Lobbying Strategies for Federal Appropriations: Nursing versus Medical Education.

Abstract

The aims of this comparative exploratory descriptive qualitative study were to learn which lobbying strategies of interest groups are used and which of these strategies influence federal appropriators’ decisions. This study compared the lobbying strategies used to advocate for the Title VIII Nursing Workforce Development programs with those employed to advocate for Children’s Hospital Graduate Medical Education (CHGME). The CHGME program was selected as the comparison program for Title VIII because both programs are federally funded through the Labor Health and Human Services appropriations bill, authorized under the Public Health Service Act, and support a single healthcare discipline. Given the 483% increase in funding between Fiscal Year (FY) 2000 and FY 2001, it is clear the CHGME program has been able to significantly increase federal dollars. The Title VIII programs have not been able to secure the same level of appropriations or a dramatic funding increase.

Twenty-seven interviews were conducted with nursing lobbyists (n=10), CHGME lobbyists (n=7), and Congressional appropriations staff (n=10). The constant comparative method of analysis, a component of grounded theory method, was used to analyze the data. Open coding was used to generate the main themes and axial coding was used to relate concepts to each other. For example, comments by the nursing lobbyists were compared to those of the CHGME lobbyists and in turn with the lobbyists responses related to those made by the Congressional staff.

Results indicated that while nursing used similar strategies to those who advocate for CHGME, their level of investment in these strategies was significantly less. Moreover, nursing lacks specific components of inside and outside advocacy strategies such as grass tops advocacy and grassroots intensity, which impacts the profession’s ability to secure higher levels of funding for the Title VIII programs. A conceptual framework, future research and implications for the profession are offered.