Nurses are the backbone of Tennessee’s healthcare system. With more than 100,000 registered nurses (RNs) practicing across the state, their voices carry tremendous weight — not just in hospital corridors, but in the halls of the Tennessee General Assembly. The Tennessee Nurses Association (TNA), founded in 1905, is the professional organization that amplifies those voices, translating bedside experience into legislative action and health policy reform.
Each legislative session, TNA publishes its Legislative & Health Policy Statement, a document that outlines the Association’s priorities, the bills it monitors, and the positions it advocates before state lawmakers. Understanding what TNA is fighting for illuminates some of the most urgent challenges facing nursing and patient care in Tennessee today.
Who Is the Tennessee Nurses Association?
The Tennessee Nurses Association is a professional membership organization representing registered nurses across all specialties, settings, and career stages in Tennessee. It is a constituent member organization of the American Nurses Association (ANA), connecting Tennessee’s nurses to a national network of over 4.4 million RNs.
TNA’s founding in 1905 was itself an act of advocacy. The organization was formed specifically to secure a state law regulating nursing practice. After two failed legislative attempts in 1907 and 1909, TNA members succeeded on February 14, 1911, when Tennessee’s first Nurse Practice Act became law — a milestone that set the stage for more than a century of policy engagement.
Today, TNA operates with a clear dual mandate:
- Mission: Empower the registered nurse, advocate for the practice of nursing, model nurse advocacy and political involvement, and champion quality health care equity for all Tennesseans.
- Vision: TNA will be the unifying voice for nursing in Tennessee to positively influence the future of health care.
These principles are not aspirational slogans. They are the lens through which TNA evaluates every piece of legislation, every regulatory change, and every budget line that touches nursing or patient care in the state.
The Government Affairs (GOVA) Committee: TNA’s Legislative Engine
The primary vehicle for TNA’s policy work is its Government Affairs (GOVA) Committee. This standing committee serves as the association’s watchdog and advocate at the Tennessee State Capitol, working alongside TNA’s professional lobbyist to identify, analyze, and respond to legislation affecting nurses and healthcare.
The GOVA Committee’s responsibilities include:
- Monitoring all bills introduced in the Tennessee General Assembly that affect nursing practice, nursing education, or healthcare delivery
- Developing TNA’s formal positions on proposed legislation
- Coordinating nurse-to-legislator outreach and relationship building
- Educating legislators on the scope and expertise of registered nurses at the RN and APRN levels
- Supporting the TN Nurses PAC in identifying nurse-friendly candidates for state office
As TNA’s advocacy materials note, “Too many decisions are made at the State Capitol regarding your profession and the practice of nursing for you not to be involved. Politics and policy affect health care and every area of nursing, whether it’s education, practice, or research.”
The GOVA Committee’s effectiveness depends on robust relationships with legislators. TNA strongly encourages nurses to build these relationships before a specific vote is needed — the kind of social capital that means a legislator will pick up the phone when a nurse calls, and equally, will call nurses when facing health policy questions.
TNA’s 2024–2025 Legislative & Health Policy Statement: Core Priorities
TNA’s biennial Legislative & Health Policy Statement identifies the issues the Association is actively pursuing, monitoring, or opposing during the current legislative cycle. While the full document is available to TNA members and advocates through the Advocacy Programs & Toolbox section of the TNA website, key themes emerge consistently across all of TNA’s public communications, newsletters, and government affairs updates.
The following table summarizes the major areas of TNA’s legislative agenda and the Association’s general stance:
| Policy Area | TNA’s Position | Status in Tennessee |
|---|---|---|
| APRN Full Practice Authority | Supports removal of physician supervision requirement | Restricted (no progress since 2007) |
| Mandatory Overtime for Nurses | Supports restrictions on mandatory overtime | No current state-level restriction |
| Nursing Workforce Development | Supports funding for education, scholarships, and preceptor incentives | Ongoing — nursing shortage worsening |
| Nurse Practice Act Updates | Supports current, evidence-based standards for RN/LPN/APRN | Board of Nursing rules updated Oct. 2024 |
| Workplace Violence Prevention | Supports legislation to protect healthcare workers from assault | Active training programs; legislation monitored |
| Health Equity | Champions equitable access to quality care for all Tennesseans | Ongoing disparities in rural and underserved areas |
| Nursing Education Pipeline | Supports expanded access to clinical placements and curriculum flexibility | 2024 legislation changed BON curriculum standards |
| Telehealth and Rural Access | Supports expanded telehealth, particularly for rural communities | State and federal programs in progress |
APRN Full Practice Authority: Tennessee’s Most Persistent Battle
No issue better illustrates TNA’s long-term legislative commitment than the fight for Advanced Practice Registered Nurse (APRN) full practice authority (FPA). This is among the most consequential nursing policy debates in the country — and Tennessee finds itself at the losing end of the national trend.
As of 2025, 34 states and the District of Columbia have granted nurse practitioners full practice authority, meaning APRNs can evaluate patients, diagnose conditions, order and interpret diagnostic tests, and prescribe medications — including controlled substances — without physician supervision or collaboration agreements. Tennessee is not one of those states.
