Election 2016 – Page 2

Nurses Continue to Help Define HIV Care, and Are Pivotal to Ending the Epidemic

The moving documentary film 5B testifies to the compassionate, committed responses of a nurse-led community in the early days of the HIV and AIDS epidemic. 5B was a ward of San Francisco General Hospital where nurses, along with patients and their caregivers, redefined palliative care in the face of a cruel disease and a health care system in the 1980s that was tragically unprepared. The film is a tribute to nurses who were on those frontlines. On camera, veterans of 5B reflect on their experience and how they transformed care, long before the term “person-centered” entered the lexicon of health care delivery and public policy.

5B viewers are also clearly able to understand, nearly 40 years later, how nurses remain on the frontlines, and continue to play a key role in HIV and AIDS care. Today, more than one million people in the U.S. are living with HIV, and around 15 percent of these people are unaware that they have HIV. As nurse leaders in the field Carole Treston and Carol Dawson-Rose write in the December 2019 issue of American Nurse Today, we now have treatment and prevention technologies that are “proven to work and allow us to imagine an end to the HIV epidemic.”

Treatment as prevention is the approach that holds the promise of reaching that goal of ending HIV. Specifically, effective use of antiretroviral treatment can lower HIV levels to the point where HIV cannot be transmitted. Recognizing the power of this approach, the American Nurses Association (ANA) recently signed onto the U=U prevention campaign (Undetectable = Untransmittable, or, U=U). In addition, use of preexposure prophylaxis (PrEP) is a proven intervention to prevent HIV from being acquired through sexual contact.

As Treston and Dawson-Rose point out, however, not everyone is benefitting from these approaches. The barriers are many, including stigma, systemic racism, sexism, homophobia, transphobia, lack of affordable health care coverage, and other social determinants of health such as lack of transportation or housing. The implications of these challenges for nurses’ role in ending the epidemic are explored in ANA’s updated position statements Prevention and Care for HIV and Related Conditions.

Nurses are pivotal to efforts to end HIV, by supporting patient access to testing, as well as ensuring access to treatment and prevention. A new ANA publication Ending the HIV Epidemic: Frontline Interventions Every Nurse Should Know links to useful guidelines and practice resources. Many advanced practice registered nurses can prescribe HIV treatment and PrEP, and nurses can coordinate care for people living with HIV when they need support to stay in treatment.

In addition to supporting a treatment-as-prevention approach, ANA prioritizes community-based solutions that meet the needs of diverse groups of people living with HIV and AIDS. The policy statements also highlight the APRN’s role with prescriptive authority to treat and prevent HIV, and call for full practice authority at the federal and state levels. The updated policy statements are aligned with national strategies and goals, and mirror the policy priorities of ANA’s partner Association of Nurses in AIDS Care (ANAC).

Legislation to End Workplace Violence Passes in the House of Representatives

Just prior to the Thanksgiving holiday, the House of Representatives dedicated hours of work, debated, and ultimately passed, another priority of ANA – H.R. 1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act.

Studies show one in four nurses has been assaulted at work – making nurses more likely to be exposed to violence than either prison guards or police officers. H.R. 1309 requires the Department of Labor to address needed protections from workplace violence in the health care and social services sectors. It directs the Occupational Safety and Health Administration (OSHA) to issue a standard requiring health care and social service employers to develop and implement a comprehensive violence prevention plan tailored to the facility and services with the intention to protect employees from violent incidents in the workplace.

We are pleased to report the final vote in the House of Representatives was 251-158 – including 32 Republicans. Unlike other pieces of legislation that ANA supports, including the recently passed H.R. 728, Title VIII Nursing Workforce Reauthorization Act, H.R. 1309 is not as bipartisan. A chief concern amongst Republicans is the worry about smaller hospitals and facilities complying within the given time. With that said, we are very encouraged to hear Republicans and Democrats all acknowledge this is a major issue and something needs to be done. The issue is finding the sweet spot where the legislation can receive bipartisan support.

So, now we look to the Senate knowing we have an uphill battle ahead. We must continue to educate members of Congress about this issue and its severe implications if something is not done soon. To join us in this effort, please go here.

However, ANA is not just focused on Congress. Before the vote in the House of Representatives, the White House issued a statement of administration policy which stated that it opposes H.R. 1309 in its current form. An example given is the Administration believes the bill’s timelines for issuing the interim final, proposed final, and final standards are inappropriate. It notes that OSHA has announced plans for a Small Business Regulatory Enforcement Fairness Act (SBREFA) panel to address these issues. We are calling on the SBREFA panel to come together and make a final decision as soon as possible.

Additionally, ANA staff is meeting with key agencies, including OSHA, to educate agency staff on the importance of this issue and see how we can all work together to move the needle in the right direction.

