ANA's message to Congress:
<<<"The most reliable and cost-effective way to ensure high-quality inpatient care is to provide an adequate number of registered nurses (RNs) at the bedside. ANA urges Members of Congress to:
Support the PATIENT SAFETY ACT of 2001 (H.R.1804, S. 863) which would require Medicare providers to publically report nurse staffing levels and mix, and patient outcomes.
Require acute care facilities to develop and implement valid and reliable staffing methodologies AS A CONDITION OF PARTICIPATION IN MEDICARE AND MEDICAID.
On May 10, 2001, Rep. Maurice Hinchey (D-NY) and Sen. Harry Reid (D-NV) introduced a new version of the Patient Safety Act, H.R.1804/S.863.
The new bill would require health care institutions to make public specified information on staffing levels, mix and patient outcomes. At a minimum, they would have to make public:
the number of registered nurses providing direct care;
numbers of unlicensed personnel utilized to provide direct patient care;
average number of patients per registered nurse providing direct patient care;
patient mortality rate;
incidence of adverse patient care incidents; and
methods used for determining and adjusting staffing levels and patient care needs.
In addition, health care institutions would have to make public data regarding complaints filed with the state agency, the Health Care Financing Administration or an accrediting agency related to Medicare conditions of participation. The agency would then have to make public the results of any investigations or finding related to the complaint.
Recent studies have demonstrated a direct relationship between RN staffing levels and positive patient outcomes. This legislation is intended to allow consumers and researchers to have ready access to information on this issue and brings "market pressure" to bear for the facilities to comply with safe staffing.
The Issues Surrounding the Registered Nurse Staffing in Acute Care
Adequate staffing levels allow nurses the time that they need to make patient assessments, complete nursing tasks, and respond to health care emergencies. It also increases nurse satisfaction and reduces turnover. For these reasons, ANA supports efforts to require facilities to implement and use a valid and reliable staffing plan as a condition of participation in the Medicare and Medicaid programs.
During the past decade, health care providers have implemented aggressive measures to reduce the costs of health care. As nurse salaries are the single largest hospital expense (representing 20% of the average hospital budget), we were some of the first to feel the pinch. In fact, census data shows that between 1994 and 1997 RN wages across all employment settings dropped by an average of 1.5 percent per year (in constant 1997 dollars). Between 1993 and 1997, the average wage of an RN employed in a hospital dropped by roughly a dollar an hour (in real terms).
These changes have often resulted in RN staffing levels that are inadequate to promote and protect the safety and quality of patient care. These changes have occurred at the same time that the patient acuity has increased, the use of sophisticated technology has increased, and the length of stay has decreased. The combination of these factors has created a situation that threatens patient safety.
ANA has long maintained that the safety and quality of care provided in the nation's health care facilities are directly related to the number and mix of direct care nursing staff. In fact, four agencies with the Department of Health and Human Services recently sponsored a joint study on this very topic. The resulting report (Nurse Staffing and Patient Outcomes in Hospitals, released on April 20, 2001) found strong and consistent evidence that increased RN staffing is directly related to the decreased incidence of urinary tract infections, pneumonia, shock, upper gastrointestinal bleeding, and shorter hospital lengths of stay.
Recent research conducted by the Center for Health Outcomes and Policy Research at the University of Pennsylvania shows that 70-80% of more than 43,000 registered nurses surveyed in five countries reported that there are not enough RNs in hospitals to provide high quality care. Only 33% of the American nurses surveyed believed that hospital staffing is sufficient to "get work done."
ANA's recent survey of American nurses states that 75 percent of nurses surveyed feel that the quality of nursing care at the facility in which they work has declined over the past two years. Out of nearly 7,300 respondents, over 5,000 nurses (68 percent) cited inadequate staffing as a major contributing factor to the decline in quality of care. More than half of the respondents believed that the time they have available for patient care has decreased.
The public at large should be alarmed that more than 40 percent of the respondents to the ANA survey stated that they would not feel comfortable having a family member cared for in the facility in which they work." >>>>
Long Term Care:
ANA Message to Congress:
<<"The ANA supports the immediate enactment of upwardly adjustable, minimum skilled nursing facility (SNF) nurse staffing ratios AS A CONDITION OF PARTICIPATION IN MEDICARE AND MEDICAID. At a very minimum, these ratios must require the following:
All SNFs must have a registered nurse (RN) on staff and available to meet patient needs at all times (24 hours a day, 7 days a week).
