Why Should Nurses Be Engaged/Involved in the Policy Process?

Discuss objectives:
Why should nurses be engaged/involved in the policy process?
How can they influence the process/have their voice heard?
What is “government”?
Government defined
Merriam Webster defines government as “the group of people who control and make decisions for a country, state, etc.”
In the United States, we have a representative democracy
Citizens elect leaders to represent their interests in the lawmaking process
The people that an elected official (i.e. Senator, Representative, etc.) represent are known as their “constituents”
Once an individual is elected to public office, nothing legally binds them to vote in a certain way

Brief overview of different branches of government, their roles, duties, etc.:
The system of government used in the United States is characterized by a “separation of powers”
Government is divided into three branches: the legislative branch, the executive branch, and the judicial branch
Certain powers are reserved to each branch, creating a system of “checks and balances”
This was designed to prevent any branch of government from obtaining too much power

Legislative
This is the branch that passes laws
At the federal level, the legislative branch is often referred to as “Congress”; at the state level, it is usually simply referred to as the “state legislature”
For both the federal and state government, the legislative branch is “bicameral”
This means that it is divided into two separate chamber, the “house” and the “senate”
Apportionment & Terms
Federal level—outlined in the U.S. Constitution
Senate
Each state has two U.S. senators, regardless of population
Senators represent their entire state—elections are conducted statewide
Senators are elected to terms of 6 years
Elections are “staggered”, meaning every 2 years, 1/3 of the country’s senate seats are up for election
The senate was designed to be the more deliberative, slower-moving chamber
House
The number of house seats allocated to each state is done proportionately, based on population
The larger a state’s population, the more house seats they are allocated
Regardless of population, each state is guaranteed at least 1 seat in the House of Representatives
“Reapportionment” is done every 10 years—if the census shows a state has grown or shrunk in population, relative to other states, they may gain or lose a house seat
In states with a single house seat, like North Dakota, representatives are elected by a statewide vote, and they represent the entire state
Most states have multiple house seats
Here, the respective state legislatures divide the state into “congressional districts” (each district is required to be approximately equal in population)
These representatives are chosen by elections held within each district, not by a statewide vote
In Congress, they are tasked with representing the constituents of their particular district, not the entire state
House Representatives are elected to serve 2-year terms
In contrast with the U.S. Senate, all members of the U.S. House of Representatives face election at the same time
“The People’s House”
This chamber was designed to be faster moving than the U.S. Senate and more reflective to the people’s immediate opinions, which is why its members face reelection every 2-years
State level—outlined in the North Dakota Constitution
Both members of the ND Senate and the ND House of Representatives are elected to serve 4-year terms
The state is divided into 47 districts, approximately equal in population
Each legislative district is represented in Bismarck by 1 state senator and 2 state representatives
Elections are staggered, so that approximately half of the state’s legislative districts hold elections every 2 years
The Senate and the House vote on laws separately
If a law passes one chamber, it is sent to the other for consideration
If a law is passed by both the Senate and the House, it is sent to the executive branch to be signed
At the federal level, it is sent to the President
At the state level, it is sent to the Governor
A law cannot be sent to the executive branch to be signed unless it passes both chambers
Executive
The executive branch is the branch of government tasked with executing the laws passed by the legislative branch
At the federal level, it is led by the President of the United States
At the state level, it is led by the Governor
Both the President and the Governor are elected to serve 4-year terms
At the federal level, Presidential and Vice-Presidential candidates run together as a “ticket”
They are elected by the “electoral college”
Each state has a designated number of votes in the electoral college, equal to the sum of their number of U.S. Senators and their number of U.S. Representatives
If a Presidential ticket wins the popular vote in a state, they win the whole of that state’s electoral votes (ignoring a few exceptions)
Currently, there are 538 votes in the electoral college; because a candidate must receive a simple majority of the votes in the electoral college to win, 270 votes are required
This system can allow for a Presidential ticket receiving fewer votes nationwide than another ticket, that is, losing the popular vote, to still win the presidency (i.e. George W. Bush in 2000)
Small state like North Dakota have greater influence under this system because they are guaranteed 3 votes in the electoral college
At the state level, candidates run for the positions of Governor and Lieutenant Governor together as a unified ticket
They are elected to 4-year terms
In contrast to the use of the electoral college at the federal level, a simple statewide election is used to determine North Dakota’s Governor and Lieutenant Governor
The executive branch has the power to sign into effect laws passed by the legislative branch
The President, or Governor, has the power to “veto” legislation sent to them by the legislative branch
If this occurs, the law does not go into effect—it is “sent back” to the legislature
The legislature can override the executive’s veto with the vote of a “supermajority”, 2/3, of each chamber
The Vice-President (federal) and Lieutenant Governor (state) are also members of the executive branch
The Vice-President serves as the President of the U.S. Senate and the Lieutenant Governor serves as President of the N.D. Senate
In the event of a tie in the senate, they cast the tie-breaking vote
All of the various departments, charged with implementing and enforcing laws passed by the legislative branch, are a part of the executive branch
Examples at the federal level
Department of Agriculture
Department of Health and Human Services
Department of the Treasury
Examples at the state level
Department of Health
Department of Transportation
Department of Commerce
Judicial
The courts system
Much more than just trying individuals for crimes
From whitehouse.gov: “Federal courts enjoy the sole power to interpret the law, determine the constitutionality of the law, and apply it to individual cases. The courts, like Congress, can compel the production of evidence and testimony through the use of a subpoena. The inferior courts are constrained by the decisions of the Supreme Court — once the Supreme Court interprets a law, inferior courts must apply the Supreme Court's interpretation to the facts of a particular case.”
The judicial branch provides a crucial check on the legislative and executive branches
Can strike down any law passed by Congress on the grounds of constitutionality
May also rule actions of the President (executive branch) to be unconstitutional
Executive orders
Actions of executive agencies, such as the EPA
Weakness
The courts cannot act alone
A case must be brought to them
In order for someone to bring a case to them, they must have been wronged
The courts have no enforcement mechanism
They may strike down a law on constitutional grounds, but they have no way of enforcing their decision
The courts need the support of the executive branch to implement their decision

