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welcome to the 2019 nurses day at the legislature compassion advocacy responsibility and empowerment this is Patricia Moulton with the North Dakota Center for nursing and joining me today is Kristen roars who is the former vice president of government relations from the North Dakota Nurses Association and a newly elected senator for our North Dakota legislature this present presentation was developed by our nurses day at the legislature committee nurses day at the legislature is developed by a planning committee that is part of the North Dakota Center for nursing leadership team this committee is always growing and we always invite additional leadership team members and those that are interested in helping to plan the event today on our webinar we will provide a review on how a bill becomes a law legislative committees and structure parts of our government and tracking and we will also be taking a tour of the North Dakota state legislative website and our advocacy website Kristian roars we'll be talking about testifying and advocacy examples of previous bills roses of associations and then we'll provide a brief overview of nurse's day at the legislature and registration so loss can be made a couple of different ways they can be made by elected officials through the legislative branch and usually they are ideas by citizens or by legislators that are then sponsored and run through our legislative session or certainly laws can also be made by a vote of the people through referendums initiatives etc the medical marijuana measure and several of the initiatives on our recent vote would be examples of this in the picture is actually representative of Karen Rohr she is a nurse practitioner from the Bismarck area and she's been a legislature for several years so to talk for a moment on how a bill becomes a law first a bill has to be passed by the legislature which is divided into two different chambers the house in the Senate the bill then must be signed by the governor's office through the executive branch without a signature the bill doesn't become law the governor may veto the law and send it back to the legislature this actually happened several times in the last session the governor vetoed sections or even a couple of words of some of the bills that we were tracking if the governor vetoes a bill the bill can still be made into law if both chambers of the legislature vote a supermajority of 2/3 to override the governor's veto the power to sign veto legislation is one of the most significant tools at the disposal of the governor in promoting their agenda and it's also a significant tool for the legislators because the legislature is hat legislators have to work closely with the governor in order to make sure that what the bills that they are working on will not eventually be vetoed by the governor once the bill is passed and is signed by the governor it is then implemented some laws go into effect immediately those bills have an emergency clause that allows us to become effective the day the governor signs the bill but most bills are passed and go into effect on August 1st the exception to this are appropriations and revenue bills which typically go into effect on July 1st which is the beginning of the fiscal year the executive the executive branch is charged with executing and implemented the laws passed by the legislature and signed by the governor and the various executive agencies may be assigned responsibilities and implementing and reinforcing the law so for instance if a bill includes a change to the nurse Practices Act the Board of Nursing actually is involved in figuring out how to implement it a lot of times bills or bills and laws are a very brief for example there is a a sentence in the nurse Practices Act that talks about that the Board of Nursing should have an education loan program but that is all that it says and so it was up to the Board of Nursing to actually develop rules and procedures for this and what happens after that is they develop these rules which are called administrative rules and they have public hearing and a public process the Attorney General reviews it to make sure it is here's to the Constitution and is legal and then it goes back to the administrative rules committee which is made up of legislators who then check to make sure that the rules don't the law that they passed but is it really this simple well yes and no the system works but there's a whole lot that goes behind the scenes there's a lot of activity with different political parties different lobbyists and interest parties and with the different levels of government and this is why the North Dakota Center for nursing has a tracking system and leadership team as a matter of fact our vision when we started in 2011 is to provide a unified voice for nursing excellence and so what we we want to achieve and what we have been working to achieve is that all the nursing community works together to get legislation passed and to make sure that legislation is is what we want it to be as a nursing community so as far as steps in the bill process it starts really with the idea the idea could come from the legislature or it can come from the public or a citizen somebody from an interested citizen or during an intern committee meeting and at that point the legislative council would prepare the bill for a legislator who would sponsor it that sponsoring are usually more than one sponsor as a matter of fact if you're trying to get a bill passed it's actually advantageous to have a sponsor from the Democratic and a Republican Party on both the House and Senate and then the bill is sponsored by the legislature is introduced at the legislative session they have a reading of the bill there's a committee assignment a nerd introduction where the presiding officer of that part of either the house or the Senate refers the bill to the proper committee the committee is actually then tasked with what I would call the investigation of the bill the bill is explained discussed there's a public hearing the committee debates and talks about it and then the committee comes back to the House or Senate with their recommendation since there is a little bit over around a thousand bills at each session not every legislator can go through and look into detail on every single bill so they really rely a lot on the committee to provide to do that and provide the recommendation and provide their information by and large a lot of legislators do follow the committee recommendation unless it's a highly controversial one and or it's something that a particular party through their caucus have already decided which way they're going to vote so they go back with an amendment or without an amendment from the committee and then once it comes out