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); (Accessed, April 2023)

New Mexico Climate Change Annual Report (2021);

World Health Organization (WHO); (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:

2022 Congressional Spending Bill Included Several ANA-Supported Nursing Provisions to Cap off the Year


As 2022 was winding down, Congress finalized negotiations on an end of year package to keep the government open. This bill would fund government agencies through Sept. 30, 2023. It includes $773 billion in domestic spending and $858 billion in defense funding. In addition, there is $45 billion in aid for Ukraine and $40 billion for disaster aid for communities impacted by recent storms and wildfires.  

ANA staff went through the bill and pulled out provisions of interest to the nursing community that we have outlined below:  

Nursing Workforce Programs 

ANA has actively advocated for increases for the Nursing Workforce Development Programs and the National Institute of Nursing Research (NINR) for decades. In this package, Title VIII Nursing Workforce Development Programs received $300.472 million. This is a $20 million increase over Fiscal Year (FY) 2022 enacted levels.  

The NINR received $197.693 million. This is a $16.831 million increase over FY 2022 enacted levels. In the report language, it highlights that $10 million of this is to support research “related to identifying and reducing health disparities.”  


ANA Chief Nursing Officer, Debbie Hatmaker, sent a letter to Congressional Leadership highlighting the need for certain bills and/or provisions to be included in this omnibus package. We are pleased to report that H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act of 2021 was included. Specifically, ANA supported the inclusion of H.R. 1384, the Mainstreaming Addiction Treatment (MAT) Act. This legislation would eliminate the duplicative and burdensome requirement that providers, including APRNs, apply for a Drug Enforcement Administration waiver in order to dispense lifesaving buprenorphine to treat those suffering from opioid use disorder.  

ANA successfully led the charge in 2018 for permanent prescribing authority of medication assisted treatment by nurse practitioners. A compromise was reached to give five years prescribing authority for Certified Nurse-Midwives, Clinical Nurse Specialists, and Nurse Anesthetists who take additional continuing education in the SUPPORT for Patients and Communities Act of 2018. The inclusion of H.R. 1384 will further ensure Certified Nurse-Midwives, Clinical Nurse Specialists, and Nurse Anesthetists will not lose prescribing authority for medication assisted treatment when the provision sunsets in October 2023.  


The omnibus continues Medicare’s expanded access to telehealth by extending COVID-19 telehealth flexibilities for an additional two years, through Dec. 31, 2024.  

Pandemic Preparedness 

The omnibus provides language to improve the Strategic National Stockpile to ensure critical pandemic supplies are operational, resilient, and ready to deploy. This includes the replenishing sale/transfer mechanism that will provide useful predictability for domestic manufacturing of personal protective equipment. The bill also provides support to the public health workforce by encouraging investments in the next generation of health care workers through grants and public health loan forgiveness.  

The bill includes $350 million in flexible funding for public health infrastructure and capacity, a 75 percent increase for the program that was established in fiscal year 2022 for the Centers for Disease Control to bolster public health infrastructure and rebuild the workforce at the state and local level to strengthen our capacity to be ready to respond to emerging public health threats. 

Annual Medicare Payment Changes 

Medicare providers were faced with 8.5% payment cuts slated to go into effect on January 1, 2023. The legislation prevents the 4% PAYGO cut as well as a portion of the 4.5 reimbursement cut resulting from expiration of previous congressional mitigation measures. Specifically, the cuts will be reduced by 2.5% in 2023 and 1.25% in 2024.  

If you have any questions about these provisions, or anything else, please leave a comment or contact someone on ANA’s Policy and Government Affairs staff.