The United States is making significant changes to address various healthcare issues, from staffing shortages to funding education, revising policies and regulations for healthcare professionals, and much more. Nurses may be interested in understanding these recent legislative developments on the state and national levels.
Please contact Nurse.org if there is relevant legislation missing from this list or if you are an elected leader who would like to comment for a future article about a specific piece of legislation.
This Preceptor Tax Incentive bill, represented by Neil Rafferty, is a program where it will provide income tax credits to healthcare workers who train in rural and underserved counties in the state. According to reports, 44% of Alabama’s population resides in rural areas. Due to staffing shortages, many rural hospitals have closed since 2011. The bill became law recently on June 6, 2023.
Image: Alabama Daily News
Alaska is shifting towards solving the nursing shortage with a bill by politician Mike Prax that allows the state to join the Nurse Licensure Compact. Hospitals and the Alaska nursing state board agree with the legislation. The Nurse Licensure Compact (NLC) will enable a nurse to have one license and practice in any NLC-approved state.
However, the nursing unions are opposing the bill. Joelle Hall, president of the state labor union federation and the Congress of Industrial Organizations, claims the bill will not solve the nursing shortage but replace Alaska’s nurses with an out-of-state workforce. As of May 2023, the bill remains pending.
House Bill 2691
The governor of Arizona, Doug Ducey, recently signed legislation that provides 15 million dollars for the Nurse Education Investment Pilot Program. It will provide funding for nursing programs in community colleges and public universities. The program claims it will aid in increasing nursing faculties in colleges. According to reports from the American Academy of Colleges, the lack of nurse educators made an impact where students could not get accepted into the nursing program.
The Arkansas School of Nurses and Rep. Julie Mayberry filed a bill for better compensation for school nurses. The association claims the bill will help with nursing retention and recruitment in the state. In addition, the association argues the bill could improve student outcomes in physiological and psychological care. The legislation did not meet the standards for funding and therefore died in the Senate.
The Arkansas School Nurses Association shared with the public:
“While some Education committee members recognize the importance of school nurses, the committee chose not to fund pay at this time. When discussed in Tax and Revenue, most members were on board for the topic but lacked funding. The committee believes funding should come from the education committee and the school funding matrix.”
Assemblymember Mia Bonta and the California Nurses Association filed an assembly bill to provide workers’ compensation to all healthcare workers. Currently, front-line workers such as emergency medical technicians (EMTs), firefighters, and police officers are eligible for workers’ compensation, while nurses and other healthcare workers are not.
“Our workers’ compensation system is currently set up to delay and deny the healing that nurses need after we are injured and sickened on the job.”
As of today, the bill has yet to go through the California Senate House.
Image: National Nurses United
Rep. Maria Elena Durazo presents Bill 525 to provide a $25 minimum wage salary to all healthcare workers in the state of California. State senator, Durazo, claims the legislation will be beneficial to retain healthcare workers and provide financial relief. The California Nurses Association requests the bill to exclude nurses, as the bill can impact nurses’ wages. As of now, the bill has passed the California Senate House.
Beginning July 1, 2024, any individual who obtains a certification from the American Midwifery Certification Board must pay a required fee and complete a criminal background check to obtain licensure and practice as a midwife within Colorado. Politician representatives are Sen. Faith Winter and Sen. Perry Will. Governor Jared Polis recently signed the bill into law on May 25, 2023.
A health facility must obtain appropriate policies to reflect the bill’s guidelines to obtain informed consent from the patient, including training or education procedures. The bill was recently signed into law by Gov. Polis on May 25, 2023.
Hospitals are to create a staffing plan-directed by nurses.
Nurses are to make up 50% of the staffing committee.
The law claims to force hospitals to follow through with a staffing plan or will be subject to violations and fines.
Nurses will be eligible to object to or decline an assignment.
Hospitals cannot obligate nurses to mandatory overtime if they have worked more than 12 hours in 24 hours or more than 48 hours in a workweek. A nurse can volunteer to work overtime.
