West Virginia Nurse - January 2022

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Page 8 West Virginia Nurse January, February, March 2022 National Maternal Health and Midwifery Legislative Update Moira Tannenbaum, MSN, APRN, CNM Co-Treasurer, WV ACNM Affiliate West Virginia’s nurse-midwives and many midwives nationally have been discussing two pieces of legislation that could improve the landscape for us and the families we serve; talking up a piece of legislation to help postpartum nurses in the workforce; and celebrating the passage and signing into law of a bill to help mothers who are veterans. The first is the Midwives for MOMS Act (HR 3352/S 1697), which was introduced in the House and the Senate in May 2021 and has bipartisan support. “MOMS” here stands for “Maximizing Optimal Maternity Services.” Yes, those cute bill names are designed to attract attention and to help people remember the bill in the large ocean of other bills. The Midwives for MOMS Act would increase funding for midwifery education, not just for certified nurse-midwives (CNMs), but also for midwives with the “sibling credential” to CNMs, which is certified midwives (CMs), as well as for certified professional midwives (CPMs). Both CMs and CPMs are sometimes identified as “direct entry midwives,” meaning that they entered the midwifery profession “directly,” without a stop in the nursing profession. The funding would focus on midwifery students from historically underserved communities, including Black and Indigenous People of Color (BIPOC), and including students at Historically Black Colleges and Universities (HBCUs), by prioritizing grant funding to midwifery educational programs that demonstrate their focus on bolstering and increasing racial and ethnic diversity in their student body. The goal is to further a more diverse midwifery workforce to better serve the needs of historically marginalized childbearing families and to serve all childbearing families by increasing the number of midwives. To do this, the Midwives for MOMS Act would establish two new funding streams under Title VII and Title VIII of the Public Health Service Act. Funding would be designated for accredited midwifery education programs. Funding for CMs and CPMs would fall under Title VII (“Health Professions and Training Programs”) while funding for CNMs would fall under Title VIII (“Nursing Workforce Development Programs”). If you’re like me, you may be a little rusty on the Public Health Service Act (PHSA) but might want to know more about it to better advocate for this bill or merely to understand it. The PHSA was passed in 1944, in the middle of World War II. Along the way, it has had many amendments, such as: • Title X, passed in 1970 during the Nixon Administration, which established “Family Planning and Population Services” funding; • The Health Insurance Portability and Accountability Act (known widely as HIPAA), passed in 1996 under the Clinton Administration; • The Newborn Screening Saves Lives Act of 2007, passed during the George W. Bush Administration (which funds the newborn metabolic screenings now found in all states); and • The Affordable Care Act (ACA) of 2010, passed during the Obama Administration. The second piece of legislation is the BABIES Act (HR 3337/S 1716). This bill would require the Centers for Medicare & Medicaid Services (CMS) to establish “Medicaid demonstration model birth centers” in up to six states. It would pay for birth center care prospectively (going forward throughout prenatal care), instead of waiting till the end of the pregnancy episode and paying in one lump sum then. That payment model is very difficult for the many birth centers which are small businesses and is partly responsible for the low percentage of birth centers who can accept as many Medicaid patients as they would like to serve. This bill’s cute name stands for “Birth Access Benefitting Improved Essential Facility Services” (i.e., “BABIES”). Birth center care — referring to care in freestanding birth centers — is also more difficult to access for START YOUR NEXT CHAPTER WITH US. It’s a great time to begin your WVU Medicine nursing career. LEARN MORE CamdenClarkNurses.org APPLY NOW! Donna Monroe, RN WVU Medicine Camden Clark (L