This month’s legislative update covers the US House of Representatives’ passage of a bill that would give Department of Veterans Affairs (VA) nurses and other clinicians full collective bargaining rights, the case for approving NP full practice authority in Pennsylvania, the finalized PA Licensure Compact Model Legislation, and an update on resolutions and amended reports pertaining to NPs and PA from the AMA’s House of Delegates interim meeting.
House Passes VA Employee Fairness Act (HR 1948) Passed
The US House of Representatives passed the VA Employee Fairness Act (HR 1948) with bipartisan support by a margin of 219 to 201 on December 15, 2022. The bill would grant VA nurses and other clinicians full collective bargaining rights. National Nurses United (NNU) applauded the bill, which was sponsored by Rep. Mark Takano, D-Calif, chairman of the House Committee on Veterans Affairs.
“As a nurse who has proudly served our veterans for nearly 4 decades, I want to extend my deepest thanks to Chairman Takano for his tireless efforts to get the VA Employee Fairness Act through the House with bipartisan support,” said Irma Westmoreland, RN, and NNU vice-president, who works in the Charlie Norwood VA Medical Center in Augusta, Ga. “Nurses are patient advocates, and our input and insight [are] 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.”
Nurses and other clinicians in the VA are currently prohibited from bargaining over issues relating to professional conduct or competence, patient care, and peer review. The VA Employee Fairness Act would restore bargaining rights and the NNU said this legislation will 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 also will help both recruit and retain VA health care professionals, the NNU stated, which is essential given the estimated 3.5 million patients who will be entered into the VA health care system with the passing of the Honoring Our PACT Act.
In a statement of administration policy, the White House said it supports HR 1948 “to expand collective bargaining opportunities” for RNs and other clinicians covered in the bill, calling attention to “dedicated VA employees work tirelessly to support our veterans’ health needs, including in combating COVID-19.”
“We know that, in order to recruit and retain experienced nurses, the VA must listen to the concerns of the nurses at the bedside,” said Westmoreland. “Nurses will stay at the VA if we have full bargaining rights, feel heard and valued, and have the resources and support to provide the highest quality of care for our patients. We are grateful the House has recognized how important our voices are in creating a healing environment for our veterans. We now call on the Senate to follow the House and quickly pass the VA Employee Fairness Act.”
The Case for NP Full Practice Authority for NPs in Pennsylvania
The case for passage of Senate Bill 25, which would allow NPs in Pennsylvania full practice authority, was made in a recent article by Moiz Bhai, PhD, and David Mitchell, PhD.
More than 580,000 people in Pennsylvania live in areas HRSA-designated Health Professional Shortage Areas and the shortage is particularly concentrated in rural areas and persons of color in low-income areas. “The state needs 109 additional primary care physicians in these low-access areas,” Drs Bhai and Mitchell wrote.
Full practice authority for NPs in Pennsylvania is included in Senate Bill 25. Under this legislation, each new NP would need to work 3 years and 3,600 hours in a clinical setting prior to earning Full Practice Authority as regulated by the State Board of Nursing. In April 2022, Pennsylvania State Senate passed Senate Bill 25 on a bipartisan vote of 39-to-10. The bill is under consideration by the House.
Drs Bhai and Mitchell outline the benefits of full practice authority and clear up common myths regarding the quality and cost-effectiveness of this practice. “With one licensing reform lawmakers can provide low-income and rural Pennsylvanians with better access to high-quality, cost-effective health care,” they concluded.
Dr Moiz Bhai is an associate professor of economics at the University of Arkansas Little Rock. Dr David Mitchell is a professor of economics at the University of Central Arkansas and director of the Arkansas Center for Research in Economics.
PA Compact Model Legislation Approved
The PA Licensure Compact Model Legislation is now finalized and will enable licensed PAs to practice in all states that join the compact, rather than securing individual licenses in every state in which they want to practice. The legislation is a critical step toward advancing interstate practice mobility, according to the American Academy of Physician Associates (AAPA).
“This model legislation would allow a PA with a full and unrestricted license issued by another compact participating state to more quickly obtain authorization to practice in another compact participating state,” said AAPA President Jennifer M. Orozco, DMSc, PA-C, DFAAPA. The legislation “will continue to improve access to care and allow PAs and health care systems to develop innovative and alternative health care delivery models that meet the needs of their communities such as telemedicine.”
The PA Licensure Compact will be active when 7 states pass bills containing the model legislation language. Once this occurs, a commission will be established to set up essential processes and administer the new compact.
AMA Amends Resolutions Related to NPs and PAs
At the AMA’s House of Delegates (HOD) meeting in November 2022, delegates adopted amended reports and resolutions and reaffirmed current policy of particular interest to NPs and PAs including the following items, as reported by the AAPA:
- Collaborative Ethics and Transparency – Council on Ethical and Judicial Affairs Report 2 – Amendment to Opinion 10.8 Collaborative Care reaffirmed physicians as the sole clinical leaders in medicine. The remainder of the report was amended to provide that members of health care teams, including physicians, PAs, and NPs, should be candid about their professional credentials, experience, and role they will play in a patient’s care to promote collaboration and transparency.
- Workforce Shortages and the Role of Nonphysicians in Hospitals – Resolution 206 – The Shortage of Bedside Nurses and Intersection with Concerns in Nurse Practitioner Training reaffirmed existing policies Physician Assistants and Nurse Practitioners H-160.947 and Physician Assistants and Nurse Practitioners, and Status and Utilization of New or Expanding Health Professionals in Hospitals H-35.996.
“These policies call for the AMA to develop plans to assist state and local medical societies in identifying and lobbying against laws that allow advanced practice nurses to provide medical care without the supervision of a physician and favor the archaic Guidelines for Physician/Physician Assistant Practice,” explained Stephanie Radix, senior director of state advocacy and outreach at the AAPA. “Further, these policies call for hospital governing authorities to depend primarily on the medical staff to recommend the extent of functions that may be delegated to, and services that may be provided by, PAs, NPs, and those allied health professionals functioning in an expanded medical support role.”
Nurses applaud U.S. House for passing legislation to grant VA nurses full collective bargaining rights. News release. National Nurses United. December 15, 2022. Accessed December 16, 2022. https://www.nationalnursesunited.org/press/nurses-applaud-us-house-passing-legislation-to-grant-va-nurses-full-collective-bargaining-rights
Mitchell D, Bhai M. The case for nurse practitioner reform: full practice authority in Pennsylvania. December 5, 2022. Accessed December 16, 2022. https://www.commonwealthfoundation.org/research/nurse-practitioner-reform-full-practice-authority-pennsylvania/
Release of PA Licensure Compact Model Legislation critical step toward advancing PA profession interstate practice mobility. News release. American Academy of Physician Associates. November 21, 2022. https://www.pacompact.org/siteassets/pa-licensure-compact/pdf/pa-compact-model-legislation.pdf