At high levels, the judicial branch is insulated from the people
Justices of the Supreme Court/Judges of Federal Courts are appointed by the President, confirmed by the Senate
In contrast with the legislative/executive branches, they are not elected by the people—they don’t have any voters to appease, nor any fear of an upcoming election
Theoretically, this allows justices to vote their conscience, whether or not it will be politically popular

How is government divided? What do each of them do?
Federal
National level
President, Congress, Supreme Court, etc.
Powers are both originated and limited by the U.S. Constitution
10th Amendment: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
State
Laws apply only to the individual states
Governors, state legislatures, state supreme courts, etc.
City (“Municipal”)
Mayor, City Council, Municipal Court
School Board, Park Board, etc.
Policies apply only to cities themselves
Called “ordinances”, not “laws”
County
County commissions, Sheriffs, etc.

Why do I need to know about government? Why is it important to be informed/engaged in the process?
Everything that government does affects us
Recent-historical example of issue that had an effect on the nursing industry (this issue will be referenced throughout module)
Laws are always changing at the state and federal level
Upcoming issues (on-the-horizon) that may affect the nursing industry (these will be referenced throughout module as well)
Government by the people, for the people
If you don’t stay informed, take advantage of your right to make a difference, you’re surrendering your voice
Laws will still be made without your involvement in the process, but are they the laws that are best for you, your family, your organization, etc.?
Engagement and involvement allows you to influence the outcome
How does something become law? (very brief overview)
A couple of different ways—can be made by elected officials, or can be done by a vote of the people (explain referendums, initiatives, etc.)
The first way is far more common
How does this way work?
First, must be passed by the legislature, which is divided into 2 groups called “chambers”
Both chambers have to pass the law
House
Senate
**content on each of these chambers**
Next, it has to be signed by the Governor’s office (executive branch)
Without his signature, the bill doesn’t become law (veto)
Supermajority to override veto
Governor’s office has an agenda they are working to get through the legislature
Finally, the law is implemented according to the text
Is it really this simple?
Yes and no…
This is how the system works, but there’s a lot that goes on behind the scenes
Let’s learn more about the legislature
How many members are in the House & Senate?
Federal level
Senate: 100 members
House: 435 members, plus 5 nonvoting members that represent the District of Columbia, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands
State level
Senate: 47 members
House: 94 members
Why the difference?
At both the state and federal level, the House of Representatives is larger than the Senate
The House is supposed to be the chamber that is more connected to the people
By having more members, there is a greater likelihood that a broader range of viewpoints will be represented
The Senate is designed to be the more deliberative, slower-moving body
It was envisioned as the more “experienced” chamber—at the federal level, Senators must be a minimum 30 years of age while Representatives need only be 25
Because the chamber is smaller, it should be easier for negotiations to take place and for consensus to form
How do citizens get chosen to serve in the House & Senate?
Quick overview of campaign process
2-party system
The American political process is characterized by some as a “2-party system”
This is in reference to the two major political parties in the United States
Republicans & Democrats
But aren’t there more than two political parties?
Yes! In fact, there are dozens
Two of the more well-known “third-parties” include the Libertarian Party and the Green Party
Some candidates run as independents