Disallow waivers for staffing requirements
(administrators who are RNs do not count in the staff mix)
Issues Surrounding Registered Nurse Staffing in Long Term Care:
A number of recent studies have shown disturbing problems with America's nursing facilities. In 1999, the GAO reported that "more than one-quarter of nursing homes have deficiencies that have caused actual harm to residents or placed them at risk of death or serious injury. The Institute of Medicine (IOM) recently released a report (Improving the Quality of Long-Term Care, December, 2000) stating "Multiple studies indicate that staffing in nursing homes is inadequate to provide care that meets consumer expectations or maximizes resident's independence."
The 2000 IOM report and a longer IOM report published in 1996 (Nursing Staff in Hospitals and Nursing Homes: It is Adequate?) urge Congress to require the presence of an RN in all nursing facilities 24 hours a day, seven days a week. In both reports, the IOM asserts that the relationship between RN-to-resident staffing and quality of care in nursing facilities has been established beyond question.
The Nursing Home Reform Act of 1987 (Public Law 100-203) promised each nursing home resident the right to expect care and services from the nursing home which would allow him/her to "attain or maintain his/her highest practicable level of physical, mental, and psycho-social functioning." Congress has not required a specific standard setting out the number of hours per patient day that a resident should receive nursing care. Instead, the 1987 law required each nursing home to provide 24-hour licensed nursing services which are "sufficient to meet the nursing needs of its residents."
Congress has only required facilities to provide the services of an RN for eight hours a day, leaving many residents without access to an RN during the evening and night shifts." >>>
Congress needs to hear from more nurses about correcting that.
Last edit by -jt on Jan 11, '02
Message From NYSNA:
<<"The New York State Nurses Association supports nurses in their efforts to provide quality care in a safe work environment. As the professional association for registered nurses in New York state, NYSNA understands the issues that are important to nurses.
State laws can have a major impact on a nurse's practice. In the past year, laws were enacted to prevent needlestick injuries and to create a statewide peer assistance program for nurses.
Bills are currently under consideration that would ban mandatory overtime, protect nurses who speak out about unsafe patient care, and establish statewide staffing guidelines:
Disclosing staffing ratios: Nurses know that appropriate staffing affects patient outcomes. NYSNA wrote a bill that requires hospitals and nursing homes to disclose and report nurse-to-patient staffing ratios and the mix of licensed and unlicensed personnel. It calls for facilities to disclose information indicating the quality of nursing care, such as the incidence of nosocomial infections, patient falls, and pressure ulcers. Public knowledge of staffing practices will help put "market pressure" on facilities.
To protect nursing practice and patients, the bill also prevents unlicensed personnel from using the title "nurse."
Bills and Sponsors: A.2581 (Gottfried), S.510 (DeFrancisco)
Status: Passed Assembly, Senate Health Committee
Establishing safe staffing guidelines: While the state requires healthcare facilities to provide "sufficient staffing" to meet patients' needs, there are no standards to define what safe staffing is. NYSNA has taken the lead in promoting safe staffing by writing and securing sponsors for a law that would create enforceable staffing standards in hospitals and other healthcare settings.
NYSNA has supported legislation that would set staffing ratios in nursing homes and other legislation to set guidelines for hospital staffing. In addition to S4779, NYSNA supports:
Bills and Sponsors: S.117 (Marcellino) to set staffing guidelines for hospitals - Senate Health Committee
A.4171 (Gottfried), S.2185 (Hannon) to establish staffing ratios for nursing homes
Status: Passed Assembly, Senate Health Committee
Prohibiting mandatory overtime: As staffing conditions have worsened, healthcare facilities have resorted to mandatory overtime. This practice is dangerous for both nurses and patients. NYSNA wrote a bill to prohibit employers from requiring nurses to work beyond their regularly scheduled shifts. This is a "zero tolerance" measure-except in declared emergency situations, there would be no mandatory overtime for RNs or LPNs.
Bills and Sponsors: A.7127 (Nolan), S.3515 (Morahan)
Status: Assembly Rules Committee, Senate Labor Committee
Protecting nurse 'whistleblowers': After nurses were harassed by their employers for testifying at legislative hearings, NYSNA wrote and lobbied for passage of the Healthcare Whistleblower Protection Act. The bill passed the State Legislature in 2000 but was vetoed by Gov. George Pataki. It is again going through the legislative process this year.
