Advances in Health Policy Led by UCSF Nurses

July 2021By Milenko Martinovich and Katherine Tam

From the birth of Medicare to the phasing out of tobacco sales, faculty and alumni at the UCSF School of Nursing have played pivotal roles in advancing equitable and impactful health policies. Read about some of these major health policy triumphs that impact health care for all.

Setting the Standard

Our national standards for certifying nurses in pediatrics, cardiology and other specialties could not have been possible without nurse pioneer Margretta Madden Styles, Margretta Madden Styles EdD, RN, FAAN.

Styles, who served as dean of the UCSF School of Nursing from 1977 to 1987, spearheaded the first comprehensive study of nursing credentialing in the 1970s. She lectured and wrote extensively on the issue, and helped establish the national standards for certifying and credentialing nurses in numerous specialties that ensure patients receive quality care.

Providing Care to the Underrepresented

Catherine Waters More San Franciscans have access to quality, affordable health care coverage, thanks to the San Francisco Health Commission which included UCSF School of Nursing Associate Dean Catherine Waters, PhD, RN, FAAN.

As a commissioner — and particularly as a board member of the SF Health Plan (Healthy SF) — Waters helped craft quality, affordable health care coverage for San Francisco’s underserved population. Launched in 2007, Healthy SF now provides access to health coverage to 14,000 uninsured city residents. Waters also helped to secure funding for the only nurse-run clinic in the San Francisco Community Clinic Consortium, part of a network that provides care to more than 100,000 people in the city’s most vulnerable neighborhoods.

Expanding the Role and Impact of Nurse Practitioners and Nurse-Midwives

In 2020, two landmark California bills that expand the scope of practice for nurse practitioners (NPs) and nurse-midwives became law, paving the way for these professionals to help close the access to care gap across the state. UCSF nursing faculty provided research findings and data that built the case for their passage.

Joanne Spetz, PhD, ​FAAN, and Garrett Chan, PhD, RN, FAAN, served as subject matter experts to California State Assemblymember Jim Wood (D-Santa Rosa) and his staff Joanne Spetz, Garrett Chan as Wood introduced AB 890, a bill that allows NPs to practice without physician supervision. Spetz produced a series of briefs on scope of practice issues with the California Health Care Foundation. In addition, she and associate professor Ulrike Muench authored a study that found California NPs can help close the state’s primary care gap, and that state leaders, nursing educators and health care organizations should collaborate to expand education programs, increase the diversity of the NP workforce, and empower NPs to fully use their skills without physician supervision.

Spetz and Chan, who advocated for the bill’s passage through his work as president and chief executive officer of HealthImpact, also spoke at an educational event ​for legislators and legislative staff in 2020 on the topic. AB890 was signed into law by Gov. Gavin Newsom on Sept. 29, 2020.

Kim Dau In a parallel effort, Spetz and Kim Dau, RN, MS, CNM, lent their expertise to expanding the role of nurse-midwives in California. The pair co-authored a paper, with the California Health Care Foundation, that found that women cared for by nurse-midwives are less likely to have cesarean births, have similar health outcomes to those cared for by physicians, and report greater satisfaction with their care. In September 2020, California passed Senate Bill 1237, allowing certified nurse-midwives to independently provide midwifery care.

Currently, faculty members Susan Chapman, PhD, RN, FAAN, Beth Phoenix, PhD, RN, FAAN, and Matt Tierney, MS, NP, FAAN, are collaborating on studies aimed at expanding scope of practice for psychiatric mental health nurse practitioners. 

Fighting to End Tobacco 

Advocates continue to wage war against tobacco use — and UCSF nurse experts are leading these battles at regional, national and international levels.

Among them, professor Ruth Malone, PhD, RN, has conducted research on the tobacco industry for decades and is workingRuth Malone on formulating a “tobacco endgame” strategy. She has provided educational workshops and expert guidance to California communities working to enact policies that change the structural, political and social dynamics that perpetuate the tobacco epidemic. For example, in the last few years, Malone worked with advocates in Beverly Hills and Manhattan Beach, two communities that were the first in the nation to pass ordinances phasing out tobacco sales. Malone has also served as an expert consultant to the Centers for Disease Control and Prevention, the U.S. Department of Justice and the World Health Organization.

Valerie Yerger Meanwhile, professor Valerie Yerger, ND, has dedicated two decades to exposing the tobacco industry’s predatory marketing of menthol cigarettes in Black communities. In June 2020, the African American Tobacco Control Leadership Council, which she co-founded, and Action on Smoking and Health sued the FDA for failing to carry out its statutory duties and add menthol to the list of prohibited characterizing flavors to force the removal of menthol-flavored tobacco products from the marketplace. The American Medical Association and National Medical Association later joined as co-plaintiffs. On April 29, the FDA announced its commitment to issue a rulemaking process to ban menthol cigarettes and flavored cigars. Yerger encourages continued work at the state and local levels to ban the sales of menthol cigarettes and all other flavored tobacco products, as it could still be years before the FDA removes these products from the marketplace. 

On a global level, professor Stella Bialous, DrPH, RN, FAAN, has worked with numerous countries, including Brazil, South Stella Bialous Africa, Jamaica and the Solomon Islands, on developing tobacco control policies. She contributed to the United Nations’ WHO (World Health Organization) Framework Convention on Tobacco Control, a treaty developed in response to the global tobacco epidemic that “reaffirms the right of all people to the highest standard of health.” Bialous, who received the WHO’s World No Tobacco Day Award (2015) for her work in tobacco control, has collaborated with the WHO and other international agencies in developing monographs and white papers on tobacco, cancer and the role of the tobacco industry in undermining public health.

