Pro-Nursing Bills Advance in Lame Duck Congress

One bill would remove federal practice barriers for NPs. The other bill would restore collective bargaining rights for VA clinicians.

The nation's leading nursing associations are praising two bills advancing through Congress that would remove federal practice barriers for nurse practitioners and restore collective bargaining rights for nurses and other clinicians at the Department of Veterans Affairs.

ICAN Act

U.S. Sen. Jeff Merkley, D-OR, this month introduced the Improving Care and Access to Nurses (ICAN) Act (S.5212), which would remove administrative and practice barriers for advanced practice registered nurses (APRNs), which supporters say will improve access to healthcare for millions of Americans.

Companion legislation (H.R. 8812) was introduced in the U.S. House in September and assigned to the Health Subcommittee. It likely will not be heard before the lame duck Congress adjourns permanently this month. However, ICAN appears to have bipartisan support and could be taken up when House Republicans take control in January

April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners, notes that about 40% of Medicare and Medicaid patients receive care from nurse practitioners as their providers "and it is critical these patients receive timely, high-quality healthcare from their providers of choice."

"The ICAN Act will eliminate outdated barriers to care that impede the progress of our healthcare system," Kapu says.

Angela Mund, DNP, CRNA, president of the American Association of Nurse Anesthetists, says the bill will "eliminate burdensome laws and regulations."

"Allowing certified registered nurse anesthetists and other APRNs to practice to the full scope of their training and licensure will ensure that patients are put first, that competition drives down costs through the removal of artificial and unnecessary barriers, and that providers of all types are able to better serve their patients," Mund says.

This bill would authorize NPs to order and supervise cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient's terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities, and more.

The American Nursing Association says the bill "is consistent with the recommendations from numerous healthcare stakeholders, including the National Academy of Medicine in their The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report," which recommends 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 healthcare access, quality, and value."

American Nurses Association President Ernest J. Grant, PhD, RN, FAAN, says the ICAN Act means that APRNs, including nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists will be able to care for their patients at the fullest extent of their abilities.

"The ICAN Act is a significant bill that will eliminate many of the burdensome laws and regulations that have prevented patients from getting access to the kind of timely, evidenced-based care that APRNs are clinically trained and qualified to provide," Grant says.

"Allowing APRNs to practice at the top of their license, like they did during the height of the COVID-19 pandemic, will help to cultivate the kind of flexibility that modern healthcare requires. That flexibility will improve patient outcomes and lower costs. And in doing so it will ensure that more individuals, including those in rural and underserved communities, have access to the kind of healthcare that they deserve."

Collective Bargaining Rights

National Nurses United, the nation's largest nurses union, is cheering the House passage this month of the VA Employee Fairness Act of 2021 (HR 1948).

The bill, sponsored by Rep. Mark Takano, D-CA, chairman of the House Committee on Veterans Affairs, would reinstate collective bargaining rights for Veterans Affairs nurses and other clinicians. It passed the full House on Thursday on a 219-201 vote, with only four House Republicans signing on.

"VA nurses have dedicated their careers to serving veterans and have been instrumental in fighting the COVID-19 pandemic. Passing my VA Employee Fairness Act is a step towards recognizing this commitment to our veterans," Takano says

NNU Vice President Irma Westmoreland, RN, who works in the Charlie Norwood VA Medical Center in Augusta, GA, says the nurses play a critical role as patient advocates "and our input and insight is critical in determining best practices for patient care. Without full collective bargaining rights, VA nurses' ability to effectively advocate for the health and safety of our patients and ourselves is hindered."

Senate companion legislation likely will not be heard before the lame duck Congress adjourns this month. However, the pro-labor bill is expected to get a hearing when the Democrat-controlled Senate convenes next year. The bill has the support of the Biden administration.

The bill has been endorsed by every union representing VA clinicians and groups including the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), the Congressional Labor Caucus, the American Legion, and the Vietnam Veterans of America.

Proponents of HR 1948 say it will help with nurse recruiting and retention by restoring bargaining rights to RNs and other clinicians in the VA, who are banned from bargaining over issues relating to professional conduct or competence, patient care, and peer review.

NNU says restoring those rights "would reduce turnover, increase staffing levels, and improve the care that veterans receive by giving VA clinicians the tools they need to speak up for patient safety and care.

"This bill will ensure the rights of bedside nurses in the Veterans Administration are protected and, in turn, will serve to increase the quality of patient care in VA facilities," she continued. "We are extremely pleased that our representatives are recognizing our role in ensuring our nation's veterans get the very best care that they so rightly deserve."