A Message From the AMSN Advocacy Committee Chair

Advocacy is not limited to politics or lobbying. It happens whenever nurses use their knowledge, experience, and credibility to influence a decision, improve a process, or speak up for patients, colleagues, and communities. Medical-surgical nurses see the impact of healthcare decisions every day. We recognize barriers, translate complex information for patients and families, and understand how policy and operational choices affect care at the bedside. Medical-surgical nurses often feel unprepared to exercise their advocacy skills at the legislative level.

AMSN has created an Advocacy Toolkit to help close that gap. It offers a practical starting point for nurses who want to speak up more effectively. The goal is not to turn every nurse into a lobbyist, but to help every nurse recognize that advocacy is already part of professional practice and to provide tools that make action feel possible.

Mike Urton, DNP, APRN, AGCNS
Chair, Advocacy Committee

Advocacy Happens Everywhere

Advocacy happens wherever someone speaks up or takes action. You do not need to start with a trip to Washington, D.C. Begin where your experience is strongest and where you can clearly explain what is happening, who is affected, and what should change.

1. At the Bedside: Speak up for a patient or family when the plan of care does not reflect their needs.
2. On Your Unit: Raise a recurring safety concern, participate in shared governance, or lead a practice improvement.
3. Within Your Hospital: Serve on a committee, contribute to a quality council, or present a recommendation to leadership.
4. In Your Community: Partner with local organizations, schools, or public health programs to address a specific health concern.
5. Across Your State: Engage with the state nursing association, Board of Nursing, legislative day, or speak with state policymakers.
6. At the National Level: Respond to public comments, contact federal legislators, and participate in professional organization advocacy.

5 Skills That Make Advocacy More Effective

1. Understand the problem: Gather objective information. Clarify what is happening and why, who is affected, and what evidence shows the issue is recurring.
2. Frame the problem: Describe the issue in terms that matter to the audience, such as patient safety, quality, staff well-being, operational efficiency, regulatory expectations, or financial stewardship.
3. Build and maintain connections: Identify people with relevant expertise or authority. Build trust before an urgent request is needed and remain engaged after the immediate issue passes.
4. Ask for action: State a clear, realistic, and observable request. Agreement that a problem exists is not the same as commitment to a next step.
5. Follow through: Summarize decisions, clarify ownership and timelines, provide additional information, review outcomes, and recognize incremental progress.

Communicate With Confidence

The toolkit includes guidance for several communication formats. Regardless of format, keep the message focused on one issue, identify yourself as a nurse, connect the issue to meaningful outcomes, and make a specific request.

• Elevator Pitch: Use a 30- to 60-second introduction to identify yourself, name the issue, explain why it matters, and state your ask.
• Email or Letter: Avoid messages that are overly informal or generic. Add a brief frontline example, concise evidence, and a clear request.
• Phone Call: Use notes or a short script. Legislative aides are influential partners and should receive the same professionalism as elected officials.
• In-Person Meeting: Research the audience, prepare your message, be clear about the ask, and offer to serve as a resource.

A Simple Message Framework

1. I am a medical-surgical nurse and I am contacting you about safe staffing standards.
2. This matters because when nurses are stretched too thin, patient safety suffers.
3. My experience or the evidence shows that addressing this issue would support a healthy work environment and ensure that patients receive safe, timely, and high-quality care.
4. I am asking you to establish enforceable staffing standards that give nurses the resources to provide the safe, quality care our communities deserve.
5. I will follow up by email in one week.

Toolkit Exemplars To Demonstrate Advocacy

The Advocacy Toolkit provides examples of what various types of advocacy might look like for two common examples:

• Safe staffing: This exemplar provides an example on how a nurse might speak to concerns with safe staffing by documenting observations and facilitating conversations with appropriate leaders to escalate the issue and propose potential solutions.
• Workplace Violence: This exemplar focuses on documenting incidents and near misses, using established reporting processes, reviewing prevention and support resources, offering practical recommendations, and following up on assigned actions and timelines.

Your Advocacy Challenge

Choose one concern from your practice, unit, or larger issue and complete these five steps:

1. Write a one-sentence description of the concern.
2. Search and read one story or article on the topic.
3. List 2-3 objective examples or data points.
4. Identify a person, committee, or organization best positioned to respond.
5. Draft one specific request.

