As October unfurls its vibrant tapestry of autumnal hues across our beautiful state, it is with great pleasure that we welcome you to the October edition of the Association of California Nurse Leaders Diversity, Equity, and Inclusion (DEI) newsletter. In this season of change, we are excited to embark on a journey of transformation and growth, as we delve into the latest legislative updates that impact our nursing community.

At ACNL, we understand the importance of staying informed about the legislative landscape, particularly in matters that concern diversity, equity, and inclusion in healthcare. As the world continues to grapple with ongoing challenges and changes, our role as nurse leaders becomes increasingly critical. Our commitment to fostering a healthcare environment that embraces diversity and promotes equitable care delivery has never been more vital.

In this edition, we will explore recent legislative developments that directly affect nurses and healthcare organizations across California. From new bills aimed at improving patient outcomes to initiatives designed to address healthcare disparities, we will provide you with valuable insights into the evolving legal framework that shapes our profession.

However, knowledge alone is not enough. We believe in the power of collective action. As we delve into these legislative updates, we encourage you, our esteemed members, to reflect on how these changes can be translated into meaningful action at your respective healthcare institutions. The call to action is clear: it is our duty as nurse leaders to champion diversity, equity, and inclusion in every aspect of our practice.

We hope that this edition of the DEI newsletter serves as a source of inspiration, a wellspring of knowledge, and a catalyst for change. Let us seize this opportunity to redouble our efforts in creating a healthcare landscape that respects and values the rich tapestry of humanity we serve.

Indigenous Peoples' Day, observed on the second Monday of October, serves as a crucial opportunity to honor and acknowledge the rich cultures, histories, and contributions of Indigenous peoples in the United States. It is imperative that we recognize and celebrate this day to begin to heal historical injustices and foster a more inclusive society. Indigenous communities have endured centuries of marginalization, land dispossession, and unequal access to resources, including healthcare. By observing Indigenous Peoples' Day, we emphasize the importance of rectifying these disparities and promoting equitable healthcare access for Indigenous peoples. It's a chance to highlight the unique healthcare challenges faced by Indigenous communities, such as inadequate infrastructure, cultural insensitivity, and the persistence of health disparities, and to advocate for policies and practices that address these issues.

Thank you for your unwavering commitment to excellence in nursing leadership and your dedication to advancing diversity, equity, and inclusion in healthcare. Together, we can make a lasting impact that will benefit not only our profession but the communities we are privileged to serve.

In solidarity and with the utmost enthusiasm,

The DEI Committee Members:

Anitra Williams

Christina M. Oldini

Kimberly Long

Karen Mitchell-Keels

Make'da Traynum

Marshall Blue

Nicole Barnett

Sharon Goldfarb

Sheree Criner

Yury Nevarez

In 2020, the DAISY Foundation partnered with HealthImpact to create an award to honor nurses whose work advances compassionate care in policy. Registered Nurses at DAISY partner facilities with any degree who have demonstrated work in policy, whether it is in their job description or done externally to the institution, are eligible to be nominated for this recognition. Policies that affect local, regional, national, or global populations through legislation, checklists, guidelines, regulations, standards of practice, etc. will be considered. Honorees will be chosen by a panel of reviewers whose expertise is relevant to advancing compassionate care in policy.

Application now open! Click here to complete the form. The deadline for nominations is December 3rd, and recipients will be notified in early February 2024.

Another election cycle has passed, and the American people have chosen their representatives. I hope everyone who reads this participated in voting and took time to review the candidates' policies on health care, access to health care, safe nurse staffing, and the myriad of other issues that nurses need to provide guidance on to our elected officials. According to the American Association of Colleges of Nursing (2022), nursing is the nation's largest healthcare profession, with nearly 4.2 million registered nurses nationwide. A large majority (84%) of licensed nurses are employed in nursing. After all, it would be extremely difficult for any type of health care to function without nursing guidance, input, services, and research. The wide variety of roles of nurses encompass acute and chronic care, inpatient and outpatient, insurance and health maintenance organizations, public and community health, home health, long-term care, school nursing, the US armed forces, nursing education, and nursing research. We need to ensure that policy on all these areas receive guidance and input from nursing. Nurses need to be involved in health policy!

Read on here.

