Inside the Beltway – April 2022

Caring for Our Pediatric Caregivers: A Critical Step

Contributed by Health Policy Committee member Danielle Altares Sarik, PhD, APRN, CPNP-PC

As the eyes of the public focus on the RaDonda Vaught conviction and its future impact, health care providers around the country are still reeling from the effects of the pandemic, short staffing and mental and emotional fatigue. Pediatric nurse practitioners (PNPs) and their nurse practitioner colleagues are not immune to these stressors.

While fault lines existed prior to COVID-19, there is no doubt that two years of the pandemic have further exacerbated long standing concerns for the profession. Pediatric provider burnout is being seen across the country, as well as the world, and can be linked to high rates of attrition from the workforce and a general state of high stress. A 2021 study by Peck & Sonney identified that the PNP workforce pipeline may be compromised by high levels of burnout as well as challenges to provider mental health.

The toll of the pandemic on the nursing workforce more broadly is staggering. A national study by the ANA showed that a third of nurses report that they are not emotionally well, and a full two-thirds are either actively looking, or interested in leaving the workforce. Since the start of the pandemic, rates of reported burnout for nurses has increased 350%. In our own practices, many of us have seen our colleagues, from the most experienced to the novice PNP, leave the bedside or take a step back from the profession due to overwhelm and stress.

These trends are not just bad for our PNP workforce, they represent a threat to the safety net and clinical care that can be provided to pediatric patients. Without a robust, mentally and emotionally healthy PNP workforce patient care will be negatively impacted.

Federal support for our healthcare workforce is key, and we welcome the news of the recently passed Lorna Breen Healthcare Provider Protection Act (HR 1667). The bill received bipartisan support, and was cosponsored by U.S. Senators Tim Kaine (Va.) and Jack Reed (R.I.), Todd Young (Ind.), and Bill Cassidy (La.), U.S. Representatives Susan Wild (Pa.), Raja Krishnamoorthi (Ill.), Judy Chu (Calif.) and David McKinley (W.V.). This legislation will provide:

Grant funding for mental health support, as well as initiatives to promote health care provider well being and satisfaction.
Encouragement of the use and dissemination of best practices for suicide prevention and wellness promotion, based on evidence.
Support for the creation of a study to examine and address the impact of burnout on the well-being of healthcare professionals.

While many of the issues impacting our pediatric nursing workforce will not be solved overnight, this legislation and the associated initiatives are a step in the right direction. In order to continue to provide high quality pediatric care, we need to recognize the important role of nurses, and marshal resources to address these pressing needs. Without a robust and healthy nursing workforce, the future of healthcare is in jeopardy.

References/resources:

- https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/nurses-and-the-great-attrition
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014723/
- https://www.jpedhc.org/article/S0891-5245(21)00094-8/fulltext
- https://www.oncnursingnews.com/view/ana-survey-shows-nurse-emotional-health-still-severely-impacted-by-covid-19
- https://drlornabreen.org/about-the-legislation/

After Fiscal 2022 Agreement, Appropriators Turn to Fiscal 2023

After months of slow-moving negotiation, Congress finally agreed March 10 to a sweeping $1.5 trillion omnibus spending bill (H.R. 2471) that included $13.6 billion in emergency aid for Ukraine after Democratic leaders stripped out a contentious COVID-19 emergency aid provision. The Ukraine crisis led appropriators to provide a much larger allocation for defense spending and likely contributed to smaller increases for domestic spending including nursing education and research programs. The final agreement provided a $16 million increase for Title VIII nursing education programs, much less than the $50 million approved by the House, and included a nearly $6 million increase for the National Institute of Nursing Research, rather than the roughly $25 million that both chambers proposed earlier.

The omnibus spending dal also extended Medicare coverage of telehealth services, including audio-only services, for 151 days after the end of the public health emergency, increased maximum pay for nurses in VA facilities, and gave the Food and Drug Administration additional authority to regulate products that contain synthetic nicotine, closing a massive loophole in efforts to reduce youth smoking.

Less than three weeks after signing the fiscal 2022 deal, President Biden sent a $5.8 trillion budget proposal to Capitol Hill March 28, seeking to reduce the national deficit by roughly $1 trillion over 10 years and envisioning a “Bipartisan Unity Agenda” including cancer prevention, mental health care, and veteran’s services. The budget calls for a $14.5 million increase in the Title VIII programs, to a total of $294.97 million, with $25 million focused on growing and diversifying the maternal and perinatal nursing workforce and increasing the number of certified nurse-midwives in rural and underserved communities. NAPNAP is joining other national nursing organizations in renewing their request for a doubling of Title VIII funding to at least $530 million.

Exciting Week for Full Practice!

On April 11, New York Governor Kathy Hochul included necessary language in the state’s budget to grant full practice authority to nurse practitioners in New York increasing patients’ access to the high quality, evidence-based, equitable health care provided by nurse practitioners.

Kansas House Bill 2279 for full practice passed on April 1 with a vote of 80-34 and was signed into law by Governor Kelly on April 15. The newly signed law does not include transition to practice hours, a compromise many state APRN groups had to make in recent practice legislation.

Congratulations to our New York and Kansas members who have been advocating for these major achievements for many years.

