Author: Lisa Stand

ANA Leads Nursing Community to Strengthen COVID-19 Vaccine Confidence

  

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.

Open Payments Expansion Will Capture APRNs’ 2021 Transactions

  

As a result of effective advocacy by nurses, federal policymakers are gradually moving the needle to expand access to advanced practice registered nurses (APRNs). As so often is the case, added opportunities for APRNs can some with more oversight or potentially greater scrutiny. A case in point is Open Payments, which will shed sunlight on APRN relationships with drug and device manufacturers, due to upcoming implementation of a provision in the federal opioid response.

It has been two years since passage of the landmark legislation, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or the SUPPORT Act. The SUPPORT Act unequivocally recognized APRNs as a key part of the nation’s response to the opioid epidemic. Specifically, Congress permanently enabled nurse practitioners (NPs) to obtain the necessary waiver to prescribe buprenorphine as treatment for opioid use disorders (OUDs). For certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists, this same authority is provided with a five-year sunset, ending in 2023. ANA is not done working with Congress to get permanent authority of all APRNs to prescribe Medication-Assisted Treatment (MAT).

Congress first expanded APRN authority to treat OUDs, on a temporary basis, in the Comprehensive Addiction and Recovery Act of 2016 (CARA). Elevating APRNs in the opioid crisis response has given patients with OUDs increased access to MAT. Medication-Assisted Therapy is a widely endorsed, evidence-based approach combining buprenorphine use with counseling and behavioral therapy. Allowing APRNs to prescribe buprenorphine has been especially beneficial in areas of the country experiencing shortages of healthcare providers. According to one analysis of CARA, the number of NPs prescribing buprenorphine increased by 79 percent, and rural counties had a higher proportion of advanced practice prescribers, including NPs, compared to urban counties.

At the same time, the SUPPORT Act included a provision that expands Open Payments to include information about drug industry payments to APRNs. That provision is set to be implemented over the next two years.

The Open Payments program is not new. Open Payments comes under the Physician Payment Sunshine Act, which Congress enacted as part of the Affordable Care Act in 2010. Open Payments allows anyone on the internet to look up their physicians (or teaching hospital), and soon other qualified health care providers, and find out about money or gifts their providers have received from sources such as drug companies, device manufacturers, and research sponsors. Open Payments was created out of the desire for transparency in certain health industry transactions, and out of concern that patient care decisions might be influenced by money from outside interests.

The Open Payments searchable database is maintained by the Centers for Medicare and Medicaid Services (CMS). As shown in the screenshot below, members of the public can visit the site and search providers by name and other information such as zip code.

A search reveals how much money a provider received in a given year, who made the payments, the types and nature of payment, and how receiving these payments compares to activity of other providers. The nature and types of payment include general payments, research-related payments, and food and beverage.

In addition to keeping and displaying the data, CMS conducts the process of collecting and vetting Open Payments information. Here’s how the process works, step by step:

  1. For each calendar year, manufacturers and other reporting entities transmit data on individual transactions (valued at around $11 or more) to CMS during an open reporting period in the following year, no later than March 31.
  2. After manufacturers and other entities report for the previous year, CMS prepares the data for disclosure to recipients identified by reporters.
  3. Recipients then have a window of time each Spring to review and verify information about them and ask for corrections if appropriate.
  4. Information for the previous year goes live on the Open Payments website each June.

For APRNs, step 3 will be important in 2022 and beyond, to ensure that reports of payments in the previous year are accurate. However, there are key steps that can be taken in 2021 to prepare. First, visit OpenPayments. Get to know the database and learn more about how to participate in the program. On the Open Payments site, there is a section titled Program Expansion and Newly Covered Recipients. Providers can also sign up for information and notifications.

To summarize, payments in 2021 from manufacturers to APRNs will be subject to reporting. In early 2022, the information will be entered in Open Payments. Affected providers will have a limited opportunity to review what is reported about them. The database will be updated with 2021 data in June 2022. This sequence will recur annually.

Safe and Sound Week – August 10-16

  

What makes a nurse safe at work? The American Nurses Association (ANA) supports and promotes nurse safety in its many aspects, which include use of personal protective equipment (PPE), preventing workplace violence, avoiding injury in handling patients, and having staff capacity that is appropriate for quality outcomes and nurse safety.

To draw attention to safety in healthcare settings, ANA partners every August with the Occupational Safety and Health Administration (OSHA) during Safe and Sound Week, which is now under way (August 10-16). The national week of activity is meant to recognize the successes of workplace health and safety programs, and share ideas on how to keep America’s workers safe.

This year, the COVID-19 pandemic has shown dramatically that nurse safety needs to be a priority 24/7, 52 weeks a year. The pandemic has tragically taken lives, including nurses’ lives, and challenged all corners of the healthcare system. ANA has been active in public and behind the scenes to advocate for all possible steps to ensure nurses are Safe and Sound at work, so they can continue to care for patients and educate the public about the pandemic. We must safeguard nurses’ and other frontline providers’ well-being and heed their invaluable insights so that the nation can recover faster and stronger.

