Editorial: State waivers let Pa. health care function in the pandemic

TRIBUNE-REVIEW | Tuesday, Sept. 14, 2021 5:01 a.m.

A worker shortage in the pandemic economy has been troubling employers for months.

But if you think scaled-back hours at your favorite pizza shop are difficult to handle, try staffing a long-term care home without enough nursing assistants. A short-staffed restaurant can cause irate customers. Not enough nurses for the patients can have much worse consequences.

Regulatory waivers from the state helped keep the medical industry’s wheels spinning, despite the staffing shortages. Those waivers expire Sept. 30.

The waivers in question allowed, for example, out-of-state doctors and nurses to practice in Pennsylvania without licensure issues. In-state medical professionals who had retired or let their licenses lapse as they went into other professions could return to jobs where they were desperately needed without having to jump through bureaucratic hoops.

They also helped those already at work. They made it possible for nurses who were too busy filling shifts to get their continuing education credits to keep going without license hurdles. They allowed nurse practitioners to work in a streamlined fashion with multiple doctors in a health system.

In normal times, a little red tape can be a good thing. These were good rules to have in place in 2019. They make the system accountable. Health care isn’t an area where you want to cut corners.

But in 2020, having enough people to perform the important tasks of testing for illness, treating people in the emergency room, manning the respirators and all of the other tasks the sick and vulnerable needed to be performed — that was the most important thing.

The question now is this: Is it time to let the waivers go, or is it too soon?

The state’s emergency orders came to an end after the May primary, when voters approved an amendment that changed the rules, requiring the Legislature to extend a governor’s order. However, the pandemic didn’t end just because the order did. The delta variant has prompted numbers to rise again, stressing hospitals once more.

The system gets stressed not because of a lack of hospital beds. It’s more about the lack of staff to handle the load, which is what makes the impending expiration problematic. And flu season has barely started.

The Legislature and Gov. Tom Wolf need to do what they are particularly bad at doing. They need to work together to find a smart, efficient solution to the state’s medical staffing problems.

More doctors and nurses and health professionals of all kinds are needed on the floors of hospitals and nursing homes. There are shortages that predate the pandemic and will live long after it is over, so getting together to address these issues is more than just an emergency. It’s a chronic condition, and someone has to manage it.

Expiring COVID-19 waivers could make Pa. health-care staffing shortages worse

by Danielle Ohl of Spotlight PA | Sept. 13, 2021

HARRISBURG — Regulatory waivers established last year to help hospitals and health-care workers fight COVID-19 will expire this month, and those in the field are warning the lapse could exacerbate an ongoing staffing crisis as coronavirus cases rise again.

At the beginning of the pandemic, Democratic Gov. Tom Wolf approved nearly 100 waivers to ease some of the rules governing health-care workers and ensure as many professionals as possible were on the ground in hospitals, vaccination clinics, and long-term care facilities.

Photo: FRED ADAMS / FOR SPOTLIGHT PA

They included allowing out-of-state practitioners to treat patients in Pennsylvania, permitting retired or lapsed professionals to return to medicine, and expanding who could give a vaccine.

The temporary changes were made under a disaster declaration that later became a target for legislative Republicans unhappy with the administration’s business closures.

Buoyed by two successful constitutional amendments that curtailed the executive’s power, the GOP-controlled General Assembly ended Wolf’s emergency order in June, while allowing the waivers to remain in place until Sept. 30.

The legislature will reconvene this month, and leadership in the House and Senate have said lawmakers will consider whether some waivers should be made permanent.

But as coronavirus infections continue to spike among the unvaccinated, those in the health-care field worry even a temporary lapse of the loosened rules they’ve come to rely on for the past year and a half will only prolong the pandemic they’ve fought to overcome.

“To lose those waivers we’ve relied on as another surge is coming, as new variants are coming to long-term care, that would create a real challenge across the state,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which lobbies on behalf of long-term care facilities in the state. “We need those waivers until we can get out of this.”