Bonus points if you meet and follow up with the person or group you identified.

Share your 5-Step experience with AMSN by emailing ecostello@amsn.org or posting your experience on social media.

Help Us Strengthen the Advocacy Toolkit

This toolkit is intended to be practical for nurses across roles, settings, and levels of advocacy experience. As you review it, consider:

• Which section would be most useful in your current role?
• What additional exemplars would help you take action?
• Are the templates clear and easy to adapt?
• What barrier to advocacy is not yet addressed?

Share feedback, chapter advocacy updates, and examples for future newsletters with Mike Urton at mikeurton@gmail.com.

A Message From the AMSN Advocacy Committee Chair

On behalf of the AMSN Advocacy Committee, thank you for your continued engagement and commitment to advocacy. The first months of 2026 have already brought several significant policy developments—many with direct implications for bedside nurses, nursing education, and the future of our workforce. Additionally, ongoing uncertainty with international relations may have further long-term effects on future healthcare budgets and other services essential to positive healthcare outcomes.  

Medical‑Surgical nurses care for patients across the lifespan and across every care setting. As our population ages and healthcare complexity increases, our voices are more important than ever. Advocacy is not limited to Washington, D.C.—it happens every time a nurse shares their expertise, tells their story, or speaks up for patients and colleagues. As you read this edition, consider how these national conversations intersect with your own practice and community—and how you might use your voice to help shape the outcomes. 

Mike Urton, DNP, APRN, AGCNS
Chair, Advocacy Committee

1. Nursing as a Profession

In early 2026, the Dept of Education moved forward with rules changes that removed Nursing from the list of professions approved for higher graduate education loan limits. Along with Medicine, Dentistry, and Veterinary Medicine programs, the rules did keep Clinical Psychology and Theology as approved ‘professions’. Multiple national organizations and members of Congress have spoken out, but the Dept remains firm. While this doesn’t impact ADN and BSN programs, the potential increased barriers to graduate funding could impact both APRN and nurse faculty numbers. Both the ANA and Nursing Committee Coalition (along with others) continue to call for revisions of this rule.  

2. Scope of Practice & Licensure--It Matters

Nursing plays a vital role in expanding access and meeting the growing demands of healthcare. Scope of practice for nurses is determined by state Nurse Practice Acts and defines what nurses are licensed to do, ensuring safe, effective, and timely care. Strong, modern legislation empowers nurses to practice fully, improving patient outcomes. Nurses must act by supporting policies that protect scope of practice and expand licensure mobility to keep care accessible and responsive to community needs. Two specific topics to keep your eyes on: 

• Nurse Compact —Does your state participate in Nurse Compact and, if so, what are the rules/regulations surrounding the Nurse Compact? What do nearby states look like? 
• Virtual Care/Telehealth--What are the rules surrounding nurse participation in virtual care or telehealth nursing? How do those rules address patients across state lines? What are the rules/regulations around billing for services? 

3. Safe Staffing

Safe staffing is not an appeal—it is a necessity for safe patient care. Yet across the country, nurses continue to practice without enforceable staffing protections, managing rising acuity and unsafe workloads. While national standards now link staffing to patient outcomes, there is still no federal mandate for nurse-to-patient ratios. At the same time, pushback on Medicare and Medicaid staffing has delayed critical protections, as financial and workforce concerns take priority over patient safety. In New Jersey and New York, legislation continues to evolve, but gaps remain. Advocacy is no longer optional; nurses must continue to speak up, escalate concerns, and demand safe, accountable staffing.

Rosemarie S. Wright MSN, RN, CMSRN
Vice-Chair, Advocacy Committee 

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FY2027 Budget Proposals Related to Healthcare 

On April 3, the President released his budget proposal for FY2027 which again included some significant cuts to topics relevant to nurses, including Title VIII funding which is designed to support nursing workforce development (e.g., Loan Repayment), funding for nursing research via NINR, and decreases to the Dept of Health and Human Services (HHS).  

