Capitol Beat

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.

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.

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.

This Capitol Beat article was guest-written by Debbi Waters, MSN, RN, MJ, CHC, who was a student in the McKendree University Doctor of Nursing Practice (DNP) in Ethical Leadership Program. Ms. Waters completed her leadership practicum in partnership with ANA’s Department of Policy and Government Affairs and successfully completed all requirements as a DNP candidate on April 12, 2022. She will be awarded her degree on May 13, 2022.

The COVID-19 Healthcare Emergency Temporary Standard (ETS) issued by OSHA on June 21, 2021, although late in coming, was a very important step forward in providing workplace protections for all healthcare workers. There was an expectation, based upon statute and OSHA’s representations, that the ETS would be replaced with a permanent standard within six months of being issued. Thus, it was somewhat surprising on December 27, 2021, when OSHA announced they would step away from enforcement of the most protective provisions of the ETS and do so in the absence of a permanent standard. OSHA did provide assurances that a permanent standard would be forthcoming.  

On March 23, 2022, OSHA issued a notice stating the agency would again accept comments on the interim final rule that established the COVID-19 ETS. Specifically, OSHA is requesting comments on proposed changes for a final rule that would broaden the scope of the ETS while increasing flexibility for employers.

 As a Doctor of Nursing Practice candidate, I spent the past year thoroughly and carefully researching policies to safeguard healthcare personnel throughout the COVID-19 pandemic. The suggestion that OSHA is set to weaken many provisions of the ETS as OSHA transitions to a permanent standard was surprising.

The COVID-19 pandemic demonstrated the lack of readiness of the U.S. healthcare system to rapidly respond to the threat of an airborne infectious disease. As of March 30, 2022, there have been 1,071,214 cases of COVID-19 and 4,102 deaths reported among healthcare workers, a number significantly underestimated due to limitations of COVID-19 surveillance and tracking systems to accurately identify cases by occupation. This, combined with an astonishing 249 percent increase in reported workplace illnesses and injuries within the healthcare industry in 2020, an industry that led all other industries prior to COVID-19, would suggest that a permanent standard should incorporate relevant  guidance and existing ETS provisions to create a strong workplace airborne infectious disease standard.  

While it may appear that the most dangerous period of the COVID-19 pandemic is now in the rearview mirror, an extended view must be taken.  The threat of new variants of COVID-19, continued infections among healthcare workers, and the threat of the next airborne infectious disease are very real dangers that must be addressed. Some of the key provisions that should be included in a permanent standard include:

• Provision of an N95 or higher respirator when caring for any patient with a novel or unknown respiratory virus, including pandemic influenza, until it is unequivocally confirmed to be droplet transmission rather than airborne;
• Workplace hazard assessment;
• Easily accessible, written airborne infectious disease plan;
• PPE stockpile, particularly N95 or higher respirators;
• Engineering controls to rapidly convert additional patient rooms into negative airflow;
• Process for tracking and reporting disease transmission, including notification and surveillance of those who may have been exposed regardless of occupational class or department;
• Access to vaccinations for disease pathogens, based upon vaccine availability, at no cost to employees;
• Employee training on the infectious disease plan, and all policies and procedures related to protection of health and safety;
• Mini Respiratory Program to provide rapid access to respirators for precautions deemed necessary outside of the scope of a known diagnosis or suspected case of an airborne infectious disease; and
• Triggers for crisis standard use and termination.

While the significant increase in workplace morbidity and mortality within the healthcare industry is in large part attributed to COVID-19, it is also reflective of the weaknesses in the healthcare system to rapidly deploy lifesaving protections based on years of voluntary guidance rather than enforceable standards.  The OSHA rulemaking process for a permanent infectious disease standard began shortly after the H1N1 pandemic of 2009; yet, more than a decade later, healthcare workers continue to provide care without a federal workplace standard to protect them from the workplace threat of airborne infectious diseases.

This is not the time for nurse safety to backslide, but rather a time for nurses to advocate for prompt action on a permanent workplace airborne infectious disease standard. This is the time to call upon OSHA to focus on the fundamental responsibility to establish the workplace protections we deserve now and to build sustainable capacity to rapidly adapt to the next threat.

Next Steps
There is still time to act by reviewing the proposed changes to the ETS as it is considered for a permanent COVID-19 standard. OSHA will be accepting public comments through April 22, 2022, ahead of public hearings that will begin on April 27, 2022. To submit your comments and encourage OSHA to strengthen rather than weaken the ETS provisions, visit regulations.gov and select the comment button. Now is the time for the voice of nursing professionals to be heard.