Tennessee currently operates under a restricted practice authority model. Key requirements imposed on APRNs in Tennessee include:
- A formal, career-long supervisory or collaborative agreement with a physician
- The supervising physician must visit the APRN’s practice site every 30 days
- The physician must review at least 20% of the APRN’s patient charts
- A written protocol must be maintained and updated every two years
- APRNs who prescribe Schedule II–V controlled substances must obtain a separate Certificate of Fitness (CF) from the Tennessee Board of Nursing
Research published in Nursing Outlook (2024) confirmed that since the Center to Champion Nursing in America began tracking state-level progress in 2007, Tennessee is among only seven states that have made no progress toward full practice authority. Multiple legislative attempts to modernize Tennessee’s APRN practice authority provisions have failed.
Why does this matter? Tennessee has significant rural and medically underserved communities. APRNs — particularly nurse practitioners and certified nurse-midwives — are disproportionately likely to practice in these areas. Physician-supervision requirements create administrative burdens that effectively limit APRN deployment in places where they are most needed. Removing these barriers is a key TNA objective because it would directly increase patient access to high-quality, timely care across the state.
Tennessee’s Nursing Workforce Crisis
Even as TNA fights to expand what nurses can do, Tennessee is simultaneously grappling with how many nurses it will have. The state faces a compounding nursing workforce crisis that TNA’s policy agenda directly addresses.
Data from the Tennessee Trendlines labor market report and the National Nursing Workforce Study highlight the scope of the challenge:
- In 2024, 40% of registered nurses in the United States reported they were thinking about leaving their nursing careers within two years — a figure that mirrors trends in Tennessee specifically.
- 41% of Licensed Practical Nurses (LPNs) reported similar intentions to leave.
- The number of active LPN licensees in Tennessee has significantly decreased since 2018, even as RN numbers have modestly grown.
- The median age of LPNs nationally rose to 50 in 2024, suggesting an aging workforce without sufficient replacement.
- Tennessee’s 2025 Academic Demand for Occupational Supply report showed LPN demand in all nine local workforce development areas in the state, with 901 job openings and only 28 candidates listed on the state jobs portal.
TNA advocates for legislative and budget solutions to these workforce gaps, including:
- Increased state funding for nursing education programs at community colleges and universities
- Scholarships and loan forgiveness programs to recruit and retain nurses in underserved areas
- Support for nurse preceptor incentive programs — such as the Tennessee Hospital Association’s Nurse Preceptor Incentive Program, which pays eligible RN and LPN preceptors monetary awards for clinical education hours
- Nursing apprenticeship programs that create new pathways into the profession
- Rural health outreach initiatives, including partnerships like the UT Health Science Center’s Challenge Grant focusing on nursing in rural Tennessee
Safe Staffing and Restricting Mandatory Overtime
Alongside workforce supply, TNA advocates strongly for the quality of working conditions that keep nurses in the profession. Mandatory overtime is one of the most cited drivers of nurse burnout, patient safety errors, and attrition.
At the national level, TNA joined the American Nurses Association in supporting federal legislation to restrict mandatory overtime for nurses. The ANA’s 2024 Hill Day — which brought a record 481 RNs and nursing students to Capitol Hill — listed Restricting Mandatory Overtime for Nurses (H.R.) as one of its priority bills.
Tennessee does not currently have a state law specifically restricting mandatory nurse overtime, placing it behind states like Connecticut, which in 2023 enacted comprehensive nurse staffing committee requirements and overtime limitations for hospital nurses. TNA monitors similar proposals in Tennessee and supports legislation that would:
- Prohibit hospitals from requiring RNs to work beyond their scheduled shifts except in declared emergencies
- Establish minimum nurse-to-patient ratio frameworks for consideration in staffing plans
- Create formal nurse staffing committees that include direct-care RNs in staffing decisions
- Protect nurses who decline unsafe assignments from retaliation
Workplace Violence and Nurse Safety
Healthcare workers in Tennessee — as across the nation — face increasing risks of workplace violence, and nurses bear a disproportionate burden. TNA has prioritized nurse safety through both education and legislative advocacy.
TNA has partnered with the Tennessee Hospital Association to support the Managing Aggressive Patient Situations (MAPS) program, a clinical training initiative designed by clinical and mental health experts that integrates verbal de-escalation strategies, communication skills, and simulation experiences for healthcare providers. The program specifically addresses:
- The current state of healthcare violence in the U.S.
- Cultural awareness and its role in the clinician-patient relationship
- Self-awareness and self-reflection techniques for managing aggressive patients
Beyond training, TNA’s government affairs work supports legislative frameworks that treat assault of healthcare workers as a serious offense, provide anti-retaliation protections for nurses who report violent incidents, and require healthcare facilities to implement evidence-based violence prevention programs.
Health Equity: Championing All Tennesseans
Health equity is explicitly woven into TNA’s mission statement — “champion quality health care equity for all Tennesseans” — and it permeates the Association’s policy agenda across multiple issue areas.