to R) Senator Susan Collins of Maine, Senator Tammy Duckworth of Illinois, U.S. President Joe Biden. many families participating with Medicaid due to low reimbursement rates compared with what hospitals receive for the same basic services. To date, none of the West Virginia Congressional delegation (Rep. McKinney, Rep. Mooney, Rep. Miller, Sen. Capito, or Sen. Manchin) has signed on to the Midwives for MOMS Act or BABIES Act as a cosponsor. However, both bills have bipartisan support and bicameral support. Bicameral support means they have co-sponsors in both chambers: in this case, the U.S. House and the U.S. Senate. It’s not too late to drop your U.S. representative and the two WV senators (Capito and Manchin) a line and ask them to support these two bills. If you’ve forgotten who your U.S. representative is, check out this handy link: Find Your U.S. Representative. Nearly nine million nurses, dental assistants, dental hygienists, and other workers who are moms would benefit from the federal PUMP for Nursing Mothers Act (HR 3110/S 1658) if it passes the legislature. PUMP stands for “Providing Urgent Maternal Protections.” You can download a fact sheet on the PUMP Act from the U.S. Breastfeeding Coalition’s website here: U.S. Breastfeeding Committee Handouts. This bill passed the U.S. House with strong bipartisan support (276-149) in October 2021 and is waiting for a U.S. Senate hearing. The PUMP Act would clean up some loopholes that exclude many workers from the previous “pumping in the workplace” act, known as the Break Time for Nursing Mothers Law of 2010, which is part of the federal Fair Labor Standards Act (FLSA). Break Time for Nursing Mothers Law. Interestingly, none of WV’s members of Congress (McKinley, Mooney, or Miller) voted yes on the PUMP Act. If you agree that nurses and dental hygienists should be able to express milk for their baby at work, just as other workers are able to, please contact Sens. Manchin and Capito and ask for their support of the PUMP Act for Nursing Mothers (HR 3110/S 1658). Wouldn’t it be great to get WV support for the bill in the U.S. Senate and get this bill passed? One of the worst things in a busy day at work for me is realizing that a colleague who was supposed to pump, did not pump. Many midwives are also enthusiastic backers of the Black Maternal Health Momnibus, a package of bills designed by the Congressional Black Maternal Health Caucus to address the Black maternal health crisis in the U.S. One of the caucus’s founders is a nurse advocate in the U.S. House: Rep. Lauren Underwood, RN, of Illinois. Black Maternal Health Caucus Momnibus Act of 2021. And yes, “Momnibus” is yet another cute name: a play on the word “omnibus” used in legislative bills – where it means two or more unrelated items – combined with the word “mom.” The first bill from the Momnibus to pass and be signed into law is the Protecting Moms Who Served Act of 2021 (S. 796), which President Biden signed on November 30, 2021. This bill attracted positive attention in West Virginia, where roughly ten percent of the population are veterans (State of WV, 2018). The bill was also notable for its sponsorship by two women senators, representing both major parties, with one a military veteran. These are Sen. Susan Collins of Maine, a Republican, and Sen. Tammy Duckworth of Illinois, a Democrat, who is a combat veteran. Sen. Collins represents a state with an even higher percentage of veterans than WV’s: over eleven percent of the adult population of Maine are veterans, per 2017 figures (U.S. Dept. of Veterans Affairs, n.d.). As for Senator Duckworth’s home state of Illinois, only six percent of the population are veterans (U.S. Dept. of VA, n.d.-2). How the WV congressional delegation voted on S. 796: All three members of the U.S. House from WV (Rep. McKinley, Rep. Mooney, and Rep. Miller) voted Yea, and the bill passed the U.S. Senate by unanimous consent. The Protecting Moms Who Served Act will study the unique maternal health risks facing pregnant and postpartum veterans, and support Veterans Affairs (VA) maternity care coordination programs by investing $15 million. Here’s more news on the Protecting Moms Who Served Act, from Sen. Collins’s website: Protecting Moms Who Served.