This law would prohibit employers from retaliating against healthcare workers who report unsafe patient care practices to government agencies. Reports of retaliation would be investigated by the state, which can impose fines on employers for violating the law.
Nurses will be protected, not only when they report illegal activities, but also if they are required by their employer to violate the nursing code of ethics as it relates to safe patient care.
Bill and Sponsor: A.3259 (Nolan), S5620 (Spano)
Status: Passed Assembly; Senate /Rules Committee
Increasing the supply of nurses: NYSNA has promoted the introduction of a budget-related bill designed to encourage individuals to enter the nursing profession. This effort complements initiatives aimed at improving working conditions for RNs. NYSNA wrote legislation that would create the Empire State Professional Nursing Scholarship Program to provide financial support to applicants who agree to deliver nursing care in an area of New York that is experiencing a nursing shortage.
Bills and Sponsors: S.3389 (LaValle) - Senate Health Committee
A.7470 (Scozzafava) - Assembly Health Committee
A.7814 (Pretlow) - Assembly Higher Education Committee
Protecting nursing practice: There have been attempts in recent years to hand off nursing practice to unlicensed personnel and other professions. NYSNA is committed to the principle that NURSES should practice nursing.
To protect the scope of nursing practice, NYSNA is:
Working to repeal an archaic legal exemption that allows unlicensed personnel to provide nursing care in certain mental health facilities.
Bills and Sponsors: S.1830 (Padavan) , A7284 (E. Sullivan)
Status: Senate Higher Education Committee; Assembly Ways and Means Committee
Fighting to close a loophole that allows the State Department of Health to independently create new types of healthcare professionals.
Bills and Sponsors: S.3498 (LaValle), A7211 (E. Sullivan)
Status: Senate Calendar, Assembly Higher Ed Committee
Opposing legislation to allow pharmacists to administer immunizations.
Bills and Sponsors: S.3657-A (Spano), A6971-A (Colman)
Status: Senate Health Committee, Assembly Higher Education Committee
Wrote a bill to allow nurses to provide home care in small group practices without having to be licensed as a home care agency.
Bills and Sponsors: S.2409 (Velella), A.1271 (Tonko)
Status: Senate Health Committee, Passed Assembly
Supports insurance laws that are "provider neutral," so patients of nurse providers have the same rights as patients of physicians.
Bills and Sponsors: A.5066 (Gottfried), S.3241 (Seward)
Status: Passed Assembly; Senate Insurance Committee
Wrote legislation requiring insurers to reimburse nurses at the same level as other providers when nurses deliver the same services.
Bills and Sponsors: A.2677 (Gottfried), S.3278 (Padavan)
Status: Insurance Committees in both houses
Encouraging continued competency: To promote quality care and in-service training programs for nurses, NYSNA wrote legislation that would require registered nurses practicing in New York state to complete 45 hours of continuing education during each three-year registration period. Exemptions are provided for illness, military duty, and nurses who are not engaged in direct care.
Bills and Sponsors: S.3107 (LaValle), A7653 (E. Sullivan)
Status: Senate Calendar; Assembly Higher Education Committee
Legislation text can be read at the NY State government website or contact NYSNA's Practice and Governmental Affairs Program at 518.782.9400, ext. 282 or by e-mail." >>>
A word from NY nurses to their legislators in support of these bills will help pass them into state law.
Last edit by -jt on Jan 11, '02
Re: An available RN workforce for the future to step in as today's 40-something RNs begin retiring en mass:
Nurses responded after this alert went out in NY with similar alerts in the other states & they were successful in getting their DC representatives to pass this legislation thru both houses. Its now awaiting the Presidents expected signature to sign it into law:
<<"Action Alert: Nursing Shortage Legislation
The first session of the 107th Congress is about to adjourn, and the New York State Nurses Association (NYSNA) and the American Nurses Association (ANA) need your help to convince Congress that they cannot leave town without passing nursing shortage legislation. NYSNA and ANA have worked throughout the year galvanizing support for the Nurse Reinvestment Act and the Nursing Employment and Education Development Act, and we need your help in these last weeks to make the final push to enact this nursing recruitment legislation.