It’s impossible to know how many people took advantage of the waivers, as the Department of State — which oversees professional licensing in Pennsylvania — did not track that information. Agency spokesperson Ellen Lyon said the waivers aimed to mobilize a larger workforce against the COVID-19 pandemic without creating new document-filing requirements.

But more than half a dozen health-care workers and industry advocates told Spotlight PA some of the relaxed regulations helped ease staffing shortages and deliver care during the pandemic.

Betsy Snook, a nurse and CEO of the Pennsylvania State Nurses Association, said online continuing education courses have provided flexibility for nurses who need the credits to stay licensed.

She also pointed to a waiver allowing nurse practitioners to see patients and collaborate with multiple doctors within the same hospital system without needing additional written agreements, which she said expanded the care those nurses can provide. Snook said she worries the nursing board that approves the agreements will be overwhelmed once the waiver disappears.

State licensing boards, industry groups, and Department of State staff last year asked the Wolf administration to consider waiving some requirements and regulations that were either no longer possible to comply with due to the pandemic or hindering pandemic response, according to Lyon. The administration ultimately relaxed rules that govern dozens of workplaces, including barbershops, salons, dentist offices, and funeral homes.

Some of those industries have returned to a semblance of normalcy, advocates said, so the waivers in place over the past 18 months are no longer needed. The same cannot be said for hospitals and long-term care facilities, where professionals said staffing shortages that existed before the pandemic have become much worse.

“Caring for people is really tough work physically and emotionally,” said Georgia Goodman, director of government affairs for LeadingAge PA, a group that lobbies on behalf of nonprofit long-term care facilities. “A lot of staff we had left the field altogether, some had some early exits. It’s an awful storm.”

Michelle Boyle, a Pittsburgh-area nurse and former state Senate candidate, said in her decades in the field, she’s never seen nurses look so hollowed out.

“If you hollow something out, it’s just going to collapse,” she said.

Boyle, who is a member of SEIU Healthcare Pennsylvania, said allowing nurses to delay obtaining continuing education credits was helpful, as health-care workers were already “over their hours on a regular basis.”

But, she argued, the legislature needs to make meaningful changes that will make patients and the people charged with caring for them safer in order to retain staff.

Staffing shortages in the health-care field are a national problem, with difficult working conditions, burnout, and a highly competitive marketplace fueling the issue.

“If you look at almost any hospital in Pennsylvania, there are many, many, many job openings for these positions,” said Warren Kampf, senior vice president of the Hospital and Healthsystem Association of Pennsylvania.

“Hospitals are paying retention bonuses, paying bonuses to sign and they can’t fill them.”

COVID-19 infection rates have been rising nationwide, and though Pennsylvania has one of the nation’s lowest per-capita case rates, infections here are creeping up as well.

Pennsylvania recorded more than 4,500 new coronavirus cases Friday, a daily tally not seen since the spring. Hospitalizations are on the rise as well, with 1,926 patients in beds Friday and 236 on ventilators.

Patients who have been deferring care are returning to hospitals, flu season is starting, and emergency rooms are filling up with patients as public activity resumes, Kampf said. Staffing has been difficult even with the waivers.

“With nurses, physicians, [physician assistants], everyone in the hospital working like crazy under intense pressure, there are a lot of shortages out there,” he said. “You put all that together and it’s very tough to operate.”

When lawmakers return to Harrisburg this month, health-care advocates are hopeful there will be quick action to make some of the waivers, including one that permits doctors to use telemedicine, permanent. The state House committee on Aging and Older Adult Services will hold a hearing Monday to discuss how the lapsed waivers affect older Pennsylvanians.

But above all, those who spoke with Spotlight PA said permanent solutions are needed to ensure nurses, doctors, and frontline health-care workers can stay in their positions.

“The nursing shortage is probably the most important thing,” Snook said. “No matter how many beds we have, if we don’t have nurses, patients will die.”