January, February, March 2022 West Virginia Nurse Page 9 The leadership of the WV Affiliate of the American College of Nurse-Midwives (WV-ACNM) is optimistic about all three of these pending bills because of the bipartisan cooperation, and overjoyed that the Protecting Moms Who Served Act is now law. Back here at home in the Mountain State, WV-ACNM is grateful to WVNA for promoting one of our most important “state legislative agenda” items, the removal of the Certificate of Need (CON) program. You’ll find that removing the CON is listed on WVNA’s 2022 legislative agenda, outlined on p. 1 of this issue of West Virginia Nurse. The CON is a clear barrier to opening additional birth centers in West Virginia. For many years now, WV has had just one birth center. It is part of FamilyCare Health Centers and located in Charleston; recently it moved from Putnam County where it had been for many years. You can read more about WV CNMs’ concern about the CON Program on p. 9 of the January 2021 issue of West Virginia Nurse; the link is here: West Virginia Nurse link from WVNA website. References State of West Virginia, Department of Veterans Assistance. (2018). Annual veterans’ report. https://veterans. wv.gov/Documents/WVDVA-2018%20Annual%20 Report.pdf U.S. Department of Veterans Affairs. (n.d.). State summaries: Illinois. https://www.va.gov/vetdata/docs/ SpecialReports/State_Summaries_Illinois.pdf U.S. Department of Veterans Affairs. (n.d.-2). State summaries: Maine. https://www.va.gov/vetdata/docs/ SpecialReports/State_Summaries_Maine.pdf ******* Editor’s Note: The WV ACNM Affiliate is an organizational affiliate partner of WVNA. You can read about this program at WVNA Organizational Affiliate Partners. The writer represents the American Association of Birth Centers (AABC) on the United States Breastfeeding Committee (USBC), a supporter of the PUMP for Nursing Mothers Act. National Legislative Updates (Focused on Nurses and Nurse Practitioners) Jodi Biller, MSN, APRN, FNP-C WVNA Health Policy & Legislative Committee Co-Chair After months of negotiations, on November 19, 2021, the U.S. House of Representatives passed H.R. 5376, the “Build Back Better Act,” by a vote of 220 to 213, with all House Democrats except one (Rep. Jared Golden of Maine) voting in favor of the bill, and all House Republicans voting against the bill. The legislation has now moved on to the U.S. Senate. As WV Nurse is going to press, the legislation is not moving forward. By the time this edition of West Virginia Nurse is in your hands or on your phones, matters could look different. While the over 2,000-page bill encompasses many policy areas, I want to showcase several key health care-related provisions directly related to practice. I am grateful to the American Association of Nurse Practitioners (AANP) for the summary. Specifically, Build Back Better would: • Create a new hearing benefit under Medicare Part B, beginning January 1, 2023, for hearing aids for individuals with moderately severe, severe, or profound hearing loss in one or both ears. Eligibility is once every five years, if furnished through a written order by a physician, qualified audiologist, qualified hearing aid professional, physician assistant, nurse practitioner, or clinical nurse specialist qualified to write such order by the state. • Provide $50 million for Health and Human Services (HHS) to conduct studies on the appropriateness of establishing minimum nursing staff-to-resident ratios in skilled nursing facilities (SNFs). • Provide $2 billion in funding for the National Health Service Corps (NHSC). Nurse practitioners (NPs) are the second largest provider group in Real Talk About Burnout Bree Becker, MSN, NP-C, RNC-MNN bbecker@wematchwell.com Reprinted with permission from Georgia Nursing April 2021 issue Recently I was putting my son to bed. We read one of my favorite children’s books, The Giving Tree by Shel Silverstein. Despite reading this story many times, I was struck by the visceral sadness of the tale. It’s a children’s story with a simple plot. A boy is climbing a tree (personified as a woman), and he happily swings from her branches, devouring her apples and enjoying all the comfort the tree provides. Readers follow the boy on his journey through adolescence, adulthood, and then as a tired elderly man. Throughout his life, the boy takes, and the tree gives. Whatever his needs are at each stage of his life, the tree is happy to provide a piece of herself to help. She gives her branches for shade, then her wood to help build a house. Finally, with her resources depleted, she dwindles to a stump. And even then, she manages to provide a place for the boy, who is now an elderly man, to sit. I realized the tree’s exhausted state represents how many nurses feel. For us, The Giving Tree is an all-too-familiar