Nursing is not just a profession; it's a vital cornerstone of the healthcare system, and the work of nurses impacts the lives of countless individuals. In the ever-evolving landscape of healthcare, it is crucial for nurses to stay informed about legislative changes that may shape the way they practice and the care they provide to their patients. California has proposed a series of Assembly and Senate Bills that could significantly influence nursing practices and healthcare access across the state. In this article, we will delve into these proposed legislation, summarizing their key provisions and discussing how they may affect the nursing profession and patient care. Whether you're a seasoned nurse or a nursing student, understanding these legislative developments is essential for ensuring the highest standards of patient care and advocating for the needs of both nurses and those they serve.

Assembly Bills

AB 4 (Arambula) - Covered California: Expansion

This bill aims to expand healthcare coverage by allowing individuals with immigration status issues to enroll in health insurance coverage through Covered California. The goal is to make their enrollment process as similar as possible to other Californians, considering existing federal laws and rules. It also mandates outreach and marketing efforts for this purpose.

AB 315 (Bauer-Kahan) - False Advertising: Abortion

AB 315 seeks to prevent false or misleading advertising related to pregnancy-related services, particularly abortion. It aims to ensure that individuals receive accurate information about the provision (or lack thereof) of abortion services by businesses operating in California.

AB 571 (Petrie-Norris) - Medical Malpractice Insurance

This bill prevents insurers from refusing to issue or renew health care providers' professional liability insurance or imposing surcharges based solely on factors like offering abortion, contraception, gender-affirming healthcare, or other services that may be lawful in California but not in other states.

AB 576 (Weber) - Medi-Cal: Reimbursement for Abortion

AB 576 focuses on Medi-Cal coverage policies for medication abortion. It requires a review and updates to align with evidence-based clinical guidelines, allowing flexibility for providers to exercise clinical judgment when performing these services.

AB 608 (Schiavo) - Medi-Cal: Comprehensive Perinatal Services

This bill expands comprehensive perinatal services under Medi-Cal during the one-year post-pregnancy eligibility period. It ensures additional assessments, care plans, visits, and services, proportional to those available during pregnancy and the initial post-pregnancy period in 2021.

AB 765 (Wood) - Physicians and Surgeons

AB 765 enforces the California Patient Protection, Safety, Disclosure, and Transparency Act. It criminalizes the use of medical specialty titles without a valid physician and surgeon certificate.

AB 904 (Calderon) - Health Care Coverage: Doulas

This bill requires health care service plans and health insurers to develop maternal and infant health equity programs that address racial disparities through the use of doulas. It aims to improve maternal and infant health outcomes.

AB 1028 (McKinnor) - Reporting of Crimes: Mandated Reporters

AB 1028 changes reporting requirements for healthcare practitioners, removing the obligation to report physical injury caused by assaultive or abusive conduct, except when inflicted by firearms or in cases of child or elder abuse.

AB 1063 (Gabriel) - Nurse-to-Patient Staffing Ratios: Annual Report

AB 1063 mandates the State Department of Public Health to conduct an annual review of nurse-to-patient staffing ratios regulations. It includes data on complaints, investigations, and a plan to implement suggestions from direct care nurses and stakeholders.

AB 1359 (Schiavo) - Paid Sick Days: Health Care Employees

This bill establishes procedures for accruing and using sick leave for healthcare workers in covered facilities, ensuring they have adequate paid sick days. It also enables legal actions against employers violating these provisions.

AB 1577 (Low) - General Acute Care Hospitals: Clinical Placements

AB 1577 encourages collaboration between general acute care hospitals and nursing programs to address clinical placement needs. It establishes a process for hospitals to create additional clinical placement slots if needed.

AB 1695 (Gipson) - Career Technical Education: Nursing Pathway Pilot Program

AB 1695 allocates funding for the development of career pathways toward an associate degree in nursing at California's community colleges. This program aims to enhance opportunities for students pursuing nursing careers.

Senate Bills

SB 487 (Atkins) - Abortion: Provider Protections

SB 487 offers protection to healthcare providers by preventing termination or nonrenewal of contracts based on actions taken in other states that interfere with patients' rights to receive lawful care.

