NNU building nurse power, 2021-2024

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Nurses at capitol

Safe Staffing Ratios and the Staffing Crisis

In addition to running ratios bills at the federal level and in several states, NNU has advocated for safe staffing requirements in regulation and shaped the national conversation on the nurse staffing crisis. NNU has been leading a campaign to educate Congress on the nurse staffing crisis, to fight back against harmful hospital industry narratives in Washington, D.C. about the “nursing shortage,” and to build widespread support for the federal safe staffing ratios bill.

Dec. 2021 - NNU issued a report on the nurse staffing crisis— Protecting Our Front Line: Ending the Shortage of Good Nursing Jobs and the Industry-Created Unsafe Staffing Crisis. To launch the report, NNU hosted a congressional briefing where Members of Congress heard directly from nurses about the hospital industry practices that drive the staffing crisis.

Jun. 2022 – NNU submitted comments to the Centers for Medicare and Medicaid Services (CMS) supporting minimum staffing standards for long-term care facilities.

2023 – NNU launched a campaign in 2023 to inform Senator Bernie Sander’s work in the Senate Committee on Health, Education, Labor, and Pensions (HELP) proceedings to address the “nursing and health care worker shortage” and advocate for the federal ratios bill, the workplace violence prevention standard, and critical investments in nursing to diversify the nursing workforce.

Feb. 2023 - NNU submitted written testimony to the HELP Committee for their February 2023 hearing that launched these negotiations.

Mar. 2023 – NNU issued a detailed proposal for actions to end the staffing crisis, which was submitted to the HELP Committee and used across Congress. As part of our advocacy on the HELP Committee negotiations, NNU sent letters urging the committee to include workplace violence prevention measures and to protect new nursing education investments.

Apr. 2023 – NNU organized eight nurse-led meetings with committee members on both sides of the aisle during a mini lobby week.

May 2023 – NNU conducted nearly one hundred meetings with Members of Congress on the staffing crisis to build support for the ratios bill and the workplace violence prevention bill during NNU’s annual Lobby Week.

July 2023 – NNU worked with Senator Ed Markey (D-MA) to introduce a new bill, “The Public Health Nursing Act”, and we advocated for its inclusion in the Senate HELP health care workforce package. The bill was later introduced in the House by Congresswoman Melanie Stansbury (D-NM).

Mar. 2023 – NNU organized a Congressional briefing open to Members of Congress and their staff to learn about the reasons why nurses are organizing and to urge members to cosponsor the ratios bill and workplace violence prevention bill.

Mar. 2023 - NNU re-introduced our federal ratios bill with 7 Senate original cosponsors and 56 House original cosponsors—the highest number of original cosponsors to date. To promote the bill, NNU organized a press conference on the steps of the Capitol, and an Ohio event with Senator Brown and NNU nurses.

Sept. 2023 - NNU participated in a livestream with Senator Bernie Sanders about the nurse staffing crisis. NNU leaders President Nancy Hagans and Vice President Cathy Kennedy gave remarks.

Oct. 2023 - NNU President Nancy Hagans testified before the Senate HELP Committee in New Brunswick, NJ about the need for safe staffing ratios. This was the first congressional hearing on federal nurse ratios in history. Nancy’s written testimony was submitted for the congressional record.

Nov. 2023 – NNU submitted comments to CMS supporting minimum staffing standards for long-term care facilities.

Workplace Violence Prevention for Health Care and Social Service Workers

NNU has advocated for a national, enforceable Occupational Safety and Health Administration (OSHA) standard on workplace violence prevention.

Feb. 2021 – NNU issued report - Injury to None: Preventing Workplace Violence to Protect Health Care Workers and Their Patients.

Apr. 2021 – NNU worked to pass the workplace violence prevention bill in the 117th Congress in the House of Representatives in a bipartisan vote 254-166 yeas and nays.

May 2021 – NNU organized a press conference with Senator Tammy Baldwin to announce the introduction of the Senate workplace violence prevention bill.

Nov. 2021 – NNU issued report - Workplace Violence and Covid-19 in Health Care: How the Hospital Industry Created an Occupational Syndemic

July 2022 – NNU worked with women’s organizations to send a sign-on letter to the Senate urging passage of the workplace violence prevention bill.

Oct. 4, 2022 - NNU held a listening session for OSHA leadership to hear directly from nurse members regarding issues with workplace violence and the need for an enforceable standard.

2023 – NNU advocated for the inclusion of a workplace violence prevention standard as a fundamental measure to increase nurse retention over the course of the Senate HELP Committee negotiations to address the nursing and health care worker staffing crisis.

