COVID-19 Legislation Advances Nursing’s Scope of Practice

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

• Practice to the full extent of their education and training.
• Achieve higher education and training through an improved education system that promotes seamless academic progression.
• Be full partners, with physicians and other health professionals, in redesigning health care in the United States.

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:

• The types of practitioners that may bill for Medicare telehealth services from a distant site
• Nursing staff to develop and keep current a nursing care plan for each patient, allowing nurses more time to meet the clinical care needs of an increased number of patients
• Establishing nursing-related policies and procedures for outpatient departments to encourage more nurse-to-patient care, consistent with each state’s plan
• Physicians providing medical direction for, consultation for, and medical supervision of nurse practitioners, only to the extent permitted by state law
• Assisting in potential staffing shortages with the pandemic

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:

• Allowing local healthcare providers to participate in study activities under the guidance of the responsible investigator
• Shipping most oral investigational new drugs directly to patients (injectable agents must be administered at a registered site)
• Allowing researchers to adopt alternative procedures that don’t compromise safety or the integrity of the study while reporting major deviations to the Central Institutional Review Board
• Obtaining informed consent remotely, based on guidance from the Central Institutional Review Board

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.”