As the coronavirus pandemic extends into a second year, nurses enter a second year of calling on Congress and the Administration to ensure an adequate supply of personal protective equipment (PPE) and prioritize COVID-19 vaccine distribution for health care providers. On these issues, the American Nurses Association (ANA) will remain a strong, clear voice until COVID-19 is no longer a threat to nurses on the job, wherever they provide care.
Throughout a challenging year of health emergency, though, nurses and their champions have not turned away from the serious workplace issues that pre-date and continue into the COVID-19 era. An example is workplace violence, which is shown to be highly prevalent in healthcare settings, causes harm to nurses and other health care providers, and undermines quality of care.
Violence and other abuses toward nurses are notably
underreported. One reason that many nurses do not report incidents of violence
is the belief that their experience will not be acted upon effectively by their
facility’s leadership. Even so, the Government Accountability Office (GAO) reported in 2016 that violence against
health care workers could be as much as 12 times higher than the overall
workforce. This is a critical issue from ANA’s perspective, given that nurses
are often the frontline providers in these settings.
The GAO concluded that more efforts
are needed. Principally, federal workplace safety regulations should be
strengthened. On February 22, 2021, Representative Joe Courtney of Connecticut introduced
a bill, with bipartisan support, that would do just that. H.R. 1195, the Workplace
Violence Prevention for Health Care and Social Service Workers Act,
is almost identical to a measure that passed the House, but was not afforded a
vote in the Senate, in 2019.
The bill would require the Occupational Safety and Health Administration (OSHA)
to have and enforce specific standards for health care and social service
employers. Specifically, OSHA could hold these employers accountable under new
safety regulations. The regulations would require health care and social
service employers to create violence prevention programs, take concrete steps
to reduce the risk of on-site assaults, and employ best practices to encourage reporting
and employee engagement in prevention.
ANA has
endorsed H.R. 1195, and is working toward speedy passage in the House, followed
by Senate action in this Congress. Future posts on Capitol Beat will explore
the issue and the legislation in more depth.
For
more information about the ANA’s advocacy on workplace violence, click here.
On December 15,
2020, the American Nurses Association (ANA) joined with the American Hospital
Association (AHA) and the American Medical Association (AMA) in an open letter urging health care professionals to take the
COVID-19 vaccination when it becomes available to them. Since that time, ANA
has been delighted to see the welcome images and stories shared of nurses
stepping up to take the COVID-19 vaccine, and prepare themselves to vaccinate
the general public when the time comes. In one of our favorite postings on social media, Reuters tweets a video of a
nurse in New York receiving their second dose, on January 4. And here is ANA
chief nursing officer Debbie Hatmaker cheering on nurse
volunteers to go out and get
the shots in the arms of the first tiers of vaccine recipients.
More recently, ANA, AHA and AMA released a public service announcement (PSA) calling for the American public to get the COVID-19 vaccination when it is their turn. The PSA emphasizes that COVID-19 vaccines are safe and effective, and will help us all as we work together to defeat COVID-19.
Many people, including some nurses and other health care providers, are skeptical about taking the vaccine. Some are distrustful of the speed with which the vaccine came to market. Others, including many individuals from Black American, Latinx and other communities of color, legitimately distrust a healthcare system that has a history of discrimination, abuse, and neglect. This history not only points back to unethical and inhumane scientific experimentation such as the Tuskegee project, but is manifest in persistent disparities and systemic injustices in health care access and outcomes, even to this day in the COVID-19 pandemic. ANA along with the American Academy of Nursing has called for broad-based social action to address injustice and racial inequities in health care. Disparities must be addressed if the project to vaccinate the nation is to be successful.
In an effort to lead by example and show certainty of the science in the safe outcomes of COVID-19 vaccines, ANA President Dr. Ernest Grant participated in the Moderna vaccine trial. “It afforded me the opportunity to stand in solidarity with nurses on the frontline, battling the COVID-19 pandemic all across the U.S. Secondly, I recognized the urgent need for Black Americans to participate in vaccine clinical trials,” said Dr. Grant. The trial was unblinded earlier this year and Dr. Grant learned that he did receive the vaccine, as opposed to the placebo. He has elected to remain in the study for the full two years, as Moderna continues to gather data on the effects of the vaccine.
ANA leaders are confident in the capacity of the nursing profession to meet this moment. This confidence comes from knowing that nursing remains the most trusted profession, and that nurses hold themselves to high ethical and practice standards. Following these standards in the broadest sense means that a nurse will have an informed, considered approach to receiving and administering the COVID-19 vaccine. A nurse must consider their duties to optimize patient outcomes and promote the common good, along with the responsibility to safeguard their own well-being. In any situation, there is an ethical obligation to seek and obtain education and information, as well as advocate for answers when there are questions. Nurse leaders have a duty to provide nurses with accurate and accessible information so that individual nurses can make an informed decision for themselves and in turn assist in counseling their patients.