Apr. 2023 – NNU reintroduced the Workplace Violence Prevention bill in the House and Senate, together with a press conference.

Apr. 2023 – NNU submitted extensive comments regarding OSHA’s Small Business Regulatory Enforcement Fairness Act (SBREFA) review, urging OSHA to issue a protective standard as soon as possible to protect health care workers from the serious threat of workplace violence and countering employer talking points and falsehoods shared in SBREFA panels. NNU’s comments shared updated data from member and non-member nurses, a review of the relevant scientific literature, and the union’s experience with important elements of regulatory standards to prevent workplace violence in health care settings.

Sept. 2023 - NNU held a meeting with OSHA leadership to follow up on the SBREFA process on September 13, 2023, and to urge development of a protective standard as soon as possible.

2023 – NNU conducted an extended analysis of workplace violence survey data in response to reports from NNU leaders that workplace violence had been on the rise since the beginning of the Covid-19 pandemic. Data was collected from nearly 1,000 nurses in forty-eight states and the District of Columbia. The data showed clearly that workplace violence rates are accelerating across the country and that employers continue to fail to implement basic prevention measures. In-depth interviews were conducted with NNU and affiliate leaders from seven states, including New York and Minnesota, to document employer failures to protect nurses. These interviews also documented the importance and power of union advocacy to win protections. This definitive study has been the subject of multiple media articles and has drawn the interest of policymakers.

Training Repayment Agreement Provisions (TRAPs) and Other Exploitative Contracts

NNU has been a major leader in the fight against TRAPs and other exploitative contracts that require nurses to pay their employers if they leave their jobs.

Sept. 2021 - NNU was one of the first to call attention at the federal level to the issue of TRAPs in comments to the FTC.

Jul. 2022 – NNU submitted comments focused on the use of debt to control immigrant nurses to the Office of Trafficking in Persons (OTP) and was invited to join a Joint Forced Labor Working Group convened by OTP as experts.

Sept. 2022 – NNU submitted extensive comments to the Consumer Financial Protection Bureau based on a survey and interviews with nurses about their experiences with TRAPs. These comments were cited extensively in the CFPB’s 2023 report on employer-driven debt as well as in high-profile media outlets and advocacy work by allies on the issue.

Apr. 2023 – NNU submitted comments supporting the FTC’s proposed ban on the use of non-compete clauses and urging the FTC to expand its inclusion of TRAPs in the ban.

Covid-19 and Occupational Safety and Health Protections from Infectious Diseases

NNU has advocated to pass much needed regulation to ensure that nurses and other health care workers have the necessary infection control protections to prevent COVID exposure, illness, and death and to prevent exposure to other infectious diseases.

Covid-19 Protections

Sept. 9, 2021 - NNU applauds President Biden’s announcement of a comprehensive strategy on Covid-19 as a step in the right direction to get the pandemic under control.

Sept. 22, 2021 - As governments from across the world meet at the annual U.N. General Assembly and President Biden hosts a summit on the Covid-19 response, NNU calls on the president and every world leader to immediately work together to end this pandemic.

Sept. 23, 2021 - NNU condemns the Advisory Committee on Immunization Practices (ACIP) for voting against recommending Covid-19 vaccine booster shots for people aged 18-64 working in health care settings where Covid-19 infection and risk of transmission is high.

Sept. 24, 2021 - NNU praises CDC Director Rochelle Walensky's decision to overrule the CDC’s own advisors and endorse the use of Pfizer-BioNTech's Covid-19 booster shot for people aged 18-64 working in health care and other settings where Covid-19 infection and risk of transmission is high.

Sept. 27, 2021 - NNU releases data from a sixth nationwide survey of more than 5,000 registered nurses revealing that employers must do more to be fully compliant with the OSHA Emergency Temporary Standard (ETS) and to implement optimal standards to protect nurses and other health care workers from Covid-19.

Oct. 19, 2021 - NNU applauds OSHA for taking a critical step in protecting health care workers in Arizona, South Carolina, and Utah who had been left behind when their states failed to adopt the OSHA ETS on Covid-19 in Health Care issued in June 2021.

Oct. 22, 2021 - NNU applauds an announcement by the White House of plans to distribute Covid-19 vaccine doses to 28 million children aged 5 to 11.

Nov. 3, 2021 - NNU urges OSHA to adopt a permanent standard on Covid-19 in health care workplaces, building on the ETS adopted in June 2021.

