Letter to Congress: ANA "Safe Staffing Saves Lives" campaign

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.

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.

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?

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.

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?

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

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

Thanks, and you're so right. A twelve year fight, involving thousands of our members who lobbied, wrote letters, and visited their legislators and attended hearings to provide testimony to expose unsafe industry staffing that harms patients; and, about why legal, minimum standards are necessary. Also, it's important to note, that the ratio fight is a collective, dues supported advocacy campaign that altruistically benefits all nurses and all patients.

Here's a link to the timeline:
http://www.calnurses.org/assets/pdf/...fight_0104.pdf

Julia asked a question in a previous post on this thread, "Does it have to be CNA to be good?" You provided a thoughtful reply, and I would hope that the powers that be in the ANA would make a conscious attempt to avoid being the handmaidens of the healthcare industry. Hopefully they'll consider the constructive criticisms you've posted and recognize the fundamental flaws in their (UAN/SEIU) bill. Patients and direct care registered nurses will derive no real benefit from it, as written.

The danger of poorly worded, incremental attempts at reform, such as the ANA/2007 legislation, is that it holds little promise for promoting effective staffing; it merely codifies current practices in hospitals, that gives administrators supreme flexibility to maintain the status quo. As you've pointed out, there are no genuine, enforceable, universal standards.

It may be a well-intentioned attempt to "do something", but the ANA bill is like putting a fresh coat of paint on an old house. It does nothing to repair the delapidated infrastructure, so it remains unsafe for patients, and unsafe for nurses. It delays and hides the need for real repairs. It's like a placebo, a sugar pill that won't be effective in restoring optimum wellness to a diseased system. Individual nurses will continue to be blamed for errors that are the result of this system problem. The ANA's so-called "reform" bill perpetuates, for all intents and purposes, a bottom line driven staffing "system" that increases risks and costs of preventable harm, complications, and death for patients, while maximizing profits for hospitals.

You're talking about two different bills here-

I agree with all your comments concerning the ANA staffing bill- S.73/HR.4138. I like to call it the "ANA/AHA" bill.

I am lobbying for H.R. 2123- which you refer to as the UAN/SEIU bill. H.R. 2123 is nothing like the ANA bill. It has mandated minimum ratios for direct care registered nurses- the numbers are in the bill. ANA had nothing to do with this bill and most likely won't have anything to do with it. (Perhaps that's part of the story behind their wanting nothing more to do with the UAN?)

I appreciated RN Power's suggestions and think some of the "perfecting" can take place in either the regulations process or be added for the next Congress. My suggestion was that the organizations that believe in real staffing legislation work together to achieve it. Much as management dominated organizations have worked together (and are succeeding) at getting their "status quo" staffing legislation in states like Washington, Oregon and Ohio (they left the UAN, BTW).

There are progressive states and progressive nurses in the ANA who have fought for change from within and they have fought us back (a whole other story). Some of these states have introduced real staffing legislation- MN, MI, NY and others.

But please, recognize that there are two bills and states within ANA that support a different bill than ANA does. Many nurses fought hard to be able to do this. Acknowledge their determination and victory- almost double the co-sponsors of the ANA bill!

Get more information about H.R. 2123, The Safe Nurse Staffing for Patient Safety and Quality Care Act of 2007 here:
Bill Summary and Status http://thomas.loc.gov/cgi-bin/bdquery/z?d110:h.r.02123:
Bill Text http://thomas.loc.gov/cgi-bin/query/z?c110:H.R.2123:
See also: http://capwiz.com/criticalcare/issue...?bill=10365041