By Debra Wood, RN, contributor
May 23, 2014 - The federal Registered Nurse Safe Staffing Act of 2013 inched closer to passage as the American Nurses Association-supported legislation picked up support in the U.S. Senate.
Jerome “Joe” Mayer from the American Nurses Association said that legislative process for the safe staffing bill will take some time, but nurses can help make it happen.
“When we poll our membership about what is their top priority, the most important issues facing them, their patients and/or the profession, staffing is the No. 1 issue,” said Joe Mayer, associate director of the department of government affairs at the American Nurses Association (ANA) in Silver Spring, Md.
The ANA-supported bills (S 2353/HR 1821), call for the establishment of staffing committees comprised of at least 55 percent staff nurses. The committees would create unit-by-unit nurse staffing plans based on the number of patients on the unit, acuity, experience and skill level of the RNs, availability of support staff and technological resources.
Sen. Jeff Merkley (D-Oregon), chair of the Senate Nursing Caucus, signed on as a sponsor this year. The late Daniel Inouye (D-Hawaii) had sponsored the legislation in previous years. Co-chairs of the House Nursing Caucus, Reps. David Joyce (R-Ohio) and Lois Capps (D-California) introduced the House bill.
“As the husband of a nurse, I know first-hand the many challenges nurses face and how critical their care is to patients,” said Sen. Merkley in a statement. “Safe staffing that enhances patient care, reduces medical errors and bolsters nurse retention all at the same time would be a tremendous improvement to health care delivery.”
Mayer said bills in both the House and Senate provide an opportunity to educate elected leaders in both chambers about the issue of safe staffing and offer a solution.
“It’s always good to have a companion bill,” said Mayer, acknowledging with the summer recess fast approaching, the bill will likely not pass this year. “We will, hopefully, get an early introduction in the next Congress.”
Deborah Burger, RN, co-president of National Nurses United (NNU) and president of the California Nurses Association, agreed nurse staffing bills create a dialogue about the role staffing plays in improving patient safety. However, Burger and NNU support HR 1907/S 739, a ratios bill.
“In the Lois Capps bill [HR 1821], there are not mandated maximum numbers of patients nurses can take care of,” Burger said. “In states that have staffing committees already in place, they didn’t work. This [HR 1907] is a way to establish a ceiling.”
Deborah Burger, RN, said maximum patient-to-nurse ratios have been proven effective in California.
If the acuity of the patients warrants additional staffing, a ratio bill allows for more nurses but not for more patients per nurse, she explained.
Staffing ratios have worked well in California, however some care has moved to unregulated outpatient settings, Burger said. She reported a substantial number of travel nurses come to California and opt to stay.
“They think they have died and gone to heaven,” Burger said. “In some states, like Ohio, [nurses] have 15 patients.”
Multiple studies, including one from Linda Aiken, PhD, FFAN, FRCN, RN, at the University of Pennsylvania, found fewer patient deaths in California compared to other states after the ratio law went into effect. Additionally, Cal Nurses has found more nurses expressed satisfaction with their jobs.
Seven states--Connecticut, Illinois, Nevada, Ohio, Oregon, Texas and Washington--have enacted staffing committee legislation similar to S 2353/HR 1821, with mixed results.
“It’s with varying degrees of effectiveness,” Mayer said.
Mayer added that ANA is not opposed to bill HR 1907, but the organization thinks 2353/HR 1821 is more pragmatic and allows hospitals in a variety of settings--rural, academic, etc.--to determine the staffing ratio.
“We want to have partners within the hospital,” Mayer said. “Many hospitals have great staffing, but there are bad actors out there.”
The bills S 2353/HR 1821 would require hospitals that participate in Medicare to form the staffing committees and to publicly report nurse staffing plans for each unit; it would also allow the U.S. Department of Health and Human Services to impose civil monetary penalties for known violations. Mayer said the state laws do not have the same enforcement provisions.
Burger said another drawback to staffing committees is that the committee does not control the nursing budget, support staff or where patients are placed. A really sick patient may be kept on a med-surg floor for a variety of reasons outside the control of the committee.
Neither bill is likely to pass this year, with limited time before the summer recess. Mayer explained federal legislation does not move quickly, describing passage as a marathon, not a sprint.
“Just because it’s an uphill fight does not mean it’s not worth doing,” Mayer said.
Nurses have the opportunity to voice their concerns. Mayer said ANA’s government affairs committee tries to make it easy for nurses to participate in the legislative process.
On June 12, ANA will hold a lobby day. Mayer expects hundreds of nurses will participate and meet with their representatives and senators and discuss their support of the bill. Nurses not able to travel to the nation’s capital will have opportunities to call or email their elected leaders.
Meanwhile, state legislatures are debating similar issues. Massachusetts will let voters decide this year on a referendum about nurse-to-patient ratios and a cap on CEO compensation.
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