Nov. 10, 2021 - NNU praises President Biden’s Covid-19 Health Equity Task Force and urges rapid implementation of its recommendations.

Nov. 17, 2021 - NNU leadership held a meeting with OSHA leadership, letting them know the clear costs if OSHA let the ETS expire and urging that OSHA put a plan in place to protect health care workers.

Dec. 2, 2021 - Citing the new Omicron variant, NNU urges OSHA to adopt a permanent standard on Covid-19 in health care workplaces, building on the ETS adopted in June 2021 and set to expire on Dec. 21, 2021.

Dec. 16, 2021 - NNU joins more than 40 unions and other organizations in signing a petition, along with more than 6,300 individuals, to urge OSHA to adopt a permanent standard on Covid-19 in health care workplaces. The petition also encouraged OSHA to work expediently to issue a separate, broader standard to protect all workers from workplace exposure to Covid-19 and other aerosol transmissible diseases.

Dec. 21, 2021 - NNU condemns OSHA’s failure to adopt permanent Covid-19 and infectious disease protections for health care workers.

Dec. 22, 2021 - NNU sends a letter to the CDC regarding the Omicron variant and isolation time frames urging it to follow the science and the precautionary principle by maintaining Covid-19 isolation guidance.

Dec. 23, 2021 - NNU condemns the decision by the CDC to shorten the isolation period for nurses and other workers who have tested positive for Covid-19 from 10 days to seven days and no longer requiring exposed vaccinated and boosted health care workers to quarantine.

Dec. 28, 2021 - NNU condemns the Biden administration's moves to rip away protections from health care workers and the public, warning that the CDC’s weakening of Covid-19 isolation guidelines and OSHA’s announcement that it will rescind critical Covid-19 protections for health care workers—right when the Omicron variant is exploding across the country during a winter surge–puts countless lives at risk.

Jan. 3, 2022 - With Covid-19 infection numbers exploding and pediatric hospitalizations at an all-time high, NNU calls for schools to offer remote learning in order to protect our nation's children.

Jan. 5, 2022 - NNU joins national leading labor organizations and unions representing the country’s nurses and health care workers in petitioning a federal court to order OSHA to issue a permanent standard requiring employers to protect health care workers against Covid-19.

Jan. 8, 2022 - CNA condemns the decision by the California Department of Public Health (CDPH) to let asymptomatic health care workers who test positive for Covid-19—or workers who have been exposed to the virus and are asymptomatic—return to work immediately without isolation or testing.

Jan. 11, 2022 - NNU applauds the 115 members of Congress who sent a letter to President Biden urging his administration to quickly issue a final permanent Covid-19 OSHA standard for health care workers and to retain the emergency temporary standard until the permanent standard takes effect.

Jan. 12, 2022 - NNU commends the 21 U.S. senators who sent a letter to President Biden and Secretary Walsh urging the Biden administration to quickly issue a final permanent Covid-19 OSHA standard for health care workers.

Jan. 13, 2022 - NNU welcomes the decision of the U.S. Supreme Court to uphold the Biden administration’s authority to issue a vaccine mandate for all workers in health care facilities. At the same time, the nurses voice dismay that the Court overruled similar federal safety measures for all employees.

Jan. 13, 2022 - As part of a national day of action, thousands of registered nurse members of NNU hold actions across the country—including a candlelight vigil near the White House for nurses who lost their lives to Covid-19, and a national virtual press conference—to demand the hospital industry invest in safe staffing and that President Biden follow through on his campaign promise to prioritize public health and protect nurses.

Feb. 28, 2022 - NNU criticizes the latest CDC rollback of Covid-19 safety guidelines as a serious risk for increasing the spread of Covid-19 and prolonging the pandemic. NNU calls on the CDC to reverse the new guidelines.

Mar. 1, 2022 - NNU sends a letter to the CDC urging it to reverse its new dangerous Covid-19 community levels metric—which guides decision-making for prevention measures for workers, schools, and the public—and to restore the previous four-tiered Covid-19 community transmission metric.

Mar. 28, 2022 - NNU President Zenei Triunfo-Cortez, RN met with CDC, HHS Office of Intergovernmental and External Affairs, and Health Resources and Services Administration to urge the CDC to adjust its care plan for everyone by immediately updating its Covid guidelines rooted in the control and prevention of disease.

Mar. 30, 2022 - NNU sends a letter to the CDC calling on the agency to immediately approve a recommendation for a second Covid-19 vaccine booster for nurses and other health care workers.

