are registered as lobbyists with the U.S. Senate and House
of Representatives. This requires the organization to report the
amounts expended on their lobbying activities. APHN does not
have paid lobbyists and relies on APHN members to advocate
on behalf of public health nursing and issues that affect health
in our communities. Another important distinction to keep in
mind is that APHN is not lobbying when it is asked to present
testimony or respond to an inquiry before the federal or state
legislature. It does not constitute lobbying because the
organization was asked to testify. If APHN requests to testify,
then this does constitute reportable lobbying.


As an organization, APHN also has to be concerned with the
question, “How much lobbying is our association allowed to do?”
Whenever the association expends resources—staff and/or
funding—on lobbying activities, we must track these
expenditures for APHN’s tax records.

In addition, a not-for-profit organization may not spend more


percent of its permitted lobbying total on grassroots
lobbying. What is the difference between grassroots lobbying
and direct lobbying? Grassroots lobbying is appealing to the
general public to contact the legislature about an issue. Direct
lobbying is contacting government officials or employees
directly to influence legislation.

If an issue is to be decided through a ballot initiative or
referendum, appeals to the public are considered direct
lobbying, because the public in this instance acts as the
legislature. This is helpful to nonprofits that elect to come under


76 law, as they may only devote 25 percent of their total
lobbying expenditures to grassroots lobbying. APHN does not
engage in grassroots lobbying.

It is important to note that states can have specific state laws
that govern lobbying local and state policymakers. Should you
have any questions or would like additional information about
your rights and the legality or compliance of your individual or
organizational lobbying activities, please contact a local ethics
official or an attorney in your area for more details.

Keep in mind that this is just an overview of advocacy and
lobbying guidelines. The Internal Revenue Service (IRS) website
provides more detailed information on lobbying guidelines for
nonprofit organizations.


There are a lot of good reasons why professional organizations
such as APHN should actively participate in the public policy
development process. First and foremost, we can make a
difference as an organization and in concert with other
stakeholders. Our creative thinking can help find workable
solutions to public health problems. In fact, advocacy, telling our
legislators what we want, is at the very heart of democracy.
Policy makers need to hear our stories as public health
professionals and learn from our expertise in order to address
the root causes of public health issues and assist populations in


For public health professionals, including public health nurses,
effectively telling our stories can help build our credibility as a
profession and increase visibility for public health, public health
nursing, and more importantly, for the populations we serve. By
sustaining a vocal and noticeable presence throughout the
policy-making process, public health professionals can ensure
that vital public health programs and services are protected and
supported – both fiscally and politically.

If we don’t advocate for the support of public health issues,
including infrastructure and workforce needs, we can’t expect
that others will. We will cover organizational and individual
advocacy more in-depth later in the toolkit.


The legislative process can sometimes seem complicated and
overwhelming. This section of the toolkit discusses legislative
procedures at the federal level, which are important to
understand for advocacy purposes.



Budget and tax decisions drive funding levels for each
individual program.
Budget and tax decisions significantly impact our ability to
meet the needs of the populations we serve, including
children, families, the elderly, people with disabilities, and
other vulnerable members of our society.
Federal budget decisions directly affect the states and
territories that employ us.
Conservatively, federal funds account for about a fourth of
states’ budgets.
When federal funds are cut, funds are shifted onto state and
local budgets.

The Federal Budget matters to public health professionals




Agency planning.
Budget review by the Office of Management and Budget. The
first two phases together amount to the President’s budget
The Congressional appropriations cycle
Execution of the budget by the agencies starting October 1,
the beginning of the fiscal year.

It’s useful to think of the federal budget cycle in four phases.



It takes about two years to formulate, appropriate, and execute
a single fiscal year’s budget.



