Category: Congress

ANA Builds Momentum on Nursing Priorities on Capitol Hill

  

During the first quarter of 2024, the American Nurses Association’s Policy & Government Affairs Department collaborated with lawmakers on Capitol Hill on several legislative priorities. Here is a highlight of several initiatives that aim to rebuild the nursing workforce and address work environment challenges facing the nursing profession. 

ANA Responds to Problematic Staffing Bill 

The House Ways and Means Committee recently approved the Protecting America’s Seniors’ Access to Care Act (HR 7513), which would prohibit the U.S. Centers for Medicare and Medicaid Services (CMS) from finalizing its proposed long-term care safe staffing regulation.  

ANA sent a letter to House Leadership expressing its concerns about the bill’s adverse impact on the nursing workforce and the importance of ensuring safe staffing in long-term care facilities. ANA urged Congress to work with the Administration and stakeholders to find a balanced approach to addressing healthcare workforce challenges. It remains to be seen whether House Leadership brings the bill to the floor. Thankfully, the bill is dead on arrival in the Democratic-controlled Senate. 

ANA Co-Hosts Workplace Violence Briefing on Capitol Hill 

On March 22, ANA co-hosted a congressional briefing on workplace violence in emergency departments along with the Emergency Nurses Association and the American College of Emergency Physicians. Katie Boston-Leary, Director of Nursing Programs at ANA, represented ANA’s perspective on workplace violence in healthcare, its adverse impact on the nursing workforce, and potential solutions for addressing the crisis. 

 Congress Acts to Provide Mental Health Support for Health Professionals 

The House Energy and Commerce Committee recently voted to approve H.R. 7153, a bill that would reauthorize the Dr. Lorna Breen Health Care Provider Protection Act to provide mental health support to healthcare professionals. A companion bill, S. 3679, is pending in the Senate. On that same day, the U.S. Senate passed Senate Resolution 567 to recognize March 18, 2024 as the inaugural “Health Workforce Well-Being Day of Awareness.” A companion resolution is pending in the House (H. Res. 1089). 

Congress Invests to Attract More Registered Nurses 

Congress recently approved appropriations legislation to fund the federal government through the remainder of Fiscal Year 2024, which ends on September 30, 2024. While most of the Title VIII Nursing Workforce Development Programs and the National Institute of Nursing Research received static funding, Congress approved an increase of $5 million for Title XIII’s Nurse Education, Practice, Quality, and Retention Program for grants to increase the supply of registered nurses, specifically in long-term and acute care settings and in states having the greatest shortages. 

ANA Advocates for National Standards at the VA  

The House Veterans’ Affairs Committee held an oversight hearing to examine veterans’ access to healthcare services in rural settings through the U.S. Department of Veterans’ Affairs. ANA submitted a statement for the record, urging the VA to develop national practice standards for certified registered nurse anesthetists (CRNAs) that allow them to practice at the top of their license wherever they are needed within the VA health system. 

Lawmakers Introduce Bill to Restrict Mandatory Overtime for Nurses 

A bipartisan group of lawmakers in both chambers recently introduced the Nurse Overtime and Patient Safety Act (H.R. 7546/S. 3860). This bill would restrict the use of mandatory overtime for nurses with exceptions for federally-declared emergencies. The bill also includes whistleblower and nondiscrimination protections, transparency requirements, and civil penalties. The bill would require the Agency for Healthcare Research and Quality (AHRQ) to conduct a study on standards for safe working hours and the use of mandatory overtime. 

House Introduces Legislation to Attract Nurse Faculty 

The House recently introduced the Nurse Faculty Shortage Reduction Act (H.R. 7002), which would allow nursing schools to apply for grants from the Health Resources & Services Administration (HRSA) to supplement the difference between what faculty nurses are paid versus what equally trained nurses in clinical practice earn. It is bipartisan and was introduced in the Senate over the summer. 

Congress Reintroduces Measure to Support Nursing Workforce Pipeline 

The Future Advancement of Academic Nursing (FAAN) Act (H.R.7266/S.3770) was reintroduced in Congress. This legislation calls for critical investments to address immediate nursing education needs, while providing proactive measures to meet future workforce demands, including enrolling and retaining nursing students; hiring and retaining a diverse faculty to educate the future nursing workforce; support schools of nursing in partnership with healthcare facilities, to establish or expand clinical education; and to modernize educational infrastructure.

ANA on Capitol Hill – Federal Legislative Update

  

UPDATE: Since this blog was posted, Congress passed a new continuing resolution that funds the first four appropriations bills (Ag-FDA, Energy-Water, MilCon-VA, and T-HUD) until March 1 and the remaining eight bills (including Labor-HHS) until March 8.

The last quarter of 2023 was a doozy in Congress. Speaker McCarthy (R-CA) was removed by his own caucus and replaced with Speaker Mike Johnson (R-LA), taking weeks out of the Congressional schedule. It happened because conservatives in his own party didn’t think Mr. McCarthy had negotiated tough enough on the debt limit deal with the Biden Administration. To keep the government from shutting down, Speaker Johnson negotiated a 2-step continuing resolution with government funding for certain agencies expiring on January 19 and funding for others ending on February 2. The February 2 deadline applies to the U.S. Department of Health and Human Services which oversees federal agencies and programs that are relevant to the nursing profession. 

