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.

Nurses Key to COVID-19 Response, Addressing Maternal Health in Rural Communities


Today, November 19, we celebrate National Rural Health Day and acknowledge the nurses that are critical to ensuring access to health care services in rural communities across the nation. This year we focus on rural health and the role you play as clinicians in rural communities, in the midst of the ongoing COVID-19 pandemic, at a time where the number of cases and hospitalizations are steadily increasing. As we begin the holiday season, the Centers for Disease Control and Infection (CDC) continues to issue guidance and recommendations for mitigation efforts necessary to curb the spread of the virus.

ANA continues to recognize and advocate on behalf of all nurses on the frontlines of the pandemic response, as well as providing resources and support. The association knows the role of the nurse is especially critical in our rural communities that struggle with continued or exacerbated spread of the virus. This is particularly concerning as the CDC has detailed how people living in rural areas are at higher risk of contracting and/or facing complications from COVID-19. Because of this increased risk, the CDC has provided several resources and information for rural communities to respond to the COVID-19 pandemic.

In addition to releasing rural-focused data and resources, CDC also recently released data detailing how pregnant women face an increased risk of severe illness if they contract the virus, as well. The agency is working with state and external partners to collect information on COVID-19 cases in pregnant women and it continues to monitor the impact. The increased risk of COVID-19 to pregnant women is troubling given the underlying issue of existing high rates of maternal mortality in the United States, with rates more likely to be greater in rural areas.

Just earlier this year, we saw the Centers for Medicare & Medicaid Services (CMS) issue a Request for Information (RFI) seeking comment from stakeholders on how to improve access to care and outcomes for women and infants in rural communities. Submissions to the RFI, part of CMS’ larger goal of improving health through the Rethinking Rural Health Initiative, will inform the agency as it develops new and refines existing programs targeting rural families. ANA used this opportunity to share with CMS how nurses in rural communities are an integral part in addressing maternal health and ensuring women have access to needed health care services before, during, and after their pregnancy.

ANA recognizes existing barriers to improving maternal health in rural areas, such as gaps in access to providers or loss of coverage. To mitigate these barriers and challenges, nurses must be engaged to expand provider capacity. This includes utilizing Certified Nurse Midwives (CNMs) for pregnancy care, Nurse Practitioners (NPs) trained in women’s health, and Registered Nurses (RNs) to providing care coordination and connecting women to needed services—all leading to better outcomes for women and infants. Across the country, nurses are leading maternity and infant care models that ensure access to care, provide quality care, and ensure better outcomes.

Innovative models and initiatives must be encouraged in strategies to address maternal health in rural areas. It is imperative that strategies strengthen and uplift the contributions of nurses in all communities. Nurses are an integral part in the health care delivery system—especially in rural communities that face barriers to accessing needed care. Innovative payment models should be developed and implemented that recognize the critical value of RNs, NPs, and CNMs and adequately compensate for services these clinicians provide. To address gaps in access to providers, states must be incentivized to allow NPs and CNMs to practice at the full extent of their education and training.

We expect to see renewed attention on discussing and addressing maternal mortality and morbidity at the federal level. For example, the Medicaid and CHIP Payment and Access Commission continues to discuss this issue at public meetings and the June 2020 Report to Congress includes a chapter examining why mortality and morbidity rates continue to rise. As policymakers seek approaches to address rural maternal health challenges and barriers, the critical role of the nurse cannot be overstated. Leveraging the education and expertise of CNMs, NPs, and RNs to expand provider capacity and lead innovative care delivery models will only result in better maternal and infant health.

ANA continues to closely monitor this issue and take advantage of opportunities to highlight the importance of the nurse in addressing maternal health and other health care challenges in rural communities. In addition to the resources linked above, the following are available to better understand current challenges in addressing rural maternal health:

Maternal Health Care in Rural Communities
Maternal and Obstetric Care Challenges in Rural America
Rural Disparities, Racial Disparities, and Maternal Health Crisis Call Out for Solutions
Left Out: Barriers to Health Equity for Rural and Underserved Communities

We want to hear from you! Share your story of #RNAction in rural health by sending a message to