Apr. 4, 2022 - NNU argues before the U.S. Circuit Court of Appeals for the District of Columbia Circuit on behalf of leading national labor organizations and unions representing nurses and health care workers, asking OSHA to issue a permanent standard requiring employers to protect health care workers against Covid-19, and retain the existing ETS until the permanent standard goes into effect.

Apr. 14, 2022 - NNU releases data on its seventh nationwide survey of more than 2,500 registered nurses, revealing significant increases in staffing issues, workplace violence, and moral distress compared to NNU’s previous survey results released less than seven months prior. RNs also reported that their hospitals are still not adequately prepared for a Covid-19 surge.

Apr. 22, 2022 - NNU issues a statement warning against the lifting of mask mandates and highlighting the critical role masks play in a multi-layered approach to infection control and to curbing Covid-19 transmission.

Apr. 28, 2022 - NNU testifies at OSHA’s informal rulemaking hearing for occupational exposure to Covid-19 in health care settings. Nurses urge OSHA to issue a permanent standard to protect health care workers from Covid-19 and to make improvements to the temporary standard.

July 20, 2022 - NNU sends a letter to the CDC urging the agency to take immediate action to protect public health in the face of elevated transmission of Covid-19 around the country, the dominance of the extremely contagious and immune-evasive BA.5 variant, and the development of additional Omicron subvariants.

Aug. 26, 2022 - NNU issues a statement expressing disappointment in the federal court’s decision to deny its emergency petition to order OSHA to issue a permanent standard to protect health care workers against Covid-19 and to retain the emergency temporary standard until the permanent standard takes effect.

Sept. 26, 2022 - NNU sends a letter to Congress expressing its support for President Biden’s supplemental funding request for $22.4 billion for the Covid-19 pandemic response and for $4.6 billion for the mpox virus response.

Sept. 29, 2022 - NNU sends a letter to the CDC urging the agency to “recommend optimal workplace protections for nurses and other health care workers.” The letter is in response to the CDC’s policy updates which would result in decreased protections for health care workers and our patients and, as a result, increase transmission, illness, and death.

Dec. 8, 2022 - NNU applauds OSHA for sending its Covid-19 permanent standard to the Office of Information and Regulatory Affairs (OIRA) at the Office of Management and Budget (OMB) for review, and urges OIRA to complete its review promptly so the standard can be issued without delay.

Dec. 13, 2022 - NNU releases data from its eighth nationwide survey of more than 2,800 registered nurses which reveals continued significant issues around staffing, workplace violence, Covid-19 precautions, among other concerns.

Dec. 19, 2022 - NNU President Deborah Burger, RN and Health & Safety staff met with the Office of Information and Regulatory Affair (OIRA) to express urgent need for OSHA to issue a permanent Covid standard to protect health care workers from the ongoing threat of Covid and risks of long Covid.

Oct. 2023 – NNU argued that Covid-19 protections should be considered necessary accommodations for pregnant workers in comments to the EEOC on the Regulations To Implement the Pregnant Workers Fairness Act.

Nov. 2023 – NNU submitted comments to HHS on Discrimination on the Basis of Disability in Health and Human Service Programs or Activities and argued that Covid-19 protections should be considered necessary accommodations.

Jan. 2024 - NNU issued its most recent Covid survey of more than 2,600 RNs which shows that health care workers still do not have the protections they need to care for patients safely. Just 72.4% of hospital RNs report having access to a sufficient supply of N95 or other kinds of respirators on their unit. Only 61.2% report wearing a respirator for every encounter with a Covid-positive patient—Nurses face worsening working conditions amid winter surge in Covid and other respiratory viruses, as CDC looks to weaken infection control guidance

Feb. 23, 2024 - NNU sent a letter cautioning CDC Director Mandy Cohen not to weaken isolation guidance for Covid-19, after media reported that the CDC was considering such updates, and to follow the science in developing guidance that will best protect people’s health.

Mar. 2024 - After the CDC weakened isolation timeframes for Covid-19 in March 2024, NNU released a statement condemning CDC’s decision to lump Covid-19 guidance in with other respiratory viruses and to shorten its isolation guidance for Covid. NNU also participated in a press conference with the People’s CDC urging CDC Director to revisit the abrupt elimination of Covid isolation guidance.

Permanent Infectious Disease Standard

NNU has advocated for a national, enforceable standard to protect nurses and other health care workers from infectious disease hazards, including aerosol and contact transmissible diseases.