Immigration Fight Stalls Emergency COVID Funding

Administration officials are scrambling to keep federal coronavirus response programs running as Congress struggles to approve billions in supplemental emergency funding for COVID-19 initiatives. Lawmakers adjourned for a two-week spring recess April 7 without passing a compromise $10 billion plan after Senate Republicans demanded a vote on blocking the President’s plan to end the pandemic practice of expelling asylum seekers from the country for public health reasons without hearing their cases.

The Senate stalemate followed the House’s failure to include a larger $15.6 billion relief package in the fiscal 2022 omnibus appropriations deal when after Democratic members objected to using their home states’ unspent COVID-19 money to offset the cost of the new spending. The House proposal was already a compromise reducing the President’s initial plea for $22.5 billion in supplemental funding for vaccines, treatments and research. The House separately passed the $55 billion “Restaurant Revitalization Fund Replenishment Act of 2021” (H.R. 3807) to help eateries and small businesses suffering from pandemic losses, but the fate of that bill in the Senate is also unclear.

The latest COVID-19 funding standoff arose after the Biden administration announced April 1 that it would terminate the controversial expulsion of migrants under the Centers for Disease Control and Prevention’s March 2020 order to use its authority under Title 42 of the Public Health Service Act to keep asylum seekers out of the country to limit the spread of COVID-19, a policy that drew heated criticism from immigration advocates. A bipartisan group of 11 senators led by Sens. Kyrsten Sinema (D-AZ) and James Lankford (R-OK) introduced the “Public Health and Border Security Act of 2022” (S. 4036) April 7 to prevent the administration from lifting the Title 42 expulsions without a detailed plan to stop an expected surge of migrants at the southwest border.

Lawmakers Consider Mental Health Package

Committees in both chambers of Congress are working on what could be a sweeping plan to address the nation’s growing mental health and substance use crisis following the March 2 release of President Biden’s State of the Union proposal to focus on children’s mental health, crisis care, increasing the mental health workforce and enforcing insurance parity laws. NAPNAP and other nursing and children’s health groups submitted comments to committees last fall outlining key proposals and priorities.

Senate committees with jurisdiction over federal health programs and regulation of private health insurance are working separately on proposals to strengthen coverage for mental health and substance use disorder care and bolstering the nation’s behavioral health workforce, while House committees are reviewing dozens of bills aimed at addressing coverage, payment, and equity in mental health care for adults and children. The details of a comprehensive plan have yet to emerge, but committees hope to advance legislation this summer with the intention of passing it before the November election.

Pfizer Seeks Approval For Child COVID-19 Booster

Pfizer and BioNTech announced April 14 that they will soon ask the Food and Drug Administration to authorize a booster dose of its pediatric COVID-19 vaccine for children ages 5 to 11, citing data from clinical trials suggesting another shot offers greater protection from the virus. Phase II and III trial data showed a third dose administered to that age group about six months after the second shot boosts resistance to both the original coronavirus type and the Omicron strain. The FDA and the Centers for Disease Control and Prevention first recommended Pfizer boosters for teens ages 12 to 15 in January as Omicron took hold. CDC data indicate that only 24 percent of fully vaccinated 12- to 17-year-olds have gotten their first booster dose.

The companies said they will file for emergency use authorization “in the coming days.” Meanwhile, the CDC’s Advisory Committee on Immunization Practices will meet April 20 to discuss COVID-19 boosters including evidence on the potential benefit of a booster dose in young, healthy people.

In Other News…

Administration, Congress Struggle to Revive Domestic Agenda
Democratic leaders in Congress continue to work with the White House to revive portions of President Biden’s “Build Back Better” proposal after the opposition of Democratic Sen. Joe Manchin of West Virginia stalled the plan last December. After Biden urged Congress to act on key domestic priorities in his State of the Union address, Manchin indicated he was open to a scaled-down plan to lower the deficit and enact some new programs if they were permanently funded, suggesting that prescription drug savings and tax reform be used to address inflation while enacting new climate and social programs. At the end of March he proposed clean energy policies to tackle climate change but was unclear about what health care or domestic policies he would support beyond prescription drug pricing reforms.

Manchin and party leaders agree that the clock is ticking on effort to revive the social spending deal. With much of the election-year legislative calendar focused on COVID-19 supplemental spending and fiscal 2023 appropriations, leaders believe a budget reconciliation bill with health and environment provisions would have to be completed before lawmakers adjourn for the month-long August recess. Given the time it would take to agree on and draft provisions, ensure that they meet the Senate’s strict budget rules, and pass both chambers, Democratic leaders say they have to agree on a plan before the Memorial Day congressional break.

Senate Moves Pandemic Preparedness Plan
The Senate is poised to open debate on legislation aimed at modernizing and strengthening the nation’s biomedical and pandemic response programs after the Health, Education, Labor, and Pensions Committee voted 20 to 2 March 15 to approve the “Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics (PREVENT Pandemics) Act” (S. 3799) drafted by committee chair Sen. Patty Murray (D-WA) and ranking Republican Sen. Richard Burr (NC). The committee adopted amendments to address the nursing shortage, increase U.S. manufacturing of antibiotics, and identify and adjust supply needs during public health emergencies.

The committee voted 12 to 10 to adopt an amendment by Sen. Bernie Sanders (I-VT) to provide $177 million to the HHS Nurse Corps program in fiscal 2023, doubling the amount of funding the program is receiving this year. Sanders said the amendment would help address the severe nursing shortage in the U.S., particularly in rural areas, providing scholarships and loan forgiveness to some 1,700 students to attend nursing school, nurse faculty and nurses providing care in underserved areas.