So, why do people say we have a 2-party system?
It’s hard to win unless you’re a Republican or a Democrat
Advantages given to candidates belonging to either the Republican or Democratic parties…
Electoral College
In order to win any votes in the electoral college, a candidate has to win the popular vote in a state
In the 1990s, Ross Perot ran for President twice as a 3rd party candidate and gained a sizeable amount of the vote (18.9% in 1992 (“United We Stand” party) and 8.4% (“Reform Party” in 1996)
Perot earned a sizeable amount of the popular vote, but didn’t receive a majority of the popular vote in any state; didn’t earn any electoral votes either year
Ballot Access
Party Infrastructure
Primary Election
When most people think of political elections, they think of the general election in November
The candidates that voters get to choose from in November are usually determined through a “Primary Election” held sometime prior
Per North Dakota Century Code, primary elections are held “On the second Tuesday in June of every general election year”
Primary systems differ by state, so we’ll focus on North Dakota
“Open Primary”
Voters can only vote for candidates of one political party on election day, i.e. only Republicans or only Democrats
All candidates are on the same ballot
There are not separate ballots for Republicans and Democrats, just different sections on the ballots for candidates of the different parties
Voters can choose to vote for either Republican or Democratic candidates once they are in the ballot box
This means that a voter who considers themselves to be a Democrat could choose to vote for Republican candidates in the primary (or vice versa) and vote for the candidates that they think their party’s candidate would be able to defeat in the general election more easily
Most of the time in North Dakota, primary elections are a formality, that is, the majority of the races are not contested
How do candidates get their names placed on the ballot?
Most common way: Party endorsement conventions
The Republican and Democratic parties in North Dakota conduct “endorsement conventions” at both district and the state level
District level
Conventions held to endorse candidates for the state legislature (generally one senate candidate, two house candidates)
Voters attending the convention must be residents of the district
Candidates deliver speeches to attendees, who then vote on their favorites
The candidates that are selected at the district convention are then submitted for inclusion on the primary ballot
These conventions are very grassroots and easy to get involved with
Generally, there are relatively few people in attendance, so each person’s vote can carry significant influence
State level
Attendees at the state endorsing conventions are known as “delegates”
Each district is represented at the state endorsing convention by their delegates
The number of delegates allotted to each district is determined by party rules and are not equal
Delegates for each district are elected to serve in the role at their district conventions
Candidates are endorsed for partisan offices to be voted on statewide, including U.S. Senate, U.S. House, Governor/Lieutenant Governor, Agriculture Commissioner, Attorney General, Insurance Commissioner, Public Service Commissioner, Secretary of State, State Auditor, Tax Commissioner, and Treasurer
Most of the time, the candidates selected at endorsement conventions go into the primary uncontested, but sometimes they face challengers who have their name placed on the ballot through a different route
Less common way: petitions
Candidates can have their name placed on the primary election ballot by submitting a petition signed by a sufficient number of qualified electors
Number of signatures required varies by circumstance
For legislative offices, “the signatures of at least one percent of the total resident population of the legislative district as determined by the most federal decennial census.”
Required number of signatures for other circumstances can be viewed here:

Makeup of legislative districts
North Dakota is divided into 47 legislative districts
Each district is represented in the legislature by 1 senator and 2 representatives
Every 10 years, after the census, the legislatures goes through a “redistricting” process when district lines are reevaluated based on changes in population
Each district is supposed to be roughly the same size in population
Section 2 of the North Dakota Constitution states that the legislature shall “guarantee, as nearly as practicable, that every elector is equal to every other elector in the state in the power to cast ballots for legislative candidates.”
The last time redistricting happened in North Dakota was in 2011
Each district was designed to include approximately 13,664 residents
The largest district was 14,249
The smallest district was 13,053

How often does the legislature meet?
The legislature meets for its regular session once every two years
The maximum length of the regular session is 80 days, according to the North Dakota Constitution: “No regular session of the legislative assembly may exceed eighty natural days during the biennium.”
These days do not need to be consecutive
North Dakota legislative sessions generally begin in January and end sometime in late April or early May of odd-numbered years
In 2013, the Legislative Assembly convened on January 8th and adjourned on May 4th
The Governor may call special sessions of the legislature, which do not count toward the 80 day maximum
Where does the legislature meet?
The legislature meets for its general session at the state capital building in Bismarck, ND
Interim legislative committees, which meet between legislative sessions, may meet elsewhere in the state
What does the legislature “do”? What powers do they have?
The Legislative Assembly passes the laws which govern the state
They appropriate funds for the operation of state government
“Advise and Consent”
Applies only to the Senate, not the House
The Governor has the power to make appointments to a variety of positions
As a check on the power of the executive branch, the North Dakota Senate has the power to “advise and consent” the governor on some of these appointments—they must vote to confirm the governor’s appointees.
Offices that this applies to include:
Members of the State Board of Higher Education
Commissioner of Financial Institutions
Securities Commissioner
Oversight
It is the duty of the legislature to maintain proper oversight over executive agencies, government subdivisions, and other organizations receiving support from the legislature
They must ensure that these groups are respecting the intent of legislation they enact
They must ensure that the taxpayer-funds they allocate are being spent appropriately
What’s a bill? What’s a resolution?
A bill, as defined on the website of the North Dakota legislature:
“Bills create, amend, or repeal law. To become law, a bill must pass the House of Representatives and the Senate by a majority vote of the members-elect in each house. Bills may be introduced by members of the Legislative Assembly, standing committees, or the Legislative Management. A state executive agency or the North Dakota Supreme Court can have bills automatically introduced in the name of the standing committee to which the bill will be referred. House bills begin with the number 1001, and Senate bills begin with the number 2001. The Constitution of North Dakota (Article IV, Section 13) provides that bills adopted by the Legislative Assembly generally take effect August 1 after filing with the Secretary of State. However, certain appropriations and tax measures become effective July 1. The effective date may be later if specifically written into a bill. The effective date may be earlier if the Legislative Assembly declares an “emergency” and the measure receives a two-thirds vote of the members-elect in each house.
A resolution, as defined on the website of the North Dakota legislature:
Resolutions propose constitutional amendments, express opinions, request actions, congratulate, or console. Resolutions do not have the effect of law. Resolutions are the vehicles used to propose constitutional amendments for voter consideration. Resolutions are used to request an interim study by the Legislative Management on a specific subject. Resolutions frequently express legislative opinion to Congress or other federal offices with regard to federal programs or policies. House concurrent resolutions begin with the number 3001, and Senate concurrent resolutions begin with the number 4001. Concurrent means that a particular resolution must be approved by both the House and Senate. The House or Senate may use resolutions for their own separate business such as memorial resolutions for deceased members, e.g., House Memorial Resolution 7001 and Senate Memorial Resolution 8001.
What is a “Session Law”?
“Session Laws contain the text of all measures enacted (bills) or adopted (resolutions) by a particular Legislative Assembly. Session Laws also include:
Constitutional amendments proposed by the Legislative Assembly. Vote totals are provided for those “approved” or “disapproved” since publication of the preceding Session Laws.
Initiated laws or constitutional amendments and referred bills submitted to voters since publication of the preceding Session Laws (includes vote totals).
Governor’s veto messages.
Lists of House and Senate members.
A statewide legislative district map.

Recent Session Laws are online at “