Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. Our guest today is Pam Allen, Government Affairs Representative for Redlands Community Hospital. Pam was previously Director of Emergency Services at Redlands, and she currently serves on ACNL's Health Policy Committee, working to educate ACNL members on how they can get involved in shaping legislation. Today, she's here to tell us about how she transitioned from a more traditional nursing role to working in government affairs and share some advice for nurses who are interested in getting involved. Thank you so much, Pam, for joining us today.

Thank you, Charlene, for the warm welcome and really thanks for having me.

Yes, it's great to have you on the podcast and great to see your work in the Health Policy Committee. So really excited to talk about that today. I wanted to talk first about your background. You have your background in nursing, but also in leadership. And can you share your journey of transitioning from a clinical role as an emergency department director to a more legislative role as a legislative liaison for your hospital?

Yes, I can. Well, um, you know, I started at Redlands Community Hospital in the spring of 2014 as a director of emergency department. I also oversaw the observation unit, which also had medical, surgical, and telemetry patients on the unit, also oversaw the STORK program and emergency management. So I have over 30 years of experience in emergency departments with 20 years of experience in emergency department management, you know, really with various hospitals across the nation, particularly in Southern California. And I've also served in several different positions. So it really, my journey into legislation really goes back to going to go back a couple of years to the fall of 2014, where I actually attended Hospital Association of Southern California, which I'll refer to as HASC Quality Conference. Dr. Marie McCullough, who was a UCLA physician, uh ER physician, spoke about implementing safe opioid prescribing in the emergency departments in Los Angeles County. The toolkit they actually adopted came from San Diego County. I knew this was something that we needed in the Inland Empire, which comprised the San Bernardino and Riverside counties, and that's where Rutland's Community Hospital resides in the Inland Empire in San Bernardino County. So a couple of months later, because I felt I needed a bigger name tag than what I had to get this initiative going, I met with the regional vice president of HASC, Inland Empire, who also supported this initiative. We actually pulled together a variety of stakeholders, which included both county public health medical directors, and then we called ourselves the Inland Empire Safe Opioid Prescribing Medical Task Force. We actually created a toolkit which included a standardized discharge form following the example of those created in San Diego and Los Angeles, and we distributed them to every emergency department in the Inland Empire in 2017. We actually did quite a few webinars. We did site visits, reviewing the toolkit, reviewing the discharge instructions. Well, meanwhile, during this period of time, I had built a relationship with HASP and I was actually asked to chair their emergency health services committee. AB 1223, the first bill I'm going to talk about, was just introduced. This would authorize the local EMS, which is Emergency Medical Services, to adopt policies and procedures related to patient offload time, which is the time a patient comes to the emergency department, the ambulance brings them, their wheels stop, they bring the patient in, and it's a matter of how much time it takes for that transcript care to occur. The original bill would make it a never event if there were ambulance bed delays, which meant we were to notify CDPH. And I just felt, gosh, this is wrong. And there were quite a few people out there that felt the same. So worked with HASP and actually worked with California Hospital Association lobbyists to get the never event removed from legislation. We got it changed to establishing criteria for reporting of and quality assurance follow-up for a nonpatient offload time. So we really kind of felt that was a win-win. So then in 2017, I also joined the California Hospital Association. EMS Trauma Advisory Group is our co-chair, where we served as an advisory capacity to California Hospital Association regarding EMS trauma needs policies and legislation. We are, and we, because I'm still on that team, we're a multidisciplinary group across the state that includes professional associations, regulatory agencies to include the CDPH, and pre-hospital providers that act as a collaborative source of emergency services expertise. So over the years, um I've actually presented at webinars and conferences regarding ambulance patient offload delays and legislation affecting emergency departments. So in 2023, I kind of felt I needed to broaden myself a little bit, get out of the emergency department realm. It was kind of suggested to me. So I felt, all right, I think a great way to do that. I was actually pretty involved with ACNL. And at the local meetings, um, I would sometimes do a report out of legislation affecting emergency departments. So I was able to join the ACNL Health Policy Committee to broaden my knowledge on legislation affecting uh nursing. So I think with that, um, you know, I've recently taken on this newly created position of Government Affairs representative for Redlands Community Hospital. So I'm pretty excited about that. Um, started officially back December of just last year, 2023. And Redlands recognized the critical uh importance of being actively engaged in the evolving landscape of healthcare legislation and as a standalone community hospital. So we also understand the significant impact that legislative decisions can have on our operations and the care we provide to our community. So, really, in essence, we needed to be at the table.

