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Margaret Sanger began as being a visiting nurse on New York’s Lower East Side and had the unfortunately opportunity to witness a young patient of hers pass away due to an illegal abortion which caused several complications and eventually death (Nickitas, Middaugh, & Aries, 2016). After this experience, she took the initiative to fight for the right for women to be able to plan their pregnancies and prevent them if that’s what they wished to do. She went through several difficulties, including being going to jail for illegally distributing contraceptive pessaries to immigrant women through her makeshift clinic, having to create convincing arguments as to why practicing birth control would better serve the communities, and having to convince those in politics that this was the right thing to do (Nickitas et al, 2016).  Finally, in 1937, the modern family planning movement was established and birth control was endorsed. Sanger utilized her position in healthcare to improve the outcome for her future patients. Nurses have the ability to improve and influence health policies to protect patients, increase the safety of patients and facilitated access to the required resources, such as birth control, to improve the quality of care patients deserve receive (Arabi, Rafii, Cheranghi, & Ghiyasvandian, 2014).
            Sanger utilized her expertise as a nurse to advocate for change. She knew the complications women were going through to prevent an unwanted pregnancy and brought the issue to the attention of politics. Having been an expert, she lobbied to churches about the importance of family planning and the benefits it has over not having the ability to appropriately plan such life-altering conditions. She internally advocated to her local region the importance of needing better access and the ability to control family planning and birth control. She took the chances of being placed in jail to distribute contraceptive pessaries to immigrant women in the Brownsville section of Brooklyn with the intent to bring the issue of sexual and reproductive freedom out in the open as a women’s right. This event eventually results in the state of New York making a medical exception to New York’s Comstock Law (Nickitas et al, 2016). She wasn’t happy with just making a local change, she went further to Washington D.C. to advocate for nation-wide change, which was met with difficulty but was eventually welcomed. She eventually utilized external advocacy when she was able to expand from her position in New York to engage with external advocates to support her policy change. In 1952, the International Planned Parenthood was established in London (Nickitas et al., 2016) proving that her advocacy reached a broader audience than only state-wide.
            As for the Arkansas Nurses Association, they recognized a problem within their state. With 69 of the 75 counties in the state being medically underserved, they realized in 1990 that advanced practice nurses could be the answer to solving this crisis (Nickitas et al, 2016). When they first brought this issue to the legislature with the concept of APN’s having prescriptive authority, the legislature denied them. However, the ArNA, with the assistance of its lobbyist, began working together to develop a plan for APN’s to practice at the extent of their education. This began as a rural issue and eventually expanded to help improve the state-wide healthcare issue (Nickitas et al, 2016).
            In both of the case studies listed above, nurse’s experience lead to an initiative to improve the overall health of patients. Nursing is a highly trusted profession and because of this, nurses are able to become successful advocates. They must be able to develop a clear and broad understanding of the issue at hand, understand who is involved in the issue, and know how to propose a solution and identify who will be effected by it (Maryland & Gonzalez, 2012). Nurses shouldn’t be afraid to advocate for change at the local level. Their ability to see what changes should occur might eventually not only improve their own patients outcome, but it could lead to a nation-wide change to improve the outcome of all patient.

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