Tennessee has notable health disparities, particularly in rural counties, communities of color, and lower-income populations. The state’s decision not to fully expand Medicaid under the Affordable Care Act has left a significant coverage gap, and rural hospital closures and maternity care deserts continue to limit access in many parts of the state.
TNA’s health equity advocacy encompasses:
- Access to primary and preventive care: Supporting APRN practice expansion as a direct strategy for improving access in underserved areas
- Maternal and reproductive health: Engaging with Tennessee’s Maternal Health Strategic Plan (2025–2030), which addresses the closure of rural birthing hospitals and gaps in maternal health services
- Behavioral health and substance use: Supporting rural opioid response programs and mental health services, including federally funded initiatives in East Tennessee and across the state
- Health disparities data: Partnering with the Tennessee Action Coalition on workforce data collection to ensure policy decisions are grounded in evidence about where care gaps exist and who is most affected
Nursing Education: Building the Pipeline
A sustainable nursing workforce begins in the classroom and clinical training environment. TNA closely monitors legislation affecting nursing schools, the Tennessee Board of Nursing (BON), and clinical education requirements.
Significant legislative activity occurred during the 113th General Assembly (2023–2024). Key changes affecting nursing education included:
- The BON was directed to update minimum curricula standards for nursing programs, addressing program course access and enrollment flexibility
- LPN (practical nursing) program students were granted the ability to sit for the NCLEX licensure exam upon program completion, as long as the exam’s minimum age requirements are met — a change TNA supported to reduce unnecessary delays in workforce entry
- Updated BON rules took effect on October 8, 2024, covering definitions, licensing procedures, LPN IV push medication authority, RN scope of practice, APRN licensure standards, and interstate compact provisions
TNA also advocates for addressing bottlenecks in the clinical education pipeline — particularly the shortage of qualified nurse preceptors. Without preceptors, nursing students cannot complete required clinical hours, limiting program capacity even when classroom seats exist.
The TN Nurses PAC: Turning Policy into Politics
Legislative advocacy requires not just lobbying bills, but building relationships with the people who vote on them. The Tennessee Nurses Political Action Committee (TN Nurses PAC) is TNA’s mechanism for doing exactly that.
The TN Nurses PAC is a voluntary, bipartisan, unincorporated political action
committee — not affiliated with any national political party or committee. It supports members of the Tennessee Legislature who have demonstrated commitment to the initiatives of the GOVA Committee and TNA, or who hold strategic positions on key committees affecting healthcare policy.
The PAC’s activities include:
- Evaluating candidates based on their healthcare platform and track record, in consultation with TNA’s lobbyist and the GOVA Committee
- Making financial contributions to nurse-friendly candidates for state office
- Funding the TNA lobbyist’s attendance at legislative fundraising events, where personal relationships with lawmakers are built and maintained
- Identifying and supporting nurse candidates who run for elected state office
As TNA explains, “These contributions provide visibility for nurses in Tennessee and ensure we have a seat at the table with legislators working on healthcare issues. For nurses, a seat at the table is better than just being on the menu.”
In 2024, the PAC made contributions to candidates identified as TNA and nurse-friendly, positioning TNA for influence in the 114th General Assembly that began in 2025.
How Nurses Can Get Involved
TNA’s legislative effectiveness depends on the active participation of Tennessee’s nursing workforce. The Association offers multiple entry points for nurses who want to move from the bedside to the policy arena:
- Join TNA/ANA membership: Gain access to legislative updates, advocacy tools, continuing education, and the collective voice of over 4.4 million nurses nationally
- Access the Advocacy Programs & Toolbox: The TNA website provides resources including the current Legislative & Health Policy Statement, tips for meeting with legislators, and guidance on building relationships with elected officials
- Contribute to the TN Nurses PAC: Voluntary donations support the Association’s ability to make its voice heard in elections and in the legislative process
- Attend TNA Day at the Capitol: Annual legislative days bring nurses face-to-face with their state representatives and senators
- Participate in ANA Hill Day: TNA members can join the national event in Washington, D.C. — the 2024 Hill Day drew a record 481 nurses to meet with members of Congress
- Engage locally: TNA districts across the state provide community-level engagement opportunities, and nurses are encouraged to build relationships with their local legislators year-round, not just during legislative sessions
Conclusion: Nursing’s Voice in Tennessee Policy
The Tennessee Nurses Association’s Legislative & Health Policy Statement is more than a list of bills and positions. It is a declaration of what nursing stands for: professional autonomy, patient safety, equitable access to care, and a workforce that is sustainable, safe, and valued.
From the fight for APRN full practice authority — a battle Tennessee has yet to win despite national momentum — to nursing workforce development, safe staffing protections, workplace violence prevention, and health equity initiatives, TNA’s policy agenda addresses the full spectrum of challenges facing nurses and the communities they serve.
With over 100,000 RNs in Tennessee and a professional association with more than a century of advocacy experience, the potential for nursing to shape healthcare policy in this state is enormous. The question TNA continually poses to its members is the same one that has animated the organization since 1905: Will you take a seat at the table?