Yes, thank you so much for sharing your background and the transition that you made from your clinical role in the ER and then now moving into this new role. And congratulations on that. That is really inspiring to see. And it's great to see the impact that a nurse can make on all of these different significant initiatives that are going on in healthcare. And, you know, for our audience, I'm wondering what resources or training maybe did you utilize when you were just starting out with advocacy efforts? Because it's not always clear, right, for nurses to get into that. So what thoughts do you have on the resources or training?

Well, I think any um piece of nursing you're involved in, be it critical care, be it med search, be it public health, we all have professional organizations that we can join. And for many years, um, I do have my certification in emergency nursing. I do have my CEN. Um, I've been a member of the Emergency Nursing Association. And they too have a government relations committee, which I have been involved with. Um, obviously, being emergency nursing association, they are following and tracking all legislation that's affecting emergency departments. But because we see anybody with any complaint that walks through the door, we are also following legislation that has to do with behavioral health. We're following legislation that has to do with opioids, anything having to do with sex trafficking, EMS, because it all impacts emergency departments. And they too have legislative days. One day up at Sacramento, and they have another day every year that they go to Washington, DC. And I really also, I think, second, can't say enough with my partnership with HASP and CHA, that truly every meeting I meet with them, I'm learning something new. And I've also broadened, I think, my connections with both organizations. And both of them are really dedicated to advancing the interest of hospitals in California. Southern California, they represent 176 hospitals, and they have representative VPs in, you know, one in San Diego, one in Los Angeles, Orange County, LA, the Inland Empire. CHA oversees 400 hospitals throughout California. They provide local, state, and federal advocacy on legislation, budget, and regulatory concerns. So for me, that's been huge training. In addition, um, the CHA, EMS trauma advisory group that I'm on meets quarterly, and that is one that I co-chair. And um, legislative bills again affect emergency departments at EMS or every time on the agenda. And we also do a yearly emergency services conference. Our next conference is coming up in May. Um, ambulance patient offload delays, which I already talked about, have really been a hot topic for years, and several uh bills have been introduced to address the issue. And I already talked about one of those, which was AB 1223. There's one bill, AB40, which is emergency medical services, that was introduced in December of 2022. Um, this also addresses APOD. So for the last two years, I've actually had weekly meetings with CHA's VP of policy, and my co-chair of EMS Trauma, which is Rose Kalango, she's up at Sutter. So we call ourselves the Three Amigos because I represent a standalone community hospital. Rose works for a system, and you know, Cherie is the VP of policy. Um, and so we've actually, the three of us have done several webinars and uh uh PowerPoint presentations. So we kind of go where we're asked. So we've actually worked on several amendments to AB40, and we have worked with the CHA lobbyist on numerous occasions. We've also met with consultants of the committee where the bill was going to be heard, for example, Senate Health. So I'm pretty proud to say we were actually the bill did go through, but we were able to get some key things that we really felt from an emergency department hospital perspective that we needed to get change. We were able to get the time lengthened and we were able to get where we thought fines might be uh put into the bill, not be put into the bill. So we had some wins along the way, even though the bill did pass. So, with that being said, I think another training ground, which has also helped me, is I'm on the CA, especially in this new position, legislative information is like daily looking up bills, following bills. Um, I also kind of zoom in. If let's say Senate help, a couple of the bills and I'm tracking are going to be heard. I'm gonna listen in on that. And so currently, though, I am vetting legislative trackers for myself that I can probably a little bit more easily follow. And I think this is kind of where I put a little plug-in, I put a big plug-in for ACNL because they do have a new legislative tracker called Policy Engaged, which can be found on the ACNL website. And any ACL ACNL member can easily find it. And it's great because it's really about enhanced bill tracking and actually advocacy outreach. So please go ahead and you can check that out.