story. The depleted tree personifies the exhaustion and burnout most of us are experiencing today. I receive daily articles that reference burnout and company ads that offer a solution specifically for me. But at the end of the day, the responsibility of executing the proposed solution falls back on me. “Here is something else for you to do to help you with your burnout.” Burnout was identified as an issue decades ago, and is only getting worse. Despite public awareness, nurses are still being asked to do more with less. The pandemic highlighted nurses’ struggle with the mental and physical toll of the job. Instead of offering a cliched intervention for burnout, I want to have a real conversation. Let’s ask hard questions. Let’s stop pretending we know how to fix a problem that’s plagued us for decades. My personal problem with many of the resources designed to address burnout is that it creates more work for me. Now don’t get me wrong, I like learning about yoga and I actually believe things like exercise and diet have a positive effect on your mental health. But the reason I feel exhausted as a nurse is not because I don’t exercise or eat healthy. I have always adopted a healthy lifestyle even before I was a nurse. I do think that my healthy lifestyle allowed me to push myself physically and mentally as a nurse. The long hours, constant stress, and erratic schedule didn’t catch up with me for a decade. But I eventually burned out. And no amount of green smoothies or yoga could cure me. I found myself becoming overly cynical, feeling like I was not making an impact, and dreading work. Burnout is the symptom of a larger disease: it’s the result of poor processes within institutions and the larger healthcare system overall. Nurses experienced burnout long before this pandemic. The pandemic has only cast a light on an ugly truth most of us have been aware of for a long time. If burnout is not the health care worker’s problem alone to solve, who is responsible for solving it? Here are real problems, I don’t have the answers. But I know we are too fragile to continue this way. Last year, I was clueless about the horror the world was about to experience due to COVID. While I knew our medical system was broken and that health care workers were being stretched beyond capacity, I didn’t realize what a pandemic would do to our profession. I didn’t realize how vulnerable we are. The future is now. The what-ifs and maybes are reality. We can’t afford to hobble along anymore. We have to be willing to talk about the real issues and the first step is asking hard questions. I know I can’t fix this today and I know I can’t fix this alone. To me, it’s a fight worth fighting. And maybe, by the time I retire, nurses won’t suffer the way I’ve seen my peers suffer over the last decade. And maybe, unlike The Giving Tree, nurses won’t give until we are depleted and we will be empowered to care for ourselves the way we care for others. Photo courtesy Architect of the Capitol that program, ranking behind behavioral and mental health providers. • Provide $500 million in funding for the Nurse Corps, which includes funding for NPs. • Provide $500 million in funding to enhance and modernize nursing education programs and increase the number of faculty and students, particularly in underserved areas. This provision is based on the Future Advancement of Academic Nursing Act (FAAN Act), S. 246, which AANP supports. Senator Jeff Merkley of Oregon is the lead sponsor. • Provide $25 million in funding to support training of health professionals in palliative and hospice care, foster patient and family engagement, integration of palliative and hospice care with primary care and other appropriate specialties, and collaboration with community partners to address gaps in health care for individuals in need of palliative or hospice care. • Includes $20 million in funding to nursing schools, health care facilities, programs leading to certification, partnerships of such schools and facilities, and programs and initiatives to develop and implement programs to train and educate individuals in palliative care in educational, hospital, hospice, home, or long-term care settings. You can read more about the framework of Build Back Better at White House Build Back Better. BE A PART OF SOMETHING GREAT. We have a number of career opportunities for clinical and non-clinical candidates. As a member of the WVU Medicine team, we offer: ■ Competitive Compensation ■ Tuition Repayment & Tuition Assistance ■ Growth Opportunities ■ Comprehensive Benefits (within 30 days of hire) We are an EOE/AA Employer. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability, veteran status or other protected status. APPLY TODAY wvumedicine.org/united-hospital-center
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