NYSNA and ANA urge you to call your member of Congress and Senators Clinton and Schumer with the message below. Do not delay, Congress is expected to adjourn on December 14. Call the capitol switchboard at 202-224-3121 and ask for your Representative and Senators Schumer and Clinton.
Suggested Message to Congress:
America's nurses need you to act now to support nursing education and to attract more people into the nursing profession. Both the Nurse Reinvestment Act (S.1597, H.R. 1436) and the Nursing Employment and Education Development Act (S. 721) would provide needed assistance. The nursing shortage is already seriously impacting New York State (describe how - e.g., vacancies, ED diversions, increasing average age of the working nurse). Projections show that this shortage will only worsen. I urge you to pass legislation supporting nursing recruitment this year.
Both the Nurse Reinvestment Act (S. 1597, H.R. 1436), and the Nursing Employment and Education Development Act (S. 721) would authorize federal funding for scholarships and loan repayments for nursing students who agree to work in shortage areas after they graduate, nursing faculty development, career ladder programs, public service announcements to promote nursing as a career, and support for the development of nursing curriculum.
The emerging nursing shortage is very real and very different from any experienced in the past. Health care providers across the nation are having difficulty finding nurses who are willing to work in their facilities. Press reports about emergency department diversions and the cancellation of elective surgeries due to short staffing are becoming commonplace.
The lack of young people entering the nursing profession has resulted in a dramatic increase in the age of working nurses. Many RNs providing direct patient care are planning to leave the profession in the next few years. Projections show that the number of RNs per capita will fall 20% below requirements by the year 2020.
Efforts to enhance the nation's and health care's response capacity for biological and chemical warfare will place even greater strains on America's nurses - the largest healthcare workforce in the nation. Congress must act now to pass legislation supporting nursing recruitment. These bills have broad bipartisan support in Congress, as well as support from the Bush Administration.
Action Alert: Urge House and Senate to Act on Nurse Education
House and Senate Committees are preparing to move two bills that have been endorsed by ANA that would improve nurse education and promote the nursing profession. ANA has participated in a number of hearings and press events on these bills. Now is the time to contact your Congressional delegation. Call the US House of Representatives: 202.225.3121 to contact your Representative. Call the US Senate: 202.224.3121 to speak to your Senators.
Both the Nurse Reinvestment Act (H.R. 1436, S. 706) and the Nursing Education and Employment Development Act (S. 721) would provide support for nursing faculty development, scholarships and loan repayments for nurses who agree to work in shortage areas, career ladder programs for RNs, PSAs to promote the nursing career, and the development of nursing curriculum.
A fundamental shift has occurred in the Registered Nurse (RN) workforce over the last two decades. As occupational opportunities for young women have expanded, and working conditions for nurses has deteriorated, the number of young people entering nursing has declined. The deficiency has resulted in a steady, dramatic increase in the average age of the US nurse. Today, the average working RN is more than 43 years old.
The Bureau of Labor Statistics estimates that 331,000 RNs (15% of the current workforce) will retire between 1998 and 2008. At the same time, the aging of the U.S. population is expected to cause an increase in demand for nursing services.
By the year 2020, the number of nurses per capita will fall 20% below requirements if nothing is done to attract more nurses into the profession.
New York Representatives Kelly, McCarthy, and Towns, as well as Senator Clinton are sponsors of HR1436/S 706. NYSNA urges all members to call their Congressional representative and Senators Clinton and Schumer to deliver the following message:
Message to Congress
Projections show that there will be a national, systemic shortage of nurses worsening over the next few years. A number of facilities are having problems now filling nurse vacancies. The recent activation of the National Guard, the Reserves and military medical units are exacerbating this shortage. Congress must act now to support nursing students and attract more young people into nursing. I urge you to support the Nurse Reinvestment Act (H.R. 1436, S. 706) and the Nursing Employment and Education Development (NEED) Act (S. 721). The programs in these bills are needed to help address the demand for nurses.
Importantly, no effort to address the impending nursing shortage will be successful unless the work environment is also improved. Conversely efforts to educate new nurses will be fruitless unless we first fix the problems that are driving experienced nurses away from the profession. For these reasons, these nurse education bills must be accompanied by a ban on the use of mandatory overtime and the implementation of improved staffing methodologies (Patient Safety Act).