That's great. Thank you so much for the plug and for sharing these different resources and training modalities. I think that it's wonderful, wonderful to hear how many local resources there are that nurses can access. And of course, we know that there's a lot of different specialties in nursing. And, you know, for nurses who are in different specialties or even in the ER and they notice these things that they might want to change or make an impact on, um, how would you say that nurses can effectively communicate their own experiences and their own concerns to policymakers? Because maybe they do want to make some changes just like you have in your own experiences.

Well, I really think, you know, we all know as nurses, for the past 22 years, uh, you know, nurses have been rated the most trusted profession, with 78% of adults currently believing nurses, you know, have high honesty and ethical standards. So I really believe that that right there should open a door for all of us. So then I think second is we need to be prepared. Um, you need, we all need to have that five-minute elevator speech ready to go. And if you're given two minutes, don't go a second over. You know, if you're going to be speaking in front of a committee, you have a time. And you just got to stay within that time and you got to time yourself. And I think really too, draw from your career, all of us being nurses, we have so much, you know, that we can draw from. And it's, I think, also really important to have a story, make it human. It really draws them in.

Yes, I can't say enough about the importance of telling a story, especially if you do want to, you know, relay some of your experiences to policymakers. This will really help to bridge that connection and to help uh make these impacts happen. And and in your experience too, what collaborative efforts have proven successful that you've seen in advancing healthcare policies?

Well, I think we need to educate the legislators. You know, the legislators have a variety of backgrounds, you know, they're not all attorneys. Many of them are in education, many are in finance, many are in business. Um, so I really think we just a lot of it is educating them. You know, I'll give you the example of AB40, the one I talked about. It had a provision, you know, I mentioned establishing a statewide 20-minute ambulance patient offload standard. We knew that there was language that EMS Emergency Medical Services wanted to add fines to the bill for time spent on the wall over 20 minutes. So we worked with CHA, we put together marketing materials for hospitals to use when talking to public media lawmakers or rather key stakeholders to really paint a bigger picture. So it's just, it's a hospital, it's a public health sometimes, you know, crisis, and we really needed to share that. Um, we also included with our marketing, you know, an infographic called How an Emergency Department Works and Myths versus Vax Overview. Um we met with committee consultants. Um, we educated Emergency Medical Services Authority. This is something that the VPA policy has, Shereen Rose, and myself. We did a presentation. It was a 20-minute presentation with a 10-minute question and answer. And actually, the questions and answers, they let go to an hour because the audience had a lot of questions for us, where, you know, the inner workings of a hospital and how it can really impact some of the holds and what's happening in the emergency department. Another thing is breaking down the silos, letting them know what hospitals do and how much is out of our control. Um, and you know, also um, we were able to um establish a monthly meeting with the director of EMSA, Emergency Medical Services Authority, that oversees 34 of the LEMSAs within the state and their CMO. Again, it's breaking down that silos and it's educating. We met with the author, uh, Freddie Rodriguez, uh, who is from the Empire, who authored AB40, and he's former EMS. Um, so we again met with him and just you know voiced some of our concerns. We reached out to legislators uh tour the emergency departments in their educators, and that was happening up and down the state. And again, involving a wide range of stakeholders, um, involving healthcare providers, patients, insurers, communities, your chamber of commerce, your city council members to ensure policies addressing local and healthcare needs. So it's really just it's getting out there and getting your message across and really truly breaking down those silos.

Yes, it sounds like a lot of connection, a lot of networking, reaching out to the appropriate stakeholders to help advance some of these policies and to help get these stories to, you know, these voices heard and get these stories out there. And on the flip side, you know, what are some challenges that nurses can face when they engage in these advocacy efforts and how can they overcome them?

