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.

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