The Delaware School Nurses Association and sponsor Rep. Sherry Dorsey Walker support a bill to amend the Childhood Lead Poisoning Prevention Act to improve compliance with its testing and reporting requirements. The legislation claims to:
Require physicians to complete a training program every two years relating to the provisions of the Childhood Lead Poisoning Prevention Act.
Create electronic forms to use during a child’s monthly visit that records lead screening results and share them with the Division of Public Health.
It requires the Division of Public Health to share data on whether an enrolled student needs to complete screening for lead poisoning with school nurses.
Bill is ready to be signed into action by the state governor.
Certified Nurses Assistants that work in nursing homes are now eligible to become a “qualified medication aide” (QMA). CNAs that meet the licensure requirements and complete training are now eligible to administer medication under the direct supervision of a registered nurse. The governor of Florida approved the bill and it took effect on July 1, 2023.
A bill on assault or battery of hospital personnel works to expand penalties to any individual who knowingly assaults a healthcare provider in their line of work. The legislation was previously applicable to EMS, firefighters, and police officers. The governor has signed the bill, which will take effect on October 1, 2023.
Governor Brian Kemp recently signed the Safer Hospitals Act. The legislation enhances punishment for any assault or battery toward healthcare professionals in their line of work. The bill claims it will allow hospitals to create a police force.
Governor Kemp also signed another bill into law where nursing faculty can apply for student loan repayment. According to reports, the bill focuses on nursing faculties that hold at least a master’s degree and remain teaching. Furthermore, the legislation claims it will help in recruiting and retaining workers.
The Hawaii Governor is considering entering the state into the multi-state Nurse Licensure Compact (NLC). Like many other states, the NLC allows nurses to obtain one license and work in Hawaii and other NLC-approved states.
The president of the Hawaiʻi Nurses’ Association, Daniel Ross, claims about the possible consequences the bill could impose on the workforce. Ross prefers to focus on retaining and training future nurses within their home state.
Each bill was presented to both chambers beginning January 2023 but remains pending.
The rural nursing loan repayment program, sponsored by Rep. Dori Healey, offers nurses working in rural or underserved areas of the state a way to repay their nursing student debt. The state will repay accepted nurses within three years. In the first year, nurses will receive $5,000 after one year of employment, followed by $10,000 after two and three years. The governor signed the bill into law on March 21, 2023.
Image: Idaho Capital Sun
Senator Sara Feigenholtz presents two bills that claim to aid nursing faculty and students with funding, such as fellowships, grants, scholarships, and loans for nursing students. As of today, the bill remains pending in the Senate.
Illinois is another state considering passing the Nurse Licensure Compact, allowing nurses to practice in their home state and other NLC-approved states. Susan Swart, Executive Director of ANA-Illinois, shares:
“It’s becoming more and more evident that we need to provide whatever resources we can, and the Nurse Licensure Compact is one solution. We just have to do it.”
As of today, the bill remains pending in the House of Representatives.
The safe patient limits act is a legislature that claims to assign nurses with a maximum number of patients using a patient acuity system. The bill is currently pending in the House of Representatives.
Indiana faces a crisis with patients struggling to access care due to a physician shortage. Politician Rep. Ed Charbonneau sponsors a bill to allow APRNs to practice within their scope without completing a signed contract with a physician.
A physician specializing in emergency medicine and family medicine in Indianapolis, Dr. Charles Tripple, states:
“In our state, APRNs have to sign a contract with a physician in order to practice. These contracts can be costly for nurses and health systems and have shown no real benefit to patient care.”
As of February 2023, the bill remains pending in the Senate House.
Representatives Chris Cournoyer and Dan Gehlbach sponsored a bill proposing that the state of Iowa supply each school district with at least one nurse instead of hiring a nurse for every 750 students enrolled. In addition, the plan will be to provide healthcare training to teachers within the state. As of March 2023, the bill remains in the Senate House.
