Author: Molly McTaggart

This year was a busy and turbulent time for all of us as we continued to navigate life under the COVID-19 pandemic—and nobody knows this more than nurses and healthcare workers. While nurses across the country continued to provide valuable care to their patients, the Policy and Government Affairs team at American Nurses Association focused 2022 on highlighting the value of the nurse in our health care delivery system.

So, what do we mean when we talk about the value of the nurse? This takes a multitude of forms under our legislative and regulatory advocacy. We urged lawmakers to look at workplace challenges faced by nurses such as safety and staffing, advocated for the removal of barriers to practice, and the need to increase reimbursements for nursing services—all to strengthen and bolster the future of the profession. In a tumultuous year, we advocated for nurses and made important progress that will carry us into the new legislative session in 2023.

Legislative Recap

A Successful Spring

In March, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law. This law will identify and disseminate best practices to reduce and prevent mental and behavioral health conditions, suicide, and burnout, as well as increase access to evidence-based treatment for nurses and other health care professionals. Over 7,500 nurses like yourself sent a letter to Congress urging them to pass this bill, and we want to thank you for your help getting this bill signed into law.

March proved to be a successful month for ANA, as there were some key pieces of legislation for nurses passed in the omnibus appropriations bill.

• Title VIII Nursing Workforce Development Programs received $280.472 million dollars. This is $16 million more than these programs received in 2021.
• The National Institute of Nursing Research received $180. 862 million. This is a nearly $6 million increase over the fiscal year enacted levels!
• The Sexual Assault Nurse Examiners Program received $13 million, which is an increase of $4 million dollars. This funding will directly impact the Advanced Education Nursing program to expand training and certification of RNs, APRNs, and Forensic Nurses to practice as sexual assault nurse examiners.
• Nursing also received nearly $5 million for Nurse Education, Practice, Quality and Retention efforts to address the RN shortage. The agreement directs Health Resources Service Administration (HRSA) to give priority in new funding announcements to public entities for training of additional RNs, specifically for acute care settings. In addition, it directs HRSA to give priority to applicants in States listed in the HRSA publication “Supply and Demand Projections of the Nursing Workforce 2014-2030” as having the greatest shortages.

An Auspicious Autumn

ANA has made meaningful progress on several vital pieces of legislation that we will continue to advocate for in 2023 and the 118^th Congress.

This year, ANA worked with Congress on the Improving Access to Workers’ Compensation for Injured Federal Workers Act. This legislation would improve the Federal Employees Compensation Act and close a loophole negatively impacting Nurse Practitioners (NPs) and their ability to provide care to federal employees who are injured at work. This common-sense legislation passed in bipartisan fashion in the U.S. House, and in 2023 ANA will continue our work on this bill.

In September, ANA worked with several other nursing organizations and Congressional Representatives Lucille Roybal-Allard (D-CA) and Dave Joyce (R-OH) to introduce the Improving Care and Access to Nurses, or #ICAN Act, in the U.S. House. If enacted, this bill will remove practice barriers for advanced practice registered nurses (APRNs), improving access to care for Medicare and Medicaid patients. Read more about the #ICAN Act here.

In December, ANA worked closely with Senator Jeff Merkley (D-OR) to introduce the #ICAN Act in the Senate – a huge step forward to get the bill passed into law. Nearly 3,000 nurse advocates have written to their elected officials in support of this important legislation. You can join them, here.

Also in December, we continued our work with Senator Merkley, and worked with him to introduce the Nurse Overtime and Patient Safety Act in the U.S. Senate. As you know, many nurses have been forced to work overtime to alleviate staffing shortages. Substantial use of mandatory overtime can jeopardize patient safety and nurse well-being. A recent ANA survey found that nearly 60% of nurses reported being required to work beyond their shift on a weekly or even daily basis. This is unacceptably high, and Congress must rectify the issue. The trucking and aviation industries have federal mandatory overtime protections—nursing and health care are long overdue for the same safeguards. Learn more and email your senators, here.

Regulatory Recap:

A Strong Summer

Every year, CMS issues proposed rules related to Medicare reimbursement for services provided to patients. ANA uses this opportunity to comment on provisions that impact the nursing profession, highlight staffing and workforce challenges, and continue the drumbeat of the value of the nurse.

CMS also issued Requests for Information (RFI) throughout the year, allowing additional opportunities for ANA to share the nursing perspective on several topics. We weighed in on the impact of COVID-19, workforce challenges, rural health and health equity—all top priorities for ANA. In our comments, ANA asked CMS to remove barriers to practice, urged the agency to make the COVID-19 waivers permanent, and to continue to focus on workforce challenges and health equity. Read ANA’s comments, here, and learn more about our response to the Make Your Voice Heard RFI on the ANA Capitol Beat Blog.

In November, CMS released a memorandum on workplace violence in hospitals, reiterating that they will hold hospitals accountable for workplace safety. ANA is encouraged by this action, which signals that the administration is hearing our concerns around this critical issue.

