NOVA Hill Day

On March 4, 2020, NOVA nurses gathered at the Wink Hotel in Washington, DC and enjoyed dinner at Stoney’s. On Thursday, March 5, NOVA members began the day with a panel presentation. Teresa Morris, NOVA Director of Advocacy and Government Relations, talked with NOVA members about what to expect including preparing for Capitol Hill security, meeting with staffers and representatives, appropriate etiquette including tone of discussion and punctuality, questions about VA Services, priority goals, and talking points. She noted that you should always introduce yourself as a NOVA member and nurse that works at VA and provides exceptional care to Veterans, and let them know what facility you work at, especially if it is in the Congressional Member’s district. Teresa recommended that NOVA members choose two or three of NOVA’s Priority Goals that they are comfortable discussing. She recommended staffing, talking about what is needed at your facility; recruitment and retention, including the need for more human resources staff; and implementation of the VA Mission Act, including access and coordination and the need for nurses to be involved with this process. Teresa also recommended asking if the legislative staff had any questions for you, and if you receive a question that you can’t answer, let them know you will get back to them. This helps to build relationships within the office. She also mentioned leaving the NOVA 2020 Legislative Priority Goals behind and thanking them for meeting with you.  After the meeting, be sure to send a follow up email thanking them again and providing your contact information if they have any questions regarding the goals or anything else you discussed. 

Teresa then introduced Congresswoman Lauren Underwood, who serves Illinois’ 14th Congressional District and was sworn into the 116th U.S. Congress on January 3, 2019.  Congresswoman Underwood is the first woman, the first person of color, and the first millennial to represent her community in Congress. She is the youngest African American woman to serve in the United States House of Representatives. Congresswoman Underwood serves on the House Committee on Education and Labor, the House Committee on Veterans’ Affairs, and the House Committee on Homeland Security. She also serves on the House Democratic Steering and Policy Committee. Congresswoman Underwood is a member of the Future Forum, a group of young Democratic Members of Congress committed to listening to and standing up for the next generation of Americans, the Congressional Black Caucus, and the LGBT Equality Caucus. As a strong supporter of addressing the gun violence epidemic, she is a member of the Congressional Gun Violence Prevention Taskforce.  Prior to her election to Congress, Congresswoman Underwood worked with a Medicaid plan in Chicago to ensure that it provided high-quality, cost-efficient care. She served as a Senior Advisor at the U.S. Department of Health and Human Services (HHS), helping communities across the country prevent, prepare for, and respond to disasters, bioterror threats and public health emergencies. As a career public servant at HHS, Congresswoman Underwood helped implement the Affordable Care Act, broadening access for those on Medicare, improving health care quality, and reforming private insurance. She also taught future nurse practitioners through Georgetown University’s online master’s program. She is a graduate of the University of Michigan and Johns Hopkins University. 

Congresswoman Underwood noted that this year is the 10th anniversary of the Affordable Care Act which started 3/23/10. She noted that there are changes that need to be made to it, including inappropriate deadlines and errors. There was no opportunity to do cleanup prior to the implementation of the legislation. Congress needs to strengthen the law. There is a challenge to it (Texas vs. U. S.) which seeks to overturn the ACA. In 2017, Congress removed the individual mandate and repealed that portion of the law. The Supreme Court will make the decision. The House is the only part of the federal government that is defending the law. The House members are key defendants and want to improve this legislation in a balanced way, so they are not using words like “strengthening.” We need to fix the reinsurance program, decrease premiums so that the cost doesn’t exceed more than 8.5% of the income; nothing to fundamentally change the bill. Healthcare is the number one topic of concern among all demographic groups. It is driven by cost. For example, for farmers, their number one issue is healthcare. For Veterans who receive healthcare at the VA, they are frustrated due to care being more than an hour away and the need to travel. Congresswoman Underwood also focuses on mental health care and suicide prevention for Veterans. She identified that of the more than 20 suicide deaths by Veterans daily, half of those Veterans aren’t connected to VA. Millions devoted to outreach is ineffective. There is a need to make creative changes. Women’s healthcare in the VA is another significant issue. In her VISN, which includes Hines, a survey of women identified that 25% of them felt harassed when they visited. That isn’t something that can be legislated away. This needs a cultural resolution and increased support. Congress needs to create the authority for those conversations to occur. There needs to be a data driven, evidenced based policy, which is rare on Capitol Hill. There is an article in JAMA that identified how much money would be saved if VA could prescribe contraceptive coverage. She told NOVA members that Congress wants to hear your expertise. You can talk about your practice and day-to-day work. Talk about how your experience as a nurse serves Veterans. When the Congresswoman conducts site visits she talks with providers in clinics one on one and how their work flows every day. The VA Secretary talks about high level metrics with Congress but what you do every day in the clinical setting is what Congress wants to hear so they can give you the appropriate time, space, and resources.

The Congresswoman is working on legislation for post 9/11 counseling sessions for post 9/11 Veterans. It has been identified that 60% - 70% know somebody who committed suicide, which increased their own risk. Currently, they need to self-identify. We are not treating all individuals at high risk or treating them first. This legislation will allow time in the primary care visit for a basic counseling session with those at high risk to identify social supports. The evidence suggests that could be effective. Currently, there is no time and no space for those conversations. There is also legislation regarding the Mission Act to provide more grant funding to community resources for outreach and clinical referrals, and fund at very high levels, H3495. Congresswoman Underwood thinks that VA is the best place for Veterans to get care and she wants to keep that commitment. Secretary Wilke in his budget request asked for money to be put in for the Mission Act. The Congresswoman is concerned about putting funding into VA and making sure that Veterans receive care. She places a priority on eliminating the copay disparities in the ACA so that vaccines can be obtained without a copayment. That Veterans are required to pay a copay serves as a disincentive. She wants to close that loophole.  There is a lot of legislation that has passed the House, much of it unanimous, that is now just sitting in the Senate. The Senate has not been legislating. The House has passed legislation on issues such as homelessness, economic opportunity, Veterans’ care, quality, and training. There is legislation pending that will look at MOUs to make sure that the community agencies who get funding from VA will be held to the same standards as VA that is sitting in the Senate, having passed the House unanimously. She is also working on legislation to support economic growth and transparency.