Protecting Older Adults 

Dorothy Rice UCSF nurse scholars have helped ensure the care and economic security of the rapidly increasing population of older adults.

The need for older adults to have health insurance gained attention through the research and advocacy of professor emerita Dorothy Rice, BA. As an analyst in the U.S. Social Security Administration in the 1960s, she exposed the fact that half of people ages 65 and older lacked health insurance — and many were unable to afford it. Her work contributed significantly to the creation of Medicare, as well as Medicaid and Social Security. Later, as director of the National Center for Health Statistics, she led the development of the National Death Index, which is the country’s central index of death record information and a valuable resource for researchers.

The federal Program of All-Inclusive Care for the Elderly (PACE), which provides comprehensive medical and social services Jennie Chin Hansen to older adults who continue to live in their communities, got its start under alumna Jennie Chin Hansen, MS ‘71, RN. As CEO of the San Francisco non-profit On Lok, Hansen led the organization as it advanced innovation in whole person care. On Lok’s pioneering program of comprehensive care for the elderly became the prototype for the 1997 federal law that incorporated PACE into Medicare and Medicaid programs. Hansen also served six years as a federal commissioner of the Medicare Payment Advisory Commission that reported to Congress. 

Charlene Harrington In the 1980s, Congress requested that the Institute of Medicine (now the National Academy of Medicine) examine the quality of nursing homes. Professor emerita Charlene Harrington, PhD, RN, FAAN, contributed significantly to a 1986 report outlining critical improvements necessary to improve nursing homes. This led to the passage of the Nursing Home Reform Act of 1987, which established federal standards for these facilities to ensure they deliver quality care.

To enhance the lives of older adults, Carroll Estes, PhD, FAAN, dedicated decades of research and advocacy to improve the health and economic security of older people as well as women, LGBTQ Carroll Estes individuals, people of color and people with disabilities. She served as a consultant to U.S. Commissioners of Social Security and to U.S. Senate and House Committees on Aging for three decades. Estes also founded the Aging Health Policy Center at UCSF, later known as the Institute for Health & Aging. She is actively engaged in research and publishing on COVID-19 and its risk and impact on inequalities among the aging and disabled. She recently published Aging A-Z (2019), and Precarity USA in Generations Today, co-authroed with School of Nursing assistant professor Jarmin Yeh and analyst Nicholas DiCarlo.

The Fight Against HIV/AIDS

For decades, UCSF nurse scholars and clinicians have advocated for individuals with HIV and AIDS, influencing policy through their testimony and authoring critical standards of care to prevent the disease’s spread. 

Carol Dawson-Rose Carol Dawson-Rose, PhD, RN, FAAN, worked as an HIV home hospice nurse through 2000, but her service did not stop there. She has continued to champion the rights of people living with AIDS and those caring for them through letter-writing campaigns and personal appeals to Congress. She has been a consistent advocate for reauthorization of the Ryan White HIV/AIDS Program — the largest federal program dedicated to providing care and treatment to low-income people with HIV — and the benefits of syringe exchange. She has also directed policy training for people living with AIDS, accompanying them on legislative visits to Sacramento and Washington D.C. She currently serves as president of the Association of Nurses in AIDS Care, which promotes the health and rights of people living with HIV worldwide.

During the AIDS epidemic, Florence Stroud, RN, authored guidelines concerning the prevention of prenatal transmission ofFlorence Stroud HIV and the care of mothers and children infected with AIDS. She twice served as interim director of the San Francisco Department of Public Health and was the first African American to serve as health director for the City of Berkeley.

Standing Up for Maternal Health

Through research and testimony, UCSF nurse scholars are addressing the U.S. maternal mortality rate, which is the worst among developed countries.

Monica McLemore Among them, Monica McLemore, PhD, RN, FAAN, testified before the House Subcommittee on Oversight and Investigations in 2019 on Title X, the nation’s federal family planning program, and participated in a 2017 Congressional briefing on maternal mortality. McLemore, whose research has been cited in four amicus briefs to the U.S. Supreme Court, also served as a health policy advisor to Rep. Barbara Lee (D-CA). She has also been advocating for the Biden Administration to create the Office of Sexual and Reproductive Health and Wellbeing, under the Domestic Policy Council.

Diana Taylor, PhD, RN, FAAN, helped develop training and research to support a law allowing nurse practitioners, certified Diana Taylor nurse-midwives and physician assistants to perform what are called first-trimester aspiration abortions. In addition, she has helped develop women’s health care delivery models, interdisciplinary education programs, practice standards and evidence-based practice guidelines.

Protecting Workers’ Rights

Workplace disparities that affect worker wellbeing, their families, and those they serve are being addressed, thanks to studies led by nurse faculty.

Kristen Harknett The research of Kristen Harknett, PhD, in collaboration with The Shift Project, was cited by Sen. Elizabeth Warren (D-Mass.), who reintroduced The Schedules That Work Act of 2019.  The bill aims to prevent workers from dealing with unstable and unpredictable work schedules. Harknett has also provided her expertise to the U.S. Department of Labor, the National Academy of Sciences Committee on Population and the California State Assembly as well as the city councils of Los Angeles, New York City, Chicago, Washington D.C., Philadelphia, Seattle, and Emeryville, California, on workers’ rights.

Ulrike Muench, PhD, RN, FAAN, has revealed the earnings gap between male and female nurses, showing that men earn anUlrike Muench average of $5,100 more annually. Muench’s findings and similar research have led to hospital managers re-evaluating pay structures and have helped pave the way for the reintroduction of the Paycheck Fairness Act, which aims to eliminate wage discrimination. (The bill passed the U.S. House of Representatives in April).