New Mexico Nurses Association Focuses On Climate and Health

  

Eric T. Riebsomer, DNP, RN – Guest Author
New Mexico Nurses Association

According to the World Health Organization (WHO), climate change is the biggest health threat facing humanity (WHO, 2023).  As we have witnessed recently, extreme weather events directly impact both social and environmental determinants of health (e.g., clean air, water, our food, and where we live).  The WHO estimates that between 2030 and 2050, these changes will result in approximately 250,000 additional deaths per year. According to the Centers for Disease Control (CDC), health impacts in the southwest will be related to higher temperatures (increased death associated with heat), poor air quality (from wildfires and dust storms), vector-borne diseases, and water-related illness (CDC, 2023).  A recent example of this occurred during the 2022 New Mexico wildfire season, where approximately one million acres were burned due to wildfires.  These wildfires impacted the respiratory and cardiovascular health of families while they were burning, impacted water quality after the fire because of massive flood and debris flow events, and displaced thousands of people from their homes in fragile communities in New Mexico.  

New Mexico Nurses for Climate and Health is a recently formed special interest group within the New Mexico Nurses Association (NMNA).  The aim of this group is to bring together passionate, New Mexico nurse leaders to advocate for building resilience against changes in our climate that directly impact our health.  In the 2021 New Mexico Climate Strategy report published by the climate change task force, building adaptation and resilience in public health was one of the highlighted sections where New Mexico was focusing time and resources. The New Mexico Department of Health (NMDOH) was using the CDC’s Building Resilience Against Climate Effects (BRACE) Framework to help New Mexico communities prepare for the impacts of climate change.  The other areas focused on building resilience were, natural and working lands, emergency management and infrastructure, and water and natural resources.

During the 2022 legislative session, New Mexico lawmakers brought forth legislation to create a public health and climate resiliency program within the Department of Health (DOH). The purpose of the legislation was to create a fund, which would be disbursed to local and tribal government entities for the purpose of adapting to climate change through grants. The purpose of the grants would be to help the recipients to prepare for or respond to health threats related to extreme weather and other climate change effects. The legislation passed both the House and Senate committees, though it was not signed. As New Mexico continues to address climate and health issues, the New Mexico Nurses Association needs to be a part of these initiatives, offering a nurse’s perspective on how climate impacts the health of our patients, when it comes to combining primary prevention strategies with building resiliency in our communities.   

While NMNA has created a special interest group to bring nurses together for this purpose, the role of nurses can be expanded outside of this, in all states.  As health care experts, a nurse’s voice during legislative sessions can be very powerful.  Nurses should get to know their legislators, talk to them about the effects climate change has on their patients.  Community and public health nurses in particular play a vital role in communicating this.  Another way nurses can get involved is by being on planning committees where they work, in their communities, or at their child’s school.  This allows them to have a voice in preventing or modifying activities that may cause harm to the environment, which may ultimately harm people.  Also, getting involved with the disaster preparedness team at their facility, this will offer nurses an opportunity to assist in developing primary prevention strategies to reduce the impact of environmental disasters, thereby building a more resilient community. In the end, anywhere a nurse can be involved in communicating how the health of their patients is impacted by environmental and climate changes, the better we are, and the more resilient our communities will become.

References:

Centers for Disease Control (CDC); https://www.cdc.gov/climateandhealth/effects/Southwest.htm (Accessed, April 2023)

New Mexico Climate Change Annual Report (2021); https://www.climateaction.nm.gov/wp-content/uploads/2022/05/NMClimateChange_2021_final.pdf

World Health Organization (WHO); https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health (Accessed, April 2023)

Large health care investments cap off eventful 2020 as we look ahead into 2021

  

What a historic year it has been on so many levels. Leaving behind the first year of a new decade that saw struggles which we could not have foreseen in January 2020, and going into a holiday season that looks vastly different from years passed and a future that is still unclear – it’s easy to focus on the negative. However, despite the trials and tribulations of this year, it is important and inspiring to recognize all of the ground-breaking work that ANA and nurses have done in the policy, government affairs and advocacy spaces, as we look towards what is on the horizon in 2021.

At the time of publication, Congress is in the process of passing a year-end package that will avert a government shutdown, include money for vaccines and COVID-19 aid to frontline workers, boost the economy, and include language to protect patients from surprise billing for health care. ANA has been working with our allies in Congress, and advocating to get these items addressed. Please be on the lookout for further details on the year-end package by visiting ANA’s new advocacy page. In the meantime, let’s acknowledge the progress made throughout 2020, which was necessitated by the COVID-19 public health emergency (PHE).