The bill focuses on the safety of healthcare workers, creating penalties for individuals committing battery toward healthcare professionals. Governor Laura Kelly signed the bill into law in April 2023. President of the Kansas Hospital Association, Chad Austin, states:
“At a time when health care is facing a staffing crisis, we are pleased legislation that provides protections for health care workers has been signed into law. There are now criminal penalties for assault and battery of a health care worker.”
Due to the healthcare shortage, Kentucky proposes a new bill to establish the Kentucky Healthcare Workforce Investment Fund. Per reports, 65% of the funds would go towards scholarships to students interested in healthcare fields. The remaining percentage would go towards education measures such as faculties and equipment. Kentucky Nursing Association member Jennifer Wiseman shares:
“With regards to nursing, this legislation will help decrease financial barriers that are currently preventing qualified individuals from entering the nursing workforce pipeline.”
The bill passed both parties and signed into law on March 22, 2023.
Louisiana Bill 29 requires licensed healthcare facilities to use heat-producing equipment during surgical procedures. Using a surgical smoke plume evacuation system aids in removing harmful surgical smoke in all operating rooms. The Governor of Louisiana signed the bill into law on June 1, 2023, and it goes into effect in August.
The Maine Nurses Association supports Bill 1639, providing safe staffing ratios for nurses. Nurses and supporters argue that appropriate ratios improve patient health outcomes and safety for nurses. The bill is pending in the Senate House.
Image: National Nurses United
The state of Maryland established a new law allowing clinical nurse specialists to prescribe medications and medical equipment under the State Board of Nursing regulations. The governor of Maryland, Wes Moore, signed the bill in May 2023. The new law will go into effect in October.
The new legislature claims it will require the Department of Public Health to limit the number of patients a nurse can care for. Limitations would depend on the hospital unit. The bill is in the House and awaiting a hearing on July 26, 2023.
Both bills claim to ensure hospitals are not enforcing mandatory overtime and follow the 2012 law, which prohibits nurses from mandatory overtime. The 2012 law specifies that a nurse must comply with overtime in emergencies where the patient’s safety is at risk. The bill is currently pending in the House of Representatives.
A new bill will require healthcare workers to complete a safety risk assessment. Based on the assessment results, hospital facilities will create and implement programs to improve workplace safety among healthcare workers and patients. The bill is currently pending in the House of Representatives.
The Senate introduced three bills in May 2023. President of the Michigan Nurses Association, Jaime Brown, supports these legislations. Brown states:
“Healthcare is in crisis because of years of hospital understaffing. Every year, the situation gets worse. We have reached the point now where almost 40% of current nurses say that they are planning to leave within the next year. Hospital executives have failed to fix the problem for over a decade. The only way to keep patients safe is through meaningful action that will hold corporate executives accountable. We need patients to be put before profits.”
All three bills are pending in the Senate.
The Nurse Patient Safety Act is a bill that includes student loan forgiveness for hospital nurses and funding for the Department of Health to investigate why nurses are leaving the bedside. The legislature passed both parties and became a law on May 22, 2023.
Image: Minnesota Reformer
The legislation seeks to motivate graduated nursing students to stay and work in Mississippi. The program offers financial assistance for new nursing graduates who choose to work in the state. According to reports, qualified nurses can receive up to $6,000 annually for up to three years. The bill was signed into law on March 8, 2023. The Governor of Mississippi, Tate Reeves, shares:
“This legislation will strengthen the pipeline of medical professionals and improve the quality of care for all Mississippians. Innovation is the solution to our healthcare challenges and it is the solution to keeping talented Mississippians here.”
The new legislation will lift restrictions on advanced practice registered nurses to serve the communities and provide better patient care in Missouri. According to reports, APRNs can only diagnose, prescribe medications, and evaluate a patient with a physician signing off.
In the new legislation, APRNs can prescribe schedule II controlled substances to hospice patients and meet with a physician once every two weeks to review patients’ medical records and care. The bill passed and will go into effect at the end of August.
