Category: Nurse Advocacy

Throughout the summer, ANA has been fortunate to host several advocacy opportunities for nurses in Washington, D.C. As we know, when nurses speak, Washington listens. By creating organized advocacy days and partnering with nursing students and fellows, ANA is continuing to reinforce communication channels for nurses to share their stories with policymakers in the Capitol, and make their voices heard.

In June, ANA held its annual Hill Day, where nearly 300 nurses came to D.C. to advocate for their profession. As we know, there are many issues nurses care about, but for this year’s Hill Day, we focused on three key topics:

Improving Seniors’ Timely Access to Care Act of 2021 (S.3018/H.R. 3173):

This legislation would protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program. The legislation would also ensure that nurses and other practitioners no longer need to obtain pre-approval for medical treatments or tests before delivering care to their patients. We also have a very exciting update about this bill! Recently, the House Ways and Means Committee considered this legislation and passed it out of committee. The next step is now the U.S. House floor for a vote!

APRN Legislation:

While official bill text has not been introduced in Congress yet, ANA and our nurse advocates have been working hard on legislation that would allow APRNs to exercise their full practice authority in the Medicare program. The goal of this legislation is to remove burdensome administrative barriers for all four APRN roles to deliver care to their patients.

The Value of Nursing:

While ANA, and of course nurses, have always known that nurses bring knowledge, expertise, and value to health care, the COVID-19 pandemic illuminated the crucial role nurses play in delivering care for the rest of the country. Now more than ever, we need policymakers to support nurses in the workforce. ANA and nurse advocates pushed for Congress to prohibit mandatory overtime and pass legislation to prevent workplace violence.

Our nurse advocates shared their personal stories as well as important information with their elected officials about these issues, making sure that legislators and staff were informed and acting on behalf of nurses.

In July, ANA held its Minority Fellowship Program Hill Day, where nurses learned to advocate for both their profession and their patients to create a more equitable and diverse healthcare system. The MFP fellows educated lawmakers about APRNS and the value of nursing.

The fellows were able to meet with their legislators both virtually and at the Capitol, and even met with Representative Lauren Underwood (IL) on the steps of the Capitol. Representative Underwood is a fellow nurse and fierce advocate for the profession in Congress, making this meeting even more exciting!

A few weeks later, ANA hosted nursing students from James Madison University who are pursuing their Doctor of Nursing Practice (DNP) and two fellows from the prestigious David A. Winston Health Policy Fellowship to exchange ideas and discuss key issues facing nursing before they went to the Capitol to speak with their legislators.

In August, the legislative calendar is typically lighter, but ANA will not be taking a break. In fact, ANA was recently awarded the 2022 Power of Associations Silver Award for Leveraging the Association to Enhance ANA’s Voice as the Advocacy Champion for Nurses During COVID-19 and Beyond! This shows that ANA and its members are being noticed for our advocacy efforts.

While ANA has a dedicated team working on policy and legislative issues facing nurses, grassroots advocacy is a key component of passing laws. As we wrap up a summer of in-person advocacy opportunities, please continue to take action via email and phone to contact your elected officials about issues facing your profession because when nurses speak, Washington listens.

For more information on issues impacting nurses or how to take action please visit rnaction.org.

This Capitol Beat article was guest-written by Debbi Waters, MSN, RN, MJ, CHC, who was a student in the McKendree University Doctor of Nursing Practice (DNP) in Ethical Leadership Program. Ms. Waters completed her leadership practicum in partnership with ANA’s Department of Policy and Government Affairs and successfully completed all requirements as a DNP candidate on April 12, 2022. She will be awarded her degree on May 13, 2022.

The COVID-19 Healthcare Emergency Temporary Standard (ETS) issued by OSHA on June 21, 2021, although late in coming, was a very important step forward in providing workplace protections for all healthcare workers. There was an expectation, based upon statute and OSHA’s representations, that the ETS would be replaced with a permanent standard within six months of being issued. Thus, it was somewhat surprising on December 27, 2021, when OSHA announced they would step away from enforcement of the most protective provisions of the ETS and do so in the absence of a permanent standard. OSHA did provide assurances that a permanent standard would be forthcoming.  

On March 23, 2022, OSHA issued a notice stating the agency would again accept comments on the interim final rule that established the COVID-19 ETS. Specifically, OSHA is requesting comments on proposed changes for a final rule that would broaden the scope of the ETS while increasing flexibility for employers.

 As a Doctor of Nursing Practice candidate, I spent the past year thoroughly and carefully researching policies to safeguard healthcare personnel throughout the COVID-19 pandemic. The suggestion that OSHA is set to weaken many provisions of the ETS as OSHA transitions to a permanent standard was surprising.

