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William F. Connell School of Nursing

Beyond the bedside: Nurse advocates make a mark in public policy arenas

by debra bradley ruder

Karen Daley, M.S. ’04, Ph.D. ’10. Photograph: Aaron Clamage
Karen Daley, M.S. ’04, Ph.D. ’10

A tiny puncture 15 years ago changed life forever for Karen Daley, M.S. ’04, Ph.D. ’10. Daley was a veteran staff nurse in the Brigham and Women’s Hospital Emergency Department in July 1998 when she drew a patient’s blood, reached to discard the needle, and brushed her gloved hand on a used needle protruding from a sharps box. A few months later she began feeling tired and nauseated, and tests confirmed that she’d been infected with both HIV and hepatitis C.

Facing an uncertain future, Daley gave up her 26-year bedside nursing career and channeled her energy into lobbying for needlestick prevention laws and policies that have made the workplace safer for caregivers around the country.

“I see the fruits of this when I go in for my blood work now,” said Daley, who is serving her second two-year term as president of the American Nurses Association (ANA).

She is part of a growing cadre of nurse leaders, including Connell School graduates and faculty members, who are influencing public health policy as lawmakers, heads of public health departments, researchers, educators, and in other roles. Good listeners, advocates, and problem solvers by trade, nurses—who make up the largest share of the country’s health care workforce—are parlaying their expertise in care delivery, prevention, and health promotion to help improve health on the local, state, and national levels.

The trend seems certain to continue: In a 2010 Robert Wood Johnson Foundation–Gallup survey of 1,500 opinion leaders in insurance, health services, government, and industry, a majority said that nurses should play a greater role than they currently do in health policy planning and management.

One of the most visible public policy advocates is Daley. As ANA president, she regularly speaks, testifies, and sits for interviews about public health issues, from gun violence to nursing staffing levels to care coordination to health care reform. But no topic compels her more than needlestick safety.

Daley, who was leading the Massachusetts Nurses Association at the time of her accident, began pressing almost immediately for a statewide needlestick safety bill. “I had a great career. I loved what I did, and it made no sense to me why this had happened,” recalled Daley, who publicly revealed her infection during her Beacon Hill testimony in April 1999. “Now I had a mechanism for helping some necessary change occur, and that became my focus.”

Over the next year—while undergoing grueling antiviral treatment—Daley traveled to more than 24 states to raise awareness among legislators, hospital executives, and nurses about the need for more protective devices, such as syringes with retractable needles.

She championed proposed federal legislation requiring employers to use safer equipment and systems to reduce exposure to viruses and infections from needlesticks. Daley visited skeptical legislators and testified before Congress on behalf of nurses and health care workers, who sustain an estimated 600,000 sharps injuries a year.

The late Massachusetts Senator Edward M. Kennedy called Daley himself to congratulate her when the Needlestick Safety and Prevention Act passed in 2000. And she attended the White House ceremony when President Bill Clinton signed it into law.

These laws have made a difference, notes Daley. In Massachusetts, sharps injuries among acute care hospital workers dropped by 32 percent between 2002 and 2009, according to the Massachusetts Department of Public Health. Yet hazards remain for caregivers everywhere.

“Little by little, it’s getting better,” explained Daley. “Where safety devices are being used, we’re seeing many fewer injuries occur. But we aren’t where we need to be.”

Mary O’Connell Grant ’74, M.S. ’76. Photograph: Tony Rinaldo
Mary O’Connell Grant ’74, M.S. ’76

Expanding access

Like Daley, Mary O’Connell Grant ’74, M.S. ’76, knows that crafting legislation requires perseverance. During her eight years as a Massachusetts state legislator—including two as vice chair of the health care financing committee—Grant played a role in shaping the state’s landmark 2006 health care insurance reform law. The statute, which expanded coverage to nearly all Bay State residents, served as a model for the 2010 federal Affordable Care Act.

Grant represented Beverly, a small city on Boston’s North Shore, from 2003 to 2011. One of four nurse lawmakers in the State House at the time, she shared her expertise from 30 years as a child and adolescent psychiatric nurse with fellow legislators who were developing the massive law. Among other things, she wanted to make sure that clinicians were involved in important decisions about containing health care costs and improving care.

Grant also knew from experience about the value of preventive services such as patient checkups and certain diagnostic tests. As part of ongoing reform, she helped launch a legislative prevention caucus to educate Massachusetts lawmakers.

Grant found her fellow lawmakers receptive to the nursing perspective. “Every legislator has a mother, a sister, a neighbor, or somebody who’s a nurse,” she noted during an interview on Beacon Hill. “The public trusts nurses. So nurses have a very powerful voice in a legislative arena.”

Contributing to civic life comes naturally to Grant, who served as president of her class and the student senate at the Connell School. But she decided not to seek a fifth legislative term, and in 2011 joined the state’s executive branch to help implement the health care law. As clinical director of long-term services and supports at MassHealth (responsible for maintaining the safety net for vulnerable residents that is a centerpiece of the state’s health program), she oversees hundreds of facilities and community programs that serve elderly and disabled residents on Medicaid—working to ensure that people are well served and public money is well spent. Grant says she pushed buttons to vote on health issues in the legislature, and now she’s part of the effort to implement those legislative efforts.

When the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act last summer, Grant made a beeline to Massachusetts Governor Deval Patrick’s press conference applauding the decision. “I was grinning ear to ear,” she remembered. “This is one of those bills of the century, and we created a framework for it.”

Grant is convinced that nurses’ political strength comes when they speak with a collective voice while working to change health care policy. “As a profession, we have to operate with a helicopter view, and then we’ll always be at the table,” she observed.

In Daley’s opinion, advocacy and public policy engagement are part of nurses’ “social contract” to serve society beyond the bedside. Nurses should learn early on, she says, that activism “is part of what we do as nurses. This is part of how we make the system better for patients.” ✹

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