• Benign Prostatic Hyperplasia
  • Hormone Therapy
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  • Kidney Cancer
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  • Female Urology
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  • Kidney Stones
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  • Benign Conditions
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Advanced practice providers: Make advocacy part of your professional life


"It is imperative that APPs are active in advocacy for issues that remove barriers and ensure direct access to patients for their services," writes Adele M. Caruso, DNP, CRNP.

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Dr. Caruso is a nurse practitioner at the University of Pennsylvania Health System, Philadelphia. Urology Times blogs present opinions, advice, and news from urologists and other urology professionals. Opinions expressed by bloggers are their own, and do not necessarily reflect the views of Urology Times or its parent company, MJH Life Sciences.


Advocacy is an integral component of professional life for both advancing and promoting advanced practice provider disciplines, and also championing patient care issues within today’s health care system. So, let’s get active!

Advocacy and activism

Merriam-Webster defines advocacy as “the act or process of supporting a cause or proposal,” while activism is “a doctrine or practice that emphasizes direct vigorous action especially in support of or opposition to one side of a controversial issue.” Advanced practice providers (APPs) provide quality health care in the United States and have demonstrated that they can improve much-needed access to health care for patients. It is imperative that APPs are active in advocacy for issues that remove barriers and ensure direct access to patients for their services.

Health policy

According to the World Health Organization, “Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society.” One of my favorite definitions is by Longest, who defines health policies as “authoritative decisions regarding health or the pursuit of health made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others” (Longest, BB. Health Policymaking in the United States, Sixth edition. Chicago, Health Administration Press, 2016). Be cognizant of health policies that affect health through health determinants and vice versa; these include physical environment, behavior and biology, social factors, and health services.

Also by Dr. Caruso - The BCG shortage: No short-term solution!

There are also the important extrinsic factors such as money for health care, the provider work force, and technology (Longest, BB. Health Policymaking in the United States, Sixth edition. Chicago, Health Administration Press, 2016). As part of the expanding work force, APPs in urology care for the population health of patients with an array of genitourinary issues. By participating in advocacy and activism, we can support the policies we feel are in the best interest of our patients.

The legislative process

Understanding the phases of the policymaking process is key and includes the formulation phase of agenda setting and development of legislation, the implementation phase upon formal enactment of legislation, and the modification phase where all decisions in both these phases can be revisited and modified.

One must take into consideration the “window of opportunity” and external environment during this process. Know your political climate! This “window of opportunity” described by Kingdon opens when a confluence of problems, possible solutions, and political circumstances converge to stimulate legislation (Kingdon, JW. Agendas, Alternatives, and Public Policies, Update Edition, with an Epilogue on Health Care, Second edition. Upper Saddle River, NJ, Pearson Longman, 2011).

Role of advocacy in your discipline

Nurse practitioners and physician assistants have health policy initiatives, and being familiar with these initiatives is imperative when called upon to articulate these agendas. Become familiar with current legislative objectives both regionally and nationally. If you are not already a member, join your professional association. Nurse practitioners and physician assistants have advocacy agendas for both professional and patient issues on their respective websites (www.aanp.org, www.aapa.org). You might also consider becoming involved with your state’s advocacy organization; eg, www.pacnp.org. Get involved!

There are opportunities to advocate as an individual on both the state and federal levels, as well as advocate as part of an organization.  State advocacy is encouraged, and the AUA supports members to become effective state-level advocates to address legislation and regulations affecting their local communities. Federal and state legislative priorities are set annually and others may be considered as the need arises.

The AUA advocates for the specialty of urology and works at the federal and state level on behalf of its members and patients. Some federal legislative priorities include preservation of access to appropriate PSA screening, reform of the U.S. Preventive Services Task Force recommendation process, and addressing work force shortages. Examples of state advocacy priorities are medical liability reform efforts, support of efforts to reduce the burden of prior authorization, and support of legislative and regulatory efforts to expand meaningful patient access to telemedicine services.

Read: Hematuria evaluation: Evidence for optimal practice?

How can you make a difference in your professional practice? How you can help patients through advocacy? I challenge you to stay informed and participate!

As always, please feel free to share your perspective by emailing me at urology_times@mmhgroup.com.

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