Answer the following from the case study below: This case

Answer the following from the case study below: This case is a good example of nursing power through building partnerships and coalitions that have similar missions. Can you identify two coalitions that the state o florida nursing association actively works with? Can you describe the policy issues that these coalitions address? Successful advocacy is best defined as moving toward the ultimate goal(s) in a positive, substantive manner. Explain what advocacy you have done as a labor and delivery nurse, besides direct patient advocacy, to support health care in your nursing specialty. The purpose of this case study is to describe an exemplar where nursing advocacy can be more effective through strong coalitions and partnerships. The Case Study Breast cancer is the second most common form of cancer in women and is the second leading cause of cancer deaths. According to the American Cancer Society (ACS) (2017) breast cancer will affect 1 in 8 women during their lifetime and about 1 in 37 women will die of breast cancer. The statistics show that women of color and those in poverty have a higher incidence of breast cancer than white middle- and upper-class women. Breast cancer screening has been utilized to diagnose breast cancer early enough to improve the treatments, interventions, and outcomes for breast cancer. With 90% of registered nurses (RNs) being female, the American Nursing Association (ANA) (American Nurses Association, n.d.) has educated nurses to better understand breast cancer risk factors and the importance of regular screening. Nurses and other healthcare providers look to the ACS recommendations for mammogram schedules. These recommendations have gone through a number of permutations, but since 2015 the American Cancer Society recommendations state: Women with an average risk of breast cancer—most women—should begin yearly mammograms at age 45. Women should be able to start the screening as early as age 40, if they want to. At age 55, women should have mammograms every other year—though women who want to keep having yearly mammograms should be able to do so. Regular mammograms should continue for as long as a woman is in good health. Breast exams, either from a medical provider or self-exams, are no longer recommended. (American Cancer Society, 2015) Therefore, women should have mammograms as desired or as suggested by their healthcare provider based on their personal medical history and risk factor(s). This relies on the fact that a person has health insurance that covers these costs or is able to go to a free or reduced cost clinic such as Planned Parenthood (PP) for health care and screenings. Planned Parenthood and other clinics rely on funding from the federal government to assist in the costs for these services. Planned Parenthood follows the recommendations of the American Cancer Society regarding breast self-exam and can refer a person to a medical site where mammograms are done as needed. Planned Parenthood may be the only option for a woman to receive the necessary care for a breast cancer screening referral. However, if the U.S. Congress decides to reduce or completely remove funding to Planned Parenthood, what will those women do for breast cancer screening? Congress assesses what monies will go to what groups and establishments based on a number of factors, including what is the agenda of the president and Congress at the time, what is beneficial for and needed by certain congressional districts, and other special interests. According to the American Public Health Association (APHA) (2017) and other websites, the federal government does not directly fund Planned Parenthood, but rather reimburses states that have paid Medicaid bills for services by such clinics as Planned Parenthood. According to their annual report in 2015-2016, Planned Parenthood received 41% of their operating costs from government health services reimbursement and grants. With a portion of this money, Planned Parenthood did 321,700 breast exams and diagnosed 72,012 incidences of cancer through breast exams and Pap smears. If PP did not have this funding, these numbers would probably be much lower because some women would not have this care due to the inability to pay for it. For the past few years there has been a rolling debate about healthcare access and whether the federal and/or state governments will fund the health care needed by the working poor and uninsured who may not have the funds to pay for a mammogram. Initially, it seemed as though the Affordable Care Act (ACA) would reduce these disparities, and it has. However, some state governments have found ways to reduce the potential advantages that the ACA offers. For example, in New Jersey (NJ), Medicaid funding for clinics that gave patients family-planning and well-women care along with referrals for mammograms was completely eliminated by Governor Christie in 2010 (Culp-Ressler, 2015). Christie vetoed those spending bills five times in 5 years. Consequently, between 2010 and 2015, there was a 25.1% increase in breast and cervical cancer cases in Latina women in New Jersey. This was five times higher than women overall in that state (Culp-Ressler, 2015). Clearly the elimination of this funding has affected and will affect overall screening and care of vulnerable groups unable to pay for these expensive services. Contrary to this, a mid-July 2017 article by Brodesser-Akner reports that NJ legislators have enough votes with Democrats and Republicans together to override a governor’s veto for $7.5 million for funding to family-planning clinics, including Planned Parenthood. They believe that the previous vetoes have significantly reduced opportunities for NJ women to obtain necessary health care and that this funding is integral to improving the health of all NJ women. New Jersey is just one example of the ongoing divisiveness that has taken place over the funding of family planning and women’s health clinics by state and federal governments. This is not a new debate but one that has been in discussion for decades. The American Public Health Association (APHA) published a policy statement in 1991 emphasizing that minority women are at higher risk of death from breast cancer than white women and that education and regular screening are integral to the efforts of healthcare providers to reduce the occurrence of breast cancer and to improve overall outcomes. Even with this data-driven information, the federal government currently wants to eliminate funding to Planned Parenthood, thus potentially reducing access to