Health Care – Capitol Beat

New Year, New Congress and Administration, Same Mission.

The American Nurses Association (ANA) continues to advocate on behalf of the nation’s nearly 5 million registered nurses (RNs) to federal policymakers. With a new Congress and Administration comes change and a level of uncertainty. However, our priorities remain centered around the following goals: building and preserving a robust nursing workforce; improving health care outcomes and access; removing practice barriers for advanced practice registered nurses (APRNs); shaping payment strategies to account for the direct impact of nursing care; preserving the relationship between nursing and public health; and utilizing health care technology appropriately.

We detailed these priorities and positions in a letter to Congress, sent to both Senate and House leadership. For our regulatory advocacy, ANA’s Policy Team has crafted a priorities document to share with internal and external stakeholders and policymakers and recently sent a letter to Secretary Kennedy.

Building and Preserving a Robust Nursing Workforce

We believe that federal policymakers must take action to address current workforce challenges and ensure the health care workforce is able to meet future challenges by protecting our nurses and creating healthy work environments. We continue to call on Congress to address workplace violence for nurses, as well as limit mandatory overtime. Congress must take action to improve nurse staffing and reduce burnout, such as investing in mental health and substance use dependence support for nurses. Additionally, we encourage HHS to engage with nurses to implement measures that will protect a robust nursing workforce, address the current nursing shortage, and make the workplace safer for nurses.

Ensuring a robust nursing workforce requires new, well-trained nurses. We urge Congress to invest in nursing education to ensure that a new generation of nurses are ready to work in the changing health care landscape. Investments in nursing education and recruitment will attract more nurses, nurse faculty, and nurse preceptors.

Improving Health Care Outcomes and Access

ANA believes that all people in America deserve access to high quality health care and care options. One area where ANA is working to improve health care outcomes and access is in the field of maternal health—working with Congress to enact legislation to expand the perinatal nursing workforce to ensure that women have access to the perinatal care they need and recommending that HHS keep nurses central to addressing maternal health challenges. Additionally, we are currently working with allies in the health care community to defend Medicaid to ensure that our most vulnerable patient populations have access to health care providers, such as trusted nurses.

Removing Practice Barriers for APRNs

We believe that removing practice barriers for advanced practice registered nurses (APRNs) will promote quality care and help provide proper payment for nurses. We encourage HHS to issue rulemaking to implement provider nondiscrimination protections, while urging the Centers for Medicare & Medicaid Services (CMS) to use its administrative authority to remove regulatory barriers to APRN practice in Medicare. Bolstering access to APRNs only serves to increase health care access, especially for our most vulnerable patient populations.

Additionally, we are actively engaging members and other stakeholders to urge Congress to pass the bipartisan Improving Care and Access to Nurses (ICAN) Act to permanently remove longstanding Medicare and Medicaid restrictions that limit Advanced Practice Registered Nurses (APRNs) from practicing to the full extent of their education and clinical training. By addressing these barriers, the ICAN Act will enhance access to essential health care services, particularly in rural and underserved communities. We encourage our members to take action and show support for the ICAN Act.

Shaping Payment Strategies to Account for the Direct Impacts of Nursing Care

At ANA, we understand just how essential APRNs and RNs are to the provision of patient care and how they deserve fair compensation for the services they provide. We call on HHS to support CMS in taking regulatory and administrative steps to account for nursing care under Medicare and Medicaid payment methodologies and to align reimbursement and quality rewards with the provision of high-value nursing care. Additionally, ANA is ready and willing to engage with Congress on future efforts or roundtables to reform parts of the Medicare payment system.

Preserving the Relationship Between Nursing and Public Health

The COVID-19 pandemic demonstrated how intertwined the fields of nursing and public health are. We stand firm in our position that HHS must continue to promote vaccinations, in order to protect nurses and their patients, as well as to relieve overburdened health systems. ANA knows how important federal medical research and its impacts are for nurses leading research, the provision of health care, and the nursing profession. Additionally, we continue to underscore to HHS the importance of international relationships and partnerships in public health preparedness and have stressed the need to keep federal government public health datasets accessible.

Utilizing Health Care Technology Appropriately

New technologies can be used to improve health care outcomes and access, but they must be used ethically. ANA believes that HHS must investigate how artificial intelligence (AI) can best be used in the medical and health spaces, while underscoring how critical it is that AI should neither substitute licensed practitioners, nor should it be the only diagnostic tool that practitioners use. At the same time, we want to see HHS promote the use of telehealth to increase access to health care, especially to increase access to care in rural areas. Currently, there is a proposed rule on special telehealth registration from the Drug Enforcement Agency (DEA), and ANA has advocated for HHS to lead efforts to encourage the DEA to revisit their proposed rule and to issue a new rule that better reflects the needs of APRN practice. Additionally, we are working with allies to advocate for the permanent extension of telehealth flexibilities.

Looking at the Year Ahead

A new Congress and Administration provides ANA with new opportunities and challenges to advance our priorities and to advocate for our members. ANA is ready to work with the 119^th Congress on improving health care delivery and advancing the nursing perspective. We will seek common ground with the new Administration, so that we can continue to advance the nursing profession and the wellbeing of America’s nurses. As always, ANA stands ready to respond to emerging policy issues that impact nurses and their patients, while remaining steadfast in our mission to lead the profession to shape the future of nursing and health care.

HIMSS 2022: When Nurses Reimagine Health Care

ANA staff attended the 2022 Health Information and Management Systems Society (HIMSS) conference last week where reimagining health and the health care delivery system were top of mind. The week started by reimagining health with a NursePitch^TM Innovation event. ANA’s Innovation Department collaborates with HIMSS by setting the stage for nurses to share their creative business ideas and programs to a team of judges, who are health innovation, business, and industry leaders. ANA knows that nurses have important ideas and approaches that can positively change the health delivery system and we encourage them to learn more and be ready to present at an event in the future!

It would be an understatement to say that the nursing workforce was top of mind in discussions around reimagining health. Attendees at HIMSS22 represent a microcosm of the health sector and have been living during the seismic shift that the delivery system has done over the past two years. The COVID-19 pandemic has triggered the need to adapt to new treatments, delivery options, and other environmental factors. Another key focus for the health care industry is developing new ways to support providers facing the challenges of today and the hope of the health system of the future. Digital tools can help with flexible scheduling, reduce duplications in workflow, and assist in charting. However, ANA continues the drumbeat about the importance of health systems valuing nurses through reimbursement, safe work environments, and ensuring each and every nurse achieve health equity in order to meaningfully solve the staffing crisis.

Over the course of the pandemic, we have also seen reports of the increase in digital technologies to deliver health services. The increased use happened seemingly overnight and is unlikely to return to pre-February 2020 levels ever again. At the same time, we must reflect and address the existing digital divide. Investments in our workforce must reflect the patient population in every community is vital, but we also need to make sure that the digital tools that are being used to assist in clinical decision making are free from unintentional biases. Just as important for patients, we must also ensure that nurses have access to the same opportunities to reach their own health equity—the nation cannot have a workforce that is shut off from the same system they provide care in.

Attending the HIMSS 2022 conference provided a great opportunity to learn, connect, and share ideas with others working to better the health care delivery system. The one thing missing was nurses on the big stage. ANA knows that nurses have stories, research, and ideas to share and together, we must be bold, step forward, and ensure our voices are heard in front of industry leaders as we all work to shape the health delivery system of the future.

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.