In a survey of 13,000 nurses conducted last October, four out of ten nurses indicated a need for more information about the COVID-19 vaccine as a major reason for their skepticism at that time. To meet that need, ANA set about to educate nurses and equip them with the tools they need to make decisions for themselves and for their patients. One key component is a set of Guiding Principles for Nurses, organized around themes of Access, Transparency, Equity, Efficacy, and Safety, approved by the ANA Board of Directors in 2020.
ANA continues to work to gather the most credible, evidence-based information about the vaccines, and share that information widely with members, nursing communities, partners in health, and policymakers.
Nurse-focused
materials available now include:
FAQs created jointly by ANA and the pharmacist
group ASHP, written with the clinician in mind.
A webinar and short-form videos featuring perspectives from a public health nurse
and presenting the facts about COVID-19 vaccine development and distribution
ANA’s dedicated
vaccine webpage also offers links to relevant information from partners such as
the Centers for Disease Control and Prevention (CDC). ANA is using its other distribution channels
to share information helpful to nurses in the vaccination effort, such as the Vaccine Handling Toolkit recently released by ANA’s partner US
Pharmacopeia. The toolkit informs operational issues on preparation and
labeling, storage and transport, and waste and disposal of COVID-19 vaccine
material.
Providing vaccine
education and resources aligns with ANA’s commitment to immunization as a critical component of public health. In
addition to providing information directly to nurses, ANA has advocated for
public policies to address specific aspects of the vaccine roll-out that are
important for nurses and their patients. In a letter to the transition
team for the new
Biden administration, ANA emphasized that nurses are central to vaccination
efforts and their voices should be considered in distribution planning. ANA
also called for federal resources to support mass distribution and
administration. Advocacy on vaccines goes hand in hand with continued advocacy
for policies to expand access to protective equipment and provide economic
relief as strategies that are also key to slowing the spread of COVID-19.
For more
information about ANA advocacy on issues that are important to nurses, visit RNAction.org.
On January 14, President Biden’s transition team unveiled the administration’s first COVID-19 relief plan—the American Rescue Plan. The $1.9 trillion plan would roll out in two steps: rescue and recovery.
The President’s plan is broadly aimed at shoring up the economy, but the proposal does address workforce issues of particular interest to nurses and other frontline health care workers, as well as teachers. President Biden is calling on Congress to provide $350 billion in emergency funding for state, local, and territorial governments to ensure their ability to keep front line public workers on the job. A key selling point for this aid is that it would bolster state capacity to effectively distribute COVID-19 vaccines, scale testing, reopen schools, and maintain other vital services.
In order to address health care coverage needs of patients, President Biden is calling on Congress to subsidize continuation health coverage (COBRA) through the end of September. The plan also directs Congress to expand and increase the value of the Premium Tax Credit to lower health insurance premiums and set a cap of no more than 8.5 percent of patient income for coverage.
Tragically, mental health issues and substance use disorders continue to be major consequences of the pandemic for many people, including frontline health care workers and first responders. President Biden has called on Congress to appropriate $4 billion to enable the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration to expand access to services for more Americans. ANA supports these broader mental health investments, as well as targeted efforts to address nurses’ mental health.
Acknowledging the economic hardships brought on by the pandemic, the plan includes $1,400 in additional direct aid for those with incomes below $75,000 and $400/week in enhanced unemployment insurance payments. The plan also includes funds for state work-sharing programs and would continue the moratorium on evictions through September 2021 for those struggling to pay their rent or mortgage. The plan would allocate $5 billion for combatting homelessness, provide a 15 percent increase in Supplemental Nutrition Assistance Program benefits, and a $3 billion increase in Special Supplemental Nutrition Program for Women, Infants, and Children. The plan also proposes to raise the federal hourly minimum wage to $15 per hour.
In addition to including benefits for the unemployed and underemployed, the proposed plan would provide hazard pay—going forward and retroactively—to essential workers who have taken on extra risk during the pandemic by working on the front lines. ANA supports recognition of frontline health care workers and continues to advocate for hazard pay for the nurses integral to combatting the COVID-19 pandemic. Additional support for families includes $25 billion for child care centers, expansion of child care tax credits and the Earned Income Tax Credit, and $1 billion in cash assistance for Temporary Assistance for Needy Families programs.
Last, President Biden is calling on Congress to allocate $3 billion for the Economic Development Administration (EDA). Grants from EDA provide resources directly to state and local government entities, tribal institutions, institutions of higher education, and non-profit organizations to fund initiatives that support localized economic development. This funding—double the amount provided by the CARES Act last year—would support the broad range of financial needs in communities across the country as they continue to respond to and recover from the COVID-19 pandemic.
As Congress and the administration work to see the policies contained in the American Rescue Plan signed into law, ANA continues to work with lawmakers to address the needs of nurses and patients in more targeted ways. ANA’s legislative agenda calls for specific steps to address nurses’ mental health needs, provide hazard pay, institute a moratorium on nurses having to use paid time off when they contract COVID-19, and investing the public health infrastructure and workforce.
