S. 1031 was introduced by California senator Barbara Boxer (D). According to her campaign website, Boxer has made the following efforts to expanding the health care worforce:

• “Senator Boxer wrote legislation to require that hospitals have enough nurses to ensure proper care.
• She is also the author of a bill to ensure that health care workers are prepared to meet the health care needs of a growing population of older Americans by paying off the student loans of health care workers who agree to serve seniors.
• She cosponsored bills to provide scholarships to health care professionals who agree to serve in rural and other medically underserved areas and who agree to work in public health agencies – and to provide student loan relief to mental health care providers who agree to treat children.
• Senator Boxer has cosponsored legislation to expand community health centers and recruit more health care providers through the National Health Services Corps.
• She has cosponsored legislation to recruit more dental professionals, to strengthen the faculty in nursing schools, and to create more nursing education programs. “ –www.barbaraboxer.com

Several lobbying groups have already voiced support of Boxer’s bill, including National Nurses United (NNU), a group founded by California Nurses Association and Massachusetts Nurses Association. The group is the largest union of RN’s in American history and has affiliates in 12 states and the District of Columbia. NNU marched on Capitol Hill in support of this bill on May 11, 2009, three days prior to its introduction to the senate (http://thehill.com/business-a-lobbying/97077-nurses-lobby-to-expand-ranks).

Information about this group, as well as instructions for joining, can be accessed at http://www.nationalnursesunited.org/.

As the election fast approaches, the first step in supporting this bill is to educate yourself about the candidates up for election in your state and voting for candidates who are likely to support this bill. Visit their websites and websites that show their voting records, such as votesmart.org. Be aware that most sources on the internet are biased.

We all know that a group can accomplish more than an individual. If you are passionate about supporting this bill and other nursing-related legislation, join a nursing organization that participates in lobbying, such as NNU or your states Nursing Association. If you are already a member of an RN organization, bring this bill to the attention of your fellow members. Is the group already doing something to support this bill? How can you encourage the group to support the bill? Take initiative!

Political Influences and Potential Impact of this Legislation

Democratic U.S. Senator, Barbara Boxer, from California originally introduced the National Nursing Shortage Reform and Patient Advocacy Act. The objective of this bill is to address the nationwide shortage of hospital RN’s and to protect patient safety in acute and long-term facilities. In addition, another goal of this act will be to allow nurses to report unsafe patient conditions and maintain their role as an advocate for the patient. According to Boxer, “We cannot guarantee high-quality health care to every American without a high-quality workforce of nurses to provide it. By investing in nurses and in their training, we can help improve the quality of care in our nation’s hospitals and save the lives of countless patients.” She also believes that by establishing specific nurse-to-patient ratios it will not only save lives and improve the quality of care but also encourage more nurses to enter and stay in the workforce. More details about Barbara Boxer’s objectives can be found at the following links:
http://www.calnurses.org/legislative_advocacy/national-nursing-shortage.html
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5727470

The potential impacts of this bill will hopefully create a positive change for those affected by our healthcare system, both nurses and clients. The nursing shortage can contribute to numerous adverse outcomes for patients. In an article written by the Agency of Healthcare Research and Quality (AHRQ) they found that in hospitals with high RN staffing, medical patients had lower rates of adverse patient outcomes such as UTIs, pneumonia, shock, upper gastrointestinal bleeding, and longer hospital stays than patients in hospitals with low RN staffing. By setting a limit on the number of patients a nurse can have, determined by patient acuity, nurses will have the capability to provide the quality care that all patients deserve. The current nursing shortage puts a huge strain on nurses due to their increased workload. Statistics show that there has been increased job dissatisfaction and nurse burnout since this nursing shortage began. Boxer hopes that by enacting this bill nurses will have the ability to report unsafe conditions and refuse additional assignments over the safe limit without any discrimination or concerns of being penalized by their employers. With this bill, nurses will hopefully be encouraged to stay in the field and for prospective nurses to commit to the profession, knowing that their voices will be heard.

When taking a look at our healthcare system, you can find that due to the shortage of nurses, adverse patient outcomes have contributed to unnecessary and preventable hospital costs. Another AHRQ-funded study found that all adverse events studied (pneumonia, pressure ulcer, UTI, wound infection, patient fall/injury, sepsis, and adverse drug event) were associated with increased costs. For example, “the cost of care for patients who developed pneumonia while in the hospital rose by 84 percent.” By cutting down and eliminating some of these preventable events, hospitals would be able to afford to hire more nurses therefore creating proper nurse to patient ratios. The information and statistics collected by the AHRQ can be accessed using the following article: Agency for Healthcare Research and Quality (AHRQ). (2004). Hospital nurse staffing and quality of care. Research in Action, (14), 1-12.

