Author: Zina Gontscharow

ANA Issues Updated Climate Change Position

  

According to the World Health Organization, climate change is the biggest health threat facing humanity. This assertion opens ANA’s latest position statement–Nurses’ Role in Addressing Global Climate Change, Climate Justice, and Health­–which was released today. This new position statement builds on previous work at ANA around the nurses’ role in addressing this global health issue. Recognizing that climate change is a critical public health issue, the position statement calls for nurses to take action while providing additional guidance for nurses in all specialties and settings.

Foremost, ANA calls on nurses to integrate the science of climate and health in nursing education, research, and practice. Nurses also must work with other stakeholders and policymakers to identify and implement approaches to addressing climate-related health impacts. The vital role of the nurse in the nation’s health care delivery system makes our nurses critical contributors as climate change mitigation and adaptation efforts are identified and implemented.

ANA outlines several recommendations for how nurses can affect change in professional settings and in state- and federal-level legislative and regulatory advocacy. Recommendations for nurses in the professional setting include educating patients, modeling and promoting strategies responding to the impacts of climate change, and prioritizing nursing workforce capacity for disaster/climate change preparedness. State- and federal-level legislative and regulatory advocacy recommendations include advocating for underserved patients, calling for just and equitable climate responses in public health, and promoting coalitions and other partnerships.

ANA also provides guidance for all nursing organizations to build on member education, and collaborate with partners and stakeholders to strengthen the influence nurses have on climate change legislation and policy. Further, the position statement details the importance of supporting research led or supported by our nurses to further identify innovative and real approaches on climate change and climate justice.

Such efforts will be futile if we fail to participate in policy making and fail to engage in climate justice. Which is why it is imperative for nurses to use their voice to lead action aimed at mitigating the impacts of climate change and to protect vulnerable individuals, families, and communities responding to changing climate conditions. As the most trusted profession, nurses are in a unique position to also serve as a source of hope—acting ethically on behalf of their patients.

ANA does not have all the answers to climate change and its outsized impacts on healthcare delivery. As a first step, it is critical that we all recognize that the health concerns related to climate change exacerbate every issue our nursing organizations actively work to resolve. The threat of climate change will not be addressed in a silo—an all-hands approach is called for to make real and lasting progress on this issue. The guidance and recommendations in ANA’s newest position statement are a call to action, and a call for nursing leaders to get involved.

Additional ANA Resources:

ANA House of Delegates Resolution (Historic policy, 2012) — Nurses’ Role in Recognizing Educating, Advocating for Healthy Energy Choices

ANA House of Delegates Resolution (Historic policy, 2008) – Global Climate Change

ANA Makes Nurses’ Voices Heard on Equity and Efficiency

  

Recently, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) entitled Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs. Through this RFI, CMS solicited feedback from stakeholders on the impact of the COVID-19 public health emergency (PHE) on the healthcare delivery system, with specific questions related to access, health equity, and workforce challenges. ANA took advantage of the opportunity to provide feedback to the agency on the nurses’ perspectives. We focused on how the COVID-19 pandemic has impacted the nation’s health care system and pointed to important areas of consideration as we all look to the future.

Representing and supporting over 4.3 million registered nurses, ANA understands the importance of elevating the nurse’s voice regarding the challenges in health care because nurses are integral to patient care. In sharing firsthand experiences from members and association priorities, ANA’s comments addressed access to health care, the nurse’s experience in providing care, advancing health equity, and assessing the impact of waivers issued in response to the PHE. A few key ANA recommendations to CMS are:

  • Make permanent the waivers that allow better access to telehealth and that allow Advanced Practice Registered Nurses (APRNs) to practice at the top of their license by removing unnecessary barriers; and
  • Acknowledge and support the role of the nurse in addressing health inequity and other long-standing nursing concerns about patient care.

Accessing Healthcare and the Public Health Emergency Waivers:

CMS asked to understand what challenges health care workers face that impact their wellbeing and present challenges to meet patient needs. In response, ANA shared member stories of patients who experienced barriers to care due to restrictive rules on APRN practice, such as not being able to access needed mental health care or obtain prescriptions for necessary medications.

We know that when APRNs are allowed to practice at the top of their license, more patients overcome barriers to receiving safe and cost-effective care. ANA recommended that current waivers still in place from the PHE, set now to expire in January 2023, be made permanent through CMS action, so that APRNs can continue to practice at the top of their license. These recommendations also support ANA’s legislative advocacy as we encourage lawmakers to support H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act which would allow for changes in Medicare and Medicaid for APRNs to provide necessary care within their scope to better reach and support the needs of more patients.

APRNs at the #ICAN Act Press Event in September, 2022

Allowing APRNs to continue to serve their communities as they have been able to through the PHE waivers offers more timely and accessible care options in underserved areas and specialties where care can be delayed. Additionally, the PHE waivers for telehealth flexibilities have allowed APRNs to better reach patients where they are needed. ANA recommended to CMS that telehealth allowances be continued and made permanent to increase accessibility to care for more patients.

Understanding Provider Experiences:

CMS also sought feedback to better understand the challenges that impact health care workers’ wellbeing and the challenges in their meeting patient needs. ANA responded by highlighting issues that were exacerbated by COVID-19. Limited resources, critical staffing shortages, and increasing levels of burnout during the ongoing pandemic are several key issues that still need to be addressed. ANA called on CMS to take concrete steps to protect nurses and their patients using all available authority and resources to address these concerns.

