Capitol Beat

In recognition of National Voter Registration Day this week and ahead of next year’s presidential election, the American Nurses Association (ANA) launched its new and improved #NursesVote website this week. This new resource for ANA members and nurse-advocates everywhere builds on our work last fall, when thousands of nurses engaged with ANA’s #NursesVote Action Center to ensure they had all the information they needed to cast their vote and make their voices heard.

Looking ahead to 2020, the new #NursesVote expands on those efforts with a heightened focus on the presidential race. Our interactive registration tool continues to help voters in every state confirm that they’re registered to vote (or get registered if they aren’t), locate their polling place, or find out what’s needed to vote absentee or early. For nurses in particular, we know their schedules might not provide the opportunity to cast their ballots on Election Day itself.

Additionally, #NursesVote is your go-to resource for information on the candidates as their campaigns progress, ANA’s nursing priorities, and how best to engage with and support the candidate of your choice. ANA encourages all nurse advocates to become well informed voters and help ensure every presidential candidate considers advancing the nursing profession to be one of their core priorities.  

Our candidates page provides a breakdown on the ways in which each candidate has supported key federal legislation and policies on issues that include nursing education and workforce development, home health care and APRNs, how to ensure nurses are equipped to help fight the opioid epidemic, and more. ANA is heartened to know it will have a partner to work with in the White House regardless of the election’s outcome.

Also included are sections that detail the most pressing federal advocacy priorities impacting nursing, as well as a newly released comprehensive guide for those looking to engage with the various presidential campaigns – either as a volunteer or simply as a concerned citizen and nurse-advocate. From running a voter registration drive to making the most of an upcoming campaign visit in your area, #NursesVote will help you hold candidates accountable and ensure other voters understand why nursing issues are an essential part of the discussions taking place between candidates and the constituents they hope to represent.  

ANA empowers nurses across the country to become politically engaged advocates and looks forward to hearing how the new website helps further this mission.

After a very busy spring and summer, Congress has left Washington, D.C. for a few weeks and all eyes now look ahead to what is gearing up to be an active fall.

It is clear that lawmakers and staff are listening to the nurses. Many key priorities of ANA have progressed during the last few months.

It was met with great news when the House Education and Labor Committee passed the Workplace Violence and Prevention for Health Care and Social Service Workers Act (H.R. 1309) with a bipartisan vote during the week of Hill Day and Membership Assembly. This bill directs the Occupational Safety and Health Administration to issue a standard requiring health care and social service employers to develop and implement a comprehensive violence prevention plan tailored to the facility and services with the intention to protect employees from violence incidents in the workplace.

In July, the House Energy and Commerce Committee unanimously passed the Title VIII Nursing Workforce Reauthorization Act (H.R. 728). This legislation would reauthorize nursing workforce development programs through Fiscal Year 2024. That means two of ANA’s key bills are ready for a vote on the floor of the House of Representatives.

Additionally, it is appropriations season in the House of Representatives and the nurses received two wins in the House-passed Labor-HHS appropriations legislation. It included a $30 million increase in Title VIII funding and language to direct CMS to provide information for evaluating appropriate nurse staffing. ANA staff is working with the Senate to ensure they are aware of the provisions in the House-passed text.

Lastly, ANA has been working closely with the Nursing Community Coalition and the coalition was able to include an amendment to the House passed National Defense Authorization Act. This amendment would recognize the nurses who served as members of the United States Cadet Nurse Corps during World War II and provide them with honorable discharges, medal privileges, and burial benefits for cemeteries administered under the Department of Veterans Affairs. We are hopeful this amendment will be in the final legislation!

In order to keep up the great progress that has been made, we urge you to keep calling upon your members of Congress to ensure we can keep moving the ball during the upcoming months!

In late June, a federal court ruled that new family planning rules can take effect, despite ongoing litigation to strike them down. For the first time, providers receiving Title X funds are faced with figuring out the practical aspects of the new rule, including any day-to-day impact on nurses who care for reproductive-age women. ANA is following fast-moving developments with the Title X “gag rule,” and continues to be alert to the rule’s unique implications for nursing.

To recap: Title X is the federal program dedicated to ensuring that patients with low incomes have access to a range of approved family planning methods, along with related reproductive health care and prevention. Title X is administered by the Office of Population Health (OPA) within the Department of Health and Human Services (HHS). The program serves about 4 million people each year.

In March 2019, OPA revised Title X regulations to bar grantees from referring patients to abortion providers and to restrict the content of counseling offered to pregnant patients in additional ways. ANA has vocally opposed these provisions on ethical grounds: Nurses are ethically obligated to foster patient trust, “giving patients complete and accurate information about their health care options so they may make meaningful, informed decisions about their health.”

The details of the final rule raise practical issues for RNs working at sites with Title X funding. Section 59.14 allows only advanced practice clinicians, such as nurse practitioners or certified nurse-midwives, to provide pregnancy counseling, subject to the problematic referral limitations noted above. By the terms of the regulation, RNs and other personnel can provide only information about prenatal care.

While the rule certainly seems to limit the scope of RN practice in family planning, it is unclear how a nurse should proceed in an encounter with a patient who has just learned they are pregnant. This question is especially critical at sites in underserved areas where advanced practice clinicians are not always available. OPA has so far not provided any guidance on how a Title X provider in such circumstances can comply with the rules.

What happens now? In general, OPA has not publicly clarified how and when it will enforce the rules. The National Family Planning and Reproductive Health Association (NFPRHA) has publicly urged OPA “to take the time to properly expand on and better describe how it will interpret aspects of the rule — using examples that reflect the wide range of provider settings and administrative structures present in Title X.”

Despite the practical uncertainty, in the absence of judicial or legislative action to overturn it, the Title X final rule is effectively now in place. Some states may, as Illinois’ governor just announced, drop out of Title X altogether and substitute their own funding for family planning. NFPRHA recommends grantees consult their local counsel.

Nursing advocates are engaged in legislative efforts around Title X , and are working to address the implications of the rule for patient access as well as nursing practice. As clarity about implementation emerges, ANA will be tracking stories from nurses who experience direct consequences of the rule on their practice or their patients. If you have information that you would like to share about implementation of the Title X final rule, please contact gova@ana.org.