SB 541 (Menjivar) - Sexual Health: Contraceptives: Immunization

This bill requires public schools to provide free condoms to high school students and prohibits retail establishments from refusing nonprescription contraception based on age. It also expands coverage for HPV immunization for those aged 12-18 at Family PACT provider sites.

SB 625 (Nguyen) - Newborn Screening: Genetic Diseases

SB 625 establishes consent and privacy protections for newborn screening programs. It allows parents or guardians to request the destruction of newborn blood samples and restricts their use for law enforcement purposes.

SB 667 (Dodd) - Healing Arts: Pregnancy and Childbirth

SB 667 expands the scope of services authorized for certified nurse-midwives, including intrapartum care and the provision of controlled substances. It also allows nurse-midwives to admit and discharge patients independently within their scope of practice.

These bills cover a wide range of healthcare topics and may impact nursing practice, patient care, and healthcare access in California. Nurses should stay informed about these legislative developments and their potential implications for their roles and responsibilities. Advocacy and engagement in the legislative process can help shape healthcare policy to better serve the needs of both nurses and patients.

Rep. Lauren Underwood, MSN/MPH, RN, one of three nurses now serving in the U.S. House of Representatives, spoke on February 16, 2021, with nursing students, educators, and nursing professionals via Zoom about how they can advocate for a better health care system for all.

Her advice: You don’t have to get elected to Congress, and you don’t need another master's degree. But you must take action now, and you can start by acting locally.

Read more here or click below.

From enduring the consequences of forced displacement and cultural disruption to grappling with inadequate resources and discriminatory policies, Native American communities have faced multifaceted challenges that have deeply impacted their ability to receive equitable and effective healthcare. Join us in this enlightening episode as we engage with Dr. Emily Haozous, a distinguished Research Scientist at the Pacific Institute for Research and Evaluation. Through the lens of her research, Haozous delves into the historical and systemic conditions that have limited healthcare access for these communities, uncovering deeply rooted challenges and disparities. Her pioneering contributions shed light on these critical issues, striving to bridge gaps in understanding and advocating for impactful change within these healthcare systems.

Listen here or by clicking below.

Health disparities among Indigenous communities in the United States have persisted for centuries, with Indigenous people experiencing higher rates of chronic diseases, lower life expectancy, and limited access to healthcare compared to the general population. These inequities are not accidental but are deeply rooted in a complex web of historical, political, and social factors. The social determinants of health in Indigenous communities are an function of policy realities and lead to diminished health outcomes.

To understand the present-day health disparities among Indigenous communities, it is essential to examine the historical context. The colonization of America by European settlers led to the displacement, dispossession, and marginalization of Indigenous peoples. The forced removal of Native Americans from their ancestral lands, the imposition of reservations, and the introduction of diseases resulted in a significant loss of life, culture, and traditional practices.

One of the most significant factors influencing the social determinants of health among Indigenous communities is the historical and ongoing land dispossession. Indigenous lands were seized, and tribes were confined to reservations, often in remote, resource-poor areas. This land loss disrupted traditional ways of life, making it difficult for Indigenous communities to access economic opportunities. High poverty rates and limited access to quality education and employment opportunities persist in many Indigenous communities today, contributing to health disparities.

The federal government is responsible for providing healthcare to Indigenous communities through the Indian Health Service (IHS). However, the IHS has been chronically underfunded for decades, leading to inadequate healthcare facilities, staff shortages, and limited access to essential services. As a result, Indigenous people face higher rates of preventable diseases and reduced life expectancy compared to the general population.

The underfunding of healthcare for Indigenous communities has its roots in the historical neglect of Native American health. During the colonial era and westward expansion, healthcare for Indigenous populations was often an afterthought, if it was considered at all. This legacy of underinvestment has continued to shape the inadequate healthcare infrastructure present today.

The IHS is a federal agency responsible for providing healthcare services to over 2.5 million American Indians and Alaska Natives. However, its budget allocations have consistently fallen short of what is needed to provide quality healthcare. The IHS budget is determined by the federal government and is often subject to cuts or freezes, making it difficult for the agency to keep pace with rising healthcare costs and the growing Indigenous population.

Underfunding has led to severe infrastructure and staffing shortages in IHS facilities. Many healthcare facilities on reservations are outdated, overcrowded, and in need of significant repairs and upgrades. Additionally, there is a shortage of healthcare professionals, including doctors, nurses, and mental health specialists, in these areas. This scarcity of resources hampers the delivery of timely and comprehensive care.

