ANA Applauds CMS for Establishing Long-Term Care (LTC) Facility Staffing Standards


Achieving safe staffing levels for nurses across care settings remains a top priority for ANA. That is why we are pleased about a recent regulatory win—the Centers for Medicare & Medicaid Services (CMS) issued a final rule aimed at bolstering nurse staffing at long-term care (LTC) facilities.

This landmark regulation sets minimum staffing standards for nurses in LTC facilities across the country. CMS was directed to engage in this rulemaking by a February 2022 Executive Order issued by President Biden, as part of a larger focus on addressing challenges faced by nursing homes. The Administration signaled that this issue remains a top priority with Vice President Harris announcing the release of the final rule with an accompanying White House fact sheet.

ANA submitted November 2023 comment letters on the proposed rule that was released in September 2023—one on behalf of the association and the other along with over 25 state and organizational affiliates. The letters urged the agency to finalize its proposals with suggested refinements. ANA is pleased to see CMS finalize this landmark regulation, which sets nurse minimum staffing standards in LTC facilities across the country. The standards set specific ratios for registered nurses (RNs) and nurse aides (NAs) that are part of a total staffing standard. ANA is disappointed that CMS did not specifically call out licensed practical nurses/licensed vocational nurses (LPNs/LVNs) in the standard in recognition of their critical contribution to the patient care team but appreciates that the agency did note that these nurses can be used to meet total staffing standard requirement.

ANA is especially pleased that CMS also finalized its proposed requirement for all LTC facilities to have an RN onsite 24 hours a day, seven days a week (24/7). ANA has long advocated for this requirement and is encouraged that the agency also recognizes the importance of having an RN onsite 24/7. ANA comments on the proposed rule also encouraged CMS to ensure nurses are included in facility assessments and that any exemptions are granted based on rigorous assessments—which the agency incorporated in the final rule. Last, CMS also noted that they have $75 million to invest in LTC workforce development. The agency is still determining how best to roll out this initiative and ANA is watching for any opportunities to weigh in on any approaches to make sure they truly support and provide incentives for our nurses.

While ANA is encouraged that CMS finalized this important regulation—signaling the importance of safe staffing in LTC facilities across the country—we know our work on these standards is not done. Groups opposed to the rule have publicly shared that they will continue to fight to delay or halt implementation all together, potentially through the court system. We know that before the agency issued the final rule, efforts in Congress to tie CMS’ hands from issuing this rulemaking was making progress. We are discouraged by these efforts as ANA understands how important safe standards are for nurses and the patients that they serve.

ANA continues to analyze the provisions of the rule and educate its members on its importance—while taking time to recognize the significant win that this final rule represents for safe staffing efforts. We will continue to seek opportunities to protect this rule and promote similar efforts. Together with our members, we will continue to make real strides in addressing safe staffing for nurses and the patients they serve. 

ANA Builds Momentum on Nursing Priorities on Capitol Hill


During the first quarter of 2024, the American Nurses Association’s Policy & Government Affairs Department collaborated with lawmakers on Capitol Hill on several legislative priorities. Here is a highlight of several initiatives that aim to rebuild the nursing workforce and address work environment challenges facing the nursing profession. 

ANA Responds to Problematic Staffing Bill 

The House Ways and Means Committee recently approved the Protecting America’s Seniors’ Access to Care Act (HR 7513), which would prohibit the U.S. Centers for Medicare and Medicaid Services (CMS) from finalizing its proposed long-term care safe staffing regulation.  

ANA sent a letter to House Leadership expressing its concerns about the bill’s adverse impact on the nursing workforce and the importance of ensuring safe staffing in long-term care facilities. ANA urged Congress to work with the Administration and stakeholders to find a balanced approach to addressing healthcare workforce challenges. It remains to be seen whether House Leadership brings the bill to the floor. Thankfully, the bill is dead on arrival in the Democratic-controlled Senate. 

ANA Co-Hosts Workplace Violence Briefing on Capitol Hill 

On March 22, ANA co-hosted a congressional briefing on workplace violence in emergency departments along with the Emergency Nurses Association and the American College of Emergency Physicians. Katie Boston-Leary, Director of Nursing Programs at ANA, represented ANA’s perspective on workplace violence in healthcare, its adverse impact on the nursing workforce, and potential solutions for addressing the crisis. 