of the committee it is placed on the calendar where for final passage if there's an amendment they have to adapt to reject that amendment before they can actually put it on the calendar for the final passage there's a second reading and then once it passes that side and then has to cross over to the other side so if it starts in the house it has to cross over to the Senate side same same deal that gets announced and introduced goes to a committee and then they also provide a recommendation in that side then votes but what happens a lot of times is that the same bill is not passed on both sides of the house and the Senate in those cases there a conference committee is appointed it's three people from each side they discuss the bill make recommendations to both both houses and then both houses that have to approve the same bill in the exact same form at this point that bill is that enrolled and signed by the officers it's sent to the governor bills that don't require conference committee the same thing happens they're enrolled signed by the presiding officers and sent to the governor and then the governor can sign it or veto it this slide is really a nice diagram that's actually available on the legislative website it reminds me a bit of schoolhouse rock back in the 80s but it really outlines the steps I just talked about but an important part of this is really where the public input is the public you you can't go and testify during the floor sessions you really need to testify during that public hearing that is really your opportunity to do that other than public testifying during the public hearings you can also email phone or certainly send a mail letter or drop it off with your legislators or legislature in Bismarck if there's a particular bill that you are tracking but it's really important to make sure that you do utilize that public input to help impact that bill at the correct time so what is the point of Mini's I already kind of talked about how they had a lot of bills and that bills go through a lot of changes and certainly that committee has been designated by the legislature to do the heavy lifting on those bills sometimes they're even typos or simple changes in the language the North Dakota nurse practitioner Association has worked for the last few sessions on making sure that the language in all of the century code and the bills that come forward are updated according to their their Practices Act change which was about six years ago which allowed them to have plenary practice so consequently anytime the word doctor or physician comes up if it's appropriate the language needs to be changed to primary care provider to include physicians or nurse practitioners or whatever they need to do to make sure that it adheres to that particular part of the code and the change this is also a time for like I mentioned more intense deliberation they'll have a public hearing and then they will also have a working session on it at some point later sometimes a couple weeks later after the public hearing but that's really a time for the committee to really dive in at that particular bill and really decide what changes they want to make and to really weigh the four and the against testimony that they received sometimes they'll also have a second hearing if they didn't feel like everyone was heard or if they they want to find out more information so there are different committees for the House and Senate for instance there is a House Human Services Committee and a Senate Human Services Committee because they have to work on the bills for their particular side and then cross it over there are inter committees that meet in between the general legislative session and they're composed of House and Senate members and their purpose is largely educational they usually conduct studies based on topics that the legislature was stuck on at the last session so here's the standing committees on both sides the biggest difference really is the house has many different appropriations committees the Senate has one and the house split their appropriations into like an overall Appropriations Committee and then they have an education environmental government operations a human resources division so they have several Appropriations Committee they are a larger body of representatives so certainly there's a lot more people to split out into other committees and they have a few other differences so what is the role I kind of talked about that too they hold public hearings they Pro have people provide testimony they discuss the merits of the legislation problems overall impact they propose amendments and then they vote on a recommended action within the committee and then the committee itself reports out to the floor what their recommendation is once the community process is completed the legislation is reported back to the respective chamber individual committees cannot kill bills or resolutions all legislation all bills must be considered by committees and they will have a float on the floor of the respective chamber of course if a bill fails in either side it does not go to the other side it's effectively dead at that point in Minnesota they actually don't have that rule so they can actually have bills sit on their agenda for three sessions and then it will go away so they don't actually have to act on a bill often both chambers of the legislature will pass similar but not identical legislation they might be mostly the same but have different wording but they do have to pass identical legislation a lot of times the legislation by the two houses may be actually virtually opposites of each other often this is possible if the Republicans control one side and Democrats control the other side however that is not the case in North Dakota as we have had a republican-controlled House and Senate for a number of years but certainly each side might have their different ideas for instance the medical marijuana bill that passed last session there was quite a bit of difference between the two sides and then the conference committee got together to hash out their differences so as I just mentioned the legislation must be identical in both sides and passed by both chambers if this does not happen a conference committee is appointed that is composed of six members three from the house and three from the Senate the leader of each side actually point those community members and that is where party can sometimes play a role and I will say they can also reappoint members so there was a couple of instances last session where the the chair of the Senate or the house was not happy with how those could be a conference committee members were doing their job and he replaced them so they their work together and they're charged with merging common elements of the different pieces of legislation