Letter to Congress Outlining Top Legislative Priorities During National Nurses Week
May 8th, 2023
The Honorable Kevin McCarthy
Speaker of the House
United States House of Representatives
Washington, DC 20515
The Honorable Hakeem Jeffries
House Minority Leader
United States House of Representatives
Washington, DC 20515
The Honorable Charles E. Schumer
Senate Majority Leader
United States Senate
Washington, DC 20510
The Honorable Mitch McConnell
Senate Minority Leader
United States Senate
Washington, DC 20510
Dear Speaker McCarthy, Leader Schumer, Leader McConnell, and Leader Jeffries,
As we celebrate National Nurses Week, May 6th – 12th, 63 members of the Nursing Community Coalition (NCC) urge Congress to support our current and future nurses, Advanced Practice Registered Nurses (APRNs),1 nurse leaders, boards of nursing, faculty, and scientists. The NCC is a cross section of education, practice, research, and regulation within the nursing profession. As the largest segment of the health care profession,2 nursing is involved at every point of care, including rural, urban, and underserved areas, is at the frontlines of public health challenges, and is leading the way to ensure today’s science translates to tomorrow’s cures. Our nurses are working in community health centers, hospitals, long-term care facilities, local and state health departments, schools, workplaces, and patients’ homes.
As Congress looks to support our nation’s nursing workforce, during National Nurses Week and beyond, the NCC expresses our strong support for the consideration and passage of the following legislative priorities that directly impact nursing education, workforce, and research, including:
• Support at least $530 Million for Title VIII Nursing Workforce Development Programs in FY 2024.
• Support at least $210 Million for the National Institute of Nursing Research (NINR) in FY 2024.
• Invest in Nursing Education: Support our Nursing Schools, Faculty and Students.
• Support the Nursing Workforce: Ensure Patients have Access to the High-Quality Care Provided by our Nation’s APRNs.
• Make Waivers that have Supported our Nation’s Health during this Public Health Emergency Permanent.
• Institute Safety Measures for the Current and Future Nursing Workforce.
• Invest in Maternal Health Today for a Healthier Tomorrow.
• Support the Mental Health and Healthy Working Environments for Nurses.
• Invest in our Public Health Infrastructure.
Understanding the Landscape: The Current Realities Impacting our Nursing Workforce We all have witnessed the immense impact public health challenges have had on our health care workforce. Nurses continue to feel that impact. In fact, the American Association of Critical-Care Nurses outlined, “92% of nurses surveyed said they believe the pandemic has depleted nurses at their hospitals and, as a result, their careers will be shorter than they intended.”3 The American Nurses Foundation’s third COVID-19 impact study found that 19% of nurses said they intend to leave their position in the next six months, and 27% are considering leaving.4 Most recently, the National Council of State Boards of Nursing (NCSBN) unveiled their research, “Examining the impact of COVID-19 Pandemic on Burnout & Stress Among U.S. Nurses,” which found that approximately 100,000 RNs left the workforce during the pandemic and another 610,388 RNs report an “intent to leave” by 2027 due to stress, burnout, and retirement.5
“Altogether, about one-fifth of RNs nationally are projected to leave the health care workforce.”6
National data supports this need, with the Bureau of Labor Statistics (BLS) projecting demand for Registered Nurses (RNs) would increase 6% by 2031, illustrating an employment change of 195,400 nurses.7
Further, the demand for most APRNs is expected to grow by 40%.8 Given these realities, many look toward education to ensure the nursing pipeline remains strong. However, AACN’s annual survey found that, “the primary barriers to accepting all qualified students at nursing schools continues to be insufficient clinical placement sites, faculty, preceptors, and classroom space, as well as budget cuts.”9
We agree that bold, innovative, and impactful solutions are needed. Now is the time for historic investment in our current and future nursing workforce.
A Path Forward: Top Legislative Priorities to Address the Needs of Our Current and Future Nursing Workforce
• Support at least $530 Million for Title VIII Nursing Workforce Development Programs in FY 2024: As the largest dedicated funding for our current and future nurses, existing Title VIII programs have a proven track record of helping bolster and sustain the nation’s diverse nursing pipeline by addressing all aspects of nursing workforce demand. With an aging workforce, aging population, and need to support our frontline providers, funding for Title VIII must meet levels reflecting the nursing population it serves.
• Support at least $210 Million for the National Institute of Nursing Research (NINR) in FY 2024: As one of the 27 Institutes and Centers at the National Institutes of Health, NINR’s research is aimed at reducing the impact of social determinants of health and creating a more equitable health care system by promoting patient-centered care across the life continuum. The translational research by our nation’s nurse scientists is essential to developing new evidence-based practices to care for all patients.