A congressional office staff usually consists of an administrative
assistant or chief of staff, several legislative assistants (including
a legislative director), a personal scheduler, a press secretary,
several legislative correspondents to respond to the mail, and
various other staff. Your primary contacts will be the legislative
assistants, one of whom handles health affairs. Legislative
assistants monitor legislation, advise the member of congress,
address constituent concerns, research issues for the member,

While a representative or senator does not usually personally
see every incoming letter, they or a member of their staff has
reviewed the response that was drafted in response to a
particular issue. Legislators regularly receive numerous pieces
of communication from their constituents, but it is important to
note that individual letters, whether from an individual
constituent or from a grassroots organization, carry far more
weight than a form letter or postcard campaign. Before
choosing an advocacy strategy, it can be helpful to contact the
legislator’s office to find of which method of communication is



Issuance of an APHN position paper;
Coalition building on a particular issue;
Issuance of a letter of concern or support for an issue;
Participating as a “sign-on”; and/or
In-person visits to policy makers or legislators.

The APHN public policy development process is the mechanism
by which the organization addresses policy guidance to others
outside our organization. The purpose of these guidelines,
adopted by APHN’s Executive Board, is to set forth the
principles and procedures that guide external policy matters.

Ideas for new public policy activity may come from anywhere
within the organization. At times, the idea may also come from
one of APHN’s partners. Any member or partner is free to bring
an idea forward to the Public Health Policy Committee for
consideration. Before any advocacy takes place, there is a policy
development process that can result in:

Sign-ons are joint letters sent by APHN and other agencies or
partners to members of Congress, committees and other policy
makers. APHN partners with other Council of Public Health
Nursing Organizations (CPHNO), including APHA and ACHNE, as
well as ASTHO and other ASTHO affiliates, the Nursing
Community Coalition (NCC), and other organizations.




APHN policy is a plan, a course of action, a position paper, or
set of statements adopted by our APHN Board of Directors for
the purpose of influencing and determining decisions or

Although it is best when advocacy initiatives are well planned,
sometimes opportunities for advocacy arise quickly and there is
little time for preparation. For example, a policy maker may ask
APHN about the feasibility of a program or project and need an
answer very soon.

APHN might be invited to participate in a media event, or come
to an important meeting to brief policy makers. These
opportunities for advocacy may not lend themselves to
extensive policy research and analysis, or to our usual policy
adoption process. However, they can be important
opportunities for advocacy.

In some cases, the policy information is already available, so a
formal analysis is not needed. Other times, some research
needs to be done. In most cases, it is best to use both kinds of
information sources when developing an advocacy strategy.
Policy analyses are often presented in the form of a report, but
can also be organized in other ways, such as charts or matrices.



Identifying the need for policy change or policy issues
Identifying key actors and institutions that make decisions
about policies, as well as those who can influence policy
Analyzing the distribution of political power among key
Understanding formal and informal policy making processes.
Understanding the social and political context

Policy analysis provides a basis for choosing appropriate
advocacy strategies.

Policy analysis includes:

APHN will not always have the time or resources to take all
policy analysis steps before we begin advocating. The most
important point is that the more thoroughly we can analyze
policy issues, actors, and the environment in advance, the more
likely we will succeed in our advocacy efforts. Even if as an
organization APHN decides at the time not to engage in
advocacy, policy analysis will help us to reflect on the context in
which we are working as an organization and understand how
the policy environment influences the outcome of policy issues.
APHN’s Public Policy Committee may be helpful in performing
policy analysis, but any APHN member may assist and bring
their experience and viewpoint to the policy analysis process.





Learn about the legislative process. Generally, the earlier
APHN can get involved, the better. And remember, when it
comes to getting legislation passed: timing is everything.
Participate in APHN’s listserv. APHN members are kept
apprised of key issues through the listserv, including
relevant public information and updates.
Participate in Coalitions. APHN participates in coalitions
that represent its organizational values and objectives:

Association of State and Territorial Health Officials
National Association of City and County Health Officials
Council of Public Health Nursing Organizations
Alliance of Nurses for Healthy Environments
Climate for Health
Nursing Collaborative on Climate Change and Health
Nurses on Boards Coalition
Future of Nursing Champion Nursing Council
The Nursing Community Coalition

PHNs have an important role to play in educating public officials
and the public about public health issues and concerns. Here
are some tips about being an effective advocate:




Note: APHN membership/participation on coalitions may change
over time; contact APHN leadership with questions about current
coalition affiliation.