Feb. 2024 – NNU sent a letter to Acting Secretary of Labor Julie Su regarding the importance of a permanent infectious diseases standard to protect nurses, other health care workers, and their patients from infectious diseases, including Covid-19, influenza, RSV, measles, and others.

Mar. 2024 – NNU launched a new infectious diseases survey to gather updated data on employer practices regarding a range of infectious diseases.

Apr. 2024 – NNU held a listening session for OSHA leadership to hear from nurses regarding employer failures to implement strong, science-based, consistent protections from infectious diseases. Nurses are urging OSHA to issue a proposed standard as soon as possible.

Mpox Protections

NNU advocates for protections for nurses and other health care workers from mpox (formerly monkeypox) virus during the large outbreak in 2022.

June 2, 2022 - NNU sent a letter urging the CDC to strengthen infection control guidance for mpox in hospitals and other health care settings.

June 28, 2022 – NNU held a meeting with CDC leadership to discuss concerns about the limited information that the CDC was sharing about cases and transmission as well as concerns about infection control guidance and protections for health care workers.

Aug. 23, 2022 - NNU sent a letter urging the CDC to transparently post data about the outbreak and include strong protections for health care workers in infection control guidance.

2022 - NNU develops and provides education and resources for members on a variety of infectious disease topics, including the Nurses’ Guide to Preventing Transmission of Mpox (Monkeypox) in Health Care Settings:

Aug. 2022 – NNU posted Latest Science on Mpox Virus: What Nurses Need to Know, webinar offered October 2022 (CEs provided to members) and Facebook Live video

Jan. 2024 - NNU issues Nurses’ Guide to Improving Indoor Air Quality in Health Care

Mar. 2024 – NNU issues an updated version of Measles: What Nurses Need to Know 

CDC Infection Control Guidelines

2021-2022 – NNU began monitoring work at CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) to update foundational infection control guidance. This guidance governs precautions for a wide range of pathogens, such as TB, Covid-19, MRSA, Ebola, measles, influenza, etc.

2023 – NNU launched a campaign to influence the CDC HICPAC process to re-draft the CDC infection control guidelines for health care setting. NNU has been working to increase congressional oversight and highlight our concerns with the process and content of the guidance. NNU submitted multiple public records requests for Isolation Precautions (IP) Workgroup meeting summaries, which the CDC initially denied. As a result of NNU’s advocacy and organizing, those requests were fulfilled. NNU made these documents available to the public—something the CDC should have been doing to ensure transparency. The meeting summaries indicate that the IP Workgroup has had an employer-friendly orientation all along, with explicit goals set to lower protections for workers.

Jun. 2023 - NNU sounded the alarm on the IP Workgroup’s proposals, which were shared at a public HICPAC meeting for the first time. The IP Workgroup’s proposals failed to recognize the science on aerosol transmission and respiratory protection and proposed to weaken current practice. NNU VP Irma Westmoreland and NNU allies provided public comment at HICPAC’s meeting in June 2023, urging HICPAC to ensure science-based protections for health care workers and to avoid creating “flexibility” for health care employers (a stated goal of the IP Workgroup).

Jul. 2023 – NNU sent a letter expressing nurses’ concerns with the IP Workgroup’s proposals that were presented to HICPAC at the June meeting. With the AFL-CIO and other unions, NNU met with CDC HICPAC staffers to raise issues about the work group’s proposals and HICPAC’s lack of engagement of experts and unions and their members. NNU also pulled together a coalition of scientists and public health experts, who sent a letter with over 900 signers to the CDC.

Aug. 2023 – NNU delivered a petition signed by over 45 organizations representing 6 million people and with nearly 11,000 individual signatures urging CDC/HICPAC to fully recognize aerosol transmission science and to protect health care workers and patients. NNU President Zenei Triunfo-Cortez, RN alongside many allies, provided public comment at the August 2023 HICPAC meeting, urging the CDC and HICPAC to protect nurses and other health care workers.

Sept. 2023 – NNU sent a second letter as part of a coalition of scientists and public health experts with over 1,000 signers.

Oct. 2023 – NNU held a workshop as part of a coalition of scientists and public health experts to hear from scientists, health care workers, and patient advocates, including NNU President Nancy Hagans.

Nov. 2023 - NNU President Zenei Triunfo-Cortez, RN spoke powerfully during the public comment portion at the November HICPAC meeting. NNU once again turned out public health experts and community allies in large numbers. Despite NNU’s objections, HICPAC voted unanimously to approve the Workgroup’s draft and sent it to the CDC for further review.

