Recognizing the Value of Nursing Under Universal Health Care Coverage


The debate over how the nation structures its health care delivery system has waged on for decades. At the heart of this debate has been how to ensure coverage and access to needed health care services for patients. Looking at a system where most get their health needs covered by Medicare, Medicaid, or commercial, employer-sponsored covered, many recognized that too many Americans continued to be left behind. On one side of the debate, we have seen a push towards a single-payer system—like what is in place in Canada and the United Kingdom. Others, pushing for more market-based solutions to expand coverage through private plans.

At ANA, we have long supported movement toward adopting a single-payer health care system as the most desirable option. That is a health care system that is structured where services provided are financed by one payer, typically the government. Since that position was formally adopted in 1999, ANA has altered its advocacy on ensuring all Americans have access to health care coverage and nursing care, rather than focusing on how the health care system is financed. This evolution is a result of a shift in conversations about health care reform and delivery system, which was fully realized with the passage of the Affordable Care Act (ACA)—which celebrates its 11th anniversary this year. This landmark legislation made several critical reforms to the nation’s health care delivery system that continue to influence health care policymaking today.

The ACA adopted some market-based solutions to expand access to coverage through the creation of federal and state-based marketplaces, while at the same time expanding eligibility for the Medicaid program to vulnerable adult patient populations. In addition to focusing on coverage, the ACA has helped to trigger a broader movement to value and quality in how health care services are provided and paid. We know that many of our nurses are integral in leading and ensuring the success of value-based models and other innovations that better the care for patients, recognized through underlying payment structures.

As ANA engages with Congress and policymakers, it is key that the association’s position better reflect the current conversations and priorities, as well as allowing flexibility that allows the association to weigh in on proposed legislation and regulations. This will only serve to allow our voice to be more effective on behalf of our members—making it clear that the existing support of a single-payer system must be updated. Rather, we must adopt a replacement policy that endorses universal health coverage that recognizes the value of nursing. As defined by the World Health organization, universal coverage is a system wherein everyone has access to the health care services they need.

Through promoting universal health coverage that recognizes the value of nursing, ANA has the opportunity to continue to amplify the vital role nurses play in changing and improving the nation’s health care delivery system. Nurses are key to the provision of high-quality care to patients—regardless of the patient’s health care coverage. What is critical in these debates is the recognition of the nurse role through equitable payment for the services they provide to patients. Additionally, as policymakers continue to drive innovation and reform into the delivery system, nurses must be allowed to practice at the top of their license to fully contribute to the success of any system changes.

While our complex health care delivery system is far from perfect, there are many opportunities to shape policies that impact coverage, care, and ultimately the nursing profession. Over 30 million of our fellow Americans remain uninsured, a number likely to continue to grow due the economic challenges we all face due to the COVID-19 pandemic. This will likely lead to actions that work to ensure greater access to health care coverage. We also know that innovation and delivery system reform will continue to be an area of focus for policymakers. The role of the nurse must be forefront in these conversations and—most importantly—in any resulting legislation or regulations. Adopting a position that recognizes that access to health care coverage is most important, regardless of the underlying financing, lets us focus on ensuring that the value of nursing is fully recognized in our health care delivery system.

Over the next few weeks, members should watch ANA’s communication platforms as we near this year’s Membership Assembly. Dialogue forums are back, and we look forward to a robust conversation about moving ANA from endorsing a single-payer system to one that supports universal access to health care that fully recognizes the value of nursing.

Workplace Violence Bill Introduced with ANA Endorsement


As the coronavirus pandemic extends into a second year, nurses enter a second year of calling on Congress and the Administration to ensure an adequate supply of personal protective equipment (PPE) and prioritize COVID-19 vaccine distribution for health care providers. On these issues, the American Nurses Association (ANA) will remain a strong, clear voice until COVID-19 is no longer a threat to nurses on the job, wherever they provide care.

Throughout a challenging year of health emergency, though, nurses and their champions have not turned away from the serious workplace issues that pre-date and continue into the COVID-19 era. An example is workplace violence, which is shown to be highly prevalent in healthcare settings, causes harm to nurses and other health care providers, and undermines quality of care.

Violence and other abuses toward nurses are notably underreported. One reason that many nurses do not report incidents of violence is the belief that their experience will not be acted upon effectively by their facility’s leadership. Even so, the Government Accountability Office (GAO) reported in 2016 that violence against health care workers could be as much as 12 times higher than the overall workforce. This is a critical issue from ANA’s perspective, given that nurses are often the frontline providers in these settings.

The GAO concluded that more efforts are needed. Principally, federal workplace safety regulations should be strengthened. On February 22, 2021, Representative Joe Courtney of Connecticut introduced a bill, with bipartisan support, that would do just that. H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, is almost identical to a measure that passed the House, but was not afforded a vote in the Senate, in 2019.

The bill would require the Occupational Safety and Health Administration (OSHA) to have and enforce specific standards for health care and social service employers. Specifically, OSHA could hold these employers accountable under new safety regulations. The regulations would require health care and social service employers to create violence prevention programs, take concrete steps to reduce the risk of on-site assaults, and employ best practices to encourage reporting and employee engagement in prevention.