Some nurses finally get the recognition they deserve | PennLive Opinion

July 28, 2021

By Matt McCoy

It used to be that certified registered nurse anesthetists (CRNAs) were the best-kept secret in health care. Not anymore.

Right before the General Assembly adjourned for its summer recess, lawmakers passed and the governor signed into law Act 60 of 2021, which grants formal title recognition to CRNAs in Pennsylvania.

The enactment marks the end of a legislative review that stretched more than a decade, and it brings tremendous professional satisfaction to the state’s 3,700 CRNAs and students, who will finally be recognized for their advanced education, specialized training, and clinical skills.

Until that moment a few weeks ago, Pennsylvania remained just one of two states (New York is now the lone holdout) that failed to formally recognize “certified registered nurse anesthetist” in some form.

Because there was no definition for nurse anesthetists under the state’s Professional Nursing Law, CRNAs were recognized only as registered nurses, despite clear differences between the two health-care professionals.

CRNAs are the hands-on providers of anesthesia care, operating safely in every setting where anesthesia is administered, including hospital operating and delivery rooms; ambulatory surgical centers; the offices of dentists, ophthalmologists, and plastic surgeons; pain management centers, and more.

Act 60 also expands the providers that CRNAs are permitted to work with to include podiatrists.

While many CRNAs practice with physician anesthesiologists, increasingly, CRNAs practice on their own in collaboration with other health-care professionals.

Act 60 also reinforces that nurse anesthetists are able to perform the full scope of anesthesia services without the involvement of physician anesthesiologists and embraces the existing patient care model of collaboration between CRNAs and their physician colleagues.

More than 49,000 CRNAs safely administer well over 34 million anesthetics nationwide each year --- and Pennsylvania remains at the forefront.

With 13 university-led programs, including York College’s WellSpan Health Nurse Anesthetist Program, our commonwealth is a national leader in anesthesia education and training. So, it has always been frustrating that our state didn’t even officially recognize these professionals.

It was costly, too. Without an official CRNA designation here, many students left. And even after they left, some graduating students had to wait as long as six months to get credentialed in out-of-state facilities, because state boards had to verify that students met requirements to be classified appropriately there.

This new law stems the flow of this “health-care brain drain” and reinforces our reputation for education and training.

Act 60 also remedies issues with credentialing that meant logistical and financial challenges for CRNAs.

Pennsylvania-based nurse anesthetists who serve in the military, for example, had to secure designation in another state to provide anesthesia in the armed services. Our CRNAs could not assist on rapid response teams in states affected by natural disasters unless they served only as RNs because they lacked formal credentials.

But it was the pandemic that finally put this decades-long professional slight into perspective.

In response to COVID-19, many CRNAs wanted to contribute more to the facilities where they worked but couldn’t. Likewise, hospitals and other health-care institutions wanted to use CRNAs to their fullest capacity but couldn’t.

And they couldn’t because of the way the state-licensed CRNAs as RNs, which limited our role to provide the most advanced, critical care services during the biggest health-care crisis of our lifetime.

Of course, none of this would have been possible without the bipartisan cooperation of the administration and lawmakers, especially Rep. Tarah Toohil (R-Luzerne) and Sen. John Gordner (R-Columbia), whose measure ultimately was signed into law.

In the most ordinary situations, surgery and anesthesia can be frightening or intimidating. But nurse anesthetists provide comfort and reassurance by never leaving their patient’s side.

We’re usually the last people patients see before a procedure begins and the first to greet them when they awake. It’s humbling to realize that now they will get to know us for who we really are -- finally and officially -- as CRNAs in Pennsylvania.

Matt McCoy, DNP, CRNA, is president of the Pennsylvania Association of Nurse Anesthetists.

https://www.pennlive.com/opinion/2021/07/some-nurses-finally-get-the-recognition-they-deserve-opinion.html