and developing a compromise that is acceptable by the House and Senate floors and then it is voted on again so North Dakota has three branches of government that serves a check and balances just like the federal government so the legislative branch includes the House and Senate like we've been discussing there's ninety four representatives on the House and 47 centers senators and they're all elected by North Dakota voters the second branch is the executive branch and of course that's led by the governor and lieutenant governor and there are several individuals on the executive branch that are elected such as the secretary State State Treasurer but it also is composed of all the state agencies the North Dakota Department of Health the Agriculture Department and also all the licensure boards all fall under the governor in the executive branch as well the third branch of the state government is the judicial branch and of course this is the various courts leading up to the North Dakota Supreme Court the Supreme Court serves as a check and balance for the state executive branch and for the legislative branch and they can overturn laws in a particularly interesting case last session the governor vetoed several words and items from several bills of the legislature in the legislature decided to sue the governor over those vetoes the case was brought up to the North Dakota Supreme Court who did rule on it so they serve as that third branch in that third check on the next slide I will bring you on a tour of the North Dakota State Legislature website but the site includes many resources for the session including finding your legislators and looking at their biography in fact they even list what committees and what bills they have sponsored in the past you can look at the century code administrative rules you can search for a and where the actions and video are located and you can also sign up for the legislative bill tracking system and for the legislative app to track during the session this is the legislative branch website on it you will find a lot of information for the upcoming session for example under Legislative Assembly you click here or over here to the 66th Assembly and you'll get the 2019 information there isn't a lot on here yet because they haven't organized yet for the session but you'll see the legislative deadlines information about the orientation and organizational session they will have for legislators and then all the committee's will be here bill information etc will all be on this website to give you an example of what will be there when it's live here's last sessions website and so on here they have for the regular session they ha e such an information membership who is on what committee hearing schedules the house calendars so each day they post what will be on the House floor session and the Senate floor session they have conference hearing schedules posted here they have all the bills and resolutions sponsors etc the other item that you might find useful is the video feed section of course there aren't any videos right now but during the actual session you can actually click on a particular day I believe I can go back to the 60 well let me do that right now but you can click on that day and they livestream the floor sessions in the Senate and house and they also record them so you can get them here the other way to get floor recordings and more information is to actually search by bill so there'll be a section search by bill number right now there are bills from last session so let's go take a look at one I'm going to take a look at the higher education budget bill because we tracked a lot on that one and so you'll see there's an action section and so you'll see that this is the bill text for when it was introduced each of the changes and then they're marked up versions and then the final enrollment for the bill there's also on other bills there's a fiscal note but this whole bill is a fiscal note really it's a budget bill you can also click on the video link and if you'd like you can actually still go for your video for wedding it was on the Senate and House floor for instance here's senator Homburg talking about the bill on February 21st and so you can look at all the different versions and all the video and what they had to say about the bill during the entire session and you can also during that during the session too and not just afterwards also for a legislative assembly you can search for legislators under each assembly but there's also on the bottom some convenient links so you can go look at biographies you can look for contact information you can find your legislators by searching for who is your legislator for your district and there's also links to the Constitution the century code session laws that govern how the legislature holds their session and administrative rules there's also a budget information session that they have been updating during the interim and then when the session starts they'll be putting new items here as well the state revenue information for example was just updated in October and it's their monthly and then they have a quarterly update summary as to how our revenues and our oil and gas tax revenues are going and at the bottom they also have agency rules information and several other handy links back at the home page you will see there'll be other links to find my legislators and then they'll also be a link to the tracking system there is a legislative tracking system that goes live at the session that you can sign up for and there's also a handy app that you can go utilize as well and they are all linked off of this website so here's the daily schedule this is the app that they use that you can actually put in what bills you're looking for and the same with a tracking system and then there's a legislative bill tracking system but anyone could sign up and use this is the North Dakota Center for nursing Advocacy Center it is located at WWN D Center for nursing org backslash advocacy - Center at the Advocacy Center you will find our legislative updates every week when we which we will have at noon every Friday during the legislative session and our last up interim update is on November 9th we will post the most current legislative update usually that Friday morning which is the soonest that we are able to post it and also the the dial-in information and the join me system so you can follow along on the update during the meeting the legislative updates always occur at 12 o'clock on Fridays during the session starting right after the session starts we will also list our current policy briefs for the session here and also on this website you can link to other resources such as advocacy fa Q's and at the site you'll see answers to many of your questions and where to find things how