COVID-19 Legislation Advances Nursing’s Scope of Practice

July 23, 2020 by Alec Stone MA, MPA, Former ONS Director of Government Affairs and Advocacy

More than a decade has passed since the Institute of Medicine ([IOM], now known as the National Academy of Medicine) published its Report on the Future of Nursing (https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-health) in 2010, yet not a great deal has improved.

In the most downloaded report the IOM ever produced, the committee outlined that nurses should:

Nurses are essential to the provision of patient-centered, quality care, and yet their role in the healthcare system is too often relegated to second tier. The report galvanized the nursing community, policymakers, and advocates to change the system for better coordinated care. But progress has been slow the past 10 years.

And then the COVID-19 coronavirus global pandemic occurred. Healthcare workers—particularly nurses—are in greater demand now than ever before. Navigating the science of the disease and the public health approach to stopping the spread, flattening the curve, and ultimately finding a cure is daunting enough, but having limited healthcare providers to deal with the crisis is an unexpected barrier to the care and treatment of those diagnosed with COVID-19. The usual rules had to progress to accommodate a new dynamic.

CARES Act and Waivers

Taking decisive action, the U.S. government issued formal executive orders that granted the Department of Health and Human Services the authority to rewrite regulatory law and streamline traditional bureaucratic systems. Citing powers usually reserved during war through the National Emergencies Act, the Trump administration (https://www.federalregister.gov/documents/2020/03/18/2020-05794/declaring-a-national-emergency-concerning-the-novel-coronavirus-disease-covid-19-outbreak) used the Coronavirus Aid, Relief, and Economic Security (CARES) Act to change scope of practice (https://www.congress.gov/bill/116th-congress/senate-bill/3548) for nurses during the pandemic.

In response, the Centers for Medicare and Medicaid Services updated its requirements (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf) for the national emergency by releasing its COVID-19 Emergency Declaration Blanket Waivers for Healthcare Providers, which waive requirements for:

Cancer-Specific Changes

The National Cancer Institute also re-evaluated (https://www.cancer.gov/grants-training/nci-bottom-line-blog/2020/cancer-research-in-the-era-of-covid-19) its policies, making the following adjustments to clinical trials and patient care during COVID-19:

Are Scope-of-Practice Changes Staying?

Extraordinary times require an evolved sense of problem solving, including allowing nurses to practice at the intent of IOM’s report (https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-health). Although the changes are considered temporary and likely to revert after the pandemic is under control, nurses must stand firm as a profession and demand that the recommendations be fully implemented to ensure quality, patient-centered care. ONS and its member advocates advance the cause of the nurse and the profession with decision makers and policy leaders, doing as Florence Nightingale said: “Rather, 10 times, die in the surf, heralding the way to a new world, than stand idly on the shore.”


Copyright © 2020 by the Oncology Nursing Society. User has permission to print one copy for personal or unit-based educational use. Contact pubpermissions@ons.org for quantity reprints or permission to adapt, excerpt, post online, or reuse ONS Voice content for any other purpose.