A question was asked about the VA’s mission in addition to patient care, supporting research, education, and serving as backup for national emergencies, noting that the VA prepares health educators, with approximately 8200 FTEEs funded annually assisting over half a million students each year, and that funding is jeopardized with continuing resolutions, and that VA needs to be investing in innovation. The Congresswoman noted that the America Cares Act provides 5 years of funding mechanisms for research. It was identified that facilities can’t get funding for staffing to support the Mission Act. Another issue identified was the problem with hiring nurses due to issues with human resources staff. It was also identified that 14 of 18 VISNs are struggling with the budget due to money being held back because it may be needed for community care. The VA has a Hire Right/Hire Fast initiative for RNs but most facilities are not hiring because they don’t have the funds. The Congresswoman recommended that those issues should be reported to the House Veterans’ Affairs Committee.  She said that the best way to advocate for Veterans is to vote. She also encouraged visiting with House and Senate staff in local district offices, and sending emails or letters because they need to hear from NOVA members. Use of social media is not effective. Don’t assume that they are receiving feedback on their inaction.

After Congresswoman Underwood’s presentation, Teresa introduced Suzanne Miyamoto, Chief Executive Officer (CEO) of the American Academy of Nursing.  Dr. Miyamoto previously worked at the American Association of Colleges of Nursing (AACN) as their Chief Policy Officer, overseeing the strategy and operations of Health Policy, Higher Education Policy, Government Affairs, Strategic Outreach and Analytics, and Diversity and Inclusion. She was also heavily involved in AACN’s external outreach and grant process. During her tenure at AACN, Dr. Miyamoto was instrumental in formalizing and leading the Nursing Community Coalition (NCC), a partnership of nursing associations that advocates on healthcare issues.  She is a 2014 Robert Wood Johnson Foundation Executive Nurse Fellow and has been an adjunct assistant professor at Georgetown University, School of Nursing and Health Studies as well as at the University of Maryland, School of Nursing and lecturer at Johns Hopkins University, School of Nursing. Additionally, she is a member of the Editorial Board for the journal Policy, Politics & Nursing Practice. Previously, she held policy positions at the state and federal level with the National Institutes of Health, the State Commission on Patient Safety for the Michigan Health and Safety Coalition, and former United States Congressman Joseph Knollenberg. 

Dr. Miyamoto thanked NOVA nurses for what they do daily for Veterans. She noted that it was fortunate that Congresswoman Underwood was on the House Veterans’ Affairs Committee because she knows Veterans issues so well. She has also made a commitment to support nursing, and is a voice on the Hill. Dr. Miyamoto highlighted Dr. Linda Schwartz from the VA who was confirmed by the Senate as the VA’s Assistance Secretary for Policy and Planning in 2014. A disabled Air Force Veteran, she worked to make the VA more veteran-focused, noting that the mission of the VA is to ensure Veterans have the very best in care and services, as they have earned them and deserve them. She encouraged the Academy’s focus on “Have you ever served?” which encourages all private sector providers to screen patients to identify Veterans in order to screen for issues such as exposure to burn pits and risk of suicide. She noted that it takes nursing’s voice to help members of Congress understand these issues. She noted that Congress doesn’t understand the Corona virus, including how preparation should be done and what it could look like if it isn’t addressed appropriately. She noted that Congress provided $8.3 billion in funding for the virus, and it’s important for NOVA nurses to share their expertise with Congress because they don’t have the expertise. They aren’t familiar with the latest literature. Regarding the virus, she noted that Dr. Kathy Gorman from Children’s Medical Center in Washington, DC said that “We can fear or we can care.”  VA nurses are the voice of advocacy, not just in the halls of Congress but in public, too. The public needs to hear our calm voice in times of crisis. She noted that Congressional staff members have a portfolio of issues that they are responsible for, even the staff of the House Veterans’ Affairs Committee. She noted that the Committee members and the staff don’t know what VA nurses know because they just hear from the Secretary. She thanked NOVA nurses for their advocacy and leadership.

VA nurses were then taken by bus to Capitol Hill, where they talked with Congressional staff throughout the day.  At the end of the day, the bus returned and a debriefing was held. NOVA nurses acknowledged a successful day in Congress, sharing NOVA’s Legislative Priorities and other information and answering questions from legislative staff members. Legislative staff members wanted to hear from NOVA members and asked what Congress could do to support Veterans. It was identified that it would be helpful for future visits to have a list of initiatives and projects to share, as well as a list of legislation that NOVA supported, and legislation that NOVA didn’t support.  After the debriefing, members enjoyed a networking dinner at the Grillfish Restaurant.

NOVA members in attendance included Nancy Claflin, Sherry Clement, Grace Conley, Vanessa Coronel, Raquell Garrett, Catherine Giasson, Pandolla Hicks, Alma Holley, Alma Houlditch, scholarship winner Ashley Jones, Agnes Kaje, Margaret Kruckemeyer, Stella Lebrun, Carol McTavish, Leticia Mickens, Martha Moreno, Betty Ogren, scholarship winner Steven Powell, Theresa Presley, Faith Santiago, Michella Savoy-Carter, Thelma Roach-Serry, Beverly Ross, Michelle Salazar, Kelly Skinner, Yvette Twum-Danso, and TJ Wilcox-Olson.