Quality Nursing Care Act of 2004 (Federal, USA) - page 2

FOR IMMEDIATE RELEASE December 11, 2003 Capps Introduces Legislation to Require Safe Nurse-to-Patient Staff Ratios Bill Will Improve Quality of Care in Nation's Hospitals ... Read More

  1. by   pickledpepperRN
    Actual language of the bill. Should we write the committee members?
    Quality Nursing Care Act of 2004
    http://thomas.loc.gov/cgi-bin/query

    Quality Nursing Care Act of 2004 (Introduced in House)
    HR 3656 IH
    108th CONGRESS
    1st Session
    H. R. 3656
    To amend title XVIII of the Social Security Act to impose minimum nurse staffing ratios in Medicare participating hospitals, and for other purposes.
    IN THE HOUSE OF REPRESENTATIVES
    December 8, 2003
    Mrs. CAPPS introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

    A BILL
    To amend title XVIII of the Social Security Act to impose minimum nurse staffing ratios in Medicare participating hospitals, and for other purposes.
    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
    SECTION 1. SHORT TITLE.
    This Act may be cited as the `Quality Nursing Care Act of 2004'.
    SEC. 2. FINDINGS.
    The Congress makes the following findings:
    (1) There are hospitals throughout the United States that have inadequate staffing of registered nurses to protect the well-being and health of the patients.
    (2) Studies show that the health of patients in hospitals is directly proportionate to the number of registered nurses working in the hospital.
    (3) There is a critical shortage of registered nurses in the United States.
    (4) The effect of that shortage is revealed in unsafe staffing levels in hospitals.
    (5) Patient safety is adversely affected by these unsafe staffing levels, creating a public health crisis.
    (6) Registered nurses are being required to perform professional services under conditions that do not support quality health care or a healthful work environment for registered nurses.
    (7) As a payer for inpatient and outpatient hospital services for individuals entitled to benefits under the program established under title XVIII of the Social Security Act, the Federal Government has a compelling interest in promoting the safety of such individuals by requiring any hospital participating in such program to establish minimum safe staffing levels for registered nurses.
    SEC. 3. ESTABLISHMENT OF MINIMUM STAFFING RATIOS BY MEDICARE PARTICIPATING HOSPITALS.
    (a) REQUIREMENT OF MEDICARE PROVIDER AGREEMENT- Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)), as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, is amended--
    (1) by striking `and' at the end of subparagraph (U);
    (2) by striking the period at the end of subparagraph (V) and inserting `, and'; and
    (3) by inserting after subparagraph (V) and before the end matter the following:
    `(W) in the case of a hospital--
    `(i) to adopt and implement a staffing system that meets the requirements of section 1898;
    `(ii) to meet the requirements of such section relating to--
    `(I) records maintenance;
    `(II) data collection; and
    `(III) data submission; and
    `(iii) to meet the requirements of such section relating to non-discrimination and retaliation.'.
    (b) REQUIREMENTS- Part D of title XVIII of the Social Security Act, as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, is amended by adding at the end the following:
    `STAFFING REQUIREMENTS FOR MEDICARE PARTICIPATING HOSPITALS
    `SEC. 1898. (a) ESTABLISHMENT OF STAFFING SYSTEM- Each participating hospital shall adopt and implement a staffing system that ensures a number of registered nurses on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care. A staffing system adopted and implemented under this section shall--
    `(1) be developed on the basis of input from the direct care-giving registered nurse staff or, where nurses are represented, with the applicable recognized or certified collective bargaining representatives of the registered nurses;
    `(2) be based upon the number of patients and the level and variability of intensity of care to be provided, with appropriate consideration given to admissions, discharges and transfers during each shift;
    `(3) account for contextual issues affecting staffing and the delivery of care, including architecture and geography of the environment and available technology;
    `(4) reflect the level of preparation and experience of those providing care;
    `(5) account for staffing level effectiveness or deficiencies in related health care classifications, including but not limited to, certified nurse assistants, licensed vocational nurses, licensed psychiatric technicians, nursing assistants, aides and orderlies;
    `(6) reflect staffing levels recommended by specialty nursing organizations;
    `(7) subject to subsection (b), establish upwardly adjustable registered nurse-to-patient ratios based upon registered nurses' assessment of patient acuity and existing conditions;