Write Letters. A well-written letter from a constituent is
one of the most influential ways of communicating with a
legislator. Contact your Senators and Representatives urging
them to sponsor, vote for and act on behalf of public health
programs and services. Writing to a public official does make
a difference. They know that every person who writes
represents many others who feel the same but do not write.
Make Phone Calls. Make telephone calls to your elected
officials about pending legislation, regulations, or other
priority public policy matters to describe how a change in
law would affect PHN programs and constituents.
Testify. You as an individual, and APHN as a group, have the
public health nursing expertise legislators need before they
make related decisions about the budget, regulations, or
new laws that affect public health. Find out when the
appropriate committees are holding hearings on subjects
related to APHN’s mission and ask permission to testify in
person. Include in your testimony data about the impact of
your services along with public health nursing
recommendations for action on the public policy issue.
Make In-Person Visits to Legislators and Other Policy-
Makers. Every citizen has the right to seek a meeting with
his or her legislator, councilperson or other elected
representative. See “Tips for Successful Legislative Visits.
Be an “Inside Advocate.” Government employees are often
in the position of helping the legislative process from their
official positions, and just by performing normal job duties
such as providing education, can help to shape legislation or
the policy making process.






Tips to employ these and additional policy advocacy methods are
available in Part 5: Advocacy Tips and Tools.



Meeting with lawmakers and legislative staff;
Providing analysis and information to committees and
legislative offices;
Testifying in committee; and/or
Negotiating with policy makers and other lobby groups.

Media involvement (news conferences, editorial board visits,
assisting reporters with stories or social media);
Organizing legislative visits by constituents to their
Building broad and diverse coalitions around the particular
issue; and/or
Letter writing campaigns.

Effective- policy change can require both an “inside” and
“outside” advocacy strategies.

“Inside” strategies may include:

For the most part “inside” strategies are carried out by or in
coordination with advocates who work on a regular basis at the
U.S. Capitol.

An effective campaign also requires “outside” strategies, aimed
at educating the public and/or changing public perception
around an issue. Some of these activities may include:

“Outside” and “inside” strategies should be coordinated to
ensure that they make strategic sense. Points of coordination
may include timing, targeting, specificity and continuity of



Strategic communication, including individual and organizational
media engagement, is a powerful tool for shaping public opinion
and influencing policy. Media engagement is increasingly
essential for promoting health and the systemic changes
needed to reduce disparities, address social drivers of health,
and improve population health outcomes. It is particularly
important that policymakers and other key stakeholders,
including the public, hear from nurses, including public health
nurses, and other public health professionals to foster better
decision-making, policies, and inclusion. The original Woodhull
and follow-up studies demonstrated nurses are mostly invisible
in traditional media. This needs to change to enhance nurses’
influence and visibility. By one count, 500 million Tweets are
posted per minute. Social media provides a ready platform for
access to up-to-date information; make contact with colleagues,
pertinent leaders, and other key stakeholders; and engage in
new conversations.

Social media presents great advocacy opportunities for 501(c)(3)
nonprofit organizations, including public foundations, as well as
individuals. However, certain activities may constitute lobbying
or partisan political activity on social media networks. Although
the IRS has not specifically said how the advocacy laws apply to
social media, its broader rules likely apply to social media sites
just as they do to other communications channels. While a
nonprofit or charity organization is generally not responsible for
the lobbying or partisan content of others, these lines can be
somewhat blurred on social media platforms.




