Category: Nurse Advocacy

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.  

2023 Regulatory Advocacy Roundup

  

Over the past year, ANA has been the voice of nursing in a diverse array of regulatory issues. ANA’s regulatory engagements, though sometimes overlooked, are an important part of our advocacy on behalf of more than 5 million nurses in the U.S. Not surprisingly, the main focus of advocacy is the federal Department of Health and Human Services (HHS) and its subagency, the Centers for Medicare and Medicaid Services (CMS). However, ANA engages other HHS subagencies, such as the Food and Drug Administration (FDA), and government agencies including the Veterans Affairs Administration (VA), Department of Labor (DOL), and the Federal Trade Commission (FTC) as well.

In 2023, nurse advocacy recorded real progress at the federal policy and program administration level: 

  • CMS is changing the way they refer to various types of health care providers. Instead of using limiting language in regulatory publications and guidance documents, e.g., referring to physicians, advanced practice registered nurses (APRN), physician’s assistants, or any other providers by name, CMS is using the more generic term of practitioner, unless restricted by statute. CMS’ definition of practitioner specifically includes any clinician (including APRNs) that is eligible to bill for a particular service. This change is of enormous importance as it signals CMS’ intention to recognize APRN care, as it does physician care, to the extent of its regulatory authority. 
  • CMS is also implementing provisions of the Balance Budget Act (BBA) and allowing nurse practitioners (NPs) to bill for cardiac and pulmonary rehabilitation services. These services are within an NPs scope of practice, which Congress realized when the legislation passed. CMS is now implementing this legislation, which took effect on January 1, 2024.  
  • CMS is strengthening the Medicare Diabetes Prevention Program (MDPP), which ANA supports. Specifically, CMS is extending telehealth flexibilities for the MDPP for another four years and is re-aligning payments. The MDPP program presents opportunities for nurses to show their value in providing patient-centered education and health promotion to beneficiaries at risk of developing diabetes.  
  • Also in 2023, CMS released a long-awaited proposal to establish minimum staffing requirements in nursing facilities. The final rule is still pending; however, the proposed rule broke new ground in recognizing the role of RNs in safe staffing and patient well-being. ANA will advocate for a robust final rule, which could go a long way toward improving work environments in long-term care. 
  • CMS finalized adoption of a long-term care quality measure that APRNs can leverage to show their value to operators of skilled nursing facilities (SNFs) that opt to be considered for value-based payment. The Long-Stay Hospitalization Measure is aimed at improving facility-based care, specifically to reduce hospitalization for long-stay residents. APRN care in nursing facilities has a demonstrated positive impact on this metric. While this measure does not take effect until 2027, the lead time gives nurse advocates a head start to educate SNFs about this payment incentive and how nurses can help them be rewarded for results. 
  • The VA continues to move forward with their proposal to nationalize standards of practice for non-physicians. This has been a long process, and the VA has so far not proposed standards for the two covered nursing specialties—RNs and certified registered nurse anesthetists (CRNAs). Other APRNs already have standards that were codified in 2016. ANA has taken part in VA listening sessions on the proposed standards, and while there has been strong opposition to some of the standards, the RN standard has not garnered the same attention. 
  • ANA saw progress on workplace violence prevention at the DOL in its subagency, the Occupational Safety and Health Administration (OSHA). This year OSHA finally made a first step forward in creating a Workplace Violence Prevention for Health Care and Social Assistance Standard. In May 2023, OSHA conducted a Small Business Review of a proposed standard. ANA submitted comments during this review, emphasizing that nurses across the country need and deserve a set of standards tailored to their risks on the job. We continue watching OSHA to ensure they follow through with completing this standard as soon as possible. 
  • ANA members submitted hundreds of letters to OSHA on their COVID-19 final rule. Members across the country submitted letters to OSHA urging them to release their final COVID-19 in Healthcare Settings Rule. This rule was weakened in December 2021 and nurses deserve the fullest respiratory protections at work. ANA continues to press OSHA to release this final rule.
  • Another agency which heard from ANA’s regulatory staff in 2023 is the FTC. The FTC has proposed to ban non-compete agreements in the employment sector generally. The proposal has not moved forward, but ANA’s voice was heard, and staff were quoted in publications about the proposed rule. 