    `(8) provide that a registered nurse shall not be assigned to work in a particular unit without first having established the ability to provide professional care in such unit; and
    `(9) be based on methods that assure validity and reliability.
    `(b) LIMITATION- A staffing system adopted and implemented pursuant to subsection (a) may not--
    `(1) set registered-nurse levels below those required by any Federal or State law or regulation; or
    `(2) utilize any minimum registered nurse-to-patient ratio established pursuant to subsection (a)(7) as an upper limit on the staffing of the hospital to which such ratio applies.
    `(c) REPORTING, AND RELEASE TO PUBLIC, OF CERTAIN STAFFING INFORMATION-
    `(1) REQUIREMENTS FOR HOSPITALS- Each participating hospital shall--
    `(A) post daily for each shift, in a clearly visible place, a document that specifies in a uniform manner (as prescribed by the Secretary) the current number of licensed and unlicensed nursing staff directly responsible for patient care in each unit of the hospital, identifying specifically the number of registered nurses;
    `(B) upon request, make available to the public--
    `(i) the nursing staff information described in subparagraph (A); and
    `(ii) a detailed written description of the staffing system established by the hospital pursuant to subsection (a); and
    `(C) submit to the Secretary in a uniform manner (as prescribed by the Secretary) the nursing staff information described in subparagraph (A) through electronic data submission not less frequently than quarterly.
    `(2) SECRETARIAL RESPONSIBILITIES- The Secretary shall--
    `(A) make the information submitted pursuant to paragraph (1)(C) publicly available, including by publication of such information on the Internet site of the Department of Health and Human Services; and
    `(B) provide for the auditing of such information for accuracy as a part of the process of determining whether an institution is a hospital for purposes of this title.
    `(d) RECORD-KEEPING; DATA COLLECTION; EVALUATION-
    `(1) RECORD-KEEPING- Each participating hospital shall maintain for a period of at least 3 years (or, if longer, until the conclusion of pending enforcement activities) such records as the Secretary deems necessary to determine to whether the hospital has adopted and implemented a staffing system pursuant to subsection (a).
    `(2) DATA COLLECTION ON CERTAIN OUTCOMES- The Secretary shall require the collection, maintenance, and submission of data by each participating hospital sufficient to establish the link between the staffing system established pursuant to subsection (a) and--
    `(A) patient acuity from maintenance of acuity data through entries on patients' charts;
    `(B) patient outcomes that are nursing sensitive, such as patient falls, adverse drug events, injuries to patients, skin breakdown, pneumonia, infection rates, upper gastrointestinal bleeding, shock, cardiac arrest, length of stay, and patient re-admissions;
    `(C) operational outcomes, such as work-related injury or illness, vacancy and turnover rates, nursing care hours per patient day, on-call use, overtime rates, and needle-stick injuries; and
    `(D) patient complaints related to staffing levels.
    `(3) EVALUATION- Each participating hospital shall annually evaluate its staffing system and established minimum registered nurse staffing ratios to assure on-going reliability and validity of the system and ratios. The evaluation shall be conducted by a joint management-staff committee comprised of at least 50 percent of registered nurses who provide direct patient care and where nurses are represented, with the involvement of the applicable recognized or certified collective bargaining representatives of the registered nurses.
    `(e) ENFORCEMENT-
    `(1) RESPONSIBILITY- The Secretary shall enforce the requirements and prohibitions of this section.
    `(2) PROCEDURES FOR RECEIVING AND INVESTIGATING COMPLAINTS- The Secretary shall establish procedures under which--
    `(A) any person may file a complaint that a participating hospital has violated a requirement or a prohibition of this section; and
    `(B) such complaints are investigated by the Secretary.
    `(3) REMEDIES- If the Secretary determines that a participating hospital has violated a requirement of this section, the Secretary--
    `(A) shall require the facility to establish a corrective action plan to prevent the recurrence of such violation; and
    `(B) may impose civil money penalties under paragraph (4).
    `(4) CIVIL MONEY PENALTIES-
    `(A) IN GENERAL- In addition to any other penalties prescribed by law, the Secretary may impose a civil money penalty of not more than $10,000 for each knowing violation of a requirement of this section, except that the Secretary shall impose a civil money penalty of more than $10,000 for each such violation in the case of a participating hospital that the Secretary determines has a pattern or practice of such violations (with the amount of such additional penalties being determined in accordance with a schedule or methodology specified in regulations).
