Quality Nursing Care Act of 2004 (Federal, USA)

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    http://www.house.gov/apps/list/press...nursebill.html

    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


    WASHINGTON, D.C. – Congresswoman Lois Capps today announced the introduction of important new health safety legislation to address the direct link between the number of registered nurses and the quality of care provided in our nation’s hospitals. The Quality Nursing Care Act of 2004 (HR 3656) would require each hospital, in consultation with the nursing staff, to implement a staffing system that ensures an appropriate number of registered nurses on each shift and in each unit of the hospital to guarantee quality patient care.

    “Sufficient staffing is the number one concern of nurses today, and it is critical to the delivery of quality patient care,” said Capps, a registered nurse and co-chair of the House Nursing Caucus. “It’s no secret that when there aren’t enough nurses on the floor, there is an increased chance of medical errors and leads to staff burnout, greater work stress, and compromised patient care, and more nurses leaving the profession. This bill will encourage nurses and hospitals to work together to make sure the right number of nurses are there to provide the excellent care that each and every patient deserves.”

    Specifically, the Quality Nursing Care Act of 2004 amends the conditions of participation for hospitals in the Medicare program and establishes a requirement for minimum staffing ratios. Rather than establishing a specific numeric ratio, that act requires the establishment of 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.”

    “The American Nurses Association (ANA) commends Representative Capps for her leadership on this issue and for her commitment to protecting patients and nurses from practices that are dangerous," said ANA President Barbara Blakeney. “This legislation is necessary to improve the work environment for nurses, and it will help in recruiting new nurses into the profession while also retaining those nurses who are already practicing.”

    The act mandates that the staffing system:
    • Require input from direct care-giving RNs or their exclusive representatives;
    • Be based upon the number of patients and level and intensity of care to be provided, with consideration given to admissions, discharges and transfers during each shift;
    • Account for architecture and geography of the environment and available technology;
    • Reflect the level of preparation and experience of those providing care;
    • Reflect staffing levels recommended by specialty nursing organizations;
    • Account for ancillary staff support;
    • Provide that a RN not be assigned to work in a particular unit without first having established the ability to provide professional care in such a unit;
    • Be based on methods that assure validity and reliability.

    In addition, the Quality Nursing Care Act of 2004 requires public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs.

    Finally, the bill provides whistle-blower protections for RNs and others who may file a complaint regarding staffing. The bill establishes procedures for receiving and investigating complaints, and creates including civil monetary penalties that can be imposed by the Secretary of Health and Human Services for each knowing violation.

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  2. 30 Comments so far...

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    Is somebody out there actually listening!!! I can't believe it, if we could go back to rating each patients accuity and assign according to that, it would be so great. I used to hate doing that, but when the hospital got rid of it I found that, of course, they would say a patient is a patient, WELL NO THEY AREN'T. It basically was a way of the hospitals staffing less.

    Then if they would just raise our pay some, it would entice new nurses to come in, and other nurses to come back. NO MORE NURSING SHORTAGE...
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    Sounds good. except for that part here...."Require input from direct care-giving RNs or their exclusive representatives"

    Who would that be, exactly?? BUt still, it sounds good.

    Question, though. Since it doesn't state specific NUMBERS of nurses, just vague criteria that there be enough nurses, do you think admin would be likely to think that "enough nurses" is the same as what care-giving nurses would say?? I mean, admin already thinks we have too many people on the floor when we have just ADEQUATE staff, and people get sent home.

    I hope it works, but I'm not holding my breath.
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    My first thought that there is too much room for managment wiggle in this legislation. I would consider it a first step. I do not think this legislation totally comprehends the greed in the hearts of healthcare managment.
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    Definition of "Exclusive Representatives" = Representatives, designated or selected for purposes of collective bargaining by a majority of employees in a unit appropriate for such purposes, shall be the exclusive representative of all employees in such unit for the purposes of collective bargaining in respect to rates of pay, wages, hours of employment and other terms and conditions of employment.
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    Quote from spacenurse
    http://www.house.gov/apps/list/press...nursebill.html

    In addition, the Quality Nursing Care Act of 2004 requires public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs.


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    This is what I see as ultimately being able to make a difference! Coupled with the whistleblower protection, there will be no wiggle room with this provision.
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    Why aren't LPN's mentioned in this particular legislation aren't we licensed professionals too.

    I mean I admire and respect all RN's and will be one someday, but right now iI will be just as much responsible for patient care as any RN.
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    Quote from resqrider
    Why aren't LPN's mentioned in this particular legislation aren't we licensed professionals too.

    I mean I admire and respect all RN's and will be one someday, but right now iI will be just as much responsible for patient care as any RN.
    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?
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    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?
    Thanks for the vote of confidents I hope i can be that valuable asset that you discribed. I think that the RN gets more of the hassle especially when they get into the management arena and yet it only takes one "bad" LPN/LVN to mess it up. Well back to the books I wish all were just a concientous (sp) :hatparty: May 14 Graduate Practical Nurse
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    We are required to assign acuity to our pts too but at my hospital they still are not using it...or at least using it correctly. One night I had 9 pts.....among the group was 4 CP r/o MI's, 1 GI bleed, 2 confused (Alzheimers) nursing home pts that kept trying to climb out of bed all night, 1 terminal cancer that needed so much attention and a alcohol withdrawal pt that was both seeing and hearing things and was absolutely livid that I would not let him smoke. Thank God for a excellent CNA that was really on top of things for me. I was ready to go work at Walmarts or Burger King by 7 a.m.


    Vickie


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