National Nursing Shortage Reform and Patient Advocacy Act

On May 13, 2009, a bill was submitted to the Senate in hopes of modifying the Public Health Service act in regards to the topic of nurse to patient staffing ratio and for other purposes. Section 3101, Minimum Nurse Staffing Requirements, discusses 5 topics: staffing plan, minimum direct care registered nurse-to-patient ratios, development and reevaluation of staffing plan, acuity tool, and submission of plan to secretary.

In regard to nurse-to-patient ratios, the bill entails that each unit has its own requirements as to the number of nurses for each shift. If you are a nurse in the trauma unit or the OR, you should only have 1 patient. If you a nurse in the CCU (including NICU, labor and delivery, coronary care units, acute respiratory care units, burn units, and postanesthesia units), you should only have 2 patients. If you are an emergency room nurse or work in stepdown units, pediatric units, telemetry units, or on a combined labor, delivery, and postpartum units, you should have 3 patients. In antepartum units, intermediate care nursery units, psychiatric units, or other specialty care units, the nurse should have 4 patients. If you work on a medical/surgical floor, rehabilitation unit, or a skilled nursing unit, you should have 5 patients. Lastly, if you worked in a well-baby nursery or postpartum unit, you should have 8 patients. One important note of the staffing bill is to help ensure the annual and continual evaluation of hospital staffing plans in regard to their nurse-to-patient staffing ratio. During the evaluation of the hospital staffing plans each year, input from the registered nurses is required in order to revise the content.

Section 3102 Posting, Records, and Audits discusses how the previously noted nurse-to-patient ratios should be accessible to staff, patients, and the public, a record of the ratios for each shift for the last 2 years, and how the secretory should conduct periodic audits.

Section 3103 Minimum Direct Care Licensed Practical Nurse Staffing Requirements discusses many topics, such as the establishment of the hospital's staffing plan and how a study no later than 1 year after the date of enactment of the plan should be performed to review the effects of patient care in hospitals. Additionally, the application of registered nurse provisions to licensed practical nurse staffing requirements aims to bridge the gap between RNs and LPNs and how the requirements of this section should take effect as soon as possible (which is determined by the secretary) is no later than 2 years.

Section 3104 Federal Assistance for the Purchase of Safe Patient Handling Equipment discusses how it is necessary for this secretary to establish a grant program that entails providing financial assistance to help cover all the costs of purchasing federal/state rewuired equipment. For the year 2010, one example of a grant award was $50,000,000.

Section 3105 Whistleblower and Patient Protections discusses the following topics: recognition of duty and right of nurses to advocate in the exclusive interest of the patient, refusal of assignment, retaliation for refusal of assignment barred, cause of action, complaint to secretary, toll-free telephone number, protection of reporting, prohibition on interference with rights, notice, and effective dates. This part allows the nurse to refuse any assignment without means of retaliation, discrimination, or means of discharge. A nurse, patient, or other individual may file a complaint to the secretary (by means of a toll-free number) against any hospital for violating these policies. In order to help staff and public awareness, a notice with guidelines about patient, nurse, and public rights should be made visible.

Section 3106 Enforcement discusses how it is the duty of the secretary to investigate any complaint, encourage a reestablishment corrective action plan in regard to a facility's violation, and the penalties that the facility may face. Most penalties are financial.

Section 3107 Definitions is responsible for defining acuity system, direct care licensed practical nurse, nurse, direct care registered nurse, employment, staffing plan, and declared state of emergency. Acuity system describes the level of care needed by each patient, the number of nurses to care for these patients, whether the care is performed by a registered nurse or other personnel, and requires this information to be expressed in plain, easy to understand language. Direct care LPN is a nurse who has been licenced for more than 1 state and who provided bedside care for 1 or more patients. The nurse means any RN or LPN regardless of employment. Direct care RN who has been licenced by more than 1 state and provides bedside care for 1 or more patients. Employment is a contract (or otherwise arranged) provision of service. A declared state of emergency is an unavoidable occurrence at an unscheduled interval that relates to healthcare delivery and necessitates immediate attention declared by the federal government.

Section 3108 Rule of Construction discusses the importance of maintaining patient record confidentiality and a report to congress with recommendations regarding sufficient number of nurses no later than 1 year after the bill enactment.

Section 860 Registered Nurse Workforce Initiative (RNWI) was established as a 5 year program to help resolve the nursing shortage issue. One way they intend to do this is to establish many educational system foundations and institutional involvement to allow sufficient number of employable nurses, which is necessary to guarantee a safe and competent hospital nursing staff and care.

Section 861 Education Assistance Benefits discusses how the secretary is finding means to ensure progressive nursing educational assistance by establishing a grant program.

Bill information was found from the following webstie:
http://www.govtrack.us/congress/billtext.xpd?bill=s111-1031