A Winning Winter

In November, ANA’s Chief Nursing Officer, Debbie Hatmaker, and members of the Policy and Government Affairs team, met with Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to discuss nurse staffing concerns, workplace environment and retention challenges, and the value of the nurse in today’s health care delivery system.

ANA staff also met with Center for Medicaid and CHIP Services Director and Deputy Administrator Daniel Tsai to discuss the Medicaid program once the COVID-19 PHE ends. We also discussed Director Tsai’s greater vision for the program as they work closely with states to expand coverage and access.

Rounding out the year, ANA staff attended a Department of Health and Human Services (HHS) event focused on maternal health and mortality. This event showcased the agency’s plan to tackle this important, pressing issue. ANA staff used this opportunity to articulate to agency staff the important role nurses play in addressing maternal health and the need for nurses to be included in any agency-led approaches.

ANA staff will continue its dialogue with HHS, CMS, and other subagencies in the New Year to ensure the nursing perspective is not only heard but incorporated. We also will continue to seek opportunities for engagement as our regulatory advocacy focuses on advancing the value of the nurse.    

The Policy and Government Affairs Team is excited about the progress made legislatively and implemented through regulation in 2022 but we know our work on behalf of nurses and the nursing profession is never done. We look forward to 2023 and new opportunities to advocate for nurses and advance the nursing profession. ANA knows the value of the nurse, but we will make sure Washington does, too.

Nurses know better than anyone that the COVID-19 pandemic exacerbated problems in health care and tested the resolve of the nation’s health care system and its stewards. Among the most impactful changes to the healthcare system in response to the pandemic has been the use of a range of Public Health Emergency (PHE) waivers for restrictions and rules that were identified as barriers to safe care of all patients, not only those with COVID-19.

Readers of this blog know the importance of the PHE waivers for healthcare providers. State and federal waivers that have been active for almost three years have allowed Advanced Practice Registered Nurses (APRNs) to practice to the full extent of their education and clinical training. These waivers allowed more types of providers to practice and increased health care capacity to meet the needs of patients.

However, the PHE will not be in effect forever and these waivers will go away without Congressional action. With the recent introduction of H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act, there is a solution that Congress can consider to ensure the strides APRNs made for the nursing profession will not be erased. The ICAN Act codifies key waiver provisions and includes some new expansions. The bill represents huge progress for APRNs to continue to practice at the top of their license. ANA will continue working with federal policy makers to expand access to APRN care and advance the nursing profession. The ICAN Act would remove unnecessary and outdated barriers to providing care for APRNs across the country so they can better care for their patients who are enrolled in Medicare and Medicaid programs.

Earlier this month, writers of this blog heard a story from an ANA member and Nurse Practitioner in Nevada that perfectly encapsulated the need for the ICAN Act. As an NP, Denise* can handle most aspects, but not all, of her patients’ diabetes care. As a rural practitioner, Denise is playing a key role in her community providing care in her small town so that people do not have to drive long distances to find a provider.

One of Denise’s patients needed diabetic shoes to help manage his condition. Unfortunately, Denise and other NPs, cannot prescribe diabetic shoes to their Medicare and Medicaid patients despite managing many other aspects of care. Without the shoes, the patient’s condition deteriorated. Ultimately, he was forced to have his leg amputated.

The domino effect on the patient’s health was profound. Due to the amputation of his foot, he became suicidal and required mental health attention and a stay in a hospital far from his hometown. Now he is no longer able to drive himself and must pay for taxis to take him to his appointments. All of this, because Denise could not prescribe her patient shoes that he needed due to his condition. NPs are capable of providing holistic, quality care to their patients, but administrative barriers, such as this one, illustrate the need for the ICAN Act.

APRNs aren’t the only ones discussing the importance of removing barriers to the profession. In 2010, the Institute of Medicine issued “The Future of Nursing: Leading Change, Advancing Health” report, which called for the removal of laws, regulations, and policies that prevent APRNs from providing the full scope of health care services they are educated and trained to provide. In 2021, the National Academy of Medicine (previously named the IOM) in their 2021 The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report recommended that “all relevant state, federal, and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality and value.” Recommendations like this have been echoed on various occasions by the American Enterprise Institute, the Brookings Institute, and the Bipartisan Policy Center.

So, what can you do to help move this important legislation in the U.S. House of Representatives? Get acquainted with the legislation and share with your Member of Congress the provisions that will be most impactful to you and your patients. Then ask your Member of Congress to please cosponsor this common-sense, bipartisan legislation. You can read more about the bill and take action here.

Sending a letter to your Member of Congress will only take a minute of your time, but it will make a huge impact. If you have an experience similar to that of Denise and are interested in sharing it, you can email your story to rnaction@ana.org.

You can also visit our Twitter and Facebook (@RNAction) and tell us your #ICAN statement so we can retweet and repost you!

*Names have been changed to protect privacy.