Workforce Shortages, Nurse Retention Among Legislative Priorities

• Legislative priorities for some in Congress, as well as nursing advocacy organizations, center on the nursing workforce shortage.
• The American Nurses Association shared its legislative priorities with Congress in a February 2024 letter.
• Senators and representatives also are attempting to usher in changes at the state level.

Legislators and advocacy groups are working to address nationwide shortages in the nursing industry, in part, through backing or proposing changes to state nursing board leadership requirements and nurse-to-patient ratios.

And organizations like the American Nurses Association (ANA) have made several of these issues a priority. Debbie Hatmaker, ANA’s acting CEO, chief nursing officer and executive vice president, said in a February 2024 letter to Congress that ANA’s legislative priorities “aim to tackle some of the most pressing issues facing nurses,” such as:

• Ensuring an adequate and diverse workforce. 
• Promoting nurses’ health and well-being. 
• Expanding timely access to qualified healthcare professionals, regardless of where a patient lives. 
• Improving maternal health equity. 

ANA’s Legislative Priorities

Among ANA-supported measures is the Improving Care and Access to Nurses (ICAN) Act, which would allow providers other than physicians (namely, nurses) to “provide certain services under Medicare and Medicaid,” according to the bill summary.  

Hatmaker said that, if approved, the legislation would remove “outdated barriers and meaningfully increase access to care for Medicare beneficiaries” nationwide. 

The organization also urges Congress to appropriate more than $300 million for Title VIII Nursing Workforce Development Programs that the Health Resources and Services Administration administers. 

“These programs represent the only dedicated federal programs aimed at bolstering nursing education from entry-level preparation through graduate study,” Hatmaker wrote. “These programs address multiple facets of nursing workforce demand, including education, practice, recruitment, and retention. They also aim to recruit nursing students from diverse backgrounds and attract nurses to rural and medically underserved communities.” 

To increase workforce retention, ANA supports the Workplace Violence Prevention for Health Care and Social Service Workers Act, which would require the Occupational Safety and Health Administration to establish enforceable standards for employers to protect staff from workplace violence. 

“This issue has been a long-standing concern prior to the pandemic, and acute increases in workplace violence have illustrated why passage of this legislation is so critical,” Hatmaker wrote. 

Other bills ANA has set as legislative priorities include: 

• Nurse Overtime and Patient Safety Act, which limits mandatory overtime, includes whistleblower protection and clarifies when and how mandatory overtime can be used. 
• Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, which requires implementation of staffing plans that adhere to “specified minimum nurse-to-patient ratios.” 
• Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, which extends federal funding for training programs that cover suicide prevention, burnout, and substance abuse disorders. 
• Black Maternal Health Momnibus Act, which “collectively” addresses the U.S. maternal health crisis. 

State-Level Moves to Address Nursing Workforce Concerns

Changes Coming to Maryland’s Nursing Board? 

The requirement to hold an RN licensure to serve as executive director of Maryland’s state nursing board could soon be eliminated.   

H.B. 1053, sponsored by Del. Anne Kaiser, would remove the requirement, if approved by Gov. Wes Moore. It has already passed both the House of Representatives and the Senate.  

Despite opposition from the Maryland Nurses Association, a study by Ernst & Young LLP recommended eliminating the requirement, as “27% of Boards of Nursing in the United States do not have an RN as their executive director.”

“There is substantial clinical, education, examination, and judicial experience and expertise among MBON leadership currently to support a non-RN Executive Director,” the report stated. 

As of April 10, the issue was still awaiting Moore’s approval. 

MI Bill Could Nix Requirement for NPs to work on Physician-Led Teams 

A Michigan measure could eliminate the state requirement for nurse practitioners to work on physician-led care teams.

S.B. 279, introduced by Sen. Jeff Irwin, was intended to address the nursing workforce shortage “by removing unnecessary rules that prevent nurse practitioners from using the full extent” of their skills, Irwin stated in a 2023 news release announcing the bill. 

“We have a serious and growing shortage of health care professionals in Michigan, which makes it very difficult to access primary care in many areas of the state, both urban and rural,” Irwin said. “Full Practice Authority for nurse practitioners will make Michigan more competitive with other states and help close the healthcare gaps we are seeing across the state.”  

However, the Michigan State Medical Society was concerned about the implications.  

“In Michigan, families rely on healthcare teams equipped with the rigorous training and expertise required to provide appropriate treatment for illnesses and injuries,” Tom George, MD, and MSMS CEO said. “Senate Bill 279 undermines this trust and makes policy promises it simply cannot fulfill. 

Maine Bill to Address Patient-Nurse Ratios Moves Forward 

An amended version of a bill that would set minimum patient-to-nurse ratios across Maine received bipartisan support last month. 

The Senate approved in a 22-13 vote L.D. 1639, “An Act to Address Unsafe Staffing of Nurses and Improve Patient Care.” Introduced by Sen. Stacy Brenner, the amended version of the measure would establish the Maine Quality Care Act “to ensure safe direct-care registered nurse – also called ‘bedside nurse’ – staffing assignments in healthcare facilities … can provide safe and effective patient care,” according to a news release. 

Other aspects of the measure include: 

• Establishing minimum bedside nurse staffing requirements based on unit and patient needs 
• Stating a method to calculate facility compliance with the staffing requirements 
• Protecting bedside nurses from retaliation; and  
• Including notice, record-keeping and enforcement requirements. 

Additional votes are required for the bill to move on to the governor’s desk.   

The Bottom Line

Addressing the nursing workforce shortage is a continuous effort on both the practitioner, advocacy, and legislative levels. While not always receiving bipartisan support, the efforts are intended to alleviate the pressures on nurses and increase the quality of care. Nurses who are interested in seeing any of these bills enacted should contact their local legislators. 

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