Emergency Nurses Association
Public Policy Agenda: 2024/2025

I. Healthy and Safe Emergency Care Working Environment

Reduce Violence Against Emergency Nurses

Violence in emergency departments has reached epidemic levels and emergency nurses are particularly vulnerable. The 24-hour accessibility of the emergency department; the lack of adequately trained, armed or visible security guards; and an overall stressful environment are among the chief reasons why emergency nurses are victims of violence at such a high rate.

The Emergency Nurses Association (ENA) will continue to advocate for state laws that strengthen the criminal penalties for assaulting or battering emergency nurses and other health care workers in emergency departments.

ENA will also support legislation and regulations to prevent workplace violence and ensure the safety of patients and workers in health care facilities. These efforts should include the enhanced training of workers in identifying and addressing risk factors that make emergency departments vulnerable to violence, as well as policies that encourage the reporting of violent incidents and prevent employer retaliation against nurses who are the victims of workplace violence.

Protection Against Infectious Diseases

Nurses work in environments with high-risk for infectious disease. Without the right equipment, these professionals are left exposed to pathogens, and risk contracting illness and spreading it to their patients and others.

ENA will support policies to ensure that emergency nurses are protected in their workplace against all manner of infectious disease. This includes advocating for workplace protections and robust improvements to the supply chain and Strategic National Stockpile to ensure adequate supplies of critical gear such as personal protective equipment.

Enhance Well-Being of Frontline Health Care Workers

Burnout, anxiety and depression are unfortunate characteristics of today’s health care workforce. Insecure working conditions, risk of infectious disease and violence all contribute to higher suicide rates for health care workers.

ENA will support legislation and policies that addresses the ongoing struggles faced by frontline health care workers and work to enhance the availability of mental health and behavioral wellness services, improve training for workers, and build a future where emergency nurses and other health care workers feel more supported and able to seek assistance.

Reduce Workplace Injury

Nurses are at risk of harm from the environment in which they work. Factors influencing this situation include ergonomic injuries, needle stick injuries, increasing patient obesity rates and an aging workforce.

ENA will support federal legislation and programs aimed at reducing workplace injuries and illnesses for health care personnel and patients, while improving the safety of patient care delivery.

Establish Safe Emergency Department Staffing Guidelines

Maintaining the appropriate level of emergency nursing staff is critical to the ability of emergency departments to provide quality health care for patients.

As such, ENA supports policies that empower nurses to participate in the development of appropriate staffing plans specific to each emergency department. This approach recognizes the many factors that determine the appropriate level of staffing, as well as the flexibility needed to account for changing circumstances in emergency departments.

II. Nursing Education and Practice

Increase Funding for Nursing Education and Training

ENA urges Congress to increase its investment to alleviate the growing nursing shortage that is impacting every aspect of the U.S. health care system and negatively affecting patient care.

ENA will support legislation that reauthorizes and funds the Nursing Workforce Development programs under Title VIII of the Public Health Service Act. The Title VIII programs provide the main federal funding for nursing education, practice and retention.

Protect Emergency Nursing Scope of Practice and Support Full Practice Authority for Advanced Practice Registered Nurses

ENA will support public policies that remove restriction on the role and scope of practice of Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) in appropriate health care settings. ENA will support efforts to allow these professionals to practice to the full extent of their education and training.

ENA will support legislation that allows APRNs to practice autonomously and independently prescribe medication and oppose restrictions on the administration of procedural sedation medications by qualified emergency nurses.

Oppose the Criminalization of Medical Errors

ENA will oppose legislation that criminalizes medical and nursing errors except in cases where the health care professional has been found to have been grossly negligent or to have willfully caused harm to the patient.

III. Quality and Timely Access to Emergency Care

Improve Nation’s Pandemic Preparedness Capabilities

ENA will support legislation that acts on lessons learned from the COVID-19 pandemic response and aims to improve the nation’s preparedness for future public health emergencies.

Policies to be supported include conducting a comprehensive review of the COVID-19 response, strengthening the supply chain and national stockpiles of medical countermeasures and supplies, including personal protective equipment, improving federal coordination for future public health emergencies, and enhancing the development of tests, treatments and vaccines.

Support Policies to Ensure Equal Access to Affordable, Comprehensive High-Quality Emergency Care for Every Patient

ENA will support efforts to assist and provide equal access to affordable, comprehensive, high-quality care for every patient who presents in the emergency department.

ENA will further support policies and legislation to provide high-quality care for survivors of human trafficking, domestic violence and sexual assault.