Always looking forward, ANA encourages all nurses, RNs, and APRNs to register for their individual National Provider Identifier (NPI). ANA knows how hard nurses work, and now is the time for payment systems to fully recognize the value of nursing. Currently, the impact of registered nurses is hidden behind physician expenses or other service charges. By registering for an NPI, we can push systems to extract nursing services from the data and demonstrate the critical role of nurses in patient care. For more information, visit our NPI webpage. ANA also encourages all APRNs to apply for an NPI. Many APRNs bill through their employer, and while this is a perfectly acceptable way for their care to be reimbursed, it might limit future opportunities for the APRN. Additionally, obtaining an NPI does not require one to bill using it, as one may continue to bill through their employer, and would allow an APRN to open their own practice as Medicare and most private payers require an NPI for reimbursement. 

ANA Advocacy Focuses on Safe Staffing, Looks to Opportunities in the New Year

  

Achieving safe staffing levels continues to be one of the biggest challenges facing nurses at the bedside. Workforce shortages, while not new, are being deeply felt across the country. The COVID-19 pandemic exacerbated existing shortages and has led to significant burnout among our nurses, driving even more nurses out of the profession. These shortages are unsustainable, making it even more vital that policymakers act now to identify and take action on new approaches to addressing safe staffing and other workforce challenges. 

At ANA, we recognize this issue is essential to our nurses and are working hard to make real change at the federal level by advocating for the Administration and Congress to recognize and address this crisis. Through our regulatory advocacy, ANA has reached out to Centers for Medicare & Medicaid Services’ (CMS’) Center for Clinical Standards & Quality as well as the White House Domestic Policy Council to call for more meaningful conditions of participation that provide additional requirements and enforcement mechanisms for staffing at acute care hospitals. 

More recently, ANA submitted comments on CMS’ proposal to institute the first-ever ratios for staffing in long-term care (LTC) facilities. As directed by an Executive Order issued by President Biden, CMS was tasked with studying staffing levels in these facilities and issuing regulations aimed at improving nurse staffing levels to enhance patient care quality. CMS issued a proposed rule in early September that would set minimum ratios for registered nurses (RNs) and nurse aides and require an RN onsite 24/7, among other implementation and enforcement requirements. When finalized, this proposed regulation will set a precedent for federal staffing requirements that could bolster our advocacy efforts related to safe nurse staffing in other settings as well. 

This proposed regulation is so significant that, in addition to our comment letter, we also submitted a coalition letter to the agency that included 25 state nursing and organizational affiliate associations. Both letters echo previous calls for the Administration—CMS and other federal agencies—to work closely with the nursing community and other stakeholders to take real action to address workforce needs and challenges.  

As part of our legislative advocacy, ANA recently endorsed the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 2530/S.1113), introduced by Senator Sherrod Brown (D-OH) in the U.S. Senate and Representative Jan Schakowsky (D-IL-9) in the U.S. House of Representatives. This bill would establish minimum nurse-to-patient staffing ratios in hospitals to help ensure patients have access to nurses who can provide them with the time and attention necessary to deliver high quality patient care. ANA sees the adoption of safe staffing levels as part of a multi-pronged approach to addressing the work environment challenges resulting in burnout and workforce attrition among nurses. 

As we look to 2024, ANA will continue the drumbeat with federal policymakers about the critical need to take real action to address safe staffing for our nation’s nurses. We will keep pushing federal agencies to use their existing authority to ensure safe staffing levels in the health care facilities under their purview, while watching closely for CMS to issue the final rule on LTC facilities. ANA will also seek opportunities to call on Congress to implement safe staffing standards, while identifying and pushing back against any policies that could further exacerbate the nurse staff workforce crisis. Together with our members, we will continue to make real strides in addressing safe staffing for nurses and the patients they serve.