As leaders in both chambers continue to negotiate government spending, ANA will continue to advocate for robust funding for the Title VIII Nursing Workforce Development Program and the Minority Fellowship Program. We have held several meetings with Congressional staff and worked with coalition partners to ensure the best possible outcome for nurses and patients.  

ANA Responds to Congressional Request Relating to Rural Health Access to Care 

In October, ANA submitted a letter to the House Ways and Means Committee in response to a request for information on how Congress can improve healthcare in rural and underserved areas. The committee sought comments on several topic areas, including how Congress can revitalize the healthcare workforce and advance innovative care models and technology. In its letter, ANA called on Congress to invest in education and training for nurses, fund mobile health units, and expand home visiting programs that operate in rural and medically underserved communities. The letter also urged lawmakers to support legislative proposals that remove barriers to in-person and telemedicine services for patients in these settings. 

Emerging Nurse Leaders go to Capitol Hill to Advocate on Nursing Priorities 

Prior to Halloween, ANA convened its American Nurses Advocacy Institute (ANAI) in the nation’s capital. This event gave emerging nurse leaders from 21 states an opportunity to meet with their congressional lawmakers and nursing colleagues to discuss critical issues for the nursing community. Participants received federal legislative and regulatory updates from ANA staff, engaged in open dialogue about nursing priorities, and learned what they can expect while meeting with congressional offices. Then, nurse advocates embarked on Capitol Hill to meet with their lawmakers and staff to advocate for Title XIII appropriations funding to rebuild the nursing workforce, the Improving Care and Access to Nurses (ICAN) Act (H.R. 2713/S. 2418) to remove existing barriers to care of APRNs, and the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 2663/S. 1176) to address workplace violence in healthcare settings. 

ANA Endorses Federal Legislation Establishing Minimum Staffing Standards 

In November, ANA formally endorsed the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 2530 and S. 1113). This bill would establish minimum nurse-to-patient ratios for every hospital, examine best practices for nurse staffing, and provide whistleblower protections for nurses who choose to advocate for the safety of their patients. In its press release, ANA stressed that the adoption of safe staffing levels is just one way to address work environment issues that also include workplace violence, mandatory overtime, and reimbursement/compensation issues. 

ANA Participates in Healthcare Workforce Roundtable on Capitol Hill 

Prior to the holiday break, ANA participated in a healthcare workforce roundtable event hosted by Representatives Terri Sewell (D-AL) and Kathy Manning (D-NC). This event brought representatives from several healthcare associations together to discuss workforce challenges facing the healthcare sector and potential solutions. In her testimony, ANA’s Dr. Katie Boston-Leary called on lawmakers to support passage of legislation that would address workplace violence, establish safe staffing levels, prohibit mandatory overtime for nurses, address the nurse faculty shortage, and invest in training and education for new nurses. 

New Bill to Address Nursing Faculty Shortage Introduced 

In September, Sens. Richard Durbin (D-IL) and Lisa Murkowski (R-AK) introduced the Nurse Faculty Shortage Reduction Act (S. 2815). ANA worked with these offices to write and introduce the bill for several months. At the time of publication, the bill was just introduced in the House with bipartisan support by Reps. Dave Joyce (R-OH) and Suzanne Bonamici (D-OR). If passed, the bill would establish a 5-year demonstration project that would allow accredited schools of nursing to apply for grants to supplement the difference between what they can pay nurse faculty and what nurses with similar education and experience could expect to earn in critical care settings in those same geographic areas. The shortage of nursing faculty is one of the largest chokeholds on accepting more nursing students into nursing schools. A companion bill was previously introduced in the Senate.  

H.R. 3635 Promises to Strengthen PPE Stockpile for Future Emergencies

  

This Capitol Beat article was guest-written by Debbi Waters, MSN, RN, MJ, CHC, a student in the McKendree University Doctor of Nursing Practice (DNP) in Ethical Leadership Program, who is completing her leadership practicum in partnership with ANA Senior Policy Advisor Lisa Stand.

This month, Congress took a positive step in preventing a repeat of the catastrophic shortages of personal protective equipment (PPE) experienced by nurses at the outset of the COVID-19 pandemic. With bipartisan support, the House of Representatives passed H.R. 3635, the Strengthening America’s Strategic National Stockpile Act of 2021.