Montana is considering joining the other states in the APRN Compact. The compact allows advanced practitioner registered nurses to have one multi-state license and practice among other compact states. The HB409 indicates that Montana APRNs must complete minimal practice hours before obtaining compact licensure.
However, the Montana Nurses Association (MNA) opposes the bill in its current form. Dr. Deanna Babb is a member of the MNA and chair of the MNA Council on Advanced Practice. She testifies with the following:
“Evidence is clear, APRNs are prepared for safe entry to practice immediately following education/training and certification, and adding an inclusion of minimum practice hours as a requirement for this compact for MT APRNs is unnecessary, burdensome, and creates additional regulatory barriers.”
MNA is not against the APRN compact. However, the bill would need to reflect the regulatory practices of APRNs in the state. HB409 passed the House in February but died in the Senate.
The new bill addresses the nursing shortage in rural Nebraska. The legislation claims to provide scholarships to students as long as students are willing to work in rural hospitals. Reports indicate the bill will provide funding to colleges in Nebraska. Sen. Raymond Aguilar is sponsoring the bill, and it remains pending in Congress.
The Governor of Nevada signed a bill for a grant program for the Nevada System of Higher Education on June 14, 2023. The grant program will provide funding to expand nursing programs at both undergraduate and graduate levels.
The assembly bill allows the state of Nevada to form part of the Nurse Licensure Compact (NLC). Not only would the legislation enable nurses to practice in other NLC-approved states, but its supporters claim the bill will help with the demand of health care providers. One of those supporters includes Nevada State Board of Nursing Executive Director Cathy Dinauer. Dinauer reports:
“The nurses in Nevada want this. Nurses overwhelmingly want the compact and the option of licensure mobility. While the Board of Nursing can issue a temporary license in just a few days, sometimes the need for nurses is immediate and a few days to a nurse at the bedside can be a lifetime for the health of their victims and patients.”
In April 2023, lawmakers failed to vote for further consideration, which caused the assembly bill to die.
This bill amends the requirement for entry-level school nurses to complete a bachelor’s degree in an accredited nursing program. Also, any school nurse with an associate’s degree hired after 2019 must obtain their bachelor’s degree within six years from hired date. The bill has passed both parties but has yet to become lawful.
Both bills modify the Nursing Faculty Loan Redemption Program. Lawmakers created a program to manage the nursing faculty shortage within the state. The program is to motivate individuals to pursue higher nursing education.
The program claims to provide a five-year loan redemption in exchange for individuals to ensure full-time or part-time employment at a school nursing facility. Bill S3547 remains in the Senate, while A4614 passes the assembly house in May 2023. Sen. Nellie Pou, Sen. Joseph Vitale, and Assembly Member Louis D. Greenwald are politicians sponsoring this legislation.
Bill 148 proposes funding the Higher Education Department to develop training programs for university counselors and community health workers. Whereas Bill 149 focuses on delivering free tuition to graduate programs such as social work, psychology, and psychiatric nursing students by agreeing to work for four years in New Mexico. Both bills are currently pending.
The New York State Department of Labor is strengthening the enforcement of the mandatory overtime protection law in the state. The new enforcement became effective on June 28, 2023.
According to the New York Nurses Association, the law penalized employers who push healthcare providers to work overtime. In addition, it enables nurses to file complaints if their employer is not abiding by the mandatory law. Nurses are permitted to stay overtime during specific emergencies.
The legislation will allow nursing students to complete one-third of their clinical training in simulation experiences. According to reports, as New York struggles with the nursing shortage, students can meet their program requirements with hands-on training simulations to complete their education on time and produce more nurses. Governor Kathy Hochul signed legislation into law in May 2023.
The act removes restrictive regulations that advanced practice registered nurses can only perform with a doctor’s supervision in North Carolina. Supporters like the North Carolina Nurses Association (NCNA) argue that the act will enable APRNs to use their licenses fully. President of the NCNA, Meka Ingram, shares:
“APRNs have a phenomenal track record of providing quality care, and they deliver that care more affordably and more efficiently when given the opportunity through modernized regulation.”
