33.3 Advocacy and Coalition Building

The Essential Steps in Forming a Coalition

Coalitions can advance a cause more effectively than independent work as resources are shared and credibility is enhanced. This approach offers a more widespread reach than any single organization could achieve. For example, a parent-teacher association (PTA) is a coalition that may work toward improving student safety by requiring bike helmets for children riding their bikes to school. Members of this coalition may be from several organizations, such as retail stores, the department of public health, local government, parents, and others. These members may attend specific conferences or write letters to legislators and local news outlets to advocate for their cause. The cause’s credibility is enhanced as the coalition may represent several organizations rather than a single special interest group. This dynamic often fosters trust and cooperation among several grassroots organizations.

The decision to form a coalition may be spontaneous or may be the result of a detailed analysis of a community’s need (Figure 33.4). In some cases, receipt of a community-based grant may necessitate the formation of a coalition to fulfill the objectives specified in the grant award. The first step in deciding to form a coalition involves clarifying the objectives and appropriateness of the activities planned. A community assessment of the existing strengths and weaknesses is an essential element in forming a coalition as this identifies potential barriers and support systems in place, which guides the development of the best strategies to implement. An analysis of the strategy to employ must include the cost of the resources required. See Assessment, Analysis, and Diagnosis for more information on conducting a community assessment.

Figure 33.4 Community members in Laredo, Texas, participate in a community engagement event to discuss opportunities and challenges around food, nutrition, and health in Hispanic communities. Following such an event, community members may choose to form a coalition to focus on an identified issue. (credit: Ganjofarid Anvarzod/USDA/Flickr, Public Domain)

The coalition then decides how members are recruited, how many are needed, and what type of members are essential to meet the coalition’s goals. While individual members may be recruited, existing member organizations may already be in place that are working toward a similar objective and may be willing to collaborate. Identifying competitors and adversaries who could impede the coalition’s objectives is also important.

When forming a coalition, a leadership team is essential. It is often composed of a chairperson, facilitator, individual members, staff, a steering committee, a lead agency, and member organizations. While the chairperson is the organization’s spokesperson, this individual is often responsible for signing letters, testifying in court, or serving in other roles to represent the coalition. The facilitator plays a key role as this individual will lead discussions and activities of the coalition and must possess the knowledge and skills of managing group dynamics. The facilitator will serve in a key role to resolve any disagreements, working in concert with the chairperson. The facilitator and chairperson may or may not be from the lead agency.

The coalition’s activities will be developed, discussed, and defined at the meetings, conferences, or workshops by lead members of the coalition. The necessary resources will be identified in terms of the time commitment of the members and lead agency as well as financial considerations. Local service clubs and foundations may be essential in providing additional resources, and student trainees and volunteers may also support the coalition’s activities.

The parameters of the membership agreement are critical to the organization’s success and must be established and agreed upon. The location, frequency, and length of the meetings, as well as the members’ expectations, is another important step when organizing membership. Also, there may be limitations to the duration of the coalition’s existence. For example, the coalition’s objective may be set to be achieved within 2 years, and a plan may be in place to disband the coalition when the objective has been met. Setting time limits for a coalition may help members decide their involvement level.

The meeting structure and the method of making decisions should also be well communicated to all members. Members may also be expected to participate between structured meetings, and this commitment should be carefully outlined. After successfully forming the coalition, maintaining the energy and vision of the objective for each of the members requires skillful vision and attention to detail when problems arise. Leaders of the coalition must anticipate these difficulties, such as power sharing, group dynamics, individual disagreements, and the process for acceptance of new members.

Leaders must also actively engage steps to renew the objectives through ongoing education and training. Leaders will also embrace the challenge of bringing new issues to the group. An important step in maintaining a coalition is to focus on celebrating the group’s successes, both large and small, and acknowledge key individuals who have gone above and beyond to support the cause. Evaluating the achievements will also lead to additional improvements in the strategies, enhancing the ability to continue moving forward. Evaluations may be formative (evaluating the process) and summative (evaluating the outcome).

