Inside the Beltway June 2021

The Future of Nursing

Contributed by Health Policy Committee Chair Sarah Viall, MSN, PPCNP-BC

In May 2021, the National Academy of Medicine (NAM) published their anticipated report The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Expected last year, in July 2020 it was announced that it would be delayed in order to incorporate information from the ongoing COVID-19 crisis. At just under 500 pages it is not a quick read, however, it is important that we familiarize ourselves with the major elements of this report which is expected to guide nursing’s academic programs, workforce research, policy involvement and leadership development over the course of the next decade and beyond.

The publication is a follow-up to the 2011 NAM report, formerly known as the Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health which focused on how to promote nursing capacity, diversity, professional scope and leadership. This updated report commends the progress of the past decade while acknowledging the undeniable impact of the pandemic on current and future nursing and the entire healthcare system.

The report serves as a blueprint for ways our field can address the needs of the modern and emerging healthcare system. More precisely, how nursing can and should be a force for addressing systemic racism and its resulting inadequate and inequitable investments in the health of all U.S. citizens, particularly black, minority and other vulnerable populations. It outlines actionable, evidence-based mechanisms and research and policy priorities across nine broad recommendations with a particular emphasis on addressing social determinants of health. As was emphasized in the 2011 IOM report, Future of Nursing also endorses enabling nurses to practice to the full extent of their education and to remove barriers which prevent them from their ability to contribute to their full potential. Finally, the report recognizes the impact of the public health crisis on nurses, as professionals and humans, and recommends concrete action be taken to support our workforce which has taken on such a considerable role in the national and global crisis over the past 15 months.

NAPNAP encourages our members, policymakers and health systems to review the recommendations and use them as guidelines to shape future nursing policies.

1: Creating a shared agenda
In 2021, all national nursing organizations should initiate work to develop a shared agenda for addressing social determinants of health and achieving health equity.

2: Supporting nurses to advance health equity
By 2023, state and federal government agencies, health care and public health organizations, payers, and foundations should initiate substantive actions to enable the nursing workforce to address social determinants of health and health equity more comprehensively, regardless of practice setting.

3: Promoting nurses’ health and well-being
By 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of structures, systems, and evidence-based interventions to promote nurses’ health and well-being, especially as they take on new roles to advance health equity.

4: Capitalizing on nurses’ potential
All organizations, including state and federal entities and employing organizations, should enable nurses to practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving health care access, quality, and value.

5: Paying for nursing care
Federal, tribal, state, local, and private payers and public health agencies should establish sustainable and flexible payment mechanisms to support nurses in both health care and public health, including school nurses, in addressing social needs, social determinants of health, and health equity.

6: Using technology to integrate data on social determinants of health into nursing practice
All public and private health care systems should incorporate nursing expertise in designing, generating, analyzing and applying data to support initiatives focused on social determinants of health and health equity using diverse digital platforms, artificial intelligence, and other innovative technologies.

7: Strengthening nursing education
Nursing education programs, including continuing education, and accreditors and the National Council of State Boards of Nursing should ensure that nurses are prepared to address social determinants of health and achieve health equity.

8: Preparing nurses to respond to disasters and public health emergencies
To enable nurses to address inequities within communities, federal agencies and other key stakeholders within and outside the nursing profession should strengthen and protect the nursing workforce during the response to such public health emergencies as the COVID-19 pandemic and natural disasters, including those related to climate change.

9: Building the evidence base
The National Institutes of Health, the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, the Administration for Children and Families, the Administration for Community Living, and private associations and foundations should convene representatives from nursing, public health, and health care to develop and support a research agenda and evidence base describing the impact of nursing interventions, including multisector collaboration, on social determinants of health, environmental health, health equity, and nurses’ health and well-being.

Source: https://www.nap.edu/read/25982/chapter/1 (free to read online)


The National Association of Pediatric Nurse Practitioners (NAPNAP) would like to thank the following members of our national Health Policy Committee who will be retiring from the committee on June 30, 2021. We appreciate their dedication to our advocacy efforts and look forward to their continued participation in NAPNAP as experts in pediatrics and advocates for children.