Both bills are currently pending in Congress.
North Dakota’s Senate Workforce Development Committee developed an agency bill to establish an Alternative to Discipline (ATD) program for nurses. The program would offer non-disciplinary approaches for nurses struggling with substance use or mental health issues. The North Dakota Board of Nursing reports the program could support nurses in their mental health conditions while remaining in the workforce. The governor signed the bill on March 23, 2023.
Senator Kristina Roegner presented a bill that would include the state of Ohio in the Nurse Licensure Compact. The governor of Ohio signed the bill in July 2021. The new legislature became effective in January of this year.
The new bill claims to permit advanced practice registered nurses to have the independent authority to prescribe medications. The sponsor of this bill is Senator Brenda Stanley. The bill passed the Senate in March and is pending in the House of Representatives.
Higher nursing education will become available to individuals in rural areas of the state and potentially improve the nursing shortage. According to reports, the bill will allow 17 community colleges to offer nursing BSN programs. It will enable accessibility and affordability to future nursing students. The governor signed the legislation on July 13, 2023.
New legislation has been passed to fix the poor nurse-to-patient ratios for healthcare systems. According to the Oregon Nurses Association, the bill will develop a numerical safe staffing ratio based on each unit of the hospital for nurses and CNAs.
In addition to improving staff ratios, the bill will force employers to allow staff members a rest break and create new staffing committees. The legislature passed both houses on June 22. Rulings for staffing ratios will be mandatory starting June 1, 2024.
The Patient Safety Act addresses the safe staffing ratios in the state. The new legislation claims to enforce hospitals to provide safe nurse-to-patient ratios. The bill passed the House on June 28 by a vote of 109-84 and is now pending in the Senate.
Pennsylvania needs more teachers, nurses, and law enforcement professionals. The new legislature offers to provide a tax credit of $2,500 each year for a total of three years to individuals who:
Are resident of Pennsylvania and secures employment in the state as a certified nurse, teacher, or police officer
Come from another state and secures a job in the state as a certified nurse, teacher, or police officer
The bill passed the House of Representatives on June 20, 2023, and is now pending in the Senate House.
Rhode Island is among the states that recently approved the Nurse Licensure Compact. The governor initially signed the bill on June 24, 2023. Rhode Island will officially become a compact state starting January 1, 2024.
By amending bill 517, licensed APRNs will have full practice authority. Certified nurse midwives will also have full authority if they obtain an APRN license. The politician representative for this bill is Sen. Tom Davis. The legislature is currently pending and remains in the Senate House.
A new bill recently passed in the House of Representatives earlier this year where the state would adjust the reimbursement rate for community-based providers caring for patients that Medicaid covers. A report states nursing homes have closed within the last few years. The bill will serve as a focus to help the elderly and disabled community. The legislation is pending and currently at the Senate House.
The proposed bill will allow certified medication aides to administer medications under the supervision of a licensed, registered, or practical nurse. Applicants would need to meet the following requirements:
Work as a certified nurse aide for at least one year
Receive recommendations from employers
Complete a training program approved by the state board of nursing
Last year, the Governor signed the bill, which took effect in January.
The bill focuses on managing the nursing shortage with a new legislation that will provide scholarships, grants, and loan repayment plans to nursing faculty and students. The governor of Texas signed the bill into law on June 18, 2023.
The HEAL Texans Act proposes to remove licensing requirements for nurse practitioners where they no longer have to work under the supervision of a physician. The bill claims APRNs can evaluate, diagnose, order tests, and manage treatment. As of March, the bill remains pending in the Senate House.
Senate Bill 36 will adopt the Full Practice Authority (FPA) for nurse practitioners (NPs). Initially, in Utah, NPs held a mandatory contract with a physician. With the new legislature, the FPA allows NPs to evaluate, diagnose, order tests, and manage patient treatment. President of the American Association of Nurse Practitioners, April Kapu, shares:
“These changes will help Utah attract and retain nurse practitioners, and provide patients access to high-quality care. We thank Governor Cox and the legislature for prioritizing patients and taking action to improve health care in the Beehive State.”