In sharing provider experiences, ANA made sure to promote nurse and patient wellbeing and safety issues in its comments. These experiences include:

  • encountering the stigma of needing mental health care, affecting patients and providers;
  • lack of meal breaks during shifts;
  • unenforced safe staffing standards;
  • inadequate nurse involvement in leadership decisions where nursing is impacted; and
  • needing to promote nursing education to keep up with the growing need for more nurses.

In addition, ANA recommended that CMS support nurses and providers by promoting retention efforts of healthcare workers through payment and reimbursement system changes which would allow for appropriate compensation of nurses that more accurately reflect the value of nursing to the healthcare system. ANA also suggested that CMS look further into ensuring documentation requirements are appropriate, to allow nurses to spend more time with patients, and less time charting extraneous details which are nonessential to daily care tasks.

Advancing Health Equity and COVID-19 PHEs:

Continuing their work on advancing health equity, CMS asked how to better help eliminate health disparities. The agency also inquired about COVID-19 PHE waivers, asking what was helpful and what needs to be improved upon from these waivers. ANA responded by continuing to emphasize the important role that nurses perform in their daily tasks and the accessibility that APRNs practicing at the top of their license provides to many patients in underserved areas.

An APRN advocating for the #ICAN Act in September, 2022

Nurses have firsthand experience witnessing health disparities and barriers to care that impact their patients’ health and wellbeing. The culturally competent care nurses provide allows them to identify and offer invaluable insight on the individualized needs of patients and more widely, on advancing health equity in their communities. Because of this, ANA encourages nurse involvement in researching, designing, and implementing measures to address health disparities and advance health equity. ANA stresses the importance of recognizing the role of the nurse in any proposed measure to advance health equity.

Allowing APRNs to practice at the top of their license, as well as the emergence of widely used telehealth appointments increases the accessibility of healthcare resources and making these emergency waivers permanent is one way CMS can immediately act to advance health equity before the waivers expire and we are forced to take a step backwards in access to high quality nursing care.

ANA continues to advocate on behalf of its members and the nursing profession with the federal agencies.

This blog was guest-authored by Samantha Karp. She is completing her Master of Science in Nursing with a focus in Nursing Leadership in Healthcare at Gonzaga University and has spent her practicum semester working with the ANA Policy and Government Affairs team, learning how nurses can be active advocates in policy.

ANA Brings Nurses’ Voices to Health Equity Priorities

  

Achieving health equity is a key goal for the nation’s health care system. While not a new issue, we are seeing renewed focus on identifying and overcoming barriers that are leading to health inequities—especially with the COVID-19 pandemic magnifying underlying and persisting inequities. These barriers include sociodemographic factors, such as housing and food instability, which often lead to worse health outcomes for patients. Nurses in direct care are acutely aware of these barriers, given their roles in caring for patients in various care settings. Identifying real and lasting solutions to lead to a more equitable health care system is of vital importance to nurses and to ANA.

Addressing longstanding inequities throughout health care remains a key priority for ANA. On July 12, 2022, ANA announced a Racial Reckoning statement acknowledging our harmful past actions and outlining a plan to rectify our history and make changes for the future. ANA outlined six areas of focus to address the past and improve in the future that focus on partnering with the National Commission to Address Racism in Nursing, advocating for racial equity in policies and programs, and improving ANA’s internal governance structure.

As the largest organization of nurses, ANA has an opportunity to help reshape the profession, and the Reckoning is just the first step. In its own way, ANA’s legislative and regulatory agenda also reflects this priority. As part of this effort, the Policy & Government Affairs team has—and will continue to—approach nurse advocacy with an equity lens at every opportunity.

Our work in the last few months is an illustration, with ANA’s policy team submitting comment letters to the Centers for Medicare and Medicaid Services (CMS). The comment letters, in part, urge the agency to utilize nurses as it tackles geographical and racial equity in health outcomes for patients. These comments were in response to CMS’ request for information and other proposed provisions in several of the annual Medicare payment rules. ANA’s comments centered on the importance of engaging with nurses to identify approaches to measure and address health care disparities and barriers. The requests for feedback from CMS is part of the agency’s larger initiative to address barriers to health care, as outlined in a framework that was released earlier this year.

As noted above, we also saw the COVID-19 pandemic exacerbate underlying health inequities as vulnerable populations were most at risk for adverse outcomes from contracting the virus. This was rightly identified by the federal agencies, with the Centers for Disease Control and Prevention (CDC) providing resources to health care providers on their strategy to overcome barriers to achieve health equity in the COVID-19 response. Educating nurses on how to reduce health disparities resulting from the pandemic was an area of focus for ANA.

In addition to engaging on this prominent issue with federal agencies, ANA is also working closely with other healthcare stakeholders to determine meaningful strategies and approaches to address health equity. Most recently, ANA engaged with representatives from the American Medical Association and other trade associations to specifically discuss how health care providers can push the health care system to build and sustain a diverse workforce, ensure equitable access to care, and address the root causes of health inequities—while maintaining high quality and safe care for all patients. ANA will share more information about this initiative soon.

Through advocacy, ANA will continue to explore and promote nursing’s unique role in addressing health equity—for patients and for nurses. The association will monitor for and seek opportunities to engage with federal agencies on this critical issue. ANA will also continue to work with key partners to inform broader approaches and initiatives to address health inequities, from the nursing perspective. ANA looks forward to continued engagement with Congress, the Administration, and other policymakers to achieve health equity for all patients, while making sure the nurse’s role and voice are heard.