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. 

ANA Issues Updated Climate Change Position

  

According to the World Health Organization, climate change is the biggest health threat facing humanity. This assertion opens ANA’s latest position statement–Nurses’ Role in Addressing Global Climate Change, Climate Justice, and Health­–which was released today. This new position statement builds on previous work at ANA around the nurses’ role in addressing this global health issue. Recognizing that climate change is a critical public health issue, the position statement calls for nurses to take action while providing additional guidance for nurses in all specialties and settings.

Foremost, ANA calls on nurses to integrate the science of climate and health in nursing education, research, and practice. Nurses also must work with other stakeholders and policymakers to identify and implement approaches to addressing climate-related health impacts. The vital role of the nurse in the nation’s health care delivery system makes our nurses critical contributors as climate change mitigation and adaptation efforts are identified and implemented.

ANA outlines several recommendations for how nurses can affect change in professional settings and in state- and federal-level legislative and regulatory advocacy. Recommendations for nurses in the professional setting include educating patients, modeling and promoting strategies responding to the impacts of climate change, and prioritizing nursing workforce capacity for disaster/climate change preparedness. State- and federal-level legislative and regulatory advocacy recommendations include advocating for underserved patients, calling for just and equitable climate responses in public health, and promoting coalitions and other partnerships.

ANA also provides guidance for all nursing organizations to build on member education, and collaborate with partners and stakeholders to strengthen the influence nurses have on climate change legislation and policy. Further, the position statement details the importance of supporting research led or supported by our nurses to further identify innovative and real approaches on climate change and climate justice.

Such efforts will be futile if we fail to participate in policy making and fail to engage in climate justice. Which is why it is imperative for nurses to use their voice to lead action aimed at mitigating the impacts of climate change and to protect vulnerable individuals, families, and communities responding to changing climate conditions. As the most trusted profession, nurses are in a unique position to also serve as a source of hope—acting ethically on behalf of their patients.

ANA does not have all the answers to climate change and its outsized impacts on healthcare delivery. As a first step, it is critical that we all recognize that the health concerns related to climate change exacerbate every issue our nursing organizations actively work to resolve. The threat of climate change will not be addressed in a silo—an all-hands approach is called for to make real and lasting progress on this issue. The guidance and recommendations in ANA’s newest position statement are a call to action, and a call for nursing leaders to get involved.

Additional ANA Resources:

ANA House of Delegates Resolution (Historic policy, 2012) — Nurses’ Role in Recognizing Educating, Advocating for Healthy Energy Choices

ANA House of Delegates Resolution (Historic policy, 2008) – Global Climate Change

State Approaches to Using ARPA Funds

  

Passed through The American Rescue Plan Act (ARPA) via the 117th Congress, $195.3 billion dollars of the total $1.9 trillion dollar package has been allocated to states through The Coronavirus State and Local Fiscal Recovery Fund (SLFRF).

Although individual state circumstances will be different, highlighted below are examples of how the ARPA allocation process occurred in Delaware, Kansas, New Mexico and Vermont. We wanted to provide these examples as indicative of how nurses and the nursing community have been advocating to be included in these funds.

How Funds Have Been Awarded

While states formed varying types of committees to examine SLFRF requests, each state’s interpretation of its constitutional and statutory provisions that outline authority over unanticipated federal funds and authority to spend during a state of emergency vary greatly. Processes ranged from decision making solely vested in governors, in state legislatures or a hybrid/joint approach between the executive and legislative branches.

ARPA funds must be allocated by December 2024 and expended by December 2026 and were generally released in two rounds. States have earmarked a portion of these funds to cover payroll and benefits expenses for health care/public health employees, specifically “the portion of an employee’s time that is dedicated to responding to the COVID-19 public health emergency” per the US Treasury Department’s Final Rule (31 CFR Part 35. RIN 1505-AC77).

Capacity building, workforce expansion and associated infrastructure have been priority areas, with the use of ARPA funds increasing not only the number of current nursing students, albeit also enlarging the ability to hire faculty and train nurses across communities and practice settings. Specific utilization data can be found through the National Conference of State Legislature’s ARPA Funds Allocation Dashboard.

State Examples

  • Among other funds, Delaware received $500,000 from the state’s allocation to develop free, easy to access, evidence-based tools and programming for nurses coping with various issues exacerbated by the pandemic. Delaware’s State Clearinghouse Committee coordinates the ARPA process and consists of the Secretary of State, representatives from the House/Senate and the Director of the state’s Office of Management and Budget.
  • Kansas announced a maximum of $50 million in available funding for hospitals to either provide premium pay or improve retention of nursing resources and support personnel, approved by the SPARK Executive Committee (comprised of the Lieutenant Governor, Speaker of the House, President of the Senate and private sector representatives). This emergency funding provided immediate support for Kansas hospitals to manage the COVID-19 surge and addressed critical shortages in nurse staffing across the state.
  • New Mexico’s Governor directed $15 million of ARPA funds to increase capacity and expand nursing training programs after meeting with the New Mexico Nurses Association and representatives from the wider New Mexico nursing community. 16 institutions received funding which cumulatively added slots for pre-licensure nursing students, developed tutoring to help students pass the licensure exam, retained nursing faculty and expanded clinical sites to rural communities.
  • Vermont’s Governor signed legislation after advocacy from the Vermont Nurses Association, ultimately appropriating two million for emergency grants to support nurse educators, $400,000 for preceptorships $2.5 million for pipeline/apprenticeship programs as well as several million more in collective loan incentive and forgiveness programs.

ANA and our Constituent/State Nurses Associations will keep advocating as funding continues to be appropriated and released. Please feel free to reach out to Jason Richie, Associate Director for State Government Affairs and Policy at jason.richie@ana.org with questions or for more state specific details.