• Invest in Nursing Education: Support our Nursing Schools, Faculty and Students: To ensure a robust and diverse nursing workforce, investing in the education pathways of our future RNs and APRNs is imperative. Upon its reintroduction, the NCC urges Congress to consider and pass the Future Advancement of Academic Nursing (FAAN) Act. The FAAN Act would provide those vital resources to support the needs of nursing students, help retain and hire diverse faculty, modernize nursing education infrastructure, and create and expand clinical education opportunities. These efforts are essential and will help prepare nursing students as they transition from the classroom to the frontlines in communities across the country.
• Support the Nursing Workforce: Ensure Patients have Access to the High-Quality Care Provided by our Nation’s APRNs: From primary and maternal care to acute and chronic care, APRNs provide high-quality care in all settings and in areas throughout the nation, including rural and underserved communities. As of 2020, over 233,000 APRNs treated Medicare patients and approximately 40% of Medicare beneficiaries received care from an APRN.10 The NCC urges Congress to consider and pass H.R.2713, the Improving Care and Access to Nurses (ICAN) Act. The ICAN Act would remove outdated barriers in the Medicare and Medicaid programs that currently prevent APRNs from practicing to the full extent of their education and clinical training. Further, bills like the Improving Access to Workers’ Compensation for Injured Federal Workers Act (S.131/H.R.618) would retire outdated barriers in the Federal Employee’s Compensation Act (FECA) that limit the ability of NPs to diagnose and oversee the care and treatment of federal employees who are injured or become ill in the course of their employment. Removing these barriers on APRNs and their patients is consistent with recommendations from a broad range of organizations, including the National Academy of Medicine, the National Governors Association, the National Rural Health Association, the Federal Trade Commission, the Bipartisan Policy Center, the Brookings Institution, Americans for Prosperity, and the American Enterprise Institute.
• Make Waivers that have Supported our Nation’s Health during this Public Health Emergency (PHE) Permanent: As we near the end of the PHE on May 11th, we must ensure there is no lapse in the high-quality care our patients have relied upon these past three years. The models of care implemented during these unprecedented times help inform and improve healthcare throughout the nation. Therefore, we urge Congress to take legislative action to make permanent various waivers so nurses and APRNs can continue to provide high quality health care to patients in all communities, including in
rural and underserved areas, now and into the future.
• Institute Safety Measures for the Current and Future Nursing Workforce: A culture of safety in care delivery settings, including violence prevention, is an indispensable aspect of a high-performing, high-quality health care system. Resources and investments are needed to build and sustain safe work environments and preventive practices. Funding should be directed toward concrete violence prevention efforts such as abatement of known risks (e.g. with respect to building exteriors and interiors) and establishment of robust ongoing prevention programs.
• Invest in Maternal Health Today for a Healthier Tomorrow: From growing and diversifying the perinatal workforce and investing in social determinants of health to supporting mom’s mental health and the nurses who are caring for these patients, legislation such as the Black Maternal Health Momnibus Act and the Midwives for MOMs Act, provide a multipronged approach to addressing the maternal health needs in the United States. We encourage Congress’ support of these efforts as they are reintroduced this Congress.
• Support the Mental Health and Healthy Working Environments for Nurses: Caring for the caretaker has become even more important as we witness the mental stress COVID19 has had on our frontline workers. In fact, an American Nurses Foundation survey found that 59% of nurses continue to feel exhausted and 52% report feeling overwhelmed.11 In a separate study, “a quarter to half of nurses reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of the rope (29.4%) “a few times a week” or “every day.”12 Part of this exhaustion among nurses can be attributed to the staffing shortage. In the January 2022 American Nurses Foundation’s Pulse on the Nation’s Nurses Two-Year Impact Assessment found that, “nine-out-of-ten nurses indicated their organization was experiencing a staffing shortage, with 90% classifying it as a serious problem.”13 Separately, NCSBN highlighted that, “62% of the sample reported an increase in their workload during the pandemic.”14 We appreciate the resources dedicated to health providers’ mental health in the American Rescue Plan Act and through other legislative efforts, but more must be done. We strongly recommend Congress includes mental health resources, support for healthy working environments, and funding, specifically for our nation’s nursing students, nurses, and APRNs, in any legislative package moving forward.
• Invest in our Public Health Infrastructure: According to a national profile of local health departments, “the estimated number of registered nurses decreased by 36% from 2008 to 2019.”15 This drastic shortage of nurses within our public health system has been brought into stark reality during the COVID-19 pandemic. We must ensure nurses are at the table as we plan for tomorrow’s challenges and create a more equitable system.
This includes ensuring nursing students, nurses, and APRNs are incorporated into all aspects of public health infrastructure needs and that our public health departments have at least one nurse or APRN on staff.
With over four and half million licensed Registered Nurses (RNs), APRNs, and nursing students, the profession embodies the drive and passion to ensure the health of patients, families, and our country continues to improve.16 We urge Congress, especially during National Nurses Week, to take legislative action, support the current and future nursing workforce, and honor the essential work they provide to our healthcare system and to the public health of our nation. As these conversations continue, and if our organizations can be of any assistance or if you have any questions, please do not hesitate to contact the coalition’s Executive Director, Rachel Stevenson, at rstevenson@thenursingcommunity.org.