It has been nearly two years since the COVID-19 pandemic began to rapidly spread across the United States (U.S.), triggering the worst public health emergency the nation has witnessed in more than a century. From the beginning of the pandemic in 2020, nurses quickly found themselves fearing for their personal safety, as well as the safety of their patients and families, as PPE supplies were being depleted at an extraordinarily fast pace. Nurses on the frontlines were directed to abandon evidence-based infection prevention standards, for instance, by being required to wear the same PPE for extended periods of time, and to reuse PPE across multiple shifts. In an American Nurses Association (ANA) survey in May of 2020, 45 percent of nurses reported experiencing PPE shortages, with 79 percent of nurses reporting being encouraged or required to reuse PPE, of those 59 percent felt unsafe in doing so. The ANA completed a second survey, ending on August 14, 2020, with 47 percent of nurses reporting intermittent to occasional PPE shortages. Forty-two percent of participating nurses reported an increase in PPE availability, as compared to 36 percent reporting no change; however, 68 percent continued to report being required by their facility to reuse single-use PPE, with 62 percent reporting feeling somewhat to very unsafe. The enormity of the impact of COVID-19 on healthcare workers is yet to be determined; however, the failure to provide basic PPE to frontline nurses and healthcare workers was profound and consequential to physical and mental well-being of our nation’s nursing workforce.

Why is H.R. 3635 Important?
H.R. 3635 would address key vulnerabilities within the federal government’s ability to adequately respond to such large-scale public health emergency, particularly with the medical supply chain.

The U.S., as with most other countries around the globe, utilized unprecedented amounts of PPE during the COVID-19 pandemic. At times, the PPE burn rate was nearly a 100 percent increase over historical levels. Very early in the pandemic as hospitals exhausted PPE supplies and began experiencing challenges in purchasing supplies through the usual “just in time” supply chain channels, and as local and state supplies became depleted, states called up the federal government for assistance through the Strategic National Stockpile (SNS)

The SNS, long considered to be the contingency plan for public health emergencies, was ill-prepared to respond to a threat the size and scope of this pandemic, certainly not for a threat simultaneously affecting all 56 states, territories, and the District of Columbia. The SNS endured years of underfunding and budget cuts by Congress that, compounded by a failure to replenish and rotate stock, led not only to inadequate amounts of PPE, but also to the delivery of PPE that was expired, rotting, and inappropriate for safe use in protecting nurses from the dangers of COVID-19.

Maintaining the Stockpile
H.R. 3635 would address the issue of expired and unsafe supplies by allowing the U.S. Department of Health and Human Services (HHS) to distribute supplies from the SNS to any federal department or agency, on a reimbursable basis, if the supplies are within one year of expiration and can be replenished within the SNS. In addition, HHS would be required to ensure that supplies and equipment within the SNS are in working order.

Domestic Production
The COVID-19 pandemic also exposed the risks associated with U.S. dependence on foreign sources for nearly 60 percent of the nation’s medical supplies. This dependence created cataclysmic sourcing and price challenges for American hospitals and healthcare providers, caused by stockpiling of supplies and price gouging, at one point upwards of 1,000 percent the customary cost, for supplies that were of poor quality and at times counterfeit. The inability of domestic manufacturing proved to be detrimental to nurses who were providing care to COVID-19 patients. H.R. 3635 calls for the creation of a pilot program designed to strengthen the U.S. supply chain by increasing domestic manufacturing. Specifically, the pilot requires HHS to establish and maintain geographically dispersed domestic reserves of critical medical supplies, including PPE, and increased emergency stock of those critical supplies through cooperative agreements or partnerships with manufacturers to produce and maintain supplies. Additionally, the bill provides temporary authorization for HHS to disperse grants to states for use in maintaining or expanding state strategic stockpiles of critical supplies that are deemed essential by the State in preparation for future public health emergencies.

Transparency and Tracking
Strengthening America’s Strategic National Stockpile Act of 2021 would require HHS to develop a transparent process for distribution and use of supplies from the SNS by January 1, 2022. This would include a process for states, localities, tribes, and territories (SLTT) to request supplies; the decision-making process HHS will follow when determining if the request will be fulfilled or denied; and the process for the prioritization of distribution to the SLTT. In addition, the bill would require a monthly report to be provided detailing the requests submitted by SLTT, including the amount of materials and supplies requested, along with the outcomes of those requests. In the event a supply request is only partially filled or denied, the rationale for those outcomes must be included.

Our nation must begin building upon the lessons learned during the COVID-19 pandemic by planning and preparing a response to future public health emergencies. We must remain vigilant, as COVID-19 will not be an isolated incident, if we are going to prevent a repeat of the catastrophic failures experienced during the COVID-19 response. H.R. 3635 is a positive step towards ensuring the U.S. response to upcoming public health emergencies will be more efficient and effective, while protecting the health and safety of our frontline healthcare workers and we thank Representative Elissa Slotkin for her leadership in addressing this critical issue.

Next Steps
There is still work to be done to ensure the Strengthening America’s Strategic National Stockpile Act of 2021 is signed into law. This legislation now moves to the Senate where a companion bill S.1974 was introduced in June 2021. As you know, things tend to move slowly in the Senate and they need a groundswell of support from their constituents to pass legislation. Without action, nurses will be no more protected in future pandemics, than we were in March of 2020. Please visit our Latest News page for updates on the legislation and a chance for every nurse and health care advocate to take action and message their members of Congress soon.