    • Chair: Sarah Viall, MSN, PPCNP-BC
    • Immediate Past President: Rajashree Koppolu, RN, MSN, CPNP, MSL
    • Members: Chaka Batley, DNP, APRN-FPA, PNP-PC, PMHNP-BC, MBA; Jessica Edgar, MSN, CPNP and Nicole F. Garritano, DNP, APRN, CPNP-AC


CDC Warns of “Serious Threat” In Lagging Child Vaccinations

Routine childhood vaccinations dropped dramatically during the early months of the coronavirus pandemic, the Centers for Disease Control and Prevention reported June 10, and although they began rebounding last summer as families rescheduled visits with pediatric providers, many children and adolescents are behind on their shots. The agency warned that the lag could pose “a serious public health threat” of outbreaks of vaccine-preventable illnesses such as measles and whooping cough that have the potential to derail plans for school re-openings. The CDC is recommending that providers give coronavirus vaccines on the same day as other vaccines, especially when children and teens are behind or in danger of falling behind on recommended shots. The agency changed its guidance in May to allow for coronavirus shots to be given at the same time as others.

Researchers found that shots for children and teens between March and May 2020 were substantially lower for routine vaccinations, including for DTaP (diphtheria, tetanus and acellular pertussis), measles, and HPV, across all age groups, compared to the same three-month period in 2018 and 2019. Among children younger than 24 months old and children 2 to 6 years old, doses of DTaP fell a median of almost 16 percent and 60 percent, respectively, across all jurisdictions compared with the same period in 2018 and 2019. Doses of measles, mumps and rubella vaccine, MMR, given to children 12 to 23 months and 2 to 8 years old, fell a median of 22 percent and 63 percent. Among children 9 to 12 years old and teens ages 13 to 17, doses of human papilloma virus vaccine (HPV) fell almost 64 percent and 71 percent, compared with doses administered in the two previous years.


Biden Budget Offers Modest Increase in Nursing Workforce Funding

President Biden unveiled a $6 trillion budget for fiscal year 2022 on May 28 that includes massive spending on social priorities including universal prekindergarten, tuition-free community college, subsidies for child care and guaranteed paid leave. But the President called for only a $3.5 million increase in the current $264.47 million funding for Title VIII nursing workforce development programs – with the increase going entirely to the Nursing Workforce Diversity program, leaving other nursing education programs with flat funding at their fiscal 2021 levels. The proposed 1.3 percent increase is far below the doubling of Title VIII funding to at least $530 million sought by NAPNAP and other nursing organizations.

The President’s budget also incorporates his eight-year, $2.3 trillion infrastructure proposal and his $1.8 trillion American Families Plan, with a huge 40.8 percent increase in education funding and a boost of more than 23 precent in overall funding for the Department of Health and Human Services to a total of $133.7 billion. The budget calls for a $9 billion increase in funding for the National Institutes of Health, including a $24.8 million increase in funding for the National Institute of Nursing Research, to a total of $199.75 million. It also supports improving access to dental, hearing and vision coverage in Medicare, and covering low-income people through a public option in those states that haven’t expanded Medicaid, but offers no timeline or proposals to accomplish those goals.

Republicans were quick to condemn the President’s budget as a “tax and spend” agenda. Senate Appropriations Committee ranking Republican Sen. Richard Shelby (AL) called it “a blueprint for the higher taxes, excessive spending” that also “shortchanges our national security.” Senate Majority Leader Chuck Schumer initially targeted mid-June to pass the chamber’s version of a fiscal 2022 budget resolution, but bipartisan negotiations on an infrastructure deal could delay the resolution – which is likely to provide instructions to committees for another reconciliation bill to avoid a Senate filibuster and advance many of Democrats’ priorities without Republican votes.


HHS Releases Funds for Pediatric Tele-Mental Health

The Department of Health and Human Services announced on May 20 that it was releasing $14.2 million from the American Rescue Plan to expand pediatric mental health care access by integrating telehealth services into pediatric primary care. The funding, administered by the Health Resources and Services Administration, will expand Pediatric Mental Health Care Access (PMHCA) projects into new states and geographic areas nationwide, including tribal areas. The new networks of pediatric mental health care teams will provide teleconsultations, training, technical assistance and care coordination for pediatric primary care providers including APRNs to diagnose, treat and refer children and youth with mental health conditions and substance use disorders. There are currently 21 PMCHA projects in the country.