    `(B) PROCEDURES- The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A.
    `(C) PUBLIC NOTICE OF VIOLATIONS-
    `(i) INTERNET SITE- The Secretary shall publish on the Internet site of the
    Department of Health and Human Services the names of participating hospitals on which civil money penalties have been imposed under this section, the violation for which the penalty was imposed, and such additional information as the Secretary determines appropriate.
    `(ii) CHANGE OF OWNERSHIP- With respect to a participating hospital that had a change in ownership, as determined by the Secretary, penalties imposed on the hospital while under previous ownership shall no longer be published by the Secretary of such Internet site after the 1-year period beginning on the date of change in ownership.
    `(f) WHISTLE-BLOWER PROTECTIONS-
    `(1) PROHIBITION OF DISCRIMINATION AND RETALIATION- A participating hospital shall not discriminate or retaliate in any manner against any patient or employee of the hospital because that patient or employee, or any other person, has presented a grievance or complaint, or has initiated or cooperated in any investigation or proceeding of any kind, relating to the staffing system or other requirements and prohibitions of this section.
    `(2) RELIEF FOR PREVAILING EMPLOYEES- An employee of a participating hospital who has been discriminated or retaliated against in employment in violation of this subsection may initiate judicial action in a United States District Court and shall be entitled to reinstatement, reimbursement for lost wages and work benefits caused by the unlawful acts of the employing hospital. Prevailing employees are entitled to reasonable attorney's fees and costs associated with pursuing the case.
    `(3) RELIEF FOR PREVAILING PATIENTS- A patient who has been discriminated or retaliated against in violation of this subsection may initiate judicial action in a United States District Court. A prevailing patient shall be entitled to liquidated damages of $5,000 for a violation of this statute in addition to any other damages under other applicable statutes, regulations or common law. Prevailing patients are entitled to reasonable attorney's fees and costs associated with pursuing the case.
    `(4) LIMITATION ON ACTIONS- No action may be brought under paragraph (2) or (3) more than 2 years after the discrimination or retaliation with respect to which the action is brought.
    `(5) TREATMENT OF ADVERSE EMPLOYMENT ACTIONS- For purposes of this subsection--
    `(A) an adverse employment action shall be treated as `retaliation or discrimination'; and
    `(B) an adverse employment action includes--
    `(i) the failure to promote an individual or provide any other employment-related benefit for which the individual would otherwise be eligible;
    `(ii) an adverse evaluation or decision made in relation to accreditation, certification, credentialing, or licensing of the individual; and
    `(iii) a personnel action that is adverse to the individual concerned.
    `(g) RULES OF CONSTRUCTION-
    `(1) RELATIONSHIP TO STATE LAWS- Nothing in this section shall be construed as exempting or relieving any person from any liability, duty, penalty, or punishment provided by any present or future law of any State or political subdivision of a State, other than any such law which purports to require or permit the doing of any act which would be an unlawful practice under this title.
    `(2) RELATIONSHIP TO CONDUCT PROHIBITED UNDER THE NATIONAL LABOR RELATIONS ACT- Nothing in this section shall be construed as permitting conduct prohibited under the National Labor Relations Act or under any other federal, State, or local collective bargaining law.
    `(h) REGULATIONS- The Secretary shall promulgate such regulations as are appropriate and necessary to implement this Act.
    `(i) DEFINITIONS- For purposes of this section--
    `(1) the term `participating hospital' means a hospital that has entered into a provider agreement under section 1866;
    `(2) the term `registered nurse' means an individual who has been granted a license to practice as a registered nurse in at least one State;
    `(3) the term `unit' of a hospital is an organizational department or separate geographic area of a hospital, such as a burn unit, a labor and delivery room, a post-anesthesia service area, an emergency department, an operating room, a pediatric unit, a step-down or intermediate care unit, a specialty care unit, a telemetry unit, a general medical care unit, a subacute care unit, and a transitional inpatient care unit;
    `(4) a `shift' is a scheduled set of hours or duty period to be worked at a participating hospital; and
    `(5) a `person' includes one or more individuals, associations, corporations, unincorporated organizations or labor unions.'.
    (c) EFFECTIVE DATE- The amendments made by this section shall become effective on January 1, 2005.
  2. by   pickledpepperRN
    Still in committee?