Earlier this year, the U.S. Congress and the President signed into law the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Included in the law is language that reauthorizes Title VIII Nursing Workforce Development Programs and authorizes Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs) to order home health care for their patients. These are longtime ANA federal legislative priorities, and we applaud Congress and the administration on their passage in the early stages of the pandemic. Advanced Practice Registered Nurses (APRNs) like NPs and CNSs are key to COVID-19 care and maintaining access to non-COVID-19 care throughout the crisis.

By summer, ANA was becoming a regular voice for nurses as Congress sought additional solutions to PHE challenges in the healthcare system. ANA President Ernest Grant testified at a hearing before the Senate Finance Committee, “Part 2: Protecting the Reliability of the U.S. Medical Supply Chain During the COVID-19 Pandemic.” Dr. Grant was there to answer the many questions Senators had about the impact of COVID-19. Questions ranged from what more the federal government could do to strengthen the supply chain, to the needs of nurses on the ground.

ANA also responded on behalf of nurses to proposals outlined in a white paper released by the Senate Health, Education, Labor, and Pension (HELP) Committee. The Committee requested input on what the U.S. had learned from the past 20 years of public health preparedness and response, and how we can better prepare for future pandemics. ANA’s response focused on how to rebuild and maintain state and federal stockpiles, improving public health capabilities, and increasing medical supply surge capacity and distribution. 

ANA has been consistently present with effective advocacy on personal protective equipment (PPE), which has been in short supply all year. As a result, the enterprise was tapped as leadership of a broad-based the coalition that will be a united voice to Congress and the administration on PPE and supply chain issues, to improve public health.

As we pivot to start working with the incoming administration, ANA has hit the ground running, providing substantive recommendations to transition leaders, and applauding the appointment of a registered nurse to President-elect Biden’s COVID-19 Task Force. We have communicated the many ways in which ANA and nurses can be a resource to the transition and the upcoming administration. We continue to solidify relationships to ensure that ANA will maintain a strong voice in the White House and key agencies in the months ahead.

Like the rest of the Policy and Government Affairs team, the ANA Political Action Committee (ANA-PAC) experienced a very successful year in 2020 despite the multitude of challenges it faced at the start of the pandemic. For starters, the PAC continued its winning streak with a 95 percent win rate in the 2020 general election for the nearly 100 candidates the PAC supported based on their pro-nursing agendas. Members of ANA drove their support unlike in years passed to the tune of over 5,600 contributors to the PAC which was an increase of 34 percent over 2019 and counting! And it doesn’t stop there: the financial strength of the PAC continues to improve as receipts are up 3 percent over last year and this number only continues to grow as we head toward the year end. Policy and GOVA will be spending the early part of 2021 strategizing our support for our existing nursing champions and starting new outreach efforts to those new freshman members of Congress. Stay tuned for updates in the next ANA-PAC quarterly newsletter.

ANA advocacy on federal regulatory policy has also strengthened nurses and demonstrated the power of nurses’ voices. With the COVID-19 PHE extended until March 2021, Medicare payment flexibilities gained in 2020 will continue. A number of these provisions expand access to APRNs for non-COVID-19 care as well as COVID-19 care, which has been a boon to patients and their providers throughout the pandemic, especially in rural areas.

The readiness of the Centers for Medicare and Medicaid Services (CMS) to remove regulatory barriers to practice has come as a result of direct advocacy over the years by ANA and partner organizations. The voices of frontline nurse providers were also heard, as CMS gathered first-hand accounts and created space to share this information on regular conference calls with nurses about the impacts of COVID-19 on their practice.

The pandemic has demonstrated the value of APRNs across the health care system, and CMS’ actions tell us that Medicare leaders are hearing us. The future is indeed bright, as CMS continues to review unnecessary barriers and craft regulatory relief. ANA policy leaders are right there, urging specific changes, and making a powerful case for making permanent changes to expand access to APRNs. We saw some success in the physician payment rule for 2021, which removed federal restrictions on APRN supervision of diagnostic tests.

CMS was not the only agency hearing nurses’ voices as important decisions were made. Early and often, ANA repeatedly called for steps to improve protections for frontline providers, including a return as soon as possible to pre-pandemic standards for PPE.

We made our case to the Occupational Safety and Health Administration, the Office of Minority Health at HHS, the Department of Veterans Affairs, Federal Emergency Management Agency, Government Accountability Office, and the White House Economic Advisors. ANA has become the “go to” organization for agency staff when they hear about events happening on the ground to work together to improve conditions for nurses. 

