Why Every Nurse Should Care About Policy, From a CRNA Who Helped Change State Law

When Angela DiDonato, DNP, CRNA, FAANA, was president of the Pennsylvania Association of Nurse Anesthetists, she kept hearing the same question from state legislators: “Don’t you need a doctor to tell you what to do?”

She was in Harrisburg fighting for legislation, and lawmakers did not understand what a nurse anesthetist actually does. That frustration sparked an idea. On the latest episode of the Love n’ Leary Nursing Podcast, DiDonato tells hosts Marion Leary, PhD, MPH, RN, and Rebecca Love, RN, MSN, FIEL, how it grew into the Amplify Nursing Podcast, which she co-created with Leary at Penn Nursing to showcase what nurses really do. It also fueled a legislative win years in the making.

>>Listen to The Importance of Teaching Policy in Nursing (with Angela DiDonato, DNP, CRNA, FAANA)

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Pennsylvania was one of only two states that did not formally recognize certified registered nurse anesthetists. CRNAs were licensed only as RNs, which meant the state could not even say how many anesthesia providers it had. Pennsylvania CRNAs who wanted to practice in a neighboring state like New Jersey could wait six to nine months just to prove they were advanced practice nurses.

That changed when Governor Tom Wolf signed Senate Bill 416, now Act 60 of 2021, granting formal title recognition to the state’s CRNAs after more than a decade of advocacy. Implementation has taken time, and DiDonato says the profession is still working out the kinks, but the designation is now moving into full effect.

“Before I started engaging in teaching policy, I didn’t really think of myself as an expert. But I was doing it.”

Her takeaway for nurses: she did not think of herself as a policy expert when she started. She was simply showing up, meeting with legislators, and telling nursing’s story. “You can’t figure out where you need to go if you don’t know where you’re starting,” she says.

DiDonato now teaches policy at Penn, and she starts her students in an uncomfortable place: healthcare in the United States is an industry, and the bottom line is the bottom line. She is not casting judgment. She argues that nurses who understand this can speak the language that gets things done.

“It’s only patient-centered as long as there’s reimbursement. We didn’t even track infections until insurance companies stopped paying for them.”

She learned it firsthand. After a preventable event in the operating room, she pushed her hospital to adopt pre-case team huddles. What won leadership over was not the patient safety argument alone. It was showing finance how three to four minutes of huddling early in the day could prevent expensive OR delays later.

She is also blunt about burnout. “Compassion is a limitless quality,” she says. What exhausts nurses is not caring for patients. It is watching a system fail to fix the problems that keep bringing patients back, plus the endless documentation clicks and added tasks that make nurses “the catch-all for everything.”

Your Voice Matters, and the Clock Is Ticking on One Big Issue

The conversation lands on a live policy fight. The American Medical Association is developing CPT billing codes for clinical work performed by AI, while bedside nursing care still has no direct billing mechanism of its own. Nurses can weigh in right now: the public comment period on the CMS proposed 2027 physician payment rule is open at regulations.gov through September 14.

Love points to a recent lesson in why comments matter. When the Department of Education excluded nursing from its “professional degree” definition for federal loan caps, tens of thousands of nurses submitted public comments. The rule was finalized anyway, but those comments are now part of the public record supporting ongoing legal and legislative challenges, including lawsuits filed by 25 states and a coalition of national nursing organizations.

“You need to get out there and start to look at the issues and pick one. You don’t have to get involved in 50 issues.”

DiDonato’s advice for nurses who feel like policy is above their reach: pick one issue. Start local, even with shared governance on your own unit. And remember that policy will find you either way. “Whether or not you want to get involved because you’re a nurse, neither here nor there,” she says. “You should get involved because you’re a constituent.”

Listen to the full conversation with Angela DiDonato on the Love n’ Leary Nursing Podcast, or wherever you listen to podcasts.

🤔 What is one policy issue, on your unit or beyond, that you wish more nurses were speaking up about? Tell us in the comments.