OSHA Slowly Moves Forward on Workplace Violence Prevention 


Workplace violence continues to be a profound concern for nurses across the country. 

  • 1 in 4 nurses are assaulted at work.  
  • Health care and social assistance workers face nearly six times the risk of workplace violence (WPV) than other industries.  
  • We hear often that the COVID-19 pandemic has only exacerbated this risk. In a 2022 ANA survey of nurses, 29 percent reported experiencing a violent incident at work in the previous year.

ANA has advocated for decades that the Occupational Safety and Health Administration (OSHA) strengthen WPV protections for health care workers. OSHA is a sub-agency in the U.S. Department of Labor and OSHA’s standards are regulations that require employers to have safety protections in place for their employees. In 1996 OSHA published voluntary guidance for health care employers to help them create effective WPV prevention programs. As research evolved, OSHA updated this guidance, with the most recent edition released in 2016. From the statistics, it does not appear that voluntary guidance has had a significant impact protecting nurses from violence on the job.  

There has never been a federal regulation requiring these prevention programs and clarifying the legal responsibilities of health care employers. When there is no specific standard on a workplace safety issue, OSHA can still hold an employer accountable if inspectors find the employer violated the “general duty clause”. This clause is the basis of the Occupational Safety and Health Act of 1970 which created OSHA. The general duty clause states that employers must maintain “a place of employment which [is] free from recognized hazards that are causing or are likely to cause death or serious physical harm to…employees.” OSHA has held employers accountable for failure to protect workers from WPV under the general duty clause, but WPV prevention has been very hard to enforce without a specific standard. 

OSHA finally moved forward in creating a WPV prevention standard early this year. The first step was to gather feedback on a proposed standard from a Small Business Advocacy Review (SBAR). The Small Business Regulatory Enforcement Fairness Act of 1996 installed this first step in OSHA and other federal agencies’ rulemaking process. Small business employers apply to be on SBAR panels that review and give feedback on the proposed standard to OSHA and the Small Business Administration. The panels are open to the public to listen in, and public comments on the feedback are allowed. This review was completed at the end of March 2023. ANA staff listened to the proceedings and then submitted comments reinforcing the need for this prevention standard so that employers can be held accountable for building an organization specific prevention program. 

OSHA released a report about the SBAR review on May 1, 2023. ANA was disappointed to see that the report gives no timeline on next steps for the rulemaking, but rather recommends further research on many pieces of the proposed standard. OSHA also reopened public comments on the proposed standard and the report until July 3, 2023.

You can visit regulations.gov and submit your own comments. Let OSHA know: Why is this standard necessary? What are the biggest WPV risks you have experienced? What prevention strategies have you seen to be effective in your workplace? 

OSHA’s rulemaking process is driven by research and finding the best evidence-based solutions. This means creating a new rule can take OSHA decades. The Government Accountability Office (GAO) estimates it could take OSHA at least 7 years to create a WPV prevention standard. Rep. Joe Courtney has been a champion against health care WPV. He has led the Workplace Violence Prevention for Health Care and Social Service Workers Act in the House of Representatives for many years. This bill was reintroduced in the 118th Congress on April 18, 2023 with Sen. Tammy Baldwin leading in the Senate. It requires OSHA to release an interim final standard for WPV prevention within a year of passage and a final standard within three and a half years. OSHA already has decades of research to utilize including recent evidence gathered during the SBAR. Nurses and all health care workers cannot continue to wait for this life-saving standard. Visit RNAction today to tell your legislators to cosponsor the bill that will make sure nurses get the protection they need now. 

To learn more about ANA’s surround-sound advocacy approach on WPV prevention, visit the recording of the 2023 Nurses Month Webinar. 









New Mexico Nurses Association Focuses On Climate and Health


Eric T. Riebsomer, DNP, RN – Guest Author
New Mexico Nurses Association

According to the World Health Organization (WHO), climate change is the biggest health threat facing humanity (WHO, 2023).  As we have witnessed recently, extreme weather events directly impact both social and environmental determinants of health (e.g., clean air, water, our food, and where we live).  The WHO estimates that between 2030 and 2050, these changes will result in approximately 250,000 additional deaths per year. According to the Centers for Disease Control (CDC), health impacts in the southwest will be related to higher temperatures (increased death associated with heat), poor air quality (from wildfires and dust storms), vector-borne diseases, and water-related illness (CDC, 2023).  A recent example of this occurred during the 2022 New Mexico wildfire season, where approximately one million acres were burned due to wildfires.  These wildfires impacted the respiratory and cardiovascular health of families while they were burning, impacted water quality after the fire because of massive flood and debris flow events, and displaced thousands of people from their homes in fragile communities in New Mexico.  

New Mexico Nurses for Climate and Health is a recently formed special interest group within the New Mexico Nurses Association (NMNA).  The aim of this group is to bring together passionate, New Mexico nurse leaders to advocate for building resilience against changes in our climate that directly impact our health.  In the 2021 New Mexico Climate Strategy report published by the climate change task force, building adaptation and resilience in public health was one of the highlighted sections where New Mexico was focusing time and resources. The New Mexico Department of Health (NMDOH) was using the CDC’s Building Resilience Against Climate Effects (BRACE) Framework to help New Mexico communities prepare for the impacts of climate change.  The other areas focused on building resilience were, natural and working lands, emergency management and infrastructure, and water and natural resources.

