Health System Transformation Eclipses Other Issues
The American Nurses Association (ANA) recently unveiled its leading federal legislative priorities for Congress covering safe staffing, nursing workforce development, home health, opioid epidemic, workplace violence, and COVID-19.
Health System Transformation
Renovating America's health system tops the list and calls for following four major principles: safeguarding universal access to a standard package of essential healthcare services for all U.S. residents; optimizing primary, community-based and preventive care, while also supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; boosting mechanisms to stimulate the cost-effective use of healthcare services while also minimizing burdens on those without the means to cost-share; and delivering a sufficient supply of a skilled workforce dedicated to providing high quality healthcare services.
"Universal access includes an essential benefits package to provide access to comprehensive services, prohibition of the denial of coverage due to pre-existing conditions, inclusion of children on parents' health coverage until the age of 26, and expansion of Medicaid as a safety net for economically disadvantaged people," said Willa Fuller, BSN, RN, executive director of the Florida Nurses Association, and a national ANA spokesperson.
Optimizing care calls for a primary healthcare focused on developing an engaged partnership with patients, and includes preventive, curative, and rehabilitative services delivered in coordinated manner. It also means removing barriers and restrictions that hinder RNs and APRNs from fully contributing to community patient care; and care coordination that lowers costs and improves outcomes via consistent and sustaining payment models.
"Encouraging mechanisms to stimulate the cost-effective use of healthcare services starts with a partnership between the government and private sector to address healthcare affordability," explained Fuller. "Payment systems must reward quality and the appropriate, effective use of resources. Also, beneficiaries paying a portion of their healthcare should be provided an incentive for the efficient use of services while being assured that deductibles and co-payments do not negatively impact care."
Elimination of lifetime caps or annul limits on coverage should be part of the plan, and federal subsidies based on an income-based sliding scale should assure insurance coverage.
A sufficient supply of skilled workers dedicated to providing high quality healthcare services should include an adequate number of highly trained RNs, and increased funding via grants or loan repayments for programs and services intent on increasing the primary care workforce. This funding should elevate support for expanding nursing faculty and workforce diversity.
"The ANA continues to lobby for safe staffing ratios critical to achieving the correct staffing levels," said Fuller, noting that Congressmen Peter Welch (D-Vermont) and Morgan Griffith (R-Virginia) recently coauthored a letter to the White House COVID-19 Task Force calling for an investigation into staffing agencies' price gouging during the pandemic.
Collaborative efforts have resulted in state-level safe staffing laws in seven states: Oregon, Texas, Illinois, Connecticut, Ohio, Washington and Nevada.
Nursing Workforce Development
Because nurses continue to represent the largest group of healthcare providers whose services are linked to quality and cost-effectiveness, fully trained nurses are critical.
"Increased demand for RNs in the coming years will be driven in part by an aging population," said Fuller.
According to the Pew Research Center, an estimated 10,000 people are turning 65 on a daily basis, a trend that will continue until 2030.
"As such, the healthcare workforce will need to grow to keep up with demand for nursing care in traditional acute care settings and the expansion of non-hospital settings such as home and long-term care," said Fuller.
In 2020, Congress signed into law the Title VIII Nursing Workforce Reauthorization Act that was included in the CARES Act. It reauthorizes nursing workforce development programs through fiscal year 2024.
"Not only is it the largest source of federal funding for nursing education, but the programs are invaluable to institutions that educate RNs to practice, particularly in rural and underserved communities," said Fuller, noting the ANA will continue to lobby Congress and the Administration to appropriate more annual funds to the Title VIII programs.
Major grant programs within Title VIII cover advanced education nursing; workforce diversity grants; grants for nurse education, practice, and retention; national nurse service corps' Nurse Education Loan Repayment Program; nurse faculty loan programs; and comprehensive geriatric education grants.
The ANA promotes the authorization of APRNs to provide appropriate, timely care for their home health patients, instead of allowing patients needing the service to languish while waiting for physician approval, particularly in rural and underserved areas. For now, the CARES Act allows NPs and CNs to order home health services for Medicare beneficiaries without physician approval.
Because nurses remain at the forefront of the national health crisis, the opioid epidemic must be addressed with a comprehensive approach from community-based programs to government action at every level, said Fuller.
During the past two Congresses, dozens of bills have addressed this issue. In 2018, the SUPPORT for patients and the Communities Act gave NPs and PAs permanent authority to prescribe Medication Assisted Treatment (MAT), which also grants clinical nurse specialists, certified RN anesthetists, and registered nurse-midwives this authorization through 2023.
Last year, the Mainstreaming Addiction Treatment Act of 2021 aimed to eliminate the separate registration requirement for dispensing certain narcotic drugs for maintenance or detoxification treatment.
"Current law requires prescribers to apply for a waiver to prescribe buprenorphine to treat addiction after completing a multi-hour educational course," said Fuller.
Because one in four nurses has been abused in the workplace, the ANA has led the charge to end nurse abuse at the federal and state levels. Last February, the House of Representatives introduced the Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 1195) to require Occupational Safety and Health Administration (OSHA) to develop enforceable standards to protect employees. This legislation passed the House last April 16 with wide bipartisan support on a 254-166 vote. The ANA is working with bill sponsors to facilitate its passage and be signed into law by President Biden this Congress.
"As response to the pandemic evolves, so too has the nature of ANA's work--addressing priority issues from availability of Personal Protective Equipment (PPE) and decontamination to vaccine rollout and distribution guidance," said Fuller, adding that ANA also promotes improved public health infrastructure funding, mental health and hazard pay, and controversial vaccination requirements.