Political Action Plan..."The Follow-up"

In regards to the political action plan outlined on October 21, 2010, group members accomplished various actions. First, group members educated themselves on the candidates up for election in their state by viewing political websites, news reports, voting records, and campaigns. On November 2, 2010 group members utilized their right to vote by showing up to the polls and voting for legislators who would hopefully advocate for reversing the nursing shortage. Furthermore, other members joined the National Nurses United organization, which focuses on lobbying for national issues such as the safe staffing ratios discussed in our blog. This will benefit group members by keeping them updated on current nursing issues, providing them access to publications, and receive email updates and action alerts pertaining to this bill.

            In order to raise awareness of this bill, each group member contacted a key stakeholder or legislator. Many of us contacted RN’s that we know personally who are active in their clinical settings and influential in their communities. With this grassroots approach, the noted RN’s will be able to educate their coworkers and encourage them to also get involved in an organization that is going to lobby for this key issue. One of the steps that RN’s can do is discuss with their managers their concerns about their own safety and patient’s safety due to the current staffing ratios. From there, managers such as Leslie Schniekell, can express their concerns as well as their staff members to the attention of hospital administration. On a larger scale, the group contacted Senator Johnny Isakson of Georgia who is on the Senate Committee on Health, Education, Labor, and Pensions to sway his opinion on current healthcare legislation and others sharing his stance.

            Our group is committed to continuous support and involvement pertaining to this issue. By advocating for Senator Boxer’s bill on the national nursing shortage, joining the National Nurses Union, and contacting Senators in opposition to this bill we’re not only addressing this issue here in Virginia, we are reaching legislators and key stakeholders on a national level.  

To hear Senator Boxer in action at the National Nurses Union rally in May 2010, check out the video posted below.

Senator Boxer at NNU Rally: National Nursing Shortage Reform and Patient...

Key Stakeholders in the National Nursing Shortage Reform and Patient Advocacy Act

This week each of the blog members contacted a key stakeholder or legislator in order to invite them to take a look at our blog about the National Nursing Shortage Reform and Patient Advocacy Act.

Senator Johnny Isakson of Georgia- Senator Isakson is a Republican who has been the Senator of Georgia since 2005. He is currently a member of the Senate Committee on Health, Education, Labor, and Pensions. Senator Isakson voted against the health care bill passed by the U.S. Senate and U.S. House of Representatives and signed by President Obama on March 30, 2010. On his official website (see link below), Senator Isakson stated that he voted against the health care bill because he could not be a part of driving Americans to a government-run health care system that the country could not afford. Johnny Isakson was contacted, because as a member of the Senate Committee on Health, Education, Labor, and Pensions, he will be voting on the passage of the National Nursing Shortage Reform and Patient Advocacy Act. Introduced bills first go to a committee whose job is to examine and revise the bill before it goes to general debate. Because the majority of bills never make it out of committee, it is important to gain the support of members of this particular committee. In addition, if Isakson believes that we cannot afford to reform our health care system, then it is very possible that he would no support an act that will likely require hospitals to hire more nurses. (http://isakson.senate.gov/healthcare.html)

M.C., Nursing Student, Shenandoah University- The passage or non-passage of this bill will have a large impact on new nurses entering the field in the next few years. Due to the demanding nature of nursing school, it is very hard to keep up with news such as this. A simple, straightforward blog that takes just minutes to review could be a great resource for a busy nursing student who still wants to keep up with and support pro-nurse legislation.

Emilie Curcio and Claire McGraw- Emilie is a senior nursing student at Wagner College. Claire is a registered nurse who has not worked for years but is interested in getting back into nursing and finding a career again. Both of these women are prospective new nurses and while they are both at very different places in their lives, they both have the potential to get active and involved in nursing legislature. They both will also be impacted by the nursing shortage and need to be informed so that they can get involved and make things happen that they believe would be best for the nursing community. As future nurses, they play a key role in what can become of the nursing shortage as it impacts them personally.

Debbie Rose, RN- After working as a nurse for over 20 years, I believe that she is a key stakeholder in this legislation and will hopefully feel the positive effects of this bill if it is enacted. She currently is working on a same-day surgery unit but has also worked on many other units and was even a traveling nurse for many years. By being a traveling nurse she really saw first-hand the staffing needs of a hospital and the importance of maintaining a safe nurse-patient ratio. Her work day is often affected by short staffing which adds additional stress to the work environment and also can affect the time that she leaves her shift or whether or not she has time for a lunch break. Her employer will often call to see if she can come in on additional days when they are short on staff. By establishing a unit requirement of a nurse patient ratio, it is my hope that Debbie and nurses like her will have increased job satisfaction and feel that they are safely and effectively caring for their patients.

Luann Shupe- a currently practicing nurse and an employee at doctor’s office. Just within her office, she has seen the struggles of filling an open nursing position; therefore I believe she would be in favor of this bill being passed. She has expressed feeling overwhelmed from her day at work several times because the office was short-staffed while the workload remained the same or increased. As a result, she may experience burn out quicker due to the deceased availability of nurses ready to hire. Since many nurses may also be feeling overwhelmed, practicing nurses and student nurses would benefit from the passing of the National Nursing Shortage Reform and Patient Advocacy Act.

Leslie Schniekell- the manager of the Dialysis Unit at Georgetown University Hospital, and has been a practicing nurse for more than two decades. She is the constant "go to" for many fellow staff members because of her abundant involvement within the community. The nursing shortage plays an important role in her management tactics, hospital desires, and personal beliefs. It is a topic that she mentions and strives to change on a daily basis, and I think she would have a lot of input on the matter. Not to mention that she can talk about this topic for hours, and has tons of ideas about what newly practicing nurses should expect when being hired.

There have been no recent updates or actions taken by Congress with this bill. It is still in the process of being considered by the Senate Health, Education, Labor, and Pensions Committee

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