Sincerely,
Academy of Medical-Surgical Nurses
Academy of Neonatal Nursing
American Academy of Ambulatory Care Nursing
American Academy of Emergency Nurse Practitioners
American Academy of Nursing
American Association of Colleges of Nursing
American Association of Critical-Care Nurses
American Association of Heart Failure Nurses
American Association of Neuroscience Nurses
American Association of Nurse Anesthesiology
American Association of Nurse Practitioners
American Association of Occupational Health Nurses
American Association of Post-Acute Care Nursing
American College of Nurse-Midwives
American Nephrology Nurses Association
American Nurses Association
American Nursing Informatics Association
American Organization for Nursing Leadership
American Pediatric Surgical Nurses Association, Inc.
American Public Health Association, Public Health Nursing Section
American Psychiatric Nurses Association
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
Association for Radiologic and Imaging Nursing
Association of Community Health Nursing Educators
Association of Nurses in AIDS Care
Association of Pediatric Hematology/Oncology Nurses
Association of periOperative Registered Nurses
Association of Public Health Nurses
Association of Rehabilitation Nurses
Association of Veterans Affairs Nurse Anesthetists
Association of Women’s Health, Obstetric and Neonatal Nurses
Commissioned Officers Association of the U.S. Public Health Service
Dermatology Nurses’ Association
Friends of the National Institute of Nursing Research
Gerontological Advanced Practice Nurses Association
Emergency Nurses Association
Hospice and Palliative Nurses Association
Infusion Nurses Society
International Association of Forensic Nurses
International Society of Psychiatric-Mental Health Nurses
National Association of Clinical Nurse Specialists
National Association of Hispanic Nurses
National Association of Neonatal Nurse Practitioners
National Association of Neonatal Nurses
National Association of Nurse Practitioners in Women’s Health
National Association of Pediatric Nurse Practitioners
National Association of School Nurses
National Black Nurses Association
National Council of State Boards of Nursing
National Forum of State Nursing Workforce Centers
National Hartford Center of Gerontological Nursing Excellence
National League for Nursing
National Nurse-Led Care Consortium
National Organization of Nurse Practitioner Faculties
Nurses Organization of Veterans Affairs
Oncology Nursing Society
Organization for Associate Degree Nursing
Pediatric Endocrinology Nursing Society
Preventive Cardiovascular Nurses Association
Society of Pediatric Nurses
Society of Urologic Nurses and Associates
Wound, Ostomy, and Continence Nurses Society
CC: All members of the U.S. House of Representatives and U.S. Senate
1 APRNs include certified nurse-midwives (CNMs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs) and nurse practitioners (NPs).
2 United States Census Bureau. (2021) Who are our Health Care Workers? Retrieved from: https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html
3 American Association of Critical-Care Nurses. (2021). Hear Us Out Campaign. Retrieved from: https://www.aacn.org/newsroom/hear-us-out-campaign-reports-nurses-covid-19-reality
4 American Nurses Foundation. (2023). Three-Year Annual Assessment Survey: Nurses Needed Increased Support from their Employer. Retrieved from: https://www.nursingworld.org/~48fb88/contentassets/23d4f79cea6b4f67ae24714de11783e9/anf-impactassessment-third-year_v5.pdf
5 National Council of State Boards of Nursing (2023) Examining the impact of COVID-19 Pandemic on Burnout & Stress Among U.S. Nurses. Retrieved from: https://www.journalofnursingregulation.com/article/S2155-8256(23)00063-7/fulltext
6 National Council of State Boards of Nursing (2023) NCSBN Research Projects Significant Nursing Workforce Shortages and Crisis. Retrieved from: https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursingworkforce-shortages-and-crisis
7 U.S. Bureau of Labor Statistics. (2022). Occupational Outlook Handbook- Registered Nurses. Retrieved from: https://www.bls.gov/ooh/healthcare/registered-nurses.htm
8 U.S. Bureau of Labor Statistics. (2022). Occupational Outlook Handbook- Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. Retrieved from: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-andnurse-practitioners.htm
9 American Association of Colleges of Nursing. (2022) Nursing Schools See Enrollment Increases in Entry-Level Programs, Signaling Strong Interest in Nursing Careers. Retrieved from: https://bit.ly/3pjkNnm
10 Centers for Medicare & Medicaid Services Data.CMS.gov. CMS Program Statistics-Medicare Providers. (2022) Retrieved from: https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-service-type-reports/cmsprogram-statistics-medicare-physician-non-physician-practitioner-supplier
16 National Council of State Boards of Nursing. (2020). Active RN Licenses: A profile of nursing licensure in the U.S. as of January 13, 2020. Retrieved from: https://www.ncsbn.org/6161.htm.
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