State Approaches to Using ARPA Funds

  

Passed through The American Rescue Plan Act (ARPA) via the 117th Congress, $195.3 billion dollars of the total $1.9 trillion dollar package has been allocated to states through The Coronavirus State and Local Fiscal Recovery Fund (SLFRF).

Although individual state circumstances will be different, highlighted below are examples of how the ARPA allocation process occurred in Delaware, Kansas, New Mexico and Vermont. We wanted to provide these examples as indicative of how nurses and the nursing community have been advocating to be included in these funds.

How Funds Have Been Awarded

While states formed varying types of committees to examine SLFRF requests, each state’s interpretation of its constitutional and statutory provisions that outline authority over unanticipated federal funds and authority to spend during a state of emergency vary greatly. Processes ranged from decision making solely vested in governors, in state legislatures or a hybrid/joint approach between the executive and legislative branches.

ARPA funds must be allocated by December 2024 and expended by December 2026 and were generally released in two rounds. States have earmarked a portion of these funds to cover payroll and benefits expenses for health care/public health employees, specifically “the portion of an employee’s time that is dedicated to responding to the COVID-19 public health emergency” per the US Treasury Department’s Final Rule (31 CFR Part 35. RIN 1505-AC77).

Capacity building, workforce expansion and associated infrastructure have been priority areas, with the use of ARPA funds increasing not only the number of current nursing students, albeit also enlarging the ability to hire faculty and train nurses across communities and practice settings. Specific utilization data can be found through the National Conference of State Legislature’s ARPA Funds Allocation Dashboard.

State Examples

  • Among other funds, Delaware received $500,000 from the state’s allocation to develop free, easy to access, evidence-based tools and programming for nurses coping with various issues exacerbated by the pandemic. Delaware’s State Clearinghouse Committee coordinates the ARPA process and consists of the Secretary of State, representatives from the House/Senate and the Director of the state’s Office of Management and Budget.
  • Kansas announced a maximum of $50 million in available funding for hospitals to either provide premium pay or improve retention of nursing resources and support personnel, approved by the SPARK Executive Committee (comprised of the Lieutenant Governor, Speaker of the House, President of the Senate and private sector representatives). This emergency funding provided immediate support for Kansas hospitals to manage the COVID-19 surge and addressed critical shortages in nurse staffing across the state.
  • New Mexico’s Governor directed $15 million of ARPA funds to increase capacity and expand nursing training programs after meeting with the New Mexico Nurses Association and representatives from the wider New Mexico nursing community. 16 institutions received funding which cumulatively added slots for pre-licensure nursing students, developed tutoring to help students pass the licensure exam, retained nursing faculty and expanded clinical sites to rural communities.
  • Vermont’s Governor signed legislation after advocacy from the Vermont Nurses Association, ultimately appropriating two million for emergency grants to support nurse educators, $400,000 for preceptorships $2.5 million for pipeline/apprenticeship programs as well as several million more in collective loan incentive and forgiveness programs.

ANA and our Constituent/State Nurses Associations will keep advocating as funding continues to be appropriated and released. Please feel free to reach out to Jason Richie, Associate Director for State Government Affairs and Policy at jason.richie@ana.org with questions or for more state specific details.  

No Pride in the Status of Health Care Rights for the Transgender Community 

  

As we close out Pride month, it is important to reflect on the state of access to quality compassionate health care for LGBTQ+ communities. As LGBTQ+ Liberation makes a step forward, there is always a backlash right on its heels. Transgender individuals specifically face immense danger for living authentically, which includes having access to gender-affirming health care. They are more than four times more likely to experience violence, including sexual assault, than cisgender people. Instead of offering more support and services to this community, anti-trans legislation has grown exponentially. Before 2021 there were no gender-affirming care bans in law. Today 16 states ban this essential health care for young people. There are over 350 active anti-trans laws attacking access to care, instituting criminal charges for providers, child-abuse charges for supportive parents of transgender children, and much more. 

The risks of violence and legislative bans have undeniable implications for high-quality, equitable health care delivery. In fact, such tactics are antithetical to nursing practice. The Code of Ethics for Nurses states that “the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” Nurses are not only advocates for their patients and the right for everyone to receive the health care they need – nurses practice evidence-based care. Research continues to prove that gender-affirming care improves the overall wellness of gender diverse young people. Laws banning this care are passed under the guise that they are protecting children and parents. In reality, these laws “are not grounded in reputable science” and instead promote misinformation endangering the lives of transgender people across the country.  

Nurses continue to be voted the most ethical professionals and hold a unique and enduring level of trust with their patients. From schools to primary care and emergency rooms, we need to be increasing access to comprehensive and compassionate nursing care for the entire LGBTQ+ community. Nurses can ensure they are LGBTQ+ compassionate by following best practices and talking to their colleagues about barriers they witness in their workplaces. Even though June is over, the work to ensure the right of equitable health care for this community must continue year-round. 

References 

https://williamsinstitute.law.ucla.edu/press/ncvs-trans-press-release/

https://www.mapresearch.org/2023-medical-care-bans-report

https://translegislation.com/

https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

https://www.nursingworld.org/news/news-releases/2023/ana-rejects-laws-against-lgbtq-care/

https://opa.hhs.gov/sites/default/files/2022-03/gender-affirming-care-young-people-march-2022.pdf

https://www.nursingworld.org/news/news-releases/2022-news-releases/american-nurses-association-opposes-restrictions-on-transgender-healthcare-and-criminalizing-gender-affirming-care/

https://www.nursingworld.org/news/news-releases/2022-news-releases/americans-continue-to-rank-nurses-most-honest-and-ethical-professionals/

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. 

References: 

https://www.osha.gov/workplace-violence/sbrefa

https://www.nursingworld.org/~4a209f/globalassets/covid19/anf-2022-workforce-written-report-final.pdf

https://www.osha.gov/sites/default/files/publications/osha3148.pdf

https://www.osha.gov/laws-regs/oshact/completeoshact

https://www.nursingworld.org/~496f4b/globalassets/docs/ana/comment-letters/ana-wpv-sbar-comments_final-2023-04-06.pdf

https://www.osha.gov/sites/default/files/OSHA-WPV-SBAR-Panel-Report.pdf

https://courtney.house.gov/sites/evo-subsites/courtney.house.gov/files/evo-media-document/workplace_violence_prevention_for_health_care_and_social_service_workers_act_fact_sheet.pdf