As ANA President Ernest Grant said recently in impassioned testimony before Congress, “It is both a moral and strategic imperative for our nation’s leaders to do everything possible to arm and protect nurses and other critical responders as we work to combat the pandemic and prepare for future public health crises.”

For Safe and Sound Week in the year of COVID-19, PPE and workplace violence are of special concern to ANA.

Personal Protective Equipment. Access to appropriate PPE has been one of ANA’s main legislative priorities during COVID-19. Below are some talking points we have made to legislators and thought leaders, that you can also share with your elected officials:

  • PPE shortages continue to persist throughout the healthcare system. At one point this year, three out of four nurses said they are required to reuse their N95 respirators, or are encouraged to do so.
  • Many nurses have reported they do not feel safe using PPE that has been through a decontamination process.
  • Decontaminated respirators may not fit properly or may have other deficiencies.
  • When nurses voice their concerns about unsafe PPE, they should not be subject to retaliation. At ANA’s urging OSHA encourages workers to report such incidences.
  • A solution to addressing safety issues with PPE is to return to OSHA standards and pre-COVID guidelines as soon as possible.
  • ANA also supports creation of an OSHA standard specifically addressing risks of infection disease transmission.

For more information about ANA advocacy on PPE, visit the COVID-19 resources on Nursing World and share your voice with congress to let them know that more PPE is needed immediately.

Workplace Violence. Workplace violence by patients, family members, peers, and external individuals, including intimate partners, is a serious safety issue in healthcare settings, affecting nurses and patients. Yet violence and other abuses toward nurses are not well tracked and analyzed. One reason is that many nurses do not report incidents of violence, perhaps in the belief that their experience will not be acted upon effectively. The COVID-19 emergency has revealed unique threats that could arise in future emergency or high-stress periods, posing risks to nurses and to patient care. For instance, there have been times when family frustration about patient isolation has led to threats and violence. Nurses and other healthcare workers have also felt unsafe in their own communities, because of stigma and unfounded fears about exposure to the virus from healthcare workers specifically.

ANA believes workplace violence can and must be addressed. Our #End Nurse Abuse campaign is raising awareness about risks as well as ways to prevent violence and abuse in healthcare settings. ANA supports legislative and regulatory reform, such as OSHA standards for prevention programs, and collecting national data with effective reporting systems.

Safe and Sound Week is a good reminder that nurse safety is the responsibility of policymakers, employers, the nursing profession, and nurses themselves. Here are more ANA resources that can help keep nurses safe at work:

Safe Patient Handling and Mobility. In the HealthyNurse Survey 58 percent of nurses said they have experienced musculoskeletal pain at work in the past year. This pain is typically caused by the repetitive motions of transporting, mobilizing, repositioning, or ambulating patients. Musculoskeletal pain is not new to healthcare workers, and for the past 20 years ANA has advocated for safer practices and eliminating injuries for all professionals across the care continuum. For critically ill COVID-19 patients, proning procedures have been used to reposition patients, adding patient-handling risks for nurses.

In 2013, ANA developed the Safe Patient Handling and Mobility (SPHM) Interprofessional National Standards to assist organizations in creating SPHM policies and implementing and sustaining SPHM programs. Creating a culture of safety is the foundation for the standards. Without a commitment from staff and leadership, as well as the necessary financial resources, a successful SPHM policy cannot happen, and an SPHM program cannot be maintained. Other aspects of patient care are also addressed by safely handling patients including falls, pressure ulcers, skin injuries, and aggression among patients.

Mental Health.  Some nurses have become sick with COVID-19, but many others will suffer from anxiety, fear, anger, loss, isolation, loneliness, depression, stress, grief, or bereavement because of the pandemic. This is especially true for those who had pre-existing mental health conditions, or those serving on the front line. For all of us, mental health screenings, learning to build resilience, and getting the mental help needed immediately are key. Please see this blog and these webpages on nurse mental health and combating stress for further resources.

Self-Care. An empty plate has nothing to offer. If nurses are not rested, safe, well-nourished, fit, and satisfied with their work-life balance, then they may suffer personally and not be able to give the best care to their patients and families. That’s why self-care is so important. As difficult as this might be in the era of COVID-19 work and meal breaks, at least 7 hours of sleep daily, physical exercise, healthy food, and restorative “down time” need to be non-negotiable items in nurses’ routines. Healthy Nurses Healthy Nation has a plethora of blogs on self-care and stories of inspirational nurses.

Now more than ever, nurses, alongside other health professionals and their employers, need to focus on wellness and occupational health and safety. Nurses cannot do it alone; safe, respectful, and just workplace cultures are everyone’s responsibility. To learn more about occupational health and safety for nurses and health professionals, including immunizations, COVID-19, (see also CDC COVID-19 HCP guidance) staffing and more, visit www.nursingworld.org. For additional resources on self-care and nurse wellness, visit www.hnhn.org.