Priorities in 2023 include safe work environments, patients’ access to care, nursing workforce issues

The 118th Congress is officially underway in Washington, DC, bringing with it a return to in-person meetings in Congressional offices as the norm, a new freshmen class learning the ropes, committee assignments being made, and priorities coming to light.

As Congress settles into its legislative business, the American Nurses Association (ANA) continues to pursue nursing priorities by advocating on a broad range of issues important to nurses and the nursing profession. Here’s a look at progress made in 2022 and legislative priorities for 2023.

Mental health

ANA is pleased to report that Congress acted on mental health and well-being in 2022. One major push from ANA’s RNAction grassroots program was advocating for the Dr. Lorna Breen Health Care Provider Protection Act (S.610/H.R. 1667). Over 7,500 nurses contacted their elected officials urging them to support this crucial legislation. Thanks to this vital direct advocacy work, President Biden signed the bill into law in March 2022. The law directs funds from the American Rescue Plan Act to train current and future health professionals on how to prevent suicide, burnout, and substance abuse among themselves and their peers.

In 2022, Congress also enacted the Restoring Hope for Mental Health and Well-Being Act of 2021 (H.R. 7666). ANA supported this comprehensive legislation, especially its inclusion of the Mainstreaming Addiction Treatment (MAT) Act. Passage of the latter eliminated the duplicative and burdensome requirement that providers, including advanced practice RNs (APRNs), apply for a Drug Enforcement Administration waiver to dispense lifesaving buprenorphine to treat those suffering from opioid use disorder.

Dating back to 2018, ANA led the charge for APRNs to have permanent prescribing authority for medication-assisted treatment. A compromise solution was included in the SUPPORT for Patients and Communities Act of 2018. It gave 5 years’ prescribing authority for certified nurse-midwives, clinical nurse specialists, and nurse anesthetists who take additional continuing education. Passage of the MAT Act ensures that recognized APRNs won’t lose prescribing authority for medication-assisted treatment when the current allowance sunsets in October 2023.

Telehealth

The end-of-year spending package that was signed into law in December 2022 extended the Medicare COVID-19 telehealth flexibilities for an additional 
2 years, through December 31, 2024.

Pandemic preparedness

The final 2022 spending package also included provisions to improve the Strategic National Stockpile to ensure critical pandemic supplies are operational, resilient, and ready to deploy. This package also supports the public health workforce, including nurses, by encouraging investments in the next generation of healthcare workers through grants and public health loan forgiveness. Nurses exercised incredible grassroots advocacy on this issue, sending nearly 20,000 letters to Congress urging lawmakers to fortify the Strategic National Stockpile and protect healthcare workers during public health crises.

In 2023, ANA’s three key priorities for the 118th 
Congress are healthcare worker safety, improving patients’ access to care, and strengthening the 
nursing workforce.

Ensuring safe work environments

Workplace violence—a major factor behind burnout in nurses—unfortunately is on the upswing. ANA believes Congress must act to protect nurses and acknowledge the key role employers play in minimizing the risk of violence on-site. That’s why we’re pushing hard to win passage of the Workplace Violence Prevention for Health Care and Social Workers Act (S.4182/H.R. 1195 in the 117th Congress). This crucial legislation would require the Occupational Safety and Health Administration (OSHA) to develop and enforce specific standards for healthcare and social service employers, which would hold them accountable for protecting their staff from workplace violence. The House has passed this legislation twice—in the 117th Congress with significant bipartisan support, and in the 116th Congress—but the Senate so far has failed to act.

ANA also engages directly with OSHA, urging this agency to take independent action to prevent workplace violence in healthcare. OSHA should work with stakeholders to write specific standards that address the unique risks of violence that nurses and other healthcare workers face in all settings where they provide care. ANA advocates are at the forefront of amplifying nurses’ voices in this process.

Improving patient access to quality care

APRNs frequently provide primary and maternal healthcare in areas with limited access to physicians, such as medically underserved urban and rural 
communities. Federal and state waivers during the COVID-19 public health emergency (PHE) benefitted patients by expanding their access to APRNs 
practicing to the full extent of their clinical training and education under state rules. However, on May 11, 2023, the PHE will expire after being in place for more than 3 years. Consequently, APRNs will again be subject to a number of onerous practice restrictions, which will be automatically reinstated as federal policy. Many patients will experience these access barriers immediately, especially those who’ve benefited from being in the care of an APRN during the PHE. As a nation, we can’t afford to go backward. The Improving Care and Access to Nurses (ICAN) Act (S.5212/H.R. 8812 in the 117th Congress) would permanently remove barriers to care and increase access to high-quality services provided by APRNs under Medicare.

In addition to legislative approaches, ANA advocates for federal reforms at the administration level. For instance, each year, the Centers for Medicare and Medicaid Services (CMS) seeks public input on Medicare payment for physicians, hospitals, home health agencies, and other provider groups. ANA actively engages in CMS’s rulemaking process to support and recommend payment rules that more accurately reflect the value of all nurses practicing at the top of their license and their vital roles in care delivery across settings.
ANA is urging CMS to do more to ensure that all payers recognize nurses, including APRNs, in their provider networks and coverage policies. For instance, CMS needs to work with other federal agencies to enforce the provider nondiscrimination provisions, as Congress directed in 2020. This long-awaited rulemaking is overdue, and ANA will continue to urge strong protections that promote full practice authority.

Strengthening the nursing workforce

A crucial step toward solving the nursing shortage involves enhancing nursing education to respond to the current and future needs of nurses. A diverse, well-prepared, and adequately supported nursing workforce matters, especially in the event of any future PHEs, to ensure all patients have access to needed services. The Future Advancement of Academic Nursing (FAAN) Act (S.246/H.R. 851 in the 117th Congress) would support nursing educational programs to grow, teach, and strengthen the future workforce of nurses.
As the year unfolds, ANA will remain alert and agile in advocating on behalf of America’s 4.4 million registered nurses. All nurses are encouraged to bolster advocacy efforts by engaging in ANA’s grassroots advocacy opportunities. Participation by individual nurses, whether through their state associations, or directly with ANA at the federal level, adds up and can lead to significant legislative and policy wins.
ANA offers several ways to stay up to date and engage with the legislative process, including the following:

• Sign up for Action Alerts in the Action Center at rnaction.org. Action Alerts emails inform participants when they are needed to email their legislators. This simple and easy step takes just moments but can make a big difference when all participants make their voices heard.
• Read the Capitol Beat Blog at anacapitolbeat.org. This platform dives into policy issues and keeps the national nursing community apprised about what’s happening in Congress and with the administration.
• Follow ANA social media channels. Use @RNAction on both Facebook and Twitter to get the latest news on issues impacting nursing.

ANA looks forward to working collaboratively with its constituent and state nurses associations and nurses nationwide to elevate the voice of nurses and ensure the profession is highly valued in Washington, DC.

American Nurse Journal. 2023; 18(4). Doi: 10.51256/ANJ042346