ANA has endorsed H.R. 1195, and is working toward speedy passage in the House, followed by Senate action in this Congress. Future posts on Capitol Beat will explore the issue and the legislation in more depth.

For more information about the ANA’s advocacy on workplace violence, click here.

ANA Leads Nursing Community to Strengthen COVID-19 Vaccine Confidence


On December 15, 2020, the American Nurses Association (ANA) joined with the American Hospital Association (AHA) and the American Medical Association (AMA) in an open letter urging health care professionals to take the COVID-19 vaccination when it becomes available to them. Since that time, ANA has been delighted to see the welcome images and stories shared of nurses stepping up to take the COVID-19 vaccine, and prepare themselves to vaccinate the general public when the time comes. In one of our favorite postings on social media, Reuters tweets a video of a nurse in New York receiving their second dose, on January 4. And here is ANA chief nursing officer Debbie Hatmaker cheering on nurse volunteers to go out and get the shots in the arms of the first tiers of vaccine recipients.

More recently, ANA, AHA and AMA released a public service announcement (PSA) calling for the American public to get the COVID-19 vaccination when it is their turn. The PSA emphasizes that COVID-19 vaccines are safe and effective, and will help us all as we work together to defeat COVID-19. 

Many people, including some nurses and other health care providers, are skeptical about taking the vaccine. Some are distrustful of the speed with which the vaccine came to market. Others, including many individuals from Black American, Latinx and other communities of color, legitimately distrust a healthcare system that has a history of discrimination, abuse, and neglect. This history not only points back to unethical and inhumane scientific experimentation such as the Tuskegee project, but is manifest in persistent disparities and systemic injustices in health care access and outcomes, even to this day in the COVID-19 pandemic. ANA along with the American Academy of Nursing has called for broad-based social action to address injustice and racial inequities in health care. Disparities must be addressed if the project to vaccinate the nation is to be successful.

In an effort to lead by example and show certainty of the science in the safe outcomes of COVID-19 vaccines, ANA President Dr. Ernest Grant participated in the Moderna vaccine trial. “It afforded me the opportunity to stand in solidarity with nurses on the frontline, battling the COVID-19 pandemic all across the U.S. Secondly, I recognized the urgent need for Black Americans to participate in vaccine clinical trials,” said Dr. Grant. The trial was unblinded earlier this year and Dr. Grant learned that he did receive the vaccine, as opposed to the placebo. He has elected to remain in the study for the full two years, as Moderna continues to gather data on the effects of the vaccine.

ANA leaders are confident in the capacity of the nursing profession to meet this moment. This confidence comes from knowing that nursing remains the most trusted profession, and that nurses hold themselves to high ethical and practice standards. Following these standards in the broadest sense means that a nurse will have an informed, considered approach to receiving and administering the COVID-19 vaccine. A nurse must consider their duties to optimize patient outcomes and promote the common good, along with the responsibility to safeguard their own well-being. In any situation, there is an ethical obligation to seek and obtain education and information, as well as advocate for answers when there are questions. Nurse leaders have a duty to provide nurses with accurate and accessible information so that individual nurses can make an informed decision for themselves and in turn assist in counseling their patients. 

In a survey of 13,000 nurses conducted last October, four out of ten nurses indicated a need for more information about the COVID-19 vaccine as a major reason for their skepticism at that time.  To meet that need, ANA set about to educate nurses and equip them with the tools they need to make decisions for themselves and for their patients. One key component is a set of Guiding Principles for Nurses, organized around themes of Access, Transparency, Equity, Efficacy, and Safety, approved by the ANA Board of Directors in 2020.

ANA continues to work to gather the most credible, evidence-based information about the vaccines, and share that information widely with members, nursing communities, partners in health, and policymakers.

Nurse-focused materials available now include:

  • FAQs created jointly by ANA and the pharmacist group ASHP, written with the clinician in mind.
  • A webinar and short-form videos featuring perspectives from a public health nurse and presenting the facts about COVID-19 vaccine development and distribution

ANA’s dedicated vaccine webpage also offers links to relevant information from partners such as the Centers for Disease Control and Prevention (CDC).  ANA is using its other distribution channels to share information helpful to nurses in the vaccination effort, such as the Vaccine Handling Toolkit recently released by ANA’s partner US Pharmacopeia. The toolkit informs operational issues on preparation and labeling, storage and transport, and waste and disposal of COVID-19 vaccine material.

Providing vaccine education and resources aligns with ANA’s commitment to immunization as a critical component of public health. In addition to providing information directly to nurses, ANA has advocated for public policies to address specific aspects of the vaccine roll-out that are important for nurses and their patients. In a letter to the transition team for the new Biden administration, ANA emphasized that nurses are central to vaccination efforts and their voices should be considered in distribution planning. ANA also called for federal resources to support mass distribution and administration. Advocacy on vaccines goes hand in hand with continued advocacy for policies to expand access to protective equipment and provide economic relief as strategies that are also key to slowing the spread of COVID-19.

For more information about ANA advocacy on issues that are important to nurses, visit