422 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
55% of the 2.8 million RNs hold BSN degrees; approximately 11% have master’s or doc-
toral degrees. While the majority of nurses live in urban areas, about 445,000 RNs and
166,000 LPNs live in rural communities where 52 million people also reside (HRSA,
2013). The number and the geographical locations of nurses give them natural access to
members of Congress, especially members of the House of Representatives. Four large
nursing organizations that represent practicing nurses, educators, researchers, accredi-
tors, and administrators, the American Nurses Association (ANA), the National League
for Nursing (NLN), the AACN, and the American Organization of Nurse Executives
(AONE), form the Tri- Council for Nursing. This alliance of autonomous nursing orga-
nizations periodically issues policy and position papers that represent the view of its
member organizations. The Tri- Council for Nursing (n.d.) also discusses and advocates
for policies that cross and occasionally unite the special interests in nursing.
What constitutes the policy agenda of the Tri- Council? Given that it is an alliance and
not another nursing organization, the best clue to its business is contained in the policy
websites of its four constituent members. It can be said that securing and increasing fund-
ing for Title VIII, the Nursing Workforce Development Programs, and obtaining funding
from the National Institute of Nursing Research is high on the agenda of the Tri- Council.
The ANA (2016), the official spokesperson for nursing, lists as its legislative issues:
safe staffing, safe handling and mobility of patients, home health, nurse workforce devel-
opment, health reform, advanced practice registered nurses (APRNs) and durable med-
ical equipment, APRNs and veterans, and RN nursing home staffing. Their website also
publishes information about the ANA- PAC (political action committee), the fundraising
and political support arm of the ANA. The AACN’s (2015d) ambitious federal policy
agenda includes five familiar goals: advance policies to prepare a more highly educated
and diverse nursing workforce, focusing on seamless academic progression, afforda-
bility, and interprofessional education; amplify nurses’ role in transforming America’s
health care delivery system into one that is patient centered and team based; obtain fed-
eral investment in academic nursing’s infrastructure; secure federal funds to support
research; and elevate the role of nursing. The AONE identifies Title VIII re- authorization,
elevation of nursing research and data, promotion of the value of nursing, and sus-
taining and growing funding for nursing. The NLN (2015– 2016), the accreditor of all
programs that lead to licensure and graduate programs at the master’s and DNP lev-
els, lists its 2015– 2016 governmental affairs agenda as: access, education, diversity, and
workforce. However, these four organizations alone or in alliance are joined by other
voices that speak for nursing. These voices represent the interest of members of specialty
nursing organizations, exemplified by the American Association of Critical-Care Nurses
(AACN, 2016b). This group traces its four decade engagement in health policy on their
website. Although most nursing associations are not registered as lobbyists, many hire
Washington- based lobbying firms to advise them about bringing their issues to Congress
or the Executive Branch of government. All these organizations and a large number of
specialty nursing organizations employ policy experts on their staffs or contract with
public policy staffs. These individuals frequently visit the Hill and bring their organi-
zations’ elected and appointed leaders to meet with members of Congress and their
committee and office staffs. The ANA, the AACN and the NLN have offices based in
Washington so that they can easily access policy makers.
ORGANIZATION
Then, there is the question of organization. Nurses do not agree or rally around a com-
mon agenda. Although there are many nursing organizations, no group speaks for all