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ANA ACTION ALERT: Proposed regulations could mean big opportunity for nurses


Hospitals operate under a type of rule book: one that dictates who can do what, when, and where in patient care. They have to play by these rules, or else they don’t get paid—or worse—are forced to close.

Conditions of participation (COPs) make up this rule book for hospitals. COPs, the federal regulations implemented by the Centers for Medicare and Medicaid Services (CMS), set the ground rules for hospital operations, and hospitals must meet them in order to be eligible for Medicare reimbursement. Hospitals are typically eager to meet COPs, since reimbursement by Medicare is a significant portion of revenue.

COPs have been in place since Medicare began four decades ago, and the government updates them periodically. Some argue, however, that COPs have not been updated frequently enough to keep pace with health care’s rapidly changing landscape, and the increased competency of RNs to carry out certain tasks. As a result, in some cases the COPs limit or even prohibit what nurses can do.

On Oct. 24, CMS released proposed major modifications to COPs, as part of an overall federal regulatory burden reduction, as ordered by President Obama in January 2011. This major modification represents an update that will close the divide between COPs and changes in nursing practice. Ultimately, it will open the door for hospital nurses to have more autonomy in their practice, and to seamlessly deliver patient care within their scope and abilities.

The American Nurses Association (ANA) sees this proposed modification as a big opportunity for nurses. At both the RN and advanced practice registered nurse (APRN) levels, these changes will enhance nurses’ ability to practice to the full extent of their education and training. RNs will be able to do more with fewer constraints, such as administer certain drugs or immunizations using blanket “standing orders” that allow patients or family members to administer their own medications, and will also have better guidance on the use of restraints and seclusion. APRNs, such as nurse practitioners and certified nurse-midwives, will be able to admit, follow, and discharge their patients throughout a hospital stay. In many cases, nurses were unable to do these things because the hospital COPs did not allow it.

ANA is taking action and is providing feedback to CMS on these crucial regulatory changes. But where ANA is enthusiastic and supportive about some of the changes, particularly those that will remove scope of practice barriers for APRNs, other organizations might not be.

This is why it is very important that all nurses take this opportunity to comment on and support CMS’ proposed changes, so that CMS hears the voices of practicing nurses on this issue. This “on-the-ground” perspective is vital to ensuring that CMS’ proposals are accurate, and helps defend their proposals from opposition.

COPs also have significance in that accrediting organizations, such as The Joint Commission, take COPs and turn them into operational standards for hospitals and other facilities. This represented another layer of interpretation of COPs, and in some cases, the inhibition of nursing practice was caused by the accrediting organization. For example, when developing standards, The Joint Commission uses COPs as a guide, and in some cases, if a COP did not explicitly allow a type or practice, such as allowing patients to administer their own medications, The Joint Commission would likewise hesitate to allow hospitals to do so. CMS’ proposed modifications will give these organizations, such as The Joint Commission, much more leeway to allow hospitals to enhance practices and optimize nursing expertise.

More information on ANA’s comments to CMS is available at Read the regulations and comment on the proposed changes today. This action will be critical to the nursing profession, to CMS, and to patients.

Katie Brewer is a senior policy analyst at ANA.


  • The best way to help get healthcare cost down and still provide a high standard is to use APRN’s, RN’s, and all nurses to their full potential w/o so many restrictions and barriers.

  • Martha H. Myers RN BSN CNOR
    December 19, 2011 8:07 am

    These modifications are an exciting development and nurses must be at the table when the final decisions are made concerning the modifications of COP’s. Nurses are in a unique position to bridge gaps in primary care and provide quality affordable care and this can be accomplished by allowing nurses to practice to the full extent of their education.

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