The governor signed the bill on March 14, 2023.
The legislation targets to improve protections for healthcare workers within the state from verbal and physical assaults. The bill allows arrests to occur without a warrant or a police officer having to witness the assault. In addition, depending on the gravity of the aggression, guilty individuals could face charges such as misdemeanors or felonies. The bill recently passed earlier this year on May 30, 2023.
The bill will allow graduate nurses from an accredited nursing program in foreign countries to practice within the state with certain requirements. The legislature will allow the state board of nursing to provide necessary language examinations and verify the graduate’s credentials from their nursing program. The bill became lawful on March 26, 2023.
This bill provides standards and policies in certified nursing facilities to meet appropriate staffing requirements. The bill was introduced early this year in January and signed into law on March 24, 2023.
The legislation focuses on establishing the necessary measures to meet the goals of creating safe staffing standards in the state of Washington. The bill was introduced earlier this year and signed into law on April 20th, 2023.
Washington Nurses Association is requesting Senate Bill 5454 to amend the existing standards on workers’ compensation for nurses with PTSD. According to the association, the law only allowed nurses to seek workers’ comp after experiencing one traumatic event. However, the association argues that trauma builds in the nurse’s work and requests the legislation to permit nurses to seek mental health resources at any time. The bill was signed into law on May 9th, 2023.
A new bill allows physicians, nurses, and EMS workers to carry firearms while on duty with law enforcement. According to reports, medical professionals would need approval from law enforcement and receive a certificate from the Law Enforcement Professional Standards Subcommittee. The governor signed the bill into law, taking effect on May 3rd, 2023.
A new bill appears before the Congress of Wisconsin to address the physician shortage by permitting full practice authority to nurse practitioners and clinical nurse specialists. The legislation would remove barriers such as physician supervision. The bill is currently pending and remains in the Senate House.
Nurse Faculty Shortage Budget Request
The Nurse Faculty Shortage budget request is a legislation approved by the Joint Finance Committee in Wisconsin (JFC). According to the Wisconsin Nurses Association, $5 million will go towards funding for nurses pursuing a master’s degree or doctorate in nursing education. Qualified nurses will commit to teaching within the state for three years. Members of JFC will need to vote on the entire legislation and then proceed to Congress.
Assembly Bill 204 received approval in Wisconsin state on June 7, 2023. The legislation no longer requires RNs and LPNs to complete a workforce survey and can complete it voluntarily with a fee of $400 to participate.
The Wisconsin Nurses Association opposes this bill because the workforce survey collects significant data on concerns within the nursing workforce. WNA is meeting with Senators to advocate not removing the workforce survey.
The legislation proposes a new regulation to protect healthcare workers from threats of violence while in the line of duty. Aggressors can face misdemeanors, felonies, jail time, and fines. According to reports, the legislation may need revision as members of Congress are concerned that the bill can implicate individuals with conditions such as Alzheimer’s or dementia. On January 31, 2023, the bill failed to pass the House of Representatives by a 28-34 vote.
Image: National Nurses United
Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act
The new legislation mandates the regulation of appropriate nurse-to-patient ratios in hospitals. The bill also claims it will improve nursing retention and patient care outcomes. Congress introduced the bill on March 30, 2023, and referred it to various committees for evaluation.
The Workplace Violence Prevention for Health Care and Social Service Workers Act
This bill addresses the violence that nurses and other healthcare workers face in hospitals and other healthcare facilities in the U.S. The act would mandate facilities to develop and implement prevention programs to reduce workplace violence. Congress introduced the bill on April 18, 2023, and referred it to various committees for evaluation.
Protecting the Right to Organize (PRO) Act
The PROAct offers the right for individuals to join a union to advocate for improving working conditions such as wages, benefits, and safe work environments. The National Nurses United supports the legislation as it could enhance the current conflicts in nursing. As of July 18, 2023, the bill remains pending in the Senate House.