[marie-francoise]

So, based on the (very helpful!) responses of everyone...

Below is a consolidated list of the various pieces of potential legislation/initiatives regarding nurse-patient ratios that were mentioned in this thread.

So....

QUESTION: Do you all think we should replace the current sticky with this expanded list, so that nurses can read over the various proposals/initiatives and support the one(s) they agree with?

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http://www.safestaffingsaveslives.org/default.aspx

http://thomas.loc.gov/cgi-bin/bdquery/z?d110:h.r.02123:

LEGISLATION TEXT FOR ABOVE LINK:
http://thomas.loc.gov/cgi-bin/query/z?c110:H.R.2123:

http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.00073:

LEGISLATION TEXT FOR ABOVE LINK:
http://thomas.loc.gov/cgi-bin/query/z?c110:H.R.4138:

http://www.uannurse.org/legislative/bill.html

http://capwiz.com/criticalcare/issue...?bill=10365041

http://www.calnurses.org/nnoc/

Regarding the above link: One post noted NNOC is working on The United States Nursing Shortage Reform and Patient Advocacy Act.

[BrokenRNheart]

Thanks for all the additional information here.

It helps to post all the options to compare and decide. Even if all of them are voted for just to get the signatures to the politicians.

[RN Power Ohio]

SEIU and AFT also support this bill. Anyone know why CNA/NNOC is not supporting this and wants to introduce another bill? The only thing missing in this one is the "Kentucky River" issue, which the Respect Act covers. As H.R. 2123 already has broad support, why start over?

These are the reason's CNA/NNOC are not in agreement with the bill:

UAN/SEIU
“The Safe Nurse Staffing for Patient Safety and Quality Care Act of 2007”

· No National Uniform Standards
· Total silence on the direct care RN duty and right to advocate in the exclusive interest of her/his patient and RN use of independent professional judgment without fear of retaliation.
· Silent on addressing the NLRB Kentucky River decision making direct care RNs supervisors.
· Silent on the RN professional duty and right to act as patient advocate and that collective advocacy and free speech are protected activities.
· No prohibition on the use of technology that overrides RN judgment.
· Weak minimum direct care registered nurse-to-patient ratios.
· No requirement of current demonstrated competency.
· The offensive practice of averaging the number of patients is not prohibited. (Example: The ICU ratio is 1:2; when a patient is classified as a 1:1 a second direct care RN can be assigned 3 ICU patient because 1+3=4. Four patients divided by two RNs is two; therefore the hospital is in compliance.
· Nurse administrators and other management personnel are included in the ratios.
· Nurse administrators and other management personnel are allowed to relieve for breaks.
· There are no definitions of hospital units.
·No restrictions on the use of video cameras/monitors or any form of electronic visualization of a patient as a substitute for the direct observation required for patient assessment by the direct care registered nurse and for patient protection required by an attendant (sitter).
· No National Acuity Tool, the hospital approves the acuity system
· Establishes LVN or LPN ratios. MINIMUM ratios must be RN.
· No restrictions on the use of Unlicensed Assistive Personnel (UAP)
· No “Zero Lift” Policy Mandate No strengthening of national emergency preparedness
· No nurse title protection or license status disclosure requirements
· No registered nurse workforce initiatives to achieve immediate short and long term mitigation and remedy of the nationwide nursing shortage
· No specific monetary fines against the employer or an employee of the employer for violating employee’s rights
· No specific monetary fines for violating ratios.
· Allows for hospitals to receive additional Medicare and Medicaid reimbursement related to costs incurred related to compliance with this bill.

[Julia RN]

RN Power-
I don't have your legal training, and perhaps lack the patience to read a bill that is 20 pages long...but I'm not sure that our legislators would either. (And many judge bills based on their summaries because reading the entire text takes time)
I disagree on many of the issues you raise with 2123: "averaging" is barred by the language, competency is addressed, and there are $ penalties as reimbursement is tied to it. While there are no set fines for violating the nurses right to report the hospital, the language gives the nurse the right to sue the hospital for lost wages, attorney's costs and damages. Some of the issues you raise deserve their own bill and many of these issues are addressed in separate bills already- zero lift, Kentucky River (RESPECT ACT). The title and scope of practice issues belong in state legislation as that is where they already live.

And why not work together with other nurses on this legislation if you want to improve it?? Does it always have to be by "CNA" to be worthwhile?

[Julia RN]

Interesting..
I just read the Californis bill from 99- I didn't realize that it did not specify the ratios and that the numbers were really up to the DHS.

[RN Power Ohio]

No it does not have to be CNA to be good.

There are big prolems with the state nurse practice acts in most states and this is driving the need for effective legislation elsewhere. State BON will not get involved in employer- employee relations this creates big problems for vocal nurses.

We already have the right to sue for lost wages but are not protected to blow the whistle... ask all the nurses on the threads re: retaliated against for speaking up etc.

Read Accountable but Powerless by Barry Adams, RN.

Examine the effectiveness of provisions of other state level bills or lack there of.

I just know that the language needs to be very strong with NO room for wiggle or the hospital WILL wiggle.

I agree it is better than most state staffing ledislation and JCAHO but not quite strong enough to prevent violations. It has to hurt to violate the law or it will be easy to ignore. Sad but true in this bottom line focused world.

We have a great shot at "getting it all" why not try?

[RN Power Ohio]

JuliaRN,
There was a very long process involved in coming up with the ratio's.

[RN Power Ohio]

I found it! This document - though long is worth reading. It describes how the ratio's were devised.

STATEMENT OF REASONS:

http://www.dhs.ca.gov/lnc/pubnotice/...37-01_FSOR.pdf