Creating a greater base of support for our public policy goals
By recruiting new allies, a campaign can generate
financial support, volunteers, and other resources to
help achieve goals

Access to a larger audience
We can provide useful information to greater numbers of
people/organizations than can be reached through only
our own contacts

Greater leverage with decision-makers
By demonstrating the buy-in for an initiative by multiple
organizations, policymakers and others are more likely to
join, support, and protect our vision and goals

Undertaking an advocacy initiative is almost always a team
effort. Coalitions can help us expand the scope and
effectiveness of our public policy work. A coalition is a group of
interdependent people focused on advancing or opposing a
particular issue. A coalition’s power to affect public policy lies in
its ability to present a united front representing many, many

Coalition building involves selecting strategic relationships.
Coalition members must be informed and engaged on the
issue(s), so it’s important to have strong internal consensus
between partners before devising policy and developing
strategies for advocacy.

The advantages of joining or forming coalitions include:


How many potential members can we identify?
How focused do we need to be?
What is the level of interest, energy and expertise needed?
With whom can we work well?
With whom do we agree on basic agenda?
Who has the time and resources needed to help?
Who needs to be at the table to be credible?
What is the effect of excluding certain groups?

There are also drawbacks to coalitions and coalitions may not
always be the best strategy for advocacy. Sometimes, advocacy
is more effective when done individually. Other times, the
groups involved may not be in a position to make the
compromises that are required to advocate as part of a group.
Because coalitions have a consensus building function, they also
take time. If public health nurses or public health nursing
organizations are advocating for an issue that requires
immediate action, we may not have the time to join, build, or
agree on a common agenda within a larger coalition.

A coalition is effective only when its issue has merit and the
coalition members are organized, informed, truly in agreement
as to goals, and dedicated to communicating the importance of
the effort. Coalition building calls for establishing and
developing contacts that work well together. Through coalitions,
we can raise greater awareness of of public health issues, build
on relationships with government entities, and help shape laws
and policies that affect public health.

Effective coalitions may be built with organizations with varied
agendas, coming together over a specific issue where there is
common ground, but these agreements must be very carefully
brokered with complete agreement on terms among all parties.

Key considerations in determining strategic alliances include:


How many potential members can we identify?
How focused do we need to be?
What is the level of interest, energy and expertise needed?
With whom can we work well?
With whom do we agree on basic agenda?
Who has the time and resources needed to help?
Who needs to be at the table to be credible?
How do we share the credit?
Can we immediately agree on goals?
Is this a group with which we are likely to easily reach
Can this group stay focused on the subject at hand?
Can we agree on structure and responsibility?
Can we agree who will take the lead and who will speak for
the coalition?
Is this a group that can make compromises?
Is a group already in existence that can address the issue?
Is there a clear role for us in the coalition?
Do we have a forum for recruiting members?
Do we have the time to participate in or manage a coalition?


Before contacting legislators or decision-makers, it is important
to consider where they are likely to stand on an issue and how
much influence they may have related to the public policy issue.
The goal of contacting legislators is to persuade them to act on
policy recommendations. It may be helpful to think of legislators
in terms of where they are likely to stand on the issue in order
to use appropriate advocacy strategies. The following grid is one
way to analyze potential stakeholders. Using this analysis
process, stakeholders that fall into the Promoters category are
some of the most important stakeholders related to your
advocacy efforts as they have great interest in the topic and a
high level of influence. On the other hand, Apathetics have little
interest in the topic and minimal influence – they are likely not
the most important stakeholders to contact. Defenders may be
helpful to help promote your advocacy efforts even though they
have minimal influence, while you may be able to provide more
information about the topic of interest to Latents who are not
initially interested in the topic but have the potential to
influence movement around the public policy issue.

Community Toolbox



Be clear about what you want (what is your ask?)
State your concern for the issue clearly in the first paragraph

Be sure to include how public health practitioners,
communities, and those you serve would be affected by a
proposed change in the law

Include the number if a bill is involved (House bill: H.R. or
Senate bill: S.)
Tell a story or example to make the issue real
Include key information and use examples to support your

Describe your practice and the patient population you

Frame your message in terms of local effect
How does an issue affect the community’s health
facilities, local public health agency, nurses and other
constituents of the legislator’s district?

