ANA’s Advocacy before the August Recess – Q2 Legislative Roundup

  

Ahead of the congressional recess in August, the American Nurses Association has been hard at work advocating for the profession on Capitol Hill.

Here is what you need to know: 

The House Appropriations Committee recently advanced its Fiscal Year (FY) 2025 Labor, Health and Human Services, and Education (LHHS-ED) bill. The bill proposes an $18.343 million decrease in funding to the Title VIII Nursing Workforce Development Programs, elimination of the Nursing Workforce Diversity Program, and the elimination of the National Institute of Nursing Research (NINR) as part of a proposed restructuring of the National Institutes of Health (NIH).

ANA and its allies in the nursing community continue to urge Congress to appropriate at least $530 million to the Title VIII Programs and at least $210 million to NINR. 

In other news, the House Education and Workforce Committee recently advanced the Improving Access to Workers’ Compensation for Injured Federal Workers Act (H.R. 618). The bill would eliminate outdated barriers in the Federal Employees’ Compensation Act (FECA) that limit the ability of nurse practitioners (NPs) to provide care and treatment for injured or ill federal employees. HERE is the letter that ANA submitted to the committee ahead of the markup. 

ANA engaged Congress in a variety of other ways throughout the second quarter of 2024: 

Establishing Long-Term Care Staffing Standards

ANA recently submitted a letter to House and Senate Leadership that urges Congress to oppose ongoing efforts on Capitol Hill to overturn the Centers for Medicare and Medicaid Services’ final rule that would establish safe staffing standards in long-term care facilities. The final rule was issued by CMS in April. The House Ways and Means Committee passed HR 7513 in March to prevent the implementation of the rule, and a pair of resolutions (HJ Res. 139 / SJ Res. 91) were introduced in May that would fast-track the process for overturning the final rule pursuant to the Congressional Review Act. 

Improving Access to APRNs

ANA recently sent a letter to the Senate Finance Committee that highlights ways that Congress can ensure Medicare patients’ access to nursing care through Medicare Part B Payment Reform. 

ANA recently submitted a letter to Senators Sheldon Whitehouse (D-RI) and Bill Cassidy, MD (R-LA) that highlights how Congress can expand Medicare patients’ access to primary care services provided by APRNs. In the letter, ANA calls on Congress to reform how CMS determines reimbursement rates for APRNs and ensure that nurses have a seat at the table when those decisions are made. 

Improving Care and Access to Nurses Act (ICAN) Congressional Briefing

ANA co-hosted a congressional briefing with American Association of Nurse Anesthesiology (AANA), the American Association of Nurse Practitioners (AANP), and the American College of Nurse-Midwives (ACNM) to bring awareness of the Improving Care and Access to Nurses (ICAN) Act (H.R. 2713/S. 2418) and its effort to remove regulatory barriers that Medicare patients face when attempting to see advanced practice registered nurses (APRNs). 

Minority Fellowship Program Congressional Briefing

ANA participated in a congressional briefing with the American Psychological Association, the American Psychiatric Association, and the National Board for Certified Counselors to commemorate the 50th anniversary of the Minority Fellowship Program (MFP). Administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), the MFP provides training, career development, and mentorship to mental health professionals from minority and ethnic backgrounds who are dedicated to serving patients of color and other marginalized communities. 

One Year Later – ANA Continues the Fight for Workplace Violence Prevention

  

As workplace violence (WPV) in health care continues to rise, nurses cannot wait for solutions. Last year, the Occupational Safety and Health Administration (OSHA) finally started work on a WPV prevention standard. According to OSHA’s own data, health care and social assistance workers now face six times the risk of WPV than all other industries. This is an increase from 2018 data which showed a risk of five times that of other industries.  

Yet it has been over a year and no further progress has been made.  

To urge action from the agency, ANA led a sign-on letter to OSHA from nearly 60 nursing organizations across the country last month. Acting Secretary of Labor Julie Su was questioned about the lack of progress on this standard in a Congressional hearing on May 1st of the Committee on Education and the Workforce.  

During the hearing, Rep. Joe Courtney, champion of the Workplace Violence Prevention for Health Care and Social Service Workers Act, underlined the importance of the standard’s quick release by highlighting the murder of nurse Joyce Grayson late last year. Joyce Grayson was a home health nurse killed by her patient despite many previous warnings to her employer that the patient was aggressive and dangerous. While OSHA did expedite an investigation into this case, and has cited the employer for failing to protect their employees from known hazards, it comes too late for Joyce Grayson.   

Nurses need and deserve a safe workplace. This requires robust evidence-based prevention programs nurses can rely on, no matter where they work. We are extremely disappointed that OSHA continues to deprioritize this live-saving standard and will not stop advocating for nurses’ safety and for OSHA to do its job.  

In addition to the regulatory work, ANA kept up the pressure and conversation on a state level through collaboration with the National Lieutenant Governor’s Association (NLGA). The NLGA represents the elected officials first in the line of succession to the governors in all 50 states and five U.S. territories. The bipartisan organization’s mission is to promote interstate cooperation and knowledge sharing as well as improve the efficiency of the office of lieutenant governor.  

At the April 2024 NLGA meeting hosted by Lieutenant Governor (LG) Pamela Evette, the Executive Committee and other attending LGs unanimously approved our Consensus Resolution (updated 7/19/24) on Workplace Violence Prevention in Health Care. The resolution acknowledges the severe nature of workplace violence in health care, urging members to recognize and support programs aimed at mitigating the issues.  

The consensus resolution demonstrates ANA’s commitment to addressing workplace violence through state and national advocacy and, supporting the implementation of comprehensive prevention strategies. This continued effort is vital to ensure the safety and well-being of nurses and other health care professionals. 

From left to right: Top Row: LG Kim Driscoll (D-MA), LG Tahesha Way (D-NJ), LG David Zuckerman (P/D- VE), LG Stavros Anthony (R-NV), LG Sabina Matos (D-RI), LG Jeanette Nuñez (R-FL), LG Deidre Henderson (R-UT), LG Larry Rhoden (R-SD), LG Josh Tenorio (D-Guam). Bottom Row: Secretary of State Omar Marrero (Puerto Rico), LG Garlin Gilchrist (D-MI), LG Pamela Evette (R-SC), LG Adam Gregg (R-IA), LG Aruna Miller (D-MD), Secretary of State Chuck Gray (R-WY) 

You can urge your federal legislators to support the Workplace Violence Prevention for Health Care and Social Services Workers Act through our Action Center. You can also sign up for alerts on all our campaigns at RN Action and stay tuned for more work on this issue at every level of government.

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.