    http://thomas.loc.gov/cgi-bin/bdquery/z?d108:h.r.03656:
    Bill Summary & Status for the 108th Congress


    NEW SEARCH | HOME | HELP

    H.R.3656
    Title: To amend title XVIII of the Social Security Act to impose minimum nurse staffing ratios in Medicare participating hospitals, and for other purposes.
    Sponsor: Rep Capps, Lois [CA-23] (introduced 12/8/2003) Cosponsors: 13
    Latest Major Action: 12/17/2003 Referred to House subcommittee. Status: Referred to the Subcommittee on Health.
  3. by   Hellllllo Nurse
    I believe Congesswoman Lois Capps is an RN.

    Finally, someone is doing something!
  4. by   abbynormal
    Quote from spacenurse
    Still in committee?

    http://thomas.loc.gov/cgi-bin/bdquery/z?d108:h.r.03656:
    Bill Summary & Status for the 108th Congress


    NEW SEARCH | HOME | HELP

    H.R.3656
    Title: To amend title XVIII of the Social Security Act to impose minimum nurse staffing ratios in Medicare participating hospitals, and for other purposes.
    Sponsor: Rep Capps, Lois [CA-23] (introduced 12/8/2003) Cosponsors: 13
    Latest Major Action: 12/17/2003 Referred to House subcommittee. Status: Referred to the Subcommittee on Health.
    [font=Comic Sans MS]Hi SpaceNurse,
    [font=Comic Sans MS]Are you involved in political arena? I am working with ANA, Maine as a Legislative Buddy to educate policy makers of nursing issues and critical shortage. You seem to have a lot of knowledge, and wondering where you research, specifically. This is a new volunteer venture and I want to do the very best job to represent nurses and problems in providing high quality healthcare. Have used Maine.gov web site.
    [font=Comic Sans MS]It is great to read all the threads on these vital issues and concerns. Having a space to do it is rewarding and valueable.
    [font=Comic Sans MS]Please share any web sites with legislative info! Many Thanks:>}
    [font=Comic Sans MS]Peace and Renewal to All,
    [font=Comic Sans MS]Maine RN:angel2:
  5. by   Dixiedi
    Quote from spacenurse
    I was an LVN for many years before earning my RN.
    Here in California the LEGAL obligation of the LVN is discharged when the LVN reports abnormal symptoms or patient care concerns to the RN. Of course this must be charted such as, "C/O pain in left knee, no swelling noted. Reported to *** RN."

    The RN is LEGALLY responsible for the entire nursing process, that is all the nursing care.

    Thank God LVNs and others have a moral and ethical obligation so if the RN does not follow upan LVN/LPN who is a patient advocate will go through channels to advocate for the patient.

    Studies have shown that for surgical patients in Pennsylvania over a three year period for every additional patient beyond four assigned to each RN the mortality rate increased by 7%.

    There were no such correlations for LPNs.

    That said, LPN/LVNs ARE NURSES. I think that regardless of the studies practical nurses are valuable members of the patient care team.
    I also think there need to be more schools of nursing and a stipend/scholarship combination so those who have proven themselves as nurses can afford to earn their RN.
    In my state more than 1/2 of the new grads who accept work in hospitals leave the bedside in less than two years. Those who worked as LVNs remain at the bedside.