Dec. 2023 – NNU immediately called for the CDC Director to reject HICPAC’s draft by delivered a petition, signed by more than fifty organizations and over 5,000 individuals. NNU also worked to raise awareness in Congress about the dangers of the HICPAC draft guidance. This work resulted in a congressional letter from Senator Bernie Sanders and Congressman Bobby Scott to the Director of the CDC raising concerns with the lack of transparency in process, failure to include health care worker, and guidance draft that would weaken existing precautions.

Jan. 2024 – NNU secured a major victory when the CDC announced it would be sending the draft back to HICPAC for further work on some of the core concerns that NNU has been raising. CDC also made a commitment to expand the scope of technical expertise on HICPAC and its Workgroup, something that NNU has been calling for since the beginning.

Feb. 2024 – After the CDC sent back the draft guidance to HICPAC and directed them to expand the scope of expertise in the workgroup and HICPAC prior to continuing their work on the guidance, the CDC sent us letter responding to our petition. Their letter contained inconsistencies in the process that HICPAC followed, so NNU sent a follow up response clarifying key points that demonstrate HICPAC’s failure to include the input of health care workers and other critical perspectives.

Mar. 2024 – NNU organized a congressional briefing for Congressional Members and their staff to educate congress about the HICPAC process, our concerns with the draft, and to encourage members to sign onto a congressional letter led by Rep. Debbie Dingell urging the CDC to include health care workers in this process.

Apr. 2024 – NNU delivered a petition signed by over 5,600 individuals urging CDC Director Mandy Cohen to ensure that the range of experts and representatives of health care workers and patients are added to HICPAC and its Workgroup to ensure that updated guidance is protective, implementable, and science-based. This campaign continues!

Medicare for All, Medicare Expansion, and Prescription Drug Price Negotiations

Health care in the Build Back Better Fight 

2021-2022 – NNU worked with a broad coalition of organizations to secure strong commitments from newly elected President Joe Biden and his White House on Medicare expansion. In a massive shift for the leadership of the Democratic Party, due in large part to the advocacy of NNU and the Medicare for All movement that we led, President Biden announced support for expanding Medicare to include dental, vision and audiology, lowering the Medicare age to 60, capping all out of pocket costs for Medicare recipients, and lowering prescription drug prices through Medicare drug price negotiations. These commitments were included in President Biden’s Build Back Better Agenda, the cornerstone of his Administration’s policy in the first half of his term.

NNU was deeply involved in congressional advocacy to pass the Build Back Better Agenda with these critical Medicare commitments.

  • NNU mobilized nurses in key states and districts to meet with their members of Congress.
  • NNU supported the building of a diverse group of organizations that publicly supported these key Medicare demands, eventually building support from more than one hundred important organizations and constituencies.
  • In July 2021, NNU led an effort to send a letter to Congress in support of the Medicare demands, signed by seventeen national unions.

Aug. 2022 – The Senate passed, and President Biden signed the Inflation Reduction Act, which included much of the Build Back Better Agenda. While Senators Joe Manchin and Kyrsten Sinema defeated the Medicare expansion NNU advocated for, the final bill included Medicare drug price negotiations and a cap on the cost of insulin at $35 a month for Medicare recipients—the first time such achievements have been achieved since Medicare was first passed into law in 1965.

Medicare for All 

NNU leads the national Medicare for All Legislative Working Group, mobilizing organizations around the country to organize to pass the federal Medicare for All bill. Each congressional session, we have led organizing work to support the reintroduction of the bills in Congress, and to build the congressional cosponsors on the bill.

2021 - NNU advocated to improve the Medicare for All bills including:

  • Securing a 365-day supply of PPE in the global budgeting of institutional providers
  • The creation of an Office Health Equity, including adding language that would ensure that staffing levels, lack of healthcare infrastructure, and hospital closures are included in the data and recommendations made by the office, and language that would track racially-biased practice guidelines and algorithms.
  • New language on interim adjustments to global budgets, which would allow for adjustments based on epidemics or infectious diseases, natural disasters, and other unanticipated needs.
  • New language to protect against telehealth attacks – the bill now includes language that ensures that a health care provider is only considered qualified to provide covered services if they are licensed or certified in the state in which the patient receiving those services is located.
  • New language prohibiting step therapy and prior authorization.
  • New details in the just transition section.

Feb. 2022 – NNU advocated for a hearing on Medicare for All in the Education and Labor Committee, followed by another hearing on Medicare for All in the House Oversight Committee.