The COVID-19 pandemic demonstrated the lack of readiness of the U.S. healthcare system to rapidly respond to the threat of an airborne infectious disease. As of March 30, 2022, there have been 1,071,214 cases of COVID-19 and 4,102 deaths reported among healthcare workers, a number significantly underestimated due to limitations of COVID-19 surveillance and tracking systems to accurately identify cases by occupation. This, combined with an astonishing 249 percent increase in reported workplace illnesses and injuries within the healthcare industry in 2020, an industry that led all other industries prior to COVID-19, would suggest that a permanent standard should incorporate relevant  guidance and existing ETS provisions to create a strong workplace airborne infectious disease standard.  

While it may appear that the most dangerous period of the COVID-19 pandemic is now in the rearview mirror, an extended view must be taken.  The threat of new variants of COVID-19, continued infections among healthcare workers, and the threat of the next airborne infectious disease are very real dangers that must be addressed. Some of the key provisions that should be included in a permanent standard include:

• Provision of an N95 or higher respirator when caring for any patient with a novel or unknown respiratory virus, including pandemic influenza, until it is unequivocally confirmed to be droplet transmission rather than airborne;
• Workplace hazard assessment;
• Easily accessible, written airborne infectious disease plan;
• PPE stockpile, particularly N95 or higher respirators;
• Engineering controls to rapidly convert additional patient rooms into negative airflow;
• Process for tracking and reporting disease transmission, including notification and surveillance of those who may have been exposed regardless of occupational class or department;
• Access to vaccinations for disease pathogens, based upon vaccine availability, at no cost to employees;
• Employee training on the infectious disease plan, and all policies and procedures related to protection of health and safety;
• Mini Respiratory Program to provide rapid access to respirators for precautions deemed necessary outside of the scope of a known diagnosis or suspected case of an airborne infectious disease; and
• Triggers for crisis standard use and termination.

While the significant increase in workplace morbidity and mortality within the healthcare industry is in large part attributed to COVID-19, it is also reflective of the weaknesses in the healthcare system to rapidly deploy lifesaving protections based on years of voluntary guidance rather than enforceable standards.  The OSHA rulemaking process for a permanent infectious disease standard began shortly after the H1N1 pandemic of 2009; yet, more than a decade later, healthcare workers continue to provide care without a federal workplace standard to protect them from the workplace threat of airborne infectious diseases.

This is not the time for nurse safety to backslide, but rather a time for nurses to advocate for prompt action on a permanent workplace airborne infectious disease standard. This is the time to call upon OSHA to focus on the fundamental responsibility to establish the workplace protections we deserve now and to build sustainable capacity to rapidly adapt to the next threat.

Next Steps
There is still time to act by reviewing the proposed changes to the ETS as it is considered for a permanent COVID-19 standard. OSHA will be accepting public comments through April 22, 2022, ahead of public hearings that will begin on April 27, 2022. To submit your comments and encourage OSHA to strengthen rather than weaken the ETS provisions, visit regulations.gov and select the comment button. Now is the time for the voice of nursing professionals to be heard.  

Recently, the Biden Administration released its Fiscal Year (FY) 2023 budget proposal. The budget reflects the Administration’s priorities throughout the rest of the fiscal year. While the blueprint is vast, there are nursing related provisions to highlight within the proposal.

Title VIII Nursing Workforce Development Programs received $294.972 million for FY 2023. The $30.5 million increase is across three Title VIII programs including:

• $25 million increase to Advance Nursing Education to grow and diversify maternal and perinatal health workforce.
• $2 million increase to Nurse Education, Practice, Quality, and Retention to develop a diverse nursing workforce and help train nurses in behavioral health services and primary care, particularly those serving in rural and underserved communities.
• $3.5 million increase in the Nursing Workforce Diversity Program.

The budget also included $198.670 million for the National Institute of Nursing Research (NINR).

In addition, the Administration has directed $28 billion to go to the Centers for Disease Control and Prevention (CDC). A few specific areas of interest include:

• $5.85 billion: Public health infrastructure
• $2 billion: Public health workforce development
• $1 billion: Healthy equity
• $40 million: Personal protective equipment technology

Lastly, the topline discretionary numbers include:

• $48.62 billion for National Institutes of Health (which includes $5 billion for ARPA-H, leaving only about $44 billion for NIH base funding)
• $8.5 billion in discretionary for Health Resources and Services Administration, a 4.5% decrease from FY 22
• $4.3 billion in discretionary funding for Centers for Medicare and Medicaid Services, a 8% increase from FY 22
• $9.9 billion in discretionary funding for CDC, a 14.7% increase from FY 22
• $376 million in discretionary funding for Agency for Healthcare Research and Quality, a 7% increase from FY 22
• $3.1 billion for Administration for Community Living, a 21.55% increase from FY 22
• $33.3 billion for Administration for Children and Families, a 2.62% increase from FY 22
• $10.13 billion for Substance Abuse and Mental Health Services Administration, a 35.84% increase from FY 22

While the President’s budget is merely a wish list to Congress, it is a glance at where the Administration’s priorities are. ANA will continue to advocate the Administration and Congressional champions to ensure that nursing priorities are included in any legislation or package that will move in Congress this year.