Address only one issue in each letter and try to keep the
letter to one page
Know the committees on which your legislators serve and
indicate in the letter if the bill is being brought before those
Ask for a direct response with their position





Timing is important
Try to express your opinion on a bill when it is in

Use your own stationery, not hospital or agency stationery
Do not give the impression that you are speaking for an
organization unless you are a designated spokesperson

Sign your name with RN after it. Include any other
credentials you may have, PhD, DNP, PHN, APHN-BC, etc.
Personalize your letter

Legislators pay more attention to these than to ones
mass- produced. Form letters and response cards should
be used only if you have no other alternative for
expressing your opinions

Edit carefully
Invite a friend or colleague to read your letter and
provide feedback

Read your letter aloud and listen to the flow, grammar and

Revise your letter if needed
Be sure your correct address is on the letter and the
Send a copy to the legislator’s staff
Keep a copy of all letters that you send


When addressing the letter to a legislator, use the following
format depending on who you are sending the letter to.



Members of Congress have an e-mail address that ends in or Your message should use the following
format to begin:

Your name
City, state, zip code

Dear (Title) (Last name),

Start body of message…

Note: Although members of Congress have e-mail addresses, for
some it may not a preferred means of communication. Some utilize
online forms that require information signifying you are a
constituent. This is one reason it is helpful to contact a legislator’s
office to find out preferred communication methods.



Make an appointment in advance
When calling to schedule an appointment, identify
yourself as a constituent and clearly state the purpose of
the meeting. You can use the following script as a guide:

“Hello. I am your name from your hometown. I would
like to schedule an appointment to meet with
Senator/Representative last name to discuss state the
purpose of the meeting/topic.

Legislators have endless demands on their time. Don’t be
disappointed if your legislator is unavailable at the last minute,
in which case you would meet with a staff member. The
following are some tips when planning a visit with a legislator.


Prepare for the meeting
Do research beforehand

Know whom your legislator is, which party they belong
to, and any positions they may have taken on the
issue you wish to discuss
Research their voting record, position statements,
ratings from special interest groups and other
pertinent information

Know the issue
Although you do not need to be an expert on every
aspect of a bill, you need to know basic information
about the issue that is being addressed

Try to anticipate the arguments against your position, and be
prepared to address them
Be organized

Have brief (one or two-page) written materials available.
It should state the issue, your position and requested

Respectfully explain your position and inform your
congressman or senator – attack the problem, not the
Be concise, stick to basics, and stay focused

You may only be given 15-20 minutes total to speak with

Most legislators do not have a health care background
Make no assumptions about their level of knowledge of
public health, nursing, or health care systems, financing,
or delivery
Use the same principles you use when educating
members of your community
You may not be able to answer all of the legislator’s
questions, but offer to find the answers whenever


Frame your message in terms of local effect
Hearing how an issue affects the community’s health
facilities, local public health agency, and nurses and
other constituents of the legislator’s district will be
important to communicate

Maintain a professional appearance and attitude
Dress in business attire.
Maintain a courteous attitude

Although it is appropriate to disagree with the
positions held by a legislator, having a disagreement
evolve into an argument is not helpful for public
policy advocacy efforts.

When you leave the meeting, be sure the legislator knows
your position and the expectations you have of them
Finally, send any additional information that you said you
would provide after the meeting
Follow up your visit with a thank you note to the legislator
and staff you met with

Restate your position and requested action in the note

Telephone calls can be an effective means of communicating as
a follow-up to a letter or visit. Calls can be placed to a
legislator’s Washington, DC office or state capital’s office, or to a
local district office. Calls to a local office may result in delay of
your message getting to a federal or state legislator or
becoming part of a tally sheet listing calls “for” or “against” an
issue. When calling your legislator’s office, be sure to specify the
issue about which you are calling so that you are directed to the
appropriate staff person. In general, telephone calls should be
used to deliver a brief, concise message or to request specific


Clearly identify yourself and the issue
If you know a staff member, ask for that person
Briefly state what you want the legislator to do, and refer to
previous correspondence you may have had with the
legislator (past letter or visit)
Ask the legislator’s staff to respond to your request and to
update you on the outcome of the issue
Make a note of the name of the person you spoke with and
direct your future communication to this person

