APRNs Can Provide Quality and Access to Care and Congress Needs to Let Them


Nurses know better than anyone that the COVID-19 pandemic exacerbated problems in health care and tested the resolve of the nation’s health care system and its stewards. Among the most impactful changes to the healthcare system in response to the pandemic has been the use of a range of Public Health Emergency (PHE) waivers for restrictions and rules that were identified as barriers to safe care of all patients, not only those with COVID-19.

Readers of this blog know the importance of the PHE waivers for healthcare providers. State and federal waivers that have been active for almost three years have allowed Advanced Practice Registered Nurses (APRNs) to practice to the full extent of their education and clinical training. These waivers allowed more types of providers to practice and increased health care capacity to meet the needs of patients.

However, the PHE will not be in effect forever and these waivers will go away without Congressional action. With the recent introduction of H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act, there is a solution that Congress can consider to ensure the strides APRNs made for the nursing profession will not be erased. The ICAN Act codifies key waiver provisions and includes some new expansions. The bill represents huge progress for APRNs to continue to practice at the top of their license. ANA will continue working with federal policy makers to expand access to APRN care and advance the nursing profession. The ICAN Act would remove unnecessary and outdated barriers to providing care for APRNs across the country so they can better care for their patients who are enrolled in Medicare and Medicaid programs.

Nurse Advocates stand with Rep. Lucille Roybal-Allard to announce the ICAN Act in September.

Earlier this month, writers of this blog heard a story from an ANA member and Nurse Practitioner in Nevada that perfectly encapsulated the need for the ICAN Act. As an NP, Denise* can handle most aspects, but not all, of her patients’ diabetes care. As a rural practitioner, Denise is playing a key role in her community providing care in her small town so that people do not have to drive long distances to find a provider.

One of Denise’s patients needed diabetic shoes to help manage his condition. Unfortunately, Denise and other NPs, cannot prescribe diabetic shoes to their Medicare and Medicaid patients despite managing many other aspects of care. Without the shoes, the patient’s condition deteriorated. Ultimately, he was forced to have his leg amputated.

The domino effect on the patient’s health was profound. Due to the amputation of his foot, he became suicidal and required mental health attention and a stay in a hospital far from his hometown. Now he is no longer able to drive himself and must pay for taxis to take him to his appointments. All of this, because Denise could not prescribe her patient shoes that he needed due to his condition. NPs are capable of providing holistic, quality care to their patients, but administrative barriers, such as this one, illustrate the need for the ICAN Act.

APRNs aren’t the only ones discussing the importance of removing barriers to the profession. In 2010, the Institute of Medicine issued “The Future of Nursing: Leading Change, Advancing Health” report, which called for the removal of laws, regulations, and policies that prevent APRNs from providing the full scope of health care services they are educated and trained to provide. In 2021, the National Academy of Medicine (previously named the IOM) in their 2021 The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report recommended that “all relevant state, federal, and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality and value.” Recommendations like this have been echoed on various occasions by the American Enterprise Institute, the Brookings Institute, and the Bipartisan Policy Center.

So, what can you do to help move this important legislation in the U.S. House of Representatives? Get acquainted with the legislation and share with your Member of Congress the provisions that will be most impactful to you and your patients. Then ask your Member of Congress to please cosponsor this common-sense, bipartisan legislation. You can read more about the bill and take action here.

Sending a letter to your Member of Congress will only take a minute of your time, but it will make a huge impact. If you have an experience similar to that of Denise and are interested in sharing it, you can email your story to rnaction@ana.org.

You can also visit our Twitter and Facebook (@RNAction) and tell us your #ICAN statement so we can retweet and repost you!

*Names have been changed to protect privacy.

Nurse Advocates at the Capitol promoting the ICAN Act.

ANA Brings Nurses’ Voices to Health Equity Priorities


Achieving health equity is a key goal for the nation’s health care system. While not a new issue, we are seeing renewed focus on identifying and overcoming barriers that are leading to health inequities—especially with the COVID-19 pandemic magnifying underlying and persisting inequities. These barriers include sociodemographic factors, such as housing and food instability, which often lead to worse health outcomes for patients. Nurses in direct care are acutely aware of these barriers, given their roles in caring for patients in various care settings. Identifying real and lasting solutions to lead to a more equitable health care system is of vital importance to nurses and to ANA.

Addressing longstanding inequities throughout health care remains a key priority for ANA. On July 12, 2022, ANA announced a Racial Reckoning statement acknowledging our harmful past actions and outlining a plan to rectify our history and make changes for the future. ANA outlined six areas of focus to address the past and improve in the future that focus on partnering with the National Commission to Address Racism in Nursing, advocating for racial equity in policies and programs, and improving ANA’s internal governance structure.

As the largest organization of nurses, ANA has an opportunity to help reshape the profession, and the Reckoning is just the first step. In its own way, ANA’s legislative and regulatory agenda also reflects this priority. As part of this effort, the Policy & Government Affairs team has—and will continue to—approach nurse advocacy with an equity lens at every opportunity.

Our work in the last few months is an illustration, with ANA’s policy team submitting comment letters to the Centers for Medicare and Medicaid Services (CMS). The comment letters, in part, urge the agency to utilize nurses as it tackles geographical and racial equity in health outcomes for patients. These comments were in response to CMS’ request for information and other proposed provisions in several of the annual Medicare payment rules. ANA’s comments centered on the importance of engaging with nurses to identify approaches to measure and address health care disparities and barriers. The requests for feedback from CMS is part of the agency’s larger initiative to address barriers to health care, as outlined in a framework that was released earlier this year.

As noted above, we also saw the COVID-19 pandemic exacerbate underlying health inequities as vulnerable populations were most at risk for adverse outcomes from contracting the virus. This was rightly identified by the federal agencies, with the Centers for Disease Control and Prevention (CDC) providing resources to health care providers on their strategy to overcome barriers to achieve health equity in the COVID-19 response. Educating nurses on how to reduce health disparities resulting from the pandemic was an area of focus for ANA.

In addition to engaging on this prominent issue with federal agencies, ANA is also working closely with other healthcare stakeholders to determine meaningful strategies and approaches to address health equity. Most recently, ANA engaged with representatives from the American Medical Association and other trade associations to specifically discuss how health care providers can push the health care system to build and sustain a diverse workforce, ensure equitable access to care, and address the root causes of health inequities—while maintaining high quality and safe care for all patients. ANA will share more information about this initiative soon.

Through advocacy, ANA will continue to explore and promote nursing’s unique role in addressing health equity—for patients and for nurses. The association will monitor for and seek opportunities to engage with federal agencies on this critical issue. ANA will also continue to work with key partners to inform broader approaches and initiatives to address health inequities, from the nursing perspective. ANA looks forward to continued engagement with Congress, the Administration, and other policymakers to achieve health equity for all patients, while making sure the nurse’s role and voice are heard.

A Successful Summer of 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.

Nurse Advocates on Hill Day, 2022

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.