    Now for some unsolicited advice: Don't give up. The months will go by whether you go to school or not. Your experience and abilities are needed. For your pride and pocketbook why not?
    It's been quite a few years, since 1987, that I worked in an acute care facility (I'm in home care now); but at that time, if my patient had a C/O that was not already part of his/her care plan I called the MD. Reported the subjective and objective findings and got the order. What happened to us (LPNs) in these years?
    They talk about pt outcomes and pt acuity with an RN only having 4 or 5 pts. What about the pt outcome and pt acuity for the pt with an LPN? I still find it so hard to believe that as a group of proffesionals we have allowed another group of proffesionals run us out of town! RNs make the rules that we must follow, RNs are our bosses, we need to inlist the help of the MDs in this country to aid our plight or we will be out of a job and in the gutter with the guys who used to make cars...before the robots started doing it!
    I am not insulting RNs, I've worked with many who were excellent nurses but ALL I have worked with considered themselves REAL nurses and LPNs little more than PLAY nurses.
    We must stop the insanity!
  6. by   Footprints
    I would like to commend all of the many people who have made this Bill a start for safer nursing care. Does any one know when the Bill may get voted on?
    Is there anything as an individual nurse that I can do to help?

    Stay Safe...
  7. by   mscsrjhm
    Please look at the whistleblower coverage for nurses/staff. This is not enough to deter a facility from adverse actions against a whistleblower.

    "may initiate judicial action in a United States District Court and shall be entitled to reinstatement, reimbursement for lost wages and work benefits caused by the unlawful acts of the employing hospital. Prevailing employees are entitled to reasonable attorney's fees and costs associated with pursuing the case."

    If a hospital doesn't comply, and a nurse reports them, there is not enough punitive reprecussions to prevent them from retaliation towards the employee.

    As it is, many states do not have whistleblowing statutes for the laws already in place. The term "PROHIBITION OF DISCRIMINATION AND RETALIATION" simply means that they cannot retaliate. However, we know that they do.

    Staffing requirements are no good if they are violated, and employees are scared to speak up.

    Please read ALL of this bill before you contact your Congresspersons.

    I think we could do better.

    Mschrisco
  8. by   Dixiedi
    Quote from Mschrisco
    Please look at the whistleblower coverage for nurses/staff. This is not enough to deter a facility from adverse actions against a whistleblower.

    "may initiate judicial action in a United States District Court and shall be entitled to reinstatement, reimbursement for lost wages and work benefits caused by the unlawful acts of the employing hospital. Prevailing employees are entitled to reasonable attorney's fees and costs associated with pursuing the case."

    If a hospital doesn't comply, and a nurse reports them, there is not enough punitive reprecussions to prevent them from retaliation towards the employee.

    As it is, many states do not have whistleblowing statutes for the laws already in place. The term "PROHIBITION OF DISCRIMINATION AND RETALIATION" simply means that they cannot retaliate. However, we know that they do.

    Staffing requirements are no good if they are violated, and employees are scared to speak up.

    Please read ALL of this bill before you contact your Congresspersons.

    I think we could do better.

    Mschrisco
    It's unfortunate that we need to protect ourselves before we can protect our pts. However, as was mentioned, retaliate they do. We really can not expect ANY new or old laws to help us in this very sticky situation for the only way they can hope to pass it is with lots of loopholes that allows employers to continue to do as they please.
  9. by   mscsrjhm
    Quote from Dixiedi
    It's unfortunate that we need to protect ourselves before we can protect our pts. However, as was mentioned, retaliate they do. We really can not expect ANY new or old laws to help us in this very sticky situation for the only way they can hope to pass it is with lots of loopholes that allows employers to continue to do as they please.
    Agreed, they definitely retaliate. Some states do have statutes regarding retaliation that specifies punitive damages, along with back pay, etc. I believe that only with this extra incintive will the facilities think twice before retaliating. Check any public policy laws your state may have.