May 2022 – NNU worked with Senator Bernie Sanders, then Chairman of the Senate Budget Committee, on a hearing on Medicare for All. NNU Executive Director Bonnie Castillo testified at this hearing.

May 2023 – NNU worked closely with Congresswoman Jayapal, Congresswoman Dingell, and Senator Bernie Sanders to plan and introduce the first ever bi-cameral Medicare for All bill. The evening before the introduction, NNU participated in a town hall with Senator Sanders in Capitol Hill. NNU President Nancy Hagans spoke on behalf of NNU about the importance of Medicare for All. The next day, we participated in a press conference for the bill introduction, where Deborah Burger spoke on behalf of NNU.

Mergers and Corporate Consolidation in Health Care

NNU has helped shape a reinvigorated FTC approach to tackling health care consolidation, private equity purchases, and other harmful mergers.

Apr. 2022 – NNU submitted comments to the FTC on Request for Information on Merger Enforcement.

Sept. 2023 – NNU submitted comments to the FTC on Draft Merger Guidelines.

Apr. 2024 – Hannah Drummond, NNU RN from Mission Hospital Asheville, NC testified before the Primary Health & Retirement Subcommittee on HELP in Boston, MA hosted by Chairman Senator Markey, and attended by Senator Elizabeth Warren. NNU has advocated for the Senate to fight back against private equity and profit-driven decisions in acute-care hospitals, and this hearing was a first step at starting to hold these corporations accountable from Congress. We also submitted Hannah’s written testimony for the congressional record.

Artificial Intelligence in Health Care

NNU has been engaging with Congress and with the Biden Administration to convey our concerns and our experiences with AI in health care.

May 2021 - NNU submitted comments to AHRQ on Request for Information on the Use of Clinical Algorithms That Have the Potential To Introduce Racial/Ethnic Bias Into Healthcare Delivery.

June 2023 – NNU submitted comments to the Office of Science and Technology Policy on Request for Information; Automated Worker Surveillance and Management

Oct. 2023 – NNU participated in an AI Insight Forum hosted by Senator Schumer. Bonnie Castillo spoke on behalf of NNU, discussing the impacts that AI is having and could have on nurses and patients. NNU has also submitted letters for the record for congressional hearings held on AI and health care in the House Energy and Commerce Committee and the Senate HELP Committee. NNU has been engaging consistently with members of Congress on our concerns about AI, and we hope to influence any future AI legislation.

Dec. 2023 – NNU submitted comments to Office of Management and Budget on Request for Comments; Advancing Governance, Innovation, and Risk Management for Agency Use of Artificial Intelligence Draft Memorandum.

Dec. 2023-2024 – NNU has advocated among Senate Committees that have jurisdiction over AI issues and have been tasked with preparing potential Senate legislation on regulating AI. NNU also works with the AFL-CIO and other unions to educate people about the unique risks that AI in health care poses to patients, health care workers, and communities.

Feb. 2024 – NNU submitted comments to National Institute of Standards and Technology on Request for Information; Evaluating and auditing capabilities relating to Artificial Intelligence (AI) technologies.

May 2024 – NNU will prioritize the risks of AI in health care during our annual lobby week.

Scope of Practice, Nursing Practice, and the National Licensure Compact

NNU monitors activities at state boards of nursing and the legislature including identifying threats to RN scope of practice. This ongoing assessment and monitoring create a unified view of trends across the country, often providing warning so that offensive positions can be taken in these policy areas.

Joint Nursing Practice Commission (JNPC) 

NNU convenes quarterly meetings of the JNPC which collectively evaluates and reports trends in nursing practice. The JNPC provides a forum for sharing collective patient advocacy strategies that have been effective in practice protection. NNU provides education and support to the JNPC through research and assessment of national trends.

Jul. 2023 – NNU has worked to prevent DC from joining the Nurse Licensure Compact:

  • NNU submitted a substantive letter to DC City Council laying out the problems with the Compact and the risks that DC would face if it joined.
  • NNU held two CE classes to educate local DC nurses on the compact.
  • NNU held meetings with key DC Council members to urge them to oppose the Compact and organized local DCNA and NNOC nurses to attend these meetings.

Education, Health & Safety, and Nursing Practice Continuing Education Classes 

NNU provides critical resources for NNU members on nursing practice related issues such as standards of care, safe staffing, scope of practice, technologies impacting nursing practice, and other nursing centric issues.