CDC Urges Parents to Vaccinate Teens Against COVID-19

Citing increased hospitalization rates of teenagers with COVID-19 in March and April, Centers for Disease Control and Prevention Director Rochelle Walensky urged parents on June 4 to vaccinate their teens to protect them from the illness that can be severe even among young people. “I am deeply concerned by the numbers of hospitalized adolescents and saddened to see the numbers of adolescents who required treatment in intensive care units or mechanical ventilation,” Walensky said, referring to a new study that showed nearly one-third of teenagers hospitalized with COVID-19 earlier this year required intensive care, and 5 percent required mechanical ventilation. “Much of this suffering can be prevented,” she added, urging “parents, relatives and close friends to join me and talk with teens” about the importance of prevention strategies and to encourage vaccination.

Researchers suggested that the increased hospitalization among adolescents in March and April could be related to several factors, including more transmissible and potentially more dangerous virus variants; larger numbers of youths returning to school; and changes in physical distancing, mask-wearing and other prevention behaviors.

Drug maker Moderna asked the Food and Drug Administration June 10 to authorize the use of its coronavirus vaccine for teens ages 12 to 17, becoming the second vaccine maker to seek permission to use its shots in adolescents after regulators last month approved the Pfizer/BioNTech vaccine to be given to people 12 and older. Moderna also followed Pfizer June 1 in asking the FDA for full approval of its COVID-19 vaccine in people 18 and older, allowing it to market the shot directly to consumers.


Senate Committee Advances Maternal Health Bills

Senate Health, Education, Labor, and Pensions Committee Chair Patty Murray (D-WA) pledged May 25 to get a series of maternal health measures signed into law and fully funded, as the committee unanimously advanced six bipartisan bills to establish programs aimed at improving maternal health and fighting racial biases, including the “Maternal Health Quality Improvement Act” (S. 1675) and the “Rural Maternal and Obstetric Modernization of Services (Rural MOMS) Act” (S. 1491). Murray said, “I’ll be pushing to not only get these bills passed into law as soon as possible, but also to follow up on them, fund them, and build on them.”

The committee also approved the “Dr. Lorna Breen Health Care Provider Protection Act” (S. 610) to establish grants for training clinicians in strategies to tackle mental health and substance use disorders, aimed at reducing suicide deaths among health care providers.


In Other News

Brooks-LaSure Confirmed as Medicare, Medicaid Administrator

The Senate on May 25 confirmed former Obama administration official Chiquita Brooks-LaSure as the new administrator of the Centers for Medicare and Medicaid Services, where she will oversee the Biden administration’s efforts to shore up the Affordable Care Act and expand Medicare and Medicaid coverage. The 55 to 44 Senate vote largely split along party lines, with five Republicans joining Democrats to approve Brooks-LaSure, who is the first Black woman to run CMS.

Republicans will continue tp question Brooks-LaSure as the Biden administration rolls back the previous administration’s conservative health care policies such as Medicaid work requirements. Her confirmation drew little opposition until CMS revoked the previous administration’s eleventh-hour extension of a Texas Medicaid waiver, after which Republicans on the Senate Finance Committee unanimously opposed her confirmation and Texas Republican Sen. John Cornyn put a hold on consideration of her appointment.

Search for Bipartisan Infrastructure Deal Falters

The Biden administration’s hopes of reaching a bipartisan agreement on provisions of its “American Jobs Plan” dimmed June 9 as bipartisan group of 20 senators, 10 from each party, refused to include tax increases in their infrastructure plan after Republican talks with the White House collapsed. Democratic Sen. Jon Tester of Montana, who is part of the bipartisan discussions, said increasing taxes won’t be part of the group’s plan to pay for its proposal, while Sen. Mitt Romney of Utah said Republicans wouldn’t accept higher taxes as part of what’s expected to be a roughly $900 billion offer – significantly less that Biden’s initial $2.2 trillion plan.

Talks between the President and West Virginia Republican Sen. Shelley Moore Capito ended over disagreements on how large the measure should be and how to pay for it. The two remained about $700 billion apart after Capito’s final offer. A White House official said Biden never agreed to shift coronavirus relief funds from the American Rescue Plan to pay for infrastructure – one of Republicans’ key demands.

Democrats are pushing the President to end negotiations with Republicans and agree to advance a broad measure based on his original proposal through budget reconciliation procedures – the same approach used to enact the $1.9 trillion “American Rescue Plan Act” (H.R. 1319) earlier this year. “We’re running out of time” to take action before the month-long August congressional recess, Senate Majority Whip Dick Durbin (D-IL) said.

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