to search for bills etc and we also have several other resources linked under this site and this includes things like advocacy videos that you can download of other nurses that to talk about how they have advocated for change and other resource links to lots of different websites and it's still recording and I don't know how to stop it's still recording I think so for the 2019 legislative deadlines and key dates what's coming up is an organizational session so I'm recording this actually the day after election day in November Kristin actually recorded hers earlier but all those new representatives and the OL and the still in office rappers the house representatives and Senators will get together at December 3rd through 5th for an organizational session prior to that there will be a legislative management meeting in which they will look at the reports from all those interim committees and all the bills that were also passed out of those committees to start getting in and to get organized and during this session that's when they they pick who's going to be on what committee and and get ready also new senators and representatives will go through an orientation and the governor also this is when he he outlines his budget because every session the governor works with all of his state agencies to develop what he is proposing as his budget he also has been working for this session on developing a policy agenda that from what I understand it's gonna be a formal policy agenda and some of its going to include nursing workforce information based on a lot of the work we've been doing with the governor's nursing shortage task force so we're kind of excited because we've never been included in the governor's budget and certainly haven't gotten to this level so we're looking to December 3rd to 5th to hear more all the executive agencies by the way it's not just legislators actually that can file bills the agencies can also file bills so for instance at the North Dakota Board of Nursing wanted to make a change in the nurse Practices Act they could submit it by December 6 an agency bill and support a supreme court can do as well the session begins on January 3rd there's a state of the state address that day where governor burgum gets up and talks about what his priorities are as well and then you'll see there's deadlines for when people can introduce bills representatives can have no more than five after a certain date and then 0 after a certain date senators can submit ones at different times you see I've also highlighted a different legislative breakfast --is and days for nurses on January 15th in North Dakota a nurse practitioner association will have their legislative breakfast there's another deadline there and then we'll have our nurses day at the legislature on January 23rd and then there's deadlines for introducing resolutions and amendments and re referrals the bills public health days On February 6 and you'll notice that important date is February 22nd that's the crossover day for all bills so all bills must have passed through one side to crossover which by the way what I didn't discuss is some of the bills that require money would have a fiscal note and all those not only have to pass through the committee they also have to pass through the Appropriations Committee of those sides they'll have a very short recess and then they will reconvene and then they have to get all the bills and everything done by April 26 because the session is limited to 80 days this is a map of how the North Dakota State Capitol is set up you will be entering the doors through five or s right there the south side there are radar detectors there and then you will go into the Capitol rooms one three four five six seven and twelve 18 19 20 are all hearing rooms for committees and most of the committee's will stay in the same hearing room for the entire duration of the legislative session and this is a picture of first floor which is really the floor above the first floor of the entry floor and this is Memorial Hodge estate of Hollis where exhibits happen all legislative time I pointed out the nursing days but pretty much virtually every day somebody is having a day there and they have booze and they interact with legislators and this is the entrance into the Senate and the floor rooms and so in the afternoon usually 12:30 or 1:00 which is every day is when a floor and Senate session happens and so you can get invited to sit with your legislator in there and on the actual hall or there's a big balcony above it where anyone can go sit during the session this session by the way is also a video our livestream videoed and recorded hi this is Kristen Mars from the North Twitter Nurses Association today I'm going to talk to you a little bit about the difference between testimony and advocacy and how nurses can utilize it to affect change testimony and advocacy are two different things testimony is your specific action it's a letter it's a speech but that can be part of your advocacy advocacy is the overarching act of supporting a cause or a policy the most common formal advocacy that we engage in at the state level is testimony and specifically we often think of testimony in front of a legislative committee in North Dakota all citizens have a right to testify if they choose to if you are there representing solely yourself and your opinions then there really are no rules if you want to speak on behalf of an organization then you may need to follow some simple rules for example as a registered lobbyist I can introduce a non-registered person and then they are speaking on behalf of nd na if you are planning to testify before a legislative committee here are a few things to help you get started know the schedule get there early sign in at the lectern as soon as you have a chance try to use the time when the committee is on a small break between topics to hand out your testimony either by handing them directly to the legislators or to the committee clerk this will decrease some disruption when it is time for you to talk so they can have their attention on you rather than on the paper if your testimony is part of a coordinated effort have your different groups be organized know who is talking in which order this helps present a unified and professional front do your homework does anyone on the committee work in health care do they serve on a hospital board do they have a family member who is a health care provider is this a rural issue an urban issue or a global issue and what is the makeup of the legislators in front of you give them the information in terms that mean something to them to their constituents on your narrative you are the expert on this topic in North Dakota we have citizen legislators and very few of them understand the inner workings of the health care system