 Congress Acts to Provide Mental Health Support for Health Professionals 

The House Energy and Commerce Committee recently voted to approve H.R. 7153, a bill that would reauthorize the Dr. Lorna Breen Health Care Provider Protection Act to provide mental health support to healthcare professionals. A companion bill, S. 3679, is pending in the Senate. On that same day, the U.S. Senate passed Senate Resolution 567 to recognize March 18, 2024 as the inaugural “Health Workforce Well-Being Day of Awareness.” A companion resolution is pending in the House (H. Res. 1089). 

Congress Invests to Attract More Registered Nurses 

Congress recently approved appropriations legislation to fund the federal government through the remainder of Fiscal Year 2024, which ends on September 30, 2024. While most of the Title VIII Nursing Workforce Development Programs and the National Institute of Nursing Research received static funding, Congress approved an increase of $5 million for Title XIII’s Nurse Education, Practice, Quality, and Retention Program for grants to increase the supply of registered nurses, specifically in long-term and acute care settings and in states having the greatest shortages. 

ANA Advocates for National Standards at the VA  

The House Veterans’ Affairs Committee held an oversight hearing to examine veterans’ access to healthcare services in rural settings through the U.S. Department of Veterans’ Affairs. ANA submitted a statement for the record, urging the VA to develop national practice standards for certified registered nurse anesthetists (CRNAs) that allow them to practice at the top of their license wherever they are needed within the VA health system. 

Lawmakers Introduce Bill to Restrict Mandatory Overtime for Nurses 

A bipartisan group of lawmakers in both chambers recently introduced the Nurse Overtime and Patient Safety Act (H.R. 7546/S. 3860). This bill would restrict the use of mandatory overtime for nurses with exceptions for federally-declared emergencies. The bill also includes whistleblower and nondiscrimination protections, transparency requirements, and civil penalties. The bill would require the Agency for Healthcare Research and Quality (AHRQ) to conduct a study on standards for safe working hours and the use of mandatory overtime. 

House Introduces Legislation to Attract Nurse Faculty 

The House recently introduced the Nurse Faculty Shortage Reduction Act (H.R. 7002), which would allow nursing schools to apply for grants from the Health Resources & Services Administration (HRSA) to supplement the difference between what faculty nurses are paid versus what equally trained nurses in clinical practice earn. It is bipartisan and was introduced in the Senate over the summer. 

Congress Reintroduces Measure to Support Nursing Workforce Pipeline 

The Future Advancement of Academic Nursing (FAAN) Act (H.R.7266/S.3770) was reintroduced in Congress. This legislation calls for critical investments to address immediate nursing education needs, while providing proactive measures to meet future workforce demands, including enrolling and retaining nursing students; hiring and retaining a diverse faculty to educate the future nursing workforce; support schools of nursing in partnership with healthcare facilities, to establish or expand clinical education; and to modernize educational infrastructure.

ANA’s Advocacy: Your Voice Matters, Make it Heard

ANA members at last year’s Hill Day.

Congress is on a short break, but the American Nurses Association (ANA) is always advocating for nurses.  

During this 118th session of Congress, we have worked with our nursing champions to introduce several key pieces of legislation. These bills cover both work environment and workforce development issues, such as preventing workplace violence, recruiting nurse faculty, and addressing mandatory overtime.

ANA believes that advocacy is a pillar of nursing. Nurses advocate for their patients daily to ensure they receive the quality care they deserve and that nurses are proud to provide. Political and legislative advocacy are equally important to shaping a future where the nursing profession and patient care are prioritized.  

Our advocacy is most effective when it is imbued with nurses’ voices and perspectives. Simply put, no one better understands the day-to-day struggles and triumphs of being a nurse than nurses themselves. Thus, to truly grasp the depth of these issues, Congress needs to hear directly from nurses. Contacting one’s federal representatives is a powerful way to make your voice heard and influence policy at the national level. 

Below, you will find our most recent grassroots campaigns that provide the language and information needed to easily contact your representatives. 

Take action today: 

Check out all of our grassroots campaigns and learn more about the bills by visiting our RNAction Center!