When calling be sure to do the following:


You are a source of information. Legislators have limited
time, few staff members and, at times, limited time to devote
to any one issue. You are someone that can fill in the
information gap.
Maintain credibility. Give accurate information. You will
lose credibility if you do not do your research and
inadvertently give false or misleading information.
Know your supporters. The legislator will want to know
what group, individuals, state agencies and/or other
legislators are working with you and/or your organization on
the issue(s) you are presenting.
Know your opposition. Be prepared by understanding the
opposition’s viewpoint. Anticipate their arguments and
provide the legislator with rebuttals and answers to those
Remember that you are developing a relationship.
Make the legislator aware of connections you have to the
issue, even if you think it is insignificant. It could make a
difference. Make more than one contact with the legislator.
Do not be afraid to admit you don’t know. If your
legislator asks you for information you do not have or asks
something you do not know the answer to, tell them you do
not know the answer and offer to obtain the information for
them. Provide this information in a follow-up meeting, phone
call, or letter.
Have a specific ask. When you want a vote, information or
answers to questions, ask directly and be specific.
Follow-up. Later, follow-up with an inquiry to ask if the
legislator did what they said they would. Thank them if they
did, or ask them for more information if they did not vote as
they said they would.

Regardless of which method you utilize to contact a legislator or
decision-maker, remember the following tips:



The update of the APHN Public Health Policy Advocacy Guidebook
and Toolkit would not have been possible without the work and
support of the following individuals:

Current APHN Public Policy Committee Members
Mallory Bejster, DNP, RN
Jen Cooper, DNP, RN, PHNA-BC
Erin Michael, MSN, RN
Carolyn Nganga-Good, DrPH, RN, CPH
Judi Policicchio, DNP, RN, PHNA-BC
Margaret S (Peggy Sue) Wright, DrPH, MSN, RN, PHCNS-BC

APHN Administrative Support
Shirley Orr, MHS, APRN, NEA-BC
Jamie Weaver

Content Expert
Carole R. Myers, PhD, RN, FAAN for her addition of the social
media advocacy content


Updated Toolkit: 2021
Original Toolkit: 2016


American Association for the Advancement of Science. (2014).
The federal budget process 101.

American Public Health Association. (n.d.). The power of

Association of State & Territorial Directors of Nursing. (2009).
ASTDN Public Policy Guidebook (Archived).

Amidei. N. (2015). Washington State Coalition Against Domestic
Violence: Public policy advocacy.

C.Q. Congress. (2015). Advocacy 101: A new age of online

Gasper, C. (2016). How media affects social change.
TCC Group: Perspectives.

Internal Revenue Service. (2015). Charities and non-profits:

Jin, H. (2015). Understanding media’s extensions:
Commemoration of the 50th anniversary of the publication
of Marshall McLuhan’s Understanding media: The extensions
of man. Critical Arts: South-North Cultural & Media Studies,
29(6), 881-826.

Mason, D. J., Nixon, L., Glickstein, B., Han, S., Westphaln, K.,
Carter, L. (2018). The Woodhull study revisited: Nurses’
representation in health news media 20 years later. Journal
of Nursing Scholarship 50 (6), 695-704.



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Michigan Legislature. (2015). A citizens guide to state

McLuhan, M., & Gordon, W. T. (2003). Understanding media: the
extensions of man. Critical ed. Corte Madera, CA: Gingko

National Council of State Boards of Nursing. (n.d.). Methods of
communication with your legislator.

National Priorities Project. (n.d.). Federal budget 101.

Pathfinder International. (2011). Straight to the point: Mapping
an advocacy strategy.

Sayce, D. (n.d.). The number of tweets per day in 2020.

Sprechmann, S. & Peltman, E. (2001). Advocacy tools and
guidelines: Promoting policy change.

University of Kansas. (n.d.). Identifying and analyzing
stakeholders and their interests. The Community Toolbox.



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