Proposed Federal Legislation Could Ease Nursing Shortage

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    nursing education

    the u.s. senate committee on health, education, labor and pensions adopted an amended nursing employment and education development act that combines elements of the original language with nursing bills heralded on november 6 by sens. hillary rodham cinton, d-ny, and joseph lieberman, d-ct. the amended s. 721 would authorize over six years $85 million for a nursing corps loan repayment program, $60 million for hospitals to develop and evaluate models and best practices for retaining nurses, and $85 million for a student loan fund to fast-track nursing faculty development. other provisions include funding for multimedia nurse recruitment campaigns, community outreach programs to recruit and retain nurses, and career ladder programs. the measure next moves to the senate floor. psna worked with sen. lieberman's office to provide background information prior to the introduction of this legislation.

    mandatory overtime

    the safe nursing and patient care act of 2001, was introduced in early november 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. the american nurses association 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.

    the safe nursing and patient care act would:

    * prohibit 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. in no instance could a nurse be required to work more than 12 hours in a 24-hour period or for more than 80 hours in a two-week period - a provision that would prevent an institution from altering shift schedules in a way that would undermine the law.

    * include nondiscrimination protections for nurses who refuse overtime and for nurses who provide information and/or cooperate with investigations about the use of overtime.

    * include 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.

    * provide for a study by the department of health and human services on the maximum number of hours that may be worked by a nurse without compromising patient safety.

    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. fueling the shortage are a number of confluent factors, including an aging baby-boom population; an aging nurse population; a decline in younger nurses who are entering the profession; and a shortage of nursing faculty in the nation's nursing programs. also complicating the situation has been an increase in patient acuity, an increase in the use of sophisticated technology and a decrease in the length of stay for patients.

    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.

    psna was instrumental in getting sb 989 introduced at the state level, which if enacted would prohibit mandatory overtime as a regular means of nurse staffing. psna has also authored a position statement regarding mandatory overtime.
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  3. by   Mijourney
    Hi. Is it not true that ethical nursing practice falls under the nurse practice act? Could the nurse practice act not be used in situations where employers are trying to say a nurse is insubordinate because they won't totally prostitute him/herself?

    Karen, I will have to see if I can find and spend time, if possible reading more about the first proposal by Senators Lieberman and Clinton, the second proposal is something that I believe is needed immediately.
  4. by   NRSKarenRN
    Is it not true that ethical nursing practice falls under the nurse practice act? Could the nurse practice act not be used in situations where employers are trying to say a nurse is insubordinate because they won't totally prostitute him/herself?
    MIJourney, you are correct. Along with the ANA code for Nurses, your practice act is what protects YOU and the public. It is imperative that ALL NURSES READ their states act.

    Link to state boards of nursing...scroll to your state to see if act on line.

    There have been court cases where this has occured. Check out this story below. 6 RN's from New Mexico repeatedly informed hospital officals of a doctors questional competence. Nothing was done. A patient was harmed. Based on the states practice act and ANA Code for Ethics they reported the situation. The Hospital went to court to block the RN's from testifying saying they were hospital employees and therfore could not publically comment on the doctor AND they had to use the hospital lawyers involved in the case. At issue for the nurses was the hospital's assertion that New Mexico state regulations prohibit the sharing of patient information, regardless of the reasons!

    ANA Files Amicus Brief in Support of Six Nurse Whistleblowers
    The American Nurses Association (ANA) has filed an amicus curiae ("friend of the court") brief on behalf of six registered nurses (RNs) from New Mexico who have chosen to stand together and act as whistleblowers regarding a physician whose alleged incompetent and unprofessional conduct is claimed in a lawsuit to have resulted in the death of a patient. More...

    "The court ruled that the Memorial Medical Center could not require its employed nurses to speak only through or with hospital attorneys. Over the hospital's objections, the judge included a charge nurse within the scope of the court's protective ruling for the staff nurses. This ruling not only provides protections for the nurses involved in the case, it also reveals the importance of nurses' ethical requirements and the need for state law and judicial proceedings to protect nurses who speak out on behalf of quality patient care. In addition, the court held the hospital accountable for any retaliation against the nurses, stating that retaliatory action will be considered contempt of court. "

    Ethic article on this issue: Toward an Ethical Defense of Whistleblowing

    A great article I've found "WHISTLEBLOWING AS A FAILURE OF ORGANIZATIONAL ETHICS" from Online Journal of Issues in Nursing published Dec. 31, 1998.
  5. by   canoehead
    Thanks Karen, I really appreciate all the good information and links you put up.