so set the tone set the dialogue try to strike a balance between educating them and influencing them personal stories are great for emphasis or to illustrate your point but make sure you can back your testimony up with facts or with direct requests a sob story alone is not persuasive talk about how this particular bill will solve the problem how inaction will continue to affect patients or nurses or communities you've done your homework on the legislators but if you are crafting your message for your own members or constituents or for the media what do they already know do they already have a bias do they know you and why should they care about this be clear be concise boil it down to what they need to know keep it simple and easy to understand how does your issue fit into the bigger picture is there any opposition and if there is how can you take the wind out of their sails before they have a chance to present their side make sure you tell them what you want them to do all the stories and facts in the world don't help if they don't know what you want them to do at the end of the day an example would be to end your testimony with I encourage you to give this bill a due pass or a do not pass if you are talking to a legislator outside of committee to help educate them be prepared to walk and talk help them be productive with their limited time between committees okay it's time to get in front of the committee and here are some etiquette norms that you should be aware of when you start your testimony address the chair the members of the committee then introduce yourself so for example madam chair members of the Human Services Committee my name is Kristen roars if you are asked a question by a committee member prior to providing your answer again address the chair the members of the committee then answer it so mr. chair senator Smith members of the committee and then answer the question this language is hard to get used to but no one will get mad at you if you mess it up as long as you make an effort involvement in bills that the legislature can take on many different forms from passively monitoring to actively engaging passively monitoring can include things like monitoring just to ensure that nothing goes wrong or changes that you weren't intending for example making sure that Apr ends are included when appropriate and actively engaging may be things like testifying or letter-writing some examples in the 2017 legislative session include when North Dakota Nurses Association was approached by an individual to support a carbon monoxide monitoring bill we chose to write a letter of support but not actively get involved in the testimony another bill called the care act by AARP was one where we have written letters or written testimony in opposition but didn't devote a lot of time or effort to it some examples of bills that the nursing community as a whole have actively engaged in was ensuring that the role of the community paramedic had a clearly defined scope of practice and didn't duplicate services already in place co-sponsoring and helping to write workplace violence legislation with the Medical Association and creating position statements and providing testimony for loan forgiveness programs to benefit high need areas in nursing what role do associations play the goal of advocacy efforts by professional associations is to educate association members all professional nurses and the public about the importance of broad-based membership creative ideas esprit de corps an energetic participation in helping the profession improve and move to higher levels when greater numbers unite in one voice stronger and more powerful arguments can be advanced to achieve advocacy outcomes this is from J Matthew Matthews in the online journal of issues in nursing professional organizations like n DNA and n dnp a often take the lead in advocacy and testimony efforts as the Center for nursing and Board of Nursing have some restrictions on what they are allowed to do the Board of Nursing can only propose changes to the nurse Practice Act but can be called to testify anytime a nursing practice issue is included in a bill the Center for Nursing is limited to lobbying on specific topics related to their mission and on any formally developed policy briefs this leaves professional organizations to be the voice for Nursing and to be able to react when things rapidly change in the legislature and this would be another reason why we would encourage you to join your professional organizations so to review the events on Nurses Day at the legislature which will be January 23rd we will have exhibitor set up we invite all nursing organizations and nursing programs to have a table and sign up as an exhibitor for Nurses Day the set up is in the memorial and legislative halls which is where are the legislators go between their floor session etc and then we'll also have registration and breakfast in the Heritage Center we are asking that all of our participants Park in the Heritage Center parking lot which by the way is an advantage since we are using the Heritage Center we get to use that parking lot come through the Heritage Center - to register to get an overview of the day and breakfast before going over to the Capitol the Heritage Center is conveniently located right across the treet from the Capitol there will be legislative committee hearings and tours from 9:00 to 12:00 at the Capitol that we will have information about out the day of the events and really hopefully Friday before the event there'll be a lunch at the Capitol cafe on there you're owned we encourage you to contact legislators to eat with them if you would like and then from one two three years sometimes 12:30 to 2:30 it's really up to the House and Senate what their schedule is but they will have floor sessions you can contact your legislator or in advance if you'd like to sit with them on the floor we will also send out a survey to all our participants to determine who would like to sit on the floor as well and everyone else will have plenty of room in the balconies on both sides and then after the the various floor sessions they'll be a meet and greet with the legislators and yogurt parfait fruit cups in the memorial and legislative halls there is information and the link to register for nurse's day registration is open and live and the deadline will be in January shortly before the event so thank you so much we are so excited about our nurses day that's coming up our registration is open and on our website it's actually it's $10 for students and $30 for nurses to register for the day and usually I believe last time we had around 250 300 there so certainly we're hoping for more and it's just an awesome experience to come together as a nursing community to really impact and show our voice so thank you