The pandemic made ANA’s presence even more valuable with the American Medical Association’s (AMA) RUC and CPT committees, which are the driving force for health care reimbursement. ANA CPT advisors were at the table when the CPT codes for both the Pfizer and Moderna vaccines were developed. In a separate process, ANA advisors were consulted to account for increased practice expenses incurred during the pandemic. Throughout, ANA engaged feedback and comment from the nursing community. All of these accomplishments could not be done without the loud impassioned voice of our ANA members and RNAction advocates. This united voice sent nearly 460,000 letters to Congress, responded to public comments and engaged in several surveys where the results were presented to Congressional offices across Capitol Hill. All of the input from nurses, our nation’s most trusted profession for 18 straight years, directly impacted legislation and policy throughout the year. We have you to thank for that – your efforts on the frontlines, your expertise and your advocacy do not go unnoticed. With over 200,000 RNAction advocates, we are poised to improve the profession of nursing and conditions for your patients again in 2021.

LGBTQ+ Pride 2020 Highlights Continuing March Toward Equality

  

June has traditionally been celebrated in the United States as LGBTQ+ Pride month. This annual celebration commemorates the Stonewall riots, which began at the Stonewall Inn in Greenwich Village in New York City on June 28, 1969 and sparked the modern LGBTQ+ rights movement. Like most else in 2020, this year’s Pride celebrations have taken on a different feel due to the ongoing COVID-19 pandemic, as well as the nationwide protests demanding racial and social justice in the wake of George Floyd’s murder in Minneapolis on May 25 (ANA adopted a Resolution on Racial Justice for Communities of Color on June 20). It is important to note that the LGBTQ+ rights movement and the racial justice movement are intertwined in complex ways (the civil rights movement is rightly credited for leading the way for the LGBTQ+ rights movement) and that many of this year’s Pride observances have occurred in support of and in solidarity with these nationwide protests.

This year’s Pride month also brought an unexpected bright spot for the LGBTQ+ movement. On June 15, the U.S. Supreme Court ruled in a 6-3 decision that Title VII of the Civil Rights Act of 1964 protects LGBTQ+ individuals from discrimination in the workplace; individuals can no longer legally be fired from their jobs due to their sexual orientation or the fact that they are transgender. This Supreme Court decision was a long-sought victory for the LGBTQ+ movement and signifies the hard-fought progress that has been made over the course of the past 50+ years.

Despite this progress, however, the LGBTQ+ community still faces significant barriers, particularly with respect to access to comprehensive healthcare. One need look no further than the administration’s June 12 finalization of a rule that rolls back healthcare protections for transgender individuals under Section 1557 of the Affordable Care Act. The administration finalized this rule despite the fact that LGBTQ+ populations experience a significant rate of discrimination in healthcare settings, and experience increased negative health outcomes compared with the overall population. The reasons for this are complex and varied, but many stem from a pattern of societal stigma and discrimination exacerbated by the historical designation of homosexuality as a mental disorder, the onset of the HIV/AIDS epidemic, religious prejudice with respect to homosexuality, and government policy such as Don’t Ask, Don’t Tell.

Negative health outcomes that disproportionately impact LGBTQ+ individuals include: increased instances of mood and anxiety disorders and depression, and an elevated risk for suicidal ideation and attempts; higher rates of smoking, alcohol use, and substance use; higher instances of stigma, discrimination, and violence; less frequent use of preventive health services; and increased levels of homelessness among LGBTQ+ youth. Men who have sex with men (MSM) and transgender women also experience significantly higher rates of HIV/AIDS infections, complications, and deaths; this burden falls particularly heavily on young, African-American MSM and transgender women. As noted above, this disease burden is itself known to contribute to discrimination against LGBTQ+ individuals. Transgender individuals also face particularly severe discrimination in healthcare settings.

Although Pride month draws to a close today, it is important to celebrate LGBTQ+ communities year-round and to remember that these communities experience unique health disparities 365 days a year. As the Code of Ethics for Nurses states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” Nurses have often been on the frontlines of providing compassionate care to LGBTQ+ individuals – most notably at the outset of the HIV/AIDS crisis – and will no doubt remain in the vanguard of that care to ensure that these disparities are eliminated.

For additional resources on providing care and other health resources to LGBTQ+ individuals, please explore this guide from Drugwatch: https://www.drugwatch.com/health/lgbtq/

Photo Credit: Matt Charnock/SFist