Indigenous communities often lack access to specialized medical services, forcing patients to travel long distances to receive necessary treatments. This can result in delayed care and poor health outcomes, especially for those with chronic or serious medical conditions. Transportation barriers and the costs associated with seeking specialized care compound this problem.

The underfunding of healthcare exacerbates health disparities among Indigenous populations. Preventable diseases, such as diabetes, cardiovascular disease, and respiratory illnesses are more prevalent in these communities. Limited access to healthcare and preventive services means that conditions often go undiagnosed or untreated until they reach advanced stages, resulting in higher mortality rates.

Mental health and substance abuse services are also often under-resourced. Historical trauma, cultural disruption, and socioeconomic challenges contribute to higher rates of mental health issues and substance abuse within Indigenous communities. The lack of adequate mental health services further compounds these issues, creating a cycle of poor mental health outcomes.

Efforts to address the underfunding of healthcare in Indigenous communities have included advocacy for increased federal funding, the expansion of health insurance coverage, and initiatives to recruit and retain healthcare professionals in underserved areas. However, these efforts have often fallen short of fully addressing the magnitude of the problem.

Cultural disruption is another significant determinant of health for Indigenous communities. The suppression of Indigenous languages, traditions, and practices through policies like the Indian boarding school system has had lasting effects on mental health and community cohesion. The trauma inflicted by the boarding school system, along with other policies of cultural assimilation, has resulted in intergenerational trauma that affects mental health. Rates of depression, anxiety, and post-traumatic stress disorder are elevated among Indigenous populations. Historical trauma is linked to higher rates of suicide, substance abuse, and domestic violence.

Environmental degradation and pollution disproportionately affect Indigenous communities. Historically, Indigenous lands have been exploited for resource extraction, leading to contamination and destruction of natural resources. This not only impacts physical health but also disrupts traditional subsistence practices and cultural connections to the land.

The political disempowerment of Indigenous communities has hindered their ability to advocate for their own needs and rights. The relationship between Indigenous nations and the federal government is defined by a complex web of treaties, statutes, and court decisions. While tribal sovereignty is recognized, it is often subject to federal oversight and control. This duality has created a situation where tribes must navigate intricate legal frameworks and bureaucratic processes to exercise self-governance and access resources.

The federal government plays a central role in resource allocation to Indigenous communities. Decisions about funding for healthcare, education, infrastructure, and economic development are often made at the federal level, with limited input from Indigenous leaders. This lack of control over resource allocation can lead to disparities in access to critical services and opportunities. Jurisdictional issues are a persistent challenge for Indigenous communities. The division of authority between tribal, state, and federal governments can create confusion and conflicts over issues like law enforcement, child welfare, and environmental regulation. These complexities can hinder the ability of Indigenous nations to make decisions that best serve their communities.

Indigenous communities are underrepresented in mainstream American politics. Despite making up a significant portion of the population in certain states and regions, there are relatively few Indigenous individuals in elected positions at the federal, state, and local levels. This underrepresentation limits the ability of Indigenous communities to advocate for their own interests and concerns. Many important decisions affecting Indigenous communities are made by federal agencies and non-Indigenous officials who may not fully understand the unique needs and cultural contexts of these communities. This lack of autonomy can lead to policies that do not align with the priorities and aspirations of Indigenous nations.

Control over land and resources is a critical determinant of economic well-being. Historical land dispossession and limited control over resource management have hindered economic development opportunities for Indigenous communities. This, in turn, affects access to jobs, income, and overall economic security.

The social determinants of health in Indigenous communities in the United States are deeply intertwined with a history of colonization, dispossession, and systemic discrimination. While there have been efforts to address these disparities through policy reforms and community-led initiatives, substantial challenges remain. Achieving health equity for Indigenous communities will require ongoing commitment to addressing historical injustices, increasing funding for healthcare and education, and empowering Indigenous communities to shape their own futures. Only through such comprehensive efforts can we hope to bridge the health gap that has persisted for far too long.

Email: info@acnl.org
Website: https://www.acnl.org/
Location: 180 Promenade Circle suite 300, Sacramento, CA 95834, USA
Phone: 916-779-6949