NYSNA and the ANA ask for your support of these bills">>>
Last edit by -jt on Jan 11, '02
Immigration and the Nursing Workforce:
ANA's Message to Congress:
<<"ANA believes that the U. S. healthcare industry has failed to maintain a work environment that is conducive to safe, quality nursing practice and that retains experienced U. S. nurses within patient care. ANA supports continuation of the current certification process to apply to all foreign-educated health care workers regardless of their visa or other entry status. ANA opposes efforts to exempt foreign-educated nurses from current H-1B visa program requirements.
The Issues Surrounding Immigration and the Nursing Workforce:
The practice of changing immigration law to facilitate the use of foreign-educated nurses is a short-term solution that serves only the interests of the hospital industry, not the interests of patients, domestic nurses, or foreign-educated nurses.
ANA condemns the practice of recruiting nurses from countries with their own nursing shortage.
The Illegal Immigration Reform and Immigrant Responsibility Act of 1996 requires that all foreign health care professionals, except physicians, must be certified by the Commission on Graduates of Foreign Nursing Schools (CGFNS) or another independent, government-certified organization qualified to issue credentials. The certification process verifies that the foreign health care worker's education, training, or experience meets all applicable statutory and regulatory requirements for entry into the United States. In addition, any foreign license submitted must be validated as authentic and unencumbered. If the health care worker is a registered nurse (RN), the nurse must have passed an examination testing both nursing skill and English language proficiency.
The cause of instability in the nursing workforce must be addressed
Over-reliance on foreign-educated nurses serves only to postpone efforts required to address the needs of the U.S. nursing workforce.
Foreign-educated nurses brought into the United States tend to be placed in jobs with unacceptable working conditions with the expectation that these nurses, as temporary residents and foreigners, would not be in a position to complain.
For comparison chart of current regulations versus new proposed legislation that would change these regulations, change the certification process, and increase the number of nurses that can be recruited from overseas, See http://www.ana.org/gova/federal/gachrt97.htm
ANA OPPOSES legislation that will change the regulations and certification process and opposes legislation that will allow for increasing the numbers of nurses healthcare facilities may recruit from over-seas.
Last edit by -jt on Jan 11, '02
ANA's Message to Congress:
<<"ANA opposes the use of mandatory overtime as a staffing tool. We urge you to support the legislation that would ban the use of mandatory overtime through Medicare and Medicaid law. Nurses must be given the opportunity to refuse overtime if we believe that we are too fatigued to provide quality care.
The Issues Surrounding the Use of Mandatory Overtime:
Nurses across the nation are reporting a dramatic increase in the use of mandatory overtime as a staffing tool. We fear that this staffing methodology - deemed "mandation" by health care facilities - is having a negative impact on patient care, increasing the chances for medical errors, and driving nurses away from the bedside.
In some facilities, nurses are being threatened with dismissal or with the charge of patient abandonment if they refuse to accept overtime. We are the only health care professionals who can lose their license (our ability to practice, our livelihoods) if found guilty of patient abandonment. Therefore, many nurses have no actual choice when confronted by a request for overtime, and many of us are regularly working shifts well in excess of 12 hours.
Research shows that sleep loss influences several aspects of performance, leading to slowed reaction time, delayed responses, failure to respond when appropriate, false responses, slowed thinking, diminished memory and others. In fact, 1997 research by Dawson and Reid at the University of Australia showed that work performance is more likely to be impaired by moderate fatigue than by alcohol consumption. Their research shows that significant safety risks are posed by workers staying awake for long periods.
Federal regulations have used transportation law to place limits on the amount of time that can be worked in aviation and trucking. Certainly, nursing has as much of an impact on public health and safety as these professions. Therefore, it is appropriate for Congress to place a ban on the use of mandatory overtime in nursing through health law.
ANA maintains that the deterioration in the working conditions for nurses is the primary cause for the staff vacancies being reported by hospitals and nursing facilities - not a systemic nursing shortage. Nurses are opting not to take these nursing jobs because they are not attracted to positions where they will be confronted by mandatory overtime and short staffing.
In fact, data from the Health Resources and Services Administration's (HRSA's) 2000 national sample survey of RNs shows that more than 500,000 licensed nurses (more than 18% of the national nurse workforce) have chosen not to work in nursing. This available labor pool could be drawn back into nursing if they found the employment opportunities attractive enough.
ANA strongly supports the zero tolerance legislation to ban mandatory overtime for nurses.
Last edit by -jt on Jan 11, '02