Continue and Expand Federal Research and Support for Pediatric Emergency Care

ENA will strongly support policies that will enhance emergency medical services for children. As such, ENA urges Congress to continue to support the Emergency Medical Services for Children (EMSC) program at the Health Resources and Services Administration. EMSC, which has provided funds to every state, is the only federal program dedicated to improving emergency care for children.

ENA will support legislation that reauthorizes and provides adequate federal funding for the EMSC program.

Support Programs to Enhance Access and Improve Care for Patients with Mental Illness

ENA will support policies aimed at enhancing access and improving care for patients experiencing mental illness. Further, ENA supports policies that provides better care for such patients in the emergency department and provides better inpatient and outpatient treatment options for such patients. 

Support Policies to Reduce Patient Boarding in the Emergency Department

Emergency department boarding has become a crisis due to the increased in the number and acuity of patients presenting in the emergency department. ENA will support legislation that addresses the multi-faceted causes of boarding in the emergency department.

Support Programs to Improve Identification and Treatment for Emergency Department Patients at Risk of Suicide

Suicide rates across the nation rose more than 33 percent between 2000 and 2019. Suicide is the tenth leading cause of death in the U.S., claiming more than 47,000 lives each year. ENA research indicates that taking steps to improve suicide risk assessment in the emergency department could increase the number of patients with suicidal ideation who are identified.

ENA will support policies to improve care for patients at risk of suicide, including efforts to improve screening and assessment, as well as enhance emergency department discharge planning and procedures to encourage this patient population to seek appropriate follow-up care.

Increase Support for Trauma Systems and Trauma Centers

Trauma is the leading cause of death for people under the age of 46 and 35 million people are treated for traumatic injuries every year. Nevertheless, more than 45 million people lack access within one hour to a trauma center able to treat severe traumatic injuries.

ENA will continue to fight for legislation and funding to improve trauma care in the United States. This includes both the development of optimally functioning trauma systems and quick access to state-of-the-art trauma centers.

Maintain Funding for Poison Control Centers

According to the Centers for Disease Control and Prevention, more than 40,000 people die annually from poisoning and approximately 2,000 are treated each day in emergency departments.

ENA will support programs and funding that provide resources for the nation’s 55 poison control centers and the national poison control hotline.

Improve Treatment of Patients Who Abuse Opioids and Other Drugs

The U.S. is experiencing a historic epidemic in opioid use disorder and related overdose death. In 2020, there were a record 91,799 drug overdoses deaths in the U.S., representing a 30 percent increase in just one year.

ENA will support policies and federal funding to combat the ongoing national crisis of opioid addiction and overdose death, including provisions to encourage states and local communities to pursue a full array of proven strategies to combat addiction and support individuals in recovery.

Fund Federal Research to Improve the Delivery of Emergency Care

ENA will continue to strive for improved patient safety and enhanced quality of care by collaborating with appropriate stakeholders to promote and conduct research to enhance emergency care for all patients.

In addition, ENA will support the work of the National Institute of Nursing Research (NINR) at the National Institutes of Health (NIH) and urges adequate federal funding for NINR within the overall NIH budget.

Expand Training and Resources for Stop the Bleed Campaign

ENA will support federal and state efforts to expand the distribution of anti-blood loss supplies and the training and equipping of bystanders to help in a bleeding emergency before professional help arrives.

IV. Injury Prevention

Support Federal and State Initiatives to Enhance Highway and Auto Safety and Other Injury Prevention Measures

ENA will support legislation at the federal and state levels which enhance the safety of drivers and passengers in motor vehicles, including efforts to increase the usage of safety devices in cars and limit the size and weight of trucks. Where appropriate, ENA will advocate on behalf of other injury prevention bills that will result in significant health care benefits to the public.

Support Policies to Promote Firearms Safety and Reduce Firearms Violence

In 2021, the most recent year in which complete data is available, more than 48,000 people died as a result of firearms violence. This includes murders, suicides, and accidental deaths. Emergency nurses witness firsthand the devastation caused by gun violence and this repeated trauma takes an immeasurable toll on their wellbeing and mental health.

ENA will support a ban on assault weapons, as defined by the Bureau of Alcohol, Tobacco and Firearms. ENA will advocate for establishing a federal prohibition on ghost guns and their components.

ENA will support federal funding for firearms-related research at CDC and HHS.

ENA will advocate for the extension of the National Violent Death Reporting System to include all U.S. state and territories.

ENA will support legislation requiring all firearms sales in the United States to include a background check on the purchaser and raising the minimum purchase age to 21 for all firearms.