05.13.13
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RN Safe Staffing Bill

The American Nurses Association (ANA) applauds the introduction of federal legislation that empowers registered nurses (RNs) to drive staffing decisions in hospitals and, consequently, protect patients and improve the quality of care.

The Registered Nurse Safe Staffing Act