When nurses speak, policymakers listen and communities thrive.

THIS MONTH state legislatures nationwide are gaveling in to debate and enact laws and regulations that affect their constituents’ lives in both major and minor ways. With the future of Medicaid and other top nursing priorities on the line, this is the time for nurses to speak up and speak out.

As I wrote in October, H.R. 1—signed into law by President Trump on July 4, 2025—will bring sweeping changes to Medicaid programs, cutting an estimated $911 billion and increasing the number of citizens without health coverage by some 10 million over the next decade (bit.ly/3KstxTm). The brunt of these reductions will fall on the 40 states that participated in Affordable Care Act (ACA) expansions that extended coverage to adults with incomes less than 138% of the poverty level.

Research shows that a host of economic and population health benefits are associated with ACA expansions. With these gains now at risk, states will need to dig deep to minimize harms and find creative solutions to ensure that their most vulnerable citizens still have access to care.

Many nurses may think “political advocacy isn’t in my lane,” and prefer to sit out on the crucial debates now happening in their states. However, the Code of Ethics for Nurses calls nurses to “take an active role in the democratic process, including through robust civic engagement and legislative and political advocacy” (codeofethics.ana.org).

As well, so many aspects of our professional lives are shaped by politics—from how our licenses are regulated and whether they’re portable across states, to who’s allowed to call themselves a nurse or a doctor. Governmental policies also determine how nursing education is funded, while laws and regulations impact how many patients you’re assigned and how much you’re paid through Medicare and Medicaid reimbursements.

If this doesn’t inspire you to take action, I encourage you to reflect on your last shift. Was everything perfect? Did every patient get what they needed without barriers? Did your department have appropriate staffing, resources, and support to achieve quality patient outcomes within a healthy and safe work environment? If not, consider how institutional and governmental policies affect these realities in all work environments.

A good starting point for engaging in advocacy might include reviewing the legislative priorities of your constituent or state nurses association. But I urge you to go further. Consider joining your state nurses association’s legislative committee or attending, in person or virtually, its state lobbying days.

The American Nurses Association’s RN Action site (RNAction.org) describes the association’s federal legislative and regulatory priorities and provides easy ways for you to contact your representatives and share your stories.

Here’s the thing: advocacy doesn’t just happen in our statehouses and on Capitol Hill. It also takes place around kitchen tables, in coffee shops, and at grocery stores. Neighbor-to-neighbor and coworker-to-coworker conversations in these and other places can shed light not only on the important work you do but also on why some policies require change or new ones created. This is how our democracy advances and works for us all.

As legislators return to work, let’s remind them through our presence and our priorities that advocacy is in our lane. Nurses are caregivers and more; we’re leaders, researchers, educators, innovators, and advocates for our patients, communities, and ourselves. We’re the heartbeat of healthcare, and when we advocate everyone benefits.

Jennifer Mensik Kennedy PhD, MBA, RN, NEA-BC, FAAN
President, American Nurses Association

American Nurse Journal. 2026; 21(1). Doi: 10.51256/ANJ012618