Legislation Pending That Affects Nurses

  1. 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." >>>>
    Last edit by -jt on Jan 26, '02
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  3. by   -jt
    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
  4. by   -jt
    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
  5. by   -jt
    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.

    Background/Talking Points

    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
  6. by   -jt
    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
  7. by   -jt
    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
  8. by   -jt
    In reviewing these bills & seeing how they will have a direct positive impact on the working conditions nurses face, I find it difficult to understand why some people continue to mistakenly believe that the only effort that is being made is to educate new students and that no effort is being made to improve conditions, attract non-working nurses, or retain current nurses. Its so obvious with these bills that the focus is on repairing working conditions, attracting non-working nurses, retaining current nurses, as well as educating new nurses for the future.
  9. by   NRSKarenRN
    Second that JT.

    Find out the real stands ANA has and its advocacy for nurses by signing up for the e-mail alerts available as a FREE service to all nurses.....courtesy of ANA members dues.

  10. by   -jt
    I was sent this article today & while I think the MDs heart is in the right place, it worried me that he thinks we are leaving hospital jobs because of paper work and that he thinks its up to doctors to find solutions for nurses & "do something" about the nursing shortage. I remember the last time they tried to help us & "do something" about a previous nursing shortage
    - they came up with the idea of REGISTERED Care Technicians - which would have been licensed aides & would have replaced nurses. We shot the AMA down on that one but it was touch & go for a while there. I shudder to think what they would come up with now. I respectfully replied to him by sending him all these legislations & telling him MDs dont have to come up with solutions to solve the nursing shortage because NURSES already have the solutions but if they could pressure their hospital administrators & legislators & support us in backing OUR solutions - including better compensations - we'd appreciate it. : )

    <<Hailing one of health care's priceless resources -- nurses

    Commentary. By Michael Greenberg, MD, AMNews contributor.
    Jan. 28, 2002.

    The U.S. Dept. of the Interior spends millions of dollars to protect our nation's endangered species. It writes long lists of plants and animals whose populations are dangerously low and hires scientists to figure out ways to increase their numbers. Too bad they haven't turned their attention to nurses. In the fragile ecosystem of medical care, nurses are the ones who create the protective environment essential to the well-being of both doctors and patients.

    We cannot function without them. Their job is to provide knowledge, comfort, care and compassion. But, lest nurses be offended by my comparing them to the plant and animal life that are on the endangered species list, the metaphor stops here. My point is that it seems society expends greater resources and energy on the protection of birds and flowers than on protecting the viability of the nursing profession.

    Throughout my training, it was as many nurses as doctors who turned me from a green medical student into a full-fledged physician. At times, nurses were my primary source of learning. Because the housestaff was overwhelmed, an operating room nurse took the time to teach me the fine points of suturing. When she saw I had mastered the technique, she put the needle holder into my hand during a procedure. "The student is ready to close," she informed the surgeon.

    My initial assignment during my first post-graduate year as a pediatric resident was the newborn nursery. Not yet a father, and uncomfortable in my awareness of how little I really knew despite the magical initials that had been recently appendaged to my name, I admitted my fears to the head nurse. Her smile put me at ease. "We're going to teach this young doctor how not to drop babies," she announced to the other nurses in her unit. And by the end of the first week, I was a pro.

    Even more frightening to me were the high-risk nursery and pediatric intensive care units. But by admitting my ignorance and asking for help from the nurses in each area through which I rotated, I felt myself respected and supported. And I believe the patients were better cared for because of the partnership I created with the nursing staff. At least they prevented me from killing anybody. During my dermatology residency, nurses I met while moonlighting in attendings' private offices taught me medical techniques and also provided me with an education in business and practice promotion.

    A significant part of the success of my more than 20 years in practice is directly attributable to the wonderful nurses who have worked with me. Along with my office staff, they maintain the "sacred space" in which patients and I interact. Nurses are full-fledged partners in the health care equation, offering not only their compassionate perspective but also their eyes, ears and hearts. I am indebted to them for the many times they have prevented me from doing or saying something foolish, or worse, harming a patient. Hospitals and office practices have difficulty filling vacancies as nurses discover they can earn higher salaries in other professions.

    But beyond the money, nurses are disappearing because as much misery as managed care has brought to doctors, they have been affected more than we have. Nurses traditionally have been the human interface between the hospital and patient. While our time with patients was measured in minutes, nurses spent hours with patients. They were the ones who knew how patients were really doing and informed us at the first signs of trouble. With the advent of managed care, many nurses have been relegated to shuffling papers and recording information.