Safe work environments and quality care are not mutually exclusive; both must be considered in order to promote positive health outcomes for patients and communities. Let’s work together to continue to send that message to Capitol Hill to ensure that nurses are safe in the workplace.

Filling the Gaps – Nurses Are Key to Access in Rural America

This edition of Capitol Beat is co-authored by Billie Lynn Allard, a nurse innovator and leader in Vermont. Ms. Allard founded and now directs a transitional care program that is a core component of the Accountable Community of Health of the Southwestern Vermont Health Care system.

Honors to rural nurses! November 21 is National Rural Health Day, a reminder of the unique challenges that people are facing — and nurses are meeting — in less populated parts of the country.

Improving health and access to care in rural areas for the 60 million Americans who live there should be a priority in a rapidly changing health care system. Due to several facts of rural life, we see significant differences between rural and non-rural residents when it comes to health. For people in rural areas, health disparities can mean greater burdens of severe disease like cancer and heart disease. There are also higher rates of injury and suicide in rural areas versus non-rural areas.

Often, accessing care is a serious challenge for people in rural areas, where traveling to appointments can be difficult, and lack of health care coverage can also be a barrier. Some rural residents may avoid care where they live because they fear stigma and loss of privacy, for instance, if they are living with opioid use disorders, HIV, or mental health conditions. When there are not enough health care providers to meet the needs of rural communities, access is more restricted still.

There is good news for rural health, however.

The good news is that nurses can frequently be found leading their communities to drive transformative solutions. An example is the team-based care model forged by nurses in southwestern Vermont. Billie Lynn Allard, MS, RN, FAAN, and director of the program, shares her story:

I am fortunate enough to work in an ANCC Magnet-recognized community hospital where visionary leadership has supported our efforts in transforming care delivery to better meet the needs of the 75,000 people who live in our service area. That area, covering parts of Vermont, New York and Massachusetts, is largely rural. Our initiative has redeployed hospital-based nurses to expand primary care capacity and focus with community partners on high-risk, high-cost patients who have complex care needs.

From the beginning of this effort, transitional care nurses navigated our rural care system along with patients, in order to experience care delivery through their eyes. Our goal was to identify gaps in care coordination, communication, education and access to resources that were negatively affecting health in our community. Then, we proactively met with home care agencies, skilled nursing facilities, and community agencies to share information and find collaborative ways to improve care coordination across our community, avoiding overlap, duplication, waste or competition.

For the first time in our nursing careers, we were able to understand why so many patients were not successful at managing their chronic disease, causing multiple preventable emergency visits and hospitalizations. We acknowledged that silos of care delivery hamper any patient’s ability to understand how to take their medications correctly, and what to do when their symptoms worsen. We were overwhelmed by the role of social determinants of health (SDOH) causing so many patients to have to choose between food, heat, or medication. We witnessed clearly what Maslow’s Hierarchy of Needs taught us in nursing school — that people need adequate food, water, and shelter to achieve optimal health. We saw where we were falling short in our care coordination, as patients went home from the hospital without meaningful resources to manage their health.

In the past six years, we have systematically and effectively built relationships across our community. Transitional care nurses now regularly make home visits to high-needs patients, which has resulted in a 50 percent reduction in hospitalizations. Interdisciplinary teams are creating integrated care plans for individuals who had previously accessed the hospital seeking to meet their needs for food, shelter and social support. New pilot programs are testing out the use of clinical pharmacists in primary care practices, and physical therapists are available in the emergency department. The opening of the PUCK (Pediatric Urgent Care for Kids) center has led to improved management of high-risk children requiring mental health assessment and support. An opioid task force is increasing services available and advocating for funding. Screening of high-risk children and adults with immediate access to support is uncovering huge opportunities.

Our providers are becoming proficient in longitudinal care delivery, considering what happened before and after each patient touch in order to reach the best possible results. Step by step we are making progress and without a doubt, it is truly the most rewarding part of our careers! We must meet people where they are, embracing the role of SDOH. We must empower them to make informed decisions based on what matters to them.

Nurses are leading transformation of rural care delivery, and every day we are witnessing the difference it makes, as we seek to meet the Quadruple Aim of health care: Improve patient experience, improve the health of our community, lower costs, and improve the experience of the care giver.

ANA advocates at the federal level to augment and promote nurse-led innovation in underserved rural areas. For instance, in a recent letter to the Health Resources and Services Administration (HRSA), ANA urged more federal support for innovative models like the Accountable Community of Health in Vermont. The letter also suggested HRSA should consider ways of incentivizing states to reform nurse practice laws so that all nurses can practice to the full extent of their education and clinical training.

To support nurse advocacy in rural health, the following resources may be helpful:

Let us know if you have a story of #RNAction in rural health. Send a message to gova@ana.org.