While Congress (House and Senate) are the bodies that approve budgets, the President’s proposal is seen as a major tool to state intentions and priorities of the administration and will become the starting point for Congressional budget drafts with the 12 major appropriations bills that fund the Federal government.  

AACN Policy & Advocacy Press Release, April 6, 2026
https://www.aacnnursing.org/news-data/all-news/article/presidents-fy-2027-budget-request-proposes-deep-reductions-and-eliminations-to-nursing-education-and-research-funding 

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Skilled Nursing Staffing Requirements 

.Medical-surgical nurses practice in a wide variety of settings. While the majority of our members practice in acute care hospitals, med-surg nursing care is certainly found in a variety of post-acute settings. Earlier this year, CMS repealed rules requiring 24/7 RN staffing in skilled nursing facilities following a lobbying effort with the argument that staffing and a rigid “one-size-fits-all" CMS staffing requirement was resulting in facility closures. AMSN advocates for minimum staffing standards in acute hospitals, but this topic of staffing standards is relevant for small, critical access hospitals. How do mandatory requirements, without an adequate pool of nurses, affect access to hospitals and other services?  

Of note, new legislation was introduced March 2026 to restore these staffing standards; Safe Staffing Saves Lives Bill (HR 8100) introduced by Rep Lloyd Doggett (TX). While this bill faces a very low likelihood of advancing, it is still important to know what legislation is being introduced and by whom. 

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Maryland “Safe Staffing Act of 2026” 

Maryland has a bill related to safe staffing that is moving through its legislature. It is one model of what this might look like at a state level. I wanted to include this summary of Pro and Con points to help illustrate that there are two perspectives that need to be considered. Neither AMSN or the Advocacy Committee are commenting on the bill specifically, but rather on the discussion around the bill:  

Key Features of Bill 

• Staffing Committees: Hospitals would be required to establish clinical staffing committees composed of at least 50% direct care workers, including nurses, nursing assistants, and technicians. 

   

• Public Reporting: Bill requires hospitals to report their staffing plans and progress to the MD Health Care Commission, making them public to ensure accountability. 

   

• Timeline: By January 1, 2028, hospitals must implement these staffing plans.

   

Potential Positives (according to Supporters) 

• Reduced Mortality and Better Outcomes: By allowing workers to set staffing levels, hospitals will see reduced medical errors, fewer patient falls, and lower infection rates. 
• Reduced Emergency Room Wait Times: By ensuring adequate staffing, ER wait times and ER boarding will be reduced. 
• Improved Patient Satisfaction: Improved patient experience and care quality. 
• Reduced Burnout and Improved Retention: Will improve nurse retention, reducing reliance on expensive and temporary agency staffing.  

Potential Negative (according to Opponents) 

• Reduction in Care Access:  Rigid staffing plans could force hospitals to close beds or turn away patients, reducing access to care. 
• Increased ER Crowding: If inpatient beds are closed because staffing plans cannot be met, emergency department crowding could worsen, contrary to Proponents' claims. 
• Operational Rigidity: Mandated committees, rather than flexible, management-led staffing, could hinder the ability to adapt to rapid changes in patient volume. 

• Redundancy and Cost: bill duplicates existing federal (CMS) and Joint Commission requirements.  

PDF-Testimony in Support of HB624

PDF-Statement in Opposition of MD HB624 

Letters AMSN has Signed and Bills AMSN has Endorsed in 2026 to Date 

• January:
  • NCC Letter Supporting Workers' Comp for Injured Federal Workers Act
• February:
  • NCC Letter Supporting Nurse Faculty Shortage Reduction Act
  • NCC Support of FAAN Act
  • Nursing-and-Friends-Letter, in support of adding post-baccalaureate nursing degrees (MSN, DNP, PhD) to the list of "professional" degrees
  • Comment on the proposed revisions to the U.S. Customs and Border Protection's (CBP) Electronic System for Travel Authorization (ESTA)
  • NCC Letter Supporting Title VIII Reauthorization
• March:
  • NCC FY 2027 Title VIII and NINR Initial Funding Request
• May:
  • NCC Senate FY 2027 LHHS-ED Written Testimony for the Record
  • NCC National Nurses Week 2026 Legislative Priorities Letter