    And as much as we didn't become doctors to argue with insurance companies, nurses didn't earn their degrees to push pencils. Unfortunately, I don't have a solution for the problem. Raising awareness of the crisis is a good start. Nurses are a priceless health care resource that is not being renewed or protected. And if we as doctors don't do something to reverse the situation, both our patients and our own profession will suffer. Let's not wait until nurses become extinct. Dr. Greenberg is a dermatologist in Elk Grove Village, Ill. and author of the novel A Man of Sorrows (http://www.anovelvision.com/). You can contact him by e-mail (offped@aol.com). >>>>>>>
  11. by   -jt

    <<<From the NY Senators website:

    The Nurse Retention-Quality Care Act 2001, written by the nurses of the New york State Nurses Association and introduced to Congress by Senator Hillary Clinton (D-NY) in October 2001, addresses many of the workplace problems that are causing experienced nurses to flee the hospital environment.

    In late December, the Senate passed, by unanimous consent, a bipartisan proposal by Senator Clinton and Senator Gordon Smith (Oregon) to promote "Magnet hospital" nursing practices -innovative practices which have been proven to result in lower RN staff turnover, greater job satisfaction, and better patient care.
    This bill would provide grants to encourage hospitals and other health care facilities to adopt practices that make some hospitals nursing "magnets" because of their ability to attract and retain nurses, even during times of shortage.

    These hospitals, officially designated and awarded by the ANA's American Nurses Credentialing Center, are successful because they involve nurses in the decision-making, encourage collaboration among health professionals, give nurses the opportunity to pursue continuing education and advancement, and organize care to improve patient outcomes - emphasizing the hallmark magnet values of involving nurses in decisions, innovation and leadership.

    There are only approximately 3 dozen hospitals nation-wide that have achieved Magnet status award recognition to date, and in all of NY state the only one is Long Island Jewish Hospital. Like the others, it is not experiencing a nursing shortage or any difficulty in recruiting nurses. Like the others, after recently achieving recognition from the ANA/ANCC as being a Magnet facility, nurses from all over the area are seeking employment there. Most importantly, like the others, it is not having any difficulting retaining its RN staff.

    The Nurse Retention-Quality Care Act 2001 will provide an incentive for other facilities to change their management practices to those applied by Magnet facilities and which respect and value nurses, thus improving job satisfaction, recruitment and retention of nursing staff. Support the Nurse Retention-Quality Care Act 2001.
    http://clinton.senate.gov/news/2002/01/2002123353.html >>>
  12. by   OC_An Khe
    With regard to encouraging Magnet Hospitals, instead of grants from the Federal ggovernment, how about higher MediCare /Medicaid reimbursement rates foer those hospitals that attain and keep Magnet Status?
  13. by   -jt
    <<<The Safe Nursing and Patient Care Act:

    A bill, introduced by Rep. Pete Stark (D-CA) and Rep. Steven LaTourette (R-OH) with more than 20 U.S. House of Representatives colleagues, that would strictly limit the use of mandatory overtime for nurses. Sens. Edward Kennedy (D-MA) and John Kerry (D-MA) will introduce companion legislation in the Senate.

    The bill is expected to address the current nurse staffing crisis in the U.S. by strictly limiting the use of forced overtime among nurses, a dangerous practice that has contributed to a recent exodus of nurses from the nation's hospitals and a decline in safe, quality patient care. ANA was at the forefront of the push for this legislation and worked collaboratively on its development with members of Congress and other organizations representing nurses.

    This bill offers protection by prohibiting health care facilities from forcing exhausted nurses to work extra shifts, an unsafe practice that puts both patients and nurses at risk:

    * Prohibits health care institutions that receive Medicare funding from requiring a registered nurse (RN) or licensed practical nurse (LPN) to work beyond an agreed to, predetermined, regularly scheduled shift - a provision that would prevent an institution from altering shift schedules in a way that would undermine the law.

    * Includes non-discrimination protections for nurses who refuse overtime and for nurses who provide information and/or cooperate with investigations about the use of overtime.

    * Includes an exception in the case of a declared national, state or local emergency. Such an emergency would be in response to an unpredictable disaster, not in response to a staffing deficiency resulting from management practices.

    * Provides for a study by the Department of Health and Human Services on the maximum number of hours that are safe for nurses to work

    The ANA has long warned that mandatory overtime is dangerous for patients and nurses, and that the practice has been driving nurses away from the profession, thus exacerbating an emerging nursing shortage that is expected to worsen dramatically over the next 10 years.

    To counter staffing insufficiencies that are already occurring, many health care facilities across the nation have increasingly imposed mandatory overtime as a common practice. Typically, an employer may insist that a nurse work an extra shift (or more) or face dismissal for insubordination, as well as being reported to the state board of nursing for patient abandonment, a charge that could lead to a loss of license for the nurse. At the same time, ethical nursing practice prohibits nurses from engaging in behavior that they know could harm patients, thus leading to a dilemma for many nurses.

    By using health care law to address the problem, Congress is recognizing that mandatory overtime is a health care crisis that must be addressed if patients are to receive safe and effective care. >>>
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