breast exams and early detection of breast cancer for the millions of women who utilize these clinics annually. Nurses have been involved in lobbying efforts to better educate and assist our representatives to understand the importance of breast screening for all women regardless of socioeconomic status. Further, nurses have recognized the importance of building partnerships and coalitions in order to maximize their efforts and have deliberately partnered with groups and organizations that support the many issues that nurses support. If Congress is only looking at the cost of care given by Planned Parenthood clinics we must look at the entire picture of cost of preventive care versus the cost of breast cancer treatment. With these statistics, one would think that breast cancer screening, which can reduce cost and suffering, would be covered by insurance. The Affordable Care Act (ACA) covers an annual mammogram, as do most insurance companies as mandated by the ACA. The average cost for a mammogram is $456 (MDsave, 2018). According to a retrospective analysis by Blumen, Polkus, and Fitch (2016), the costs of complete breast cancer treatment for 1 year were from $60,637 for Stage I/II treatments up to $134,682 for Stage IV treatments. Not only will there be costs for breast cancer care but there will be potential loss of wages affecting partners and families in addition to an immeasurable psychologic toll. This huge disparity in costs for preventive mammograms and the overall cost for treatment seems to emphasize the importance of preventive care over the need to wait and treat women who get breast cancer. However, with the potential changes in the ACA and the current unemployment and underemployment numbers, what happens to those women who cannot afford the cost of a mammogram or the cost of insurance? Blumen and colleagues (2016) report that support for programs for breast cancer screening need to be implemented and strengthened to diagnose breast cancer and begin treatment earlier. With all of the political wrangling that occurs over the health and well-being of women, nurses have become advocates for these issues, and with their coalition partners have taken to Capitol Hill to educate their representatives and senators about the importance of healthcare coverage to include things like breast cancer screening. To accomplish this, (1) nurses will continue to educate their colleagues, patients, and families; (2) nurses will continue to meet with their representatives on the state and federal levels; (3) the ANA will continue to write position statements and nurses will testify in front of legislators; and (4) nurses need to bring real stories to their legislators about women with breast cancer who have benefitted from healthcare access and insurance, as well as stories where a person suffered due to lack of access and/or insurance. Nurses will continue to advocate for their patients and what is best for them by enlarging their reach through coalitions and partnerships. The Connecticut Nurses Association (CNA) is guided each year by their Connecticut (CT) legislative agenda and their prioritization of issues, which is informed by nurses and their relationships and partnerships with organizations across the healthcare and health spectrum. The CNA regularly engages in advocacy on health and nursing throughout the year and during the legislative session. To address the widespread impact of healthcare reform, the CNA is actively involved in the campaign entitled Protect Our Care CT (PCCT) (Connecticut Nurses Association, 2017). PCCT represents a coalition of organizations and individuals to support and represent the health needs of people of CT, including those who rely on the ACA, Medicare and Medicaid, and women’s health programs (personal interview Clear Sandor, 2017). For example, the CT Senate Bill 586 supported state Medicaid expansion of health benefits for children and women (State of Connecticut General Assembly, 2017). There is a long history of CNA’s active participation in the state regarding access to essential services and their partnership with other groups and coalitions; the CNA has supported this bill for increased essential benefits and access to care and members have been very vocal about this to their legislators through lobbying efforts, letters, etc. Although the bill does not increase funding for or access to breast screening mammograms, it does mandate breast cancer counseling, genetic testing, and risk assessment. In the future this bill could be expanded to include mandated mammograms no matter what a person’s insurance status is. This is an example of the impact of indirect action by multiple groups, including nurses, in strong coalitions. The CNA works collaboratively with its coalitions to strategically exert its influence and increase its voice on multiple healthcare issues that affect women. Coalition building is a key piece of being heard and getting legislation passed. Coalitions have provided nurses with a strong voice and enhanced their ability to provide high-quality, safe care. Summary This case study is one relevant example of the potential for possible negative outcomes related to decreased funding by governmental agencies; it also delineates the potential positive outcomes that are achieved with partnering, collaboration, and coalition building. Even though the issue of continued funding for Planned Parent clinics is not addressed directly, successes can be made incrementally that will increase support of important healthcare programs moving forward. Advocacy, in order to influence policy, is best operationalized through partnerships, collaboration, and coalitions. Although someone in power, such as Governor Christie, can veto a bill to reduce funding to a particular group, the representatives in the New Jersey legislature can introduce bills that can, with a bipartisan majority, override a veto by the governor. Similarly, the Connecticut Nurses Association maximizes its efforts through collaborating and partnering with various groups to form strong influential coalitions that can educate legislators about all of the pieces of breast cancer prevention and care. The combined efforts, along with the increased numbers of individuals actively participating in the process, enhances the work of lobbyists, who in turn influence the policymakers. The overall consequence is the increase in the voice of the public that influences the outcomes. This influence enhances the possibility of providing more adequate healthcare services to all citizens.

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