Well, I think number one, don't get discouraged. Um, you know, especially when progress appears slow, outcomes are not immediately apparent. And, you know, you might not get a win all the way, but I think along the way there are a couple of wins. And so I think you really need to celebrate those. You know, another, which, you know, we all have demanding schedules, and that sometimes can make it difficult to find time for advocacy work. And nurses may not always have access to the resources uh that need to be effective in their advocacy for their causes. You know, this can be financial, it can be training opportunities or support from their organization. So just, you know, kind of take a bite here, start slow. And, you know, I really look back, you know, when I started, which, you know, was back in 2014, and really where I'm at today, none of this happened overnight. It was bites. I mean, at that point, you know, being the director of the emergency department, and I was really much pretty much brought in to expand and rebuild the emergency department, which I was successful at. But, you know, we all have a lot of conflicting things going on. Life happens. Um, we have jobs, we have families. And so just take a little bit of a bite at a time and start slow. Um, and I also kind of want to share, you know, resistance from stakeholders to include policymakers and administrators. You know, nurses can use evidence-based arguments because we also were experts as far as that. Um, you want to build coalitions with other advocates and engage in respectful dialogue to try to win over the skeptics. And I, you know, I think another challenge, again, I kind of mentioned was lack of training. Nurses can seek out training opportunities through your professional organization, online courses or mentorship programs. You know, a perfect example is, you know, Emergency Nursing Association actually has a video that you can go on and watch and having a conversation with your local legislation. But what I kind of want to say, I think the cherry on the top is advocacy can empower nurses, giving them a voice, you know, in shaping healthcare policies and practices. And this can lead to increased job satisfaction and really a sense of professional fulfillment.

Yes, there are a lot of upsides to participating in this work despite these challenges. And I know that one of the challenges that you that you brought up was the time management. Maybe it's hard to dedicate the time for nurses to participate in these activities, but how would you recommend that nurses can really balance some of these advocacy efforts with their clinical duties and responsibilities?

Well, you know, I think, and I believe nurses can prioritize, you know, we're great, really truly prioritizing. We multi team, we're we're juggling quite a few things at one time. Um, you know, I think it's just setting aside specific times for advocacy work, such as, you know, before or after shifts, during breaks or on-off days, collaborating with colleagues, you know, to share advocate responsibilities and workload. You know, as I mentioned, Rose is my co-chair of EMS. We've been in this since 2017. And we a lot of times will share responsibilities on tasks that we needed to complete. We're currently working on like a uh policy and procedure template. So we're kind of dividing and conquering. Um, you know, I have to say we've also had late night and weekend phone calls, especially when we're in the car, driving. All right, I bought you in the car. Yes. Um, and I also believe, you know, nurses in you know, intricate, we all do advocacy into our daily practice. By advocating, we all advocate for our patients. Right. We also, you know, address systemic issues that affect patient care. Advocacy then becomes a natural part of their really part of our work, be it, you know, bedside work and anything that we do regarding our patients. And I really do believe, though, that nurses need to prioritize self-care because we certainly want to believe burnout. And, you know, we want to avoid burnout. And I can trickily say my work on legislation was really kind of my retreat a little bit. It was my way to kind of help me get through the craziness of the emergency department. So that's kind of what I want to share there.

Yes, you shared a lot of great nuggets. And I do want to highlight that there are a lot of transferable skills that you mentioned that nurses can take from their clinical expertise to advocacy and to legislation because they can they can still prioritize, manage their time into this work, but also they also know how to hone in on the specific points that they want to advocate and they could share that with others outside of the hospital and healthcare systems. And so I think that it's really important for nurses to acknowledge they already have these skills. They can just really transfer them over. But also important to keep in mind self-care, as you mentioned, because you know, we do want to be able to participate in these activities, but also we want to acknowledge and prioritize our own care. And so with that in mind, starting small is something that can certainly be an option. Maybe starting with the hospital or opportunities that people bring over to you or tell you about could be a good way to start. And, you know, with that in mind, I do want to ask, what impact have you seen as a result of nurses' involvement in advocacy efforts that you might want to share?

Oh, this is a great question, by the way. Um, I believe nurses' advocacy led to creation of policies that really have improved healthcare delivery, patient, you know, safety. Also, you think about working conditions for healthcare policy uh professionals. I'll give you the example of a recent bill. It's actually a two-year bill. It was introduced last year and it's following through with this year, and it's AB977. It's emergency departments. It actually is where assault and battery would make it uh assault or battery against a healthcare worker in the emergency department, punishable by imprisonment in county jail not to exceed one year, or by a fine not to exceed $2,000, or by both. And um this passed assembly, and then it is waiting for a Senate policy committee. I think one of the reasons it got through the assembly, there was a member of the Emergency Nursing Association that actually went up to speak at the committee and assembly, and it was powerful, powerful, and just made such an impact on how she really truly believed and felt that this bill needed to move forward, which so far it's looking good that it's in Senate. We hope it gets through Senate and then it will go back to assembly.

Yes, and it's great to hear that story. And did you want to share a little bit more as well on that topic?

Yes, I would. Thank you. Nurses often serve as advocates for public health issues, raising awareness about important health issues such as vaccination, mental health, and access to healthcare services. Nurses' advocacy efforts can also lead to improved patient outcomes by ensuring that healthcare policies and practices are evidence-based and patient-centered. And I truly believe we're experts with that.

Yes, thank you for sharing these really significant ways that nurses have contributed to legislation. I think oftentimes nurses may not see the impacts that they can make or understand what their voice can actually do as it translates to patient delivery, patient care. So these are really powerful examples, just as you mentioned. And I want to hear from you too about the future and how do you envision the future of nursing advocacy evolving, especially in light of ongoing changes in our healthcare systems and policies.

Well, I think the focus, uh, there's going to be, I think, several focuses, one of them being on health equity. Uh, nursing advocacy is expected to increasingly uh, I think, focus on addressing health disparities and promoting health equity. This and I believe it includes advocacy um advocating for policies that improve access to health care for those marginalized populations and addressing social detriments of health. I also believe technology is going to play into this, advocate um advocating for policies that protect patient privacy and promote the use of technology to improve patient outcomes. I also believe global health, nurses advocate advocating for policies that address global health challenges such as infectious disease and access to health care.

Those are all such popular and significant topics that are discussed nowadays. And I think now more than ever, nurses can lend their voice and their expertise to all of those different topics and make some significant changes, especially considering the fact that nurses are the largest segment of the healthcare workforce. There's many of us, many of our voices, and now is really the time to participate in these efforts. And I just wanted to give you just uh as we wrap up the conversation, just wanted to give you one chance to share any last comments or advice to any nurses or aspiring nurses who might be listening and who might be interested in participating in advocacy.

Well, I think what I want to say, I think it's a beautiful thing about nursing. Some of us start off in nursing, and you think you're going to go down this one route, but there are so many routes that we can go down. And I think, again, it's a beautiful thing about nursing. You might start off in public health. You might start off as an educator, a school nurse, critical care nurse, ICU, infectious disease nurse. And there's just a variety of things that we can do. You might start off as clinical, you know, clinical bedside nurse, and you get into leadership. You know, you can become an educator. Um, and I but all along the way, if you think about it and the care that we provide to our patients of what we are doing, we're advocating for those patients. So it is kind of a natural path that some of us may want to go. And so this is something that um I have just enjoyed doing over the years, and I am blessed to be given this opportunity at the current organization that I am currently working. And I'm loving my new job. I'm learning so much, um, just not about emergency, you know, uh legislation that affecting emergency departments, but also nursing. In addition to that, other areas um that aren't necessarily in my wheelhouse, but I'm getting exposed to.

Absolutely. Thank you so much for sharing your expertise and your insights today, Pam. It was great to hear about your story, your background, and how nurses could move forward in some of these efforts with the natural skills that they have. Thank you very much. Thank you so much. Our guest today was Pam Ellen, government affairs representative for Redlands Community Hospital. We'd love to hear your feedback. Email us at socialmedia atacnl.org and connect with us on LinkedIn and Facebook at ACNLNurse. And as always, if you like the show, please remember to rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes on the first Friday of every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.