It has become cliche to talk about how the past year has changed this or affected that, but the fact remains that the pandemic is one of the most influential events of our generation. Among the things exposed by the pandemic have been the frailties and inequities in our communities. It is clear why residents of skilled nursing and assisted living facilities suffered so brutally at the beginning of the pandemic. This is where people in ill health are trapped by their need for daily intimate care. Even the casual observer can understand these living arrangements are an ideal breeding ground for a highly contagious illness.
However, less clear prior to the pandemic, or perhaps just easier to ignore, is how communities of color and working-class communities suffered from limited healthcare access, decreased healthcare literacy and other issues that have led to poor health outcomes. These communities have suffered disproportionately when compared to white and more affluent communities. The better paid, white collar work was more easily locked down with a rapid shift to remote work and continued income while the working class had to continue working in congregant situations or lost their employment, income and health insurance. Also, the less income the family has, the more likely it is to live in densely populated, confined settings with many more individuals per square foot. These communities were affected by both job loss and reduced income as well as higher infections rates. In their essay "The COVID-19 Pandemic and Health Inequities," Clare Bambra, Ryan Riordan, John Ford and Fiona Matthews note that "there are inequalities in COVID-19 morbidity and mortality rates— reflecting existing unequal experiences of chronic diseases and the social determinants of health."
In the past, such as with the flu pandemic of 1918, inequities in our social fabric exacerbated the injury and suffering from a pandemic. Bambra et al. point out, "Emerging evidence from a variety of countries suggests that these inequalities are being mirrored today in the COVID-19 pandemic. Both then and now, these inequalities have emerged through the syndemic nature of COVID-19—as it interacts with and exacerbates existing social inequalities in chronic disease and the social determinants of health."1 As we emerge from this year of massive suffering, the healthcare community must learn from our experiences and find ways to improve our system that will address these inequities laid bare by the pandemic.
One thing that we have all learned is the viability and, in fact, the equalizing nature of telehealth. One study found, "The advantages of telemedicine moving forward include its cost-effectiveness, ability to extend access to specialty services and its potential to help mitigate the looming physician shortage. While there remain inequities such as access to technology to drive telehealth, telehealth has proven to be viable and important in providing primary care and health support during the pandemic. We must learn from these experiences as we strive to improve access to care and meet our clients where they are, so we can provide them the best possible healthcare support.
Beyond the challenges of implementing new telehealth services and overcoming patient barriers is the difficulty of practicing across state lines. Telehealth will not function without nurses, but many states have not joined the Nurse Licensure Compact, which allows nurses licensed in any compact state to practice in any other compact state. Since the location of the nursing care is determined by the physical location of the patient, a nurse calling a patient in Texas is practicing nursing in Texas, and therefore the nurse must have a Texas license, even if they are sitting in an office in Illinois. If the nurse and patient are both in a compact state, the problem is solved. Thirty-four states are currently part of the compact, but not Illinois, my home.
I currently work in telehealth and hold eight nursing licenses, and as my company’s telehealth business grows, I will be required to acquire more. While all my licenses require the same standard of nursing education, continuing education and background checks, the timing of renewals and processes I must adhere to are different for each state. I spend many hours per year maintaining my licenses. Additionally, my employer has spent many thousands of dollars to cover fees and my hours of work required to obtain my multiple licenses. It would be much easier for my employer to simply move my job, and those of my colleagues, to a compact state like Florida where we already have an office in Miami, or for me to relocate to Indiana (a compact state) so I can commute to my job in Chicago. I don’t want to move; my life, family and home are here in Illinois.
This saturation spurred me to work with CMSA Chicago to build a coalition of organizations supporting the passage of the Nurse Licensure Compact in Illinois. As part of that work, I was awarded the Margaret Leonard Public Policy Grant from the CMSA Foundation. I have used the funds to hire a PR firm, Kurth Lampe. I have worked with Kurth Lampe over the past several months to build a grassroots campaign to encourage the Illinois legislature to pass the Nurse Licensure Compact in Illinois.
We began by meeting to outline the project and review the legislation, supporting organizations and lobbyists involved. Then, in early February, we held a meeting to refine our plan that included leadership from CMSA Chicago, ANA Illinois, the National Council of State Boards of Nursing (NCSBN), the lobbyists for ANA IL and NCSBN and Kurth Lampe. At that meeting we compiled all the history and detailed information about the legislation to help guide our work. Kurth Lampe then finalized our outline for action and distributed it to the leadership team.
We worked with the lobbyists to understand who the key players were going to be. Kurth Lampe also created a tool for us to send to our supporters to build a database that we can use to mine our connections to key legislators and target the leaders needed to pass the legislation.
By early March, the legislation was assigned to committees. We launched our first letter-writing campaign using tools created by Kurth Lampe. We asked our volunteers to send letters to their own representatives and to all the members of the House Labor Committee, where the bill had been assigned. The lobbyists warned that the bill had been assigned to the Labor Committee, because the chairman could be counted to prevent the bill from getting a hearing or vote. The bill is opposed by two small but highly influential unions. The House leadership team is willing to honor the request of the state AFL-CIO to kill the bill, and despite our best efforts, the house bill has been held in committee. We are working hard to find ways to gain support to move the legislation, but it is a tough battle.
We have worked to build our grassroots campaign including a training session for volunteers and a series of meetings we called Caring without Borders in which we walk volunteers through writing a personal letter and sending it to their legislators. We could set up a website to complete and send letters for people who will provide an address and then click a button, but that kind of letter writing campaign is not very effective. A personal letter from a constituent will usually gain significant attention. Once the letters are written, we have asked our supporters to keep them handy, so as we identify new targets to influence on committees or in leadership, we can have them quickly and easily send a copy of their letter containing their personal story supporting the legislation.
Additionally, we have built a new website, www.nlcyes.com, Facebook group, Instagram account, Twitter account and LinkedIn profile to garner attention and drive the campaign on social media. We have built our case and advocated for it with press releases that have been published online and around the state.
This is what a grassroot campaign looks like, and we have used the support from the CMSA Foundation to not only build this campaign but train a large number of CMSA members in the details for running such a campaign. We hope not only to see the Nurse Licensure Compact passed in Illinois, but to emerge from this work with a new team of experience and energized CMSA members ready to act on other public policy initiatives in the future.
Interested in getting involved? Visit the CMSA Public Policy page to learn how!