During the 2022 legislative session, New Mexico lawmakers brought forth legislation to create a public health and climate resiliency program within the Department of Health (DOH). The purpose of the legislation was to create a fund, which would be disbursed to local and tribal government entities for the purpose of adapting to climate change through grants. The purpose of the grants would be to help the recipients to prepare for or respond to health threats related to extreme weather and other climate change effects. The legislation passed both the House and Senate committees, though it was not signed. As New Mexico continues to address climate and health issues, the New Mexico Nurses Association needs to be a part of these initiatives, offering a nurse’s perspective on how climate impacts the health of our patients, when it comes to combining primary prevention strategies with building resiliency in our communities.   

While NMNA has created a special interest group to bring nurses together for this purpose, the role of nurses can be expanded outside of this, in all states.  As health care experts, a nurse’s voice during legislative sessions can be very powerful.  Nurses should get to know their legislators, talk to them about the effects climate change has on their patients.  Community and public health nurses in particular play a vital role in communicating this.  Another way nurses can get involved is by being on planning committees where they work, in their communities, or at their child’s school.  This allows them to have a voice in preventing or modifying activities that may cause harm to the environment, which may ultimately harm people.  Also, getting involved with the disaster preparedness team at their facility, this will offer nurses an opportunity to assist in developing primary prevention strategies to reduce the impact of environmental disasters, thereby building a more resilient community. In the end, anywhere a nurse can be involved in communicating how the health of their patients is impacted by environmental and climate changes, the better we are, and the more resilient our communities will become.


Centers for Disease Control (CDC); https://www.cdc.gov/climateandhealth/effects/Southwest.htm (Accessed, April 2023)

New Mexico Climate Change Annual Report (2021); https://www.climateaction.nm.gov/wp-content/uploads/2022/05/NMClimateChange_2021_final.pdf

World Health Organization (WHO); https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health (Accessed, April 2023)

The End of the Public Health Emergency and What this Means for Nurses


The COVID-19 Public Health Emergency (PHE) that was declared in March 2020 is set to end on May 11, 2023, as the President has announced there will be no more extensions to the PHE. After three years of regulatory flexibility in many areas of healthcare delivery, implications of the PHE unwinding for patients, nurses, and communities will be significant. Because of specific Congressional action many of the telehealth flexibilities authorized under the PHE will continue through the end of 2024. Much of Medicare is in statute, and as a result the Administration has limited authority to expand telehealth absent Congressional action. Congress has extended the telehealth flexibility through the end of 2024, but it is unclear if it will be extended further or made permanent. Additionally, CMS is ending the requirement that the supervising clinician be immediately available at the end of the calendar year where the PHE ends. That means that this will end on December 31 of this year.

ANA has worked with the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) on making waivers permanent, but CMS believes that they do not have the authority to make any additional waivers permanent. As a result, in order for these waivers to continue, Congress must act and pass legislation making these waivers permanent.

There are a number of waivers that ANA would like to become permanent. Some of these waivers had previously expired, but ANA is still advocating to change the law and make them permanently part of the Medicare program. The main waivers are:

  • Physician Services. 42 CFR §482.12(c)(1)–(2) and §482.12(c)(4): Waiving requirements that Medicare patients admitted to a hospital be under the care of a physician, allowing APRNs to practice to the top of their licensure, while authorizing hospitals to optimize their workforce strategies.
  • Physician Visits. 42 CFR 483.30(c)(3): Allowing nurse practitioners (NPs) and clinical nurse specialists (CNS) to perform all mandatory visits in a skilled nursing facility (SNF) has enabled practices and SNFs to maximize their workforce.
  • Physician Delegation of Tasks in SNFs. 42 CFR 483.30(e)(4): Allowing APRNs to practice to the top of their licensure ensures, especially during this PHE, that patients continue to receive immediate access to high quality healthcare.
  • Responsibilities of Physicians in Critical Access Hospitals (CAHs). 42 CFR § 485.631(b)(2): Making the physician physical presence waiver permanent allows certain APRNs in CAHs to practice to the full extent of their education and clinical training and enables the entire health care team to practice to its fullest capacity in provider shortage areas.
  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): Physician Supervision of NPs in RHCs and FQHCs. 42 CFR 491.8(b)(1): Waiving the physician supervision of NPs in RHCs and FQHCs has provided workforce flexibility in rural and underserved communities where provider shortages have increased the most.
  • Anesthesia Services. 42 CFR §482.52(a)(5), §485.639(c) (2), and §416.42 (b)(2): Allowing certified registered nurse anesthetists (CRNA), in accordance with a state emergency plan, to practice to the full extent of their license by permanently extending the CMS waiver removing physician supervision as a Condition of Participation.

The end of the PHE will also have an effect on the Medicaid program. During the PHE, Medicaid enrollees automatically stayed enrolled in Medicaid and did not have to constantly keep proving eligibility. The end of the PHE will end this automatic enrollment and will require enrollees to prove eligibility. Additionally, the federal government had offered an additional 6.2% match for states who met maintenance of effort criteria during the PHE. This additional match will be slowly wound down through 2023 and the federal match will be returned to what it had been prior to the PHE in January 2024.

The end of the PHE could also lead to the resumption of student loan payments that were deferred due to the pandemic. Nursing school is expensive and as a result roughly ¾ of nursing students take out federal student loans to help pay for school. However, the Administration’s superseding debt forgiveness program is still pending in the courts. Oral arguments on the program were argued before the Supreme Court on February 28, and a decision is expected this Term. So, there is some ambiguity as to when payments will be required to resume. The original date for resumption of payments is June 30 and that is still likely to continue, but if the Supreme Court issues a decision before the end of April that date would change. The Administration has stated that payments will resume either sixty days after the Supreme Court renders an opinion or June 30, whichever comes first.

You can share your story about the impact of the Public Health Emergency HERE.

For additional resources about the end of the PHE, you can visit the websites below: