Tag: nurses

ANA Makes Nurses’ Voices Heard on Equity and Efficiency

  

Recently, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) entitled Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs. Through this RFI, CMS solicited feedback from stakeholders on the impact of the COVID-19 public health emergency (PHE) on the healthcare delivery system, with specific questions related to access, health equity, and workforce challenges. ANA took advantage of the opportunity to provide feedback to the agency on the nurses’ perspectives. We focused on how the COVID-19 pandemic has impacted the nation’s health care system and pointed to important areas of consideration as we all look to the future.

Representing and supporting over 4.3 million registered nurses, ANA understands the importance of elevating the nurse’s voice regarding the challenges in health care because nurses are integral to patient care. In sharing firsthand experiences from members and association priorities, ANA’s comments addressed access to health care, the nurse’s experience in providing care, advancing health equity, and assessing the impact of waivers issued in response to the PHE. A few key ANA recommendations to CMS are:

  • Make permanent the waivers that allow better access to telehealth and that allow Advanced Practice Registered Nurses (APRNs) to practice at the top of their license by removing unnecessary barriers; and
  • Acknowledge and support the role of the nurse in addressing health inequity and other long-standing nursing concerns about patient care.

Accessing Healthcare and the Public Health Emergency Waivers:

CMS asked to understand what challenges health care workers face that impact their wellbeing and present challenges to meet patient needs. In response, ANA shared member stories of patients who experienced barriers to care due to restrictive rules on APRN practice, such as not being able to access needed mental health care or obtain prescriptions for necessary medications.

We know that when APRNs are allowed to practice at the top of their license, more patients overcome barriers to receiving safe and cost-effective care. ANA recommended that current waivers still in place from the PHE, set now to expire in January 2023, be made permanent through CMS action, so that APRNs can continue to practice at the top of their license. These recommendations also support ANA’s legislative advocacy as we encourage lawmakers to support H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act which would allow for changes in Medicare and Medicaid for APRNs to provide necessary care within their scope to better reach and support the needs of more patients.

APRNs at the #ICAN Act Press Event in September, 2022

Allowing APRNs to continue to serve their communities as they have been able to through the PHE waivers offers more timely and accessible care options in underserved areas and specialties where care can be delayed. Additionally, the PHE waivers for telehealth flexibilities have allowed APRNs to better reach patients where they are needed. ANA recommended to CMS that telehealth allowances be continued and made permanent to increase accessibility to care for more patients.

Understanding Provider Experiences:

CMS also sought feedback to better understand the challenges that impact health care workers’ wellbeing and the challenges in their meeting patient needs. ANA responded by highlighting issues that were exacerbated by COVID-19. Limited resources, critical staffing shortages, and increasing levels of burnout during the ongoing pandemic are several key issues that still need to be addressed. ANA called on CMS to take concrete steps to protect nurses and their patients using all available authority and resources to address these concerns.

In sharing provider experiences, ANA made sure to promote nurse and patient wellbeing and safety issues in its comments. These experiences include:

  • encountering the stigma of needing mental health care, affecting patients and providers;
  • lack of meal breaks during shifts;
  • unenforced safe staffing standards;
  • inadequate nurse involvement in leadership decisions where nursing is impacted; and
  • needing to promote nursing education to keep up with the growing need for more nurses.

In addition, ANA recommended that CMS support nurses and providers by promoting retention efforts of healthcare workers through payment and reimbursement system changes which would allow for appropriate compensation of nurses that more accurately reflect the value of nursing to the healthcare system. ANA also suggested that CMS look further into ensuring documentation requirements are appropriate, to allow nurses to spend more time with patients, and less time charting extraneous details which are nonessential to daily care tasks.

Advancing Health Equity and COVID-19 PHEs:

Continuing their work on advancing health equity, CMS asked how to better help eliminate health disparities. The agency also inquired about COVID-19 PHE waivers, asking what was helpful and what needs to be improved upon from these waivers. ANA responded by continuing to emphasize the important role that nurses perform in their daily tasks and the accessibility that APRNs practicing at the top of their license provides to many patients in underserved areas.

An APRN advocating for the #ICAN Act in September, 2022

Nurses have firsthand experience witnessing health disparities and barriers to care that impact their patients’ health and wellbeing. The culturally competent care nurses provide allows them to identify and offer invaluable insight on the individualized needs of patients and more widely, on advancing health equity in their communities. Because of this, ANA encourages nurse involvement in researching, designing, and implementing measures to address health disparities and advance health equity. ANA stresses the importance of recognizing the role of the nurse in any proposed measure to advance health equity.

Allowing APRNs to practice at the top of their license, as well as the emergence of widely used telehealth appointments increases the accessibility of healthcare resources and making these emergency waivers permanent is one way CMS can immediately act to advance health equity before the waivers expire and we are forced to take a step backwards in access to high quality nursing care.

ANA continues to advocate on behalf of its members and the nursing profession with the federal agencies.

This blog was guest-authored by Samantha Karp. She is completing her Master of Science in Nursing with a focus in Nursing Leadership in Healthcare at Gonzaga University and has spent her practicum semester working with the ANA Policy and Government Affairs team, learning how nurses can be active advocates in policy.

APRNs Can Provide Quality and Access to Care and Congress Needs to Let Them

  

Nurses know better than anyone that the COVID-19 pandemic exacerbated problems in health care and tested the resolve of the nation’s health care system and its stewards. Among the most impactful changes to the healthcare system in response to the pandemic has been the use of a range of Public Health Emergency (PHE) waivers for restrictions and rules that were identified as barriers to safe care of all patients, not only those with COVID-19.

Readers of this blog know the importance of the PHE waivers for healthcare providers. State and federal waivers that have been active for almost three years have allowed Advanced Practice Registered Nurses (APRNs) to practice to the full extent of their education and clinical training. These waivers allowed more types of providers to practice and increased health care capacity to meet the needs of patients.

However, the PHE will not be in effect forever and these waivers will go away without Congressional action. With the recent introduction of H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act, there is a solution that Congress can consider to ensure the strides APRNs made for the nursing profession will not be erased. The ICAN Act codifies key waiver provisions and includes some new expansions. The bill represents huge progress for APRNs to continue to practice at the top of their license. ANA will continue working with federal policy makers to expand access to APRN care and advance the nursing profession. The ICAN Act would remove unnecessary and outdated barriers to providing care for APRNs across the country so they can better care for their patients who are enrolled in Medicare and Medicaid programs.

Nurse Advocates stand with Rep. Lucille Roybal-Allard to announce the ICAN Act in September.

Earlier this month, writers of this blog heard a story from an ANA member and Nurse Practitioner in Nevada that perfectly encapsulated the need for the ICAN Act. As an NP, Denise* can handle most aspects, but not all, of her patients’ diabetes care. As a rural practitioner, Denise is playing a key role in her community providing care in her small town so that people do not have to drive long distances to find a provider.

One of Denise’s patients needed diabetic shoes to help manage his condition. Unfortunately, Denise and other NPs, cannot prescribe diabetic shoes to their Medicare and Medicaid patients despite managing many other aspects of care. Without the shoes, the patient’s condition deteriorated. Ultimately, he was forced to have his leg amputated.

The domino effect on the patient’s health was profound. Due to the amputation of his foot, he became suicidal and required mental health attention and a stay in a hospital far from his hometown. Now he is no longer able to drive himself and must pay for taxis to take him to his appointments. All of this, because Denise could not prescribe her patient shoes that he needed due to his condition. NPs are capable of providing holistic, quality care to their patients, but administrative barriers, such as this one, illustrate the need for the ICAN Act.

APRNs aren’t the only ones discussing the importance of removing barriers to the profession. In 2010, the Institute of Medicine issued “The Future of Nursing: Leading Change, Advancing Health” report, which called for the removal of laws, regulations, and policies that prevent APRNs from providing the full scope of health care services they are educated and trained to provide. In 2021, the National Academy of Medicine (previously named the IOM) in their 2021 The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report recommended that “all relevant state, federal, and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality and value.” Recommendations like this have been echoed on various occasions by the American Enterprise Institute, the Brookings Institute, and the Bipartisan Policy Center.

So, what can you do to help move this important legislation in the U.S. House of Representatives? Get acquainted with the legislation and share with your Member of Congress the provisions that will be most impactful to you and your patients. Then ask your Member of Congress to please cosponsor this common-sense, bipartisan legislation. You can read more about the bill and take action here.

Sending a letter to your Member of Congress will only take a minute of your time, but it will make a huge impact. If you have an experience similar to that of Denise and are interested in sharing it, you can email your story to rnaction@ana.org.

You can also visit our Twitter and Facebook (@RNAction) and tell us your #ICAN statement so we can retweet and repost you!

*Names have been changed to protect privacy.

Nurse Advocates at the Capitol promoting the ICAN Act.

ANA Advocacy – Transforming Nursing’s Voice on the National Stage

  

Last week, I represented the American Nurses Association (ANA) before the United States Senate Finance Committee to reiterate the urgent need to provide nurses a sufficient supply of personal protective equipment (PPE), safeguard the mental health and well-being of nurses, and address the racial health disparities exacerbated by COVID-19. Participating in a Senate hearing for the first time was an eye-opening experience. It was evident that senators unanimously respect and appreciate the significant sacrifices being made by nurses in response to COVID-19. What came to light during the hearing was that ANA’s bi-partisan approach to advocacy is working –as both sides of the aisle were interested in hearing our message and ensuring that the nation’s 4 million registered nurses are at the witness table as Congressional debate continues over access to PPE. More needs to be done to ensure nurses have access to PPE – therefore I urge each of you to help amplify our collective voice by taking ANA’s latest PPE survey and contacting your members of Congress today.

As ANA president, I am determined to ensure that ANA continues to be at the table to advance the voices of nurses and the patients they serve. This means the association representing the nation’s registered nurses needs to work with those who are elected regardless of political affiliation. Having good working relationships with the Administration and Congress allows for productive conversations even when we disagree. This approach has provided ANA’s leadership, including me, the opportunity to proactively discuss the threats our nurses face on the frontlines of the pandemic while voicing our opposition over the Administration’s defunding of the World Health Organization or the lack of action in authorizing the Defense Production Act. Despite these differences, ANA is recognized on Capitol Hill and within the Administration as the voice of nursing. This has allowed ANA additional opportunities to meet with influential decision makers.

In 2019, ANA’s highest governing body – its Membership Assembly – voted to move away from endorsing presidential candidates. In this presidential election cycle, ANA is focused on equipping nurses with information about the candidates to better engage in the 2020 elections. While ANA is not supporting a specific presidential candidate, I encourage every nurse and nurse advocate to actively participate in the political process, and vote on November 3. The decision not to endorse was based on recommendations of a bi-partisan task force made up of influential nursing leaders. ANA has developed NursesVote to help nurses activate, educate, support and vote for the political candidate of their choice. The ANA-PAC stands by its long history of endorsing pro-nursing Congressional candidates who typically have strong relationships with our Policy and Government Affairs staff and our Constituent/State Nurses Associations.

Since the beginning of the pandemic, ANA has met with the White House and has interacted with a number of federal agencies: the Department of Health and Human Services, the Department of Labor and the Federal Emergency Management Agency to raise concerns about a lack of PPE among other pressing issues. This is in addition to political advocacy efforts on Capitol Hill, which have already resulted in wins for nurses, outlined here in a June Capitol Beat blog. Nurses are at the table – and making a difference.

ANA’s advocacy focus is to ensure our ability to expand and promote nursing’s agenda and to fight for the profession and the patients they serve. We make our concerns known both publicly and in personal meetings with elected officials and their staff. ANA will not remain silent. We continue to lead the charge for nurses.