    Mschrisco
  10. by   Destinystar
    when facilities retaliate they do it in such a way as to find a lot of witnesses to state that the nurse that made the accusation was the one who had the problem, like they will go over all of your documentation and if you did not sign a med out will say you failed to give a pt. the med, missed a treatment, etc. which really clouds the issue. still even if you blow the whistle they can still turn on you b/c it would be seen as a seperate issue. in other words if they go down they will take you down with them. they can still call the nursing boards on you and fire you for just cause based on whatever infraction of the rules they can find you violating. i mean if they called the boards and said you gave a pt. their insulin late the boards still have to investigate the complaint & you will get disciplined it doesnt matter if you blew the whistle on them or not. have.

    mschrisco[/quote]
  11. by   Dixiedi
    Quote from Mschrisco
    Agreed, they definitely retaliate. Some states do have statutes regarding retaliation that specifies punitive damages, along with back pay, etc. I believe that only with this extra incintive will the facilities think twice before retaliating. Check any public policy laws your state may have.

    Mschrisco
    I can tell you many ways around any of the laws meant to protect us in this way but I'm not going to waste the space because it's already been done in many of the posts in this thread.
    Laws protecting us in this situation don't mean anymore than a lock on a door means to a thief.
  12. by   mscsrjhm
    Quote from Dixiedi
    I can tell you many ways around any of the laws meant to protect us in this way but I'm not going to waste the space because it's already been done in many of the posts in this thread.
    Laws protecting us in this situation don't mean anymore than a lock on a door means to a thief.
    I will "waste the space", because I have personally experienced a whistleblowing civil suit. I "blew the whistle", documented, was retaliated against, filed suit, and, unfortunately I cannot discuss the ending result. I can say that "we have resolved the situation to our mutual satisfaction".
    You can tell us many ways around the laws, I can tell you many ways to enforce the law. The biggest is DOCUMENT. Get witnesses to document as it happens.
    The laws regarding retaliation can mean more than a lock on a door if nurses educate themselves, and utilize those laws. We must demand adequate whistleblowing protection. But, so many nurses think as you do... that there is nothing we can do.
    This is an area that nurses need to educate themselves in, and looking at the bills that our politicians are submitting, we need to educate IMMEDIATELY.
    Mschrisco
  13. by   pickledpepperRN
    Quote from abbynormal
    [font=Comic Sans MS]Hi SpaceNurse,
    [font=Comic Sans MS]Are you involved in political arena? I am working with ANA, Maine as a Legislative Buddy to educate policy makers of nursing issues and critical shortage. You seem to have a lot of knowledge, and wondering where you research, specifically. This is a new volunteer venture and I want to do the very best job to represent nurses and problems in providing high quality healthcare. Have used Maine.gov web site.
    [font=Comic Sans MS]It is great to read all the threads on these vital issues and concerns. Having a space to do it is rewarding and valueable.
    [font=Comic Sans MS]Please share any web sites with legislative info! Many Thanks:>}
    [font=Comic Sans MS]Peace and Renewal to All,
    [font=Comic Sans MS]Maine RN:angel2:
    I look in my unions web site, those of the ANA, and other nursing sites. After writing MANY letters to my elected representatives their offices must have me on their list because i get e-mail and snail mail from many of them.
    Then I scan the papers, do a search for words like "nurse", "hospital", and such.
    That is on my off time. When I work nightd I go to ALLNURSES.COM when I get up to go to the bathroom.

    Actually i DO have a life. I just try to do my part so if things get better I can feel like part of the MANY who helped. If we don't succeed at least I don't feel guilty for not trying.

    I do visit my local state assemblypersons office about every other month and talk with the staff about nursing related bills. Sometimes they call me when they have a family member in the hospital. I don'y give a lot of advice, just listen and sometimes explain some things to them. One staff member had never seen a Foley Catheter before!
    Last year there were a lot of questions on isolation. Now it is stem cells. I don't know enough to educate anyone else yet.

    Just an old activist. I bet your state nurses association provides opportunities for learning about how to represent nurses and patients in the political arena.

    I had to come back and add that NurseKaren is the real nursing activism and pilitics expert on this BB! Just a few examples:

    http://allnurses.com/forums/showthread.php?t=36759

    http://allnurses.com/forums/showthread.php?t=38830

    http://allnurses.com/forums/showthread.php?t=38520

    http://allnurses.com/forums/showthre...threadid=36379
    Last edit by pickledpepperRN on Jun 29, '04

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