Leaders and members of a coalition often serve to enhance visibility within a community to increase public awareness and influence the perception of the problem at hand. This may lead to additional organizations and individuals becoming interested in providing support. Lastly, while coalitions do not last forever, the mutual trust in relationships that are formed may last a lifetime, whether the objectives were met or not.

Nurses and Coalitions

Many nurses hesitate to become involved in coalitions to support public health causes until they or someone they care about is personally affected by structural inequities in health care. Sometimes, a university professor or a client may have inspired one’s interest in activism. Faculty in academic settings and nurse educators within the practice environment teach students and new nurses about safety and civility. They can ignite an interest in advocacy through mentoring and role modeling. In many ways, nurse educators are responsible for forming the professional identity of novice nurses to further the profession in an ever-changing health care environment (ANA, 2023a).

The ANA has developed a nursing advocacy coalition called RNaction that is available to help nurses act in groups on important issues in the United States that affect persons, nurses, and public health (ANA, 2023a). The Campaign for Action is another example of a coalition that has brought nurses, health care providers, consumers, educators, and businesses in almost every state together to ensure the health of all people by strengthening nursing (Campaign for Action, 2023). These state-level action coalitions build on the Future of Nursing Report to unite schools, fire and emergency services, and local businesses, clubs, and social justice organizations such as the Robert Wood Johnson Foundation to promote healthy communities by transforming health care. As a result of the Campaign for Action coalition, significant work is being conducted at the state level to address issues that impact health as a result of nursing care, such as access to health care, transforming nursing education, fostering interprofessional collaboration, the need for diversity in the nursing profession, and building healthy communities (Campaign for Action, 2023). For example, in 2022, 26 states improved access to health care by adopting full practice authority for all APRNs so they can practice to the full extent of their education and training. Several local and statewide programs have been launched to increase diversity in the nursing workforce due to this coalition. In Brandywine, Delaware, as part of the 2021 Nursing Innovations Fund project, the school district piloted an afterschool program called BSD’s Lifesavers to increase the awareness of nursing as a career to communities that are underrepresented in the nursing workforce (Campaign for Action, 2022). The program’s success will be measured by identifying the percentage of participants pursuing a career in nursing.

Nurses also advocate for health care of populations by seeking appointments or elected positions on various trustee boards for businesses and organizations that impact health care, whether in nursing, business, or education. The Nurses on Boards Coalition (NOBC) was formed in 2014 in response to the 2011 Future of Nursing Report, which called for nurses to lead change and advance health (Institute of Medicine, 2011). The NOBC collaborates with its member associations, partners in health care, and businesses to provide nursing leadership as members on the boards of directors for over 10,000 organizations (NOBC, 2021). Nurses interested in serving on boards may register on the Nurses on Boards Coalition website to find an organization that matches their skills and expertise or seek resources to build leadership skills. Many national organizations such as specialty nursing organizations have local chapters. Becoming a local chapter member is a great way to stay up to date on the latest science and network with other nurses with similar interests. Leadership opportunities often become available within a specialty organization, and most are elected positions. The Nursing on Boards Coalition offers web-based and one-on-one advisement with a mentor to develop the skills to gain leadership skills and build to higher-level positions in these or other organizations congruent with an area of interest to advocate for populations of clients and nurses.

Student Involvement in Coalitions

Universities have historically been centers for igniting social changes that improve health. At one college of nursing, senior-level nursing students were concerned about the lack of a mandate for the COVID-19 vaccination in the workplace. Under the direction of their public health faculty member, more than 100 students formed a coalition. They wrote letters to their respective legislators with their concerns, which launched a wide range discussion in the state, resulting in a meeting to discuss the issue with the state’s health commissioner. The box below shows an example of the letter the students developed. Student nurses have many avenues to become involved in advocating for the health of the communities they serve.