Continuing education courses

NNU offered over 250 CE classes in an online format available to all NNU members. NNU reached over 8500 RNs and issued over 4 million continuing education credits to RNs. NNU CE classes covered over thirty different titles including important issues such as technological restructuring, social justice and equity, the latest scientific updates on the Covid 19 public health emergency and long Covid, safe staffing standards, and more. CE classes include:

  • Current Knowledge about SARS-CoV-2 (2021)
  • Endangerment of Nurses and Patients: Exploring and Explaining the Burnout and Workplace Violence Epidemics (2021), which connected issues of stress, moral distress, and workplace violence to employer restructuring, underlining the importance of nurse organizing and advocacy to protect health and safety.
  • State of the Science on SARS-CoV-2 and Covid-19 (2022)
  • Is Covid Endemic for All? (2022)
  • Long Covid: A Public Health and Occupational Emergency (2022)
  • When Work Hurts: Advocating for Safe and Just Jobs for Nurses (2023), which included a module on workplace violence that explores prevention measures and discusses nurses’ tools for enforcement.
  • The Latest Science on Long Covid and Its Impact on Nurses, Patients, and the Public (2024)

Current CE class offerings are available here.

Continuing education content to Affiliates 

  • NNU presented CE content during the Minnesota Conventions of 2021, 2022, 2023.
  • NNU presented CE content related to virtual nursing in acute care to the Minnesota board and staff education.
  • NNU presented CE content during the NYSNA conventions of 2021, 2022, 2023.
  • NNU presented CE content related to the staffing crisis and restructuring during the Michigan Fall CE event of 2022.

Labor Law Reform, the PRO Act, and Support for Organizing and Bargaining Campaigns

Mar. 2021 – NNU joined with the AFL-CIO and other unions in pushing for passage of the PRO Act in Congress. The bill was passed by the US House of Representatives (with the support of President Biden) on March 9, 2021, but was stalled in the Senate due to that chamber’s filibuster rules requiring a supermajority to pass the bill.

Apr. 2021 – NNU supported the creation by President Biden of the White House Task Force on Worker Organizing and Empowerment. Upon its creation, we engaged repeatedly with Vice President Kamala Harris, the Department of Labor, and Health and Human Services on concrete ways the Executive Branch could impose new regulations that would facilitate the rights of nurses to organize unions free from management harassment and intimidation in American hospitals.

May 2023 – NNU participated in the reintroduction event for the Healthy Families Act (paid sick leave bill), and the FAMILY Act (paid family leave bill). NNU President Jean Ross spoke at a press conference led by Senators Sanders, Gillibrand, and Schumer, along with Congresswoman Rosa DeLauro, in announcing the introduction of both bills, with 50 NNU nurses in attendance.

Equity and Social Justice

NNU has advocated for protections on key equity and social justice issues including abortion rights and protections for non-discriminatory access to health care.

May 2021 – NNU submitted comments to AHRQ’s Request for Information on the Use of Clinical Algorithms That Have the Potential To Introduce Racial/Ethnic Bias Into Healthcare Delivery.

Sept. 2022 – NNU submitted comments to CMS and HHS Office for Civil Rights’ proposed rulemaking on Nondiscrimination in Health Programs and Activities.

Jan. 2023 – NNU submitted comments to AHRQ’s Request for Information on Patient and Provider Level Strategies To Address Racial/Ethnic Disparities in Health and Healthcare.

Jun. 2023 - NNU submitted comments to HHS’s proposed rule on HIPAA Privacy Rule To Support Reproductive Health Care Privacy.

Oct. 2023 – NNU submitted comments to EEOC’s proposed rule on Regulations To Implement the Pregnant Workers Fairness Act.

Oct. 2023 – NNU submitted comments to EEOC’s proposed enforcement guidance on Harassment Based on Protected Characteristics in the Workplace.

Nov. 2023 - NNU submitted comments to HHS Office for Civil Rights’ proposed rule on Discrimination on the Basis of Disability in Health and Human Service Programs or Activities.

Climate Change and Environmental Justice 

Apr. 2023: NNU worked closely with Senator Ed Markey (D-MA) on his bill, S.1229 The Green New Deal for Health Act, which will enable the U.S. health care system to respond to climate change by improving sustainability and supporting patients, health care workers, and communities.

Nov. 2023: NNU hosted a Global Nurses United virtual briefing with nurse union leaders from around the world to provide details on the impact that climate change is having on health systems across the world. The briefing highlighted the strong link between climate change, health care, and public health.

Nov. 2023: Global Nurses United released the Global Nurses’ Proposal to Address the Health Impacts of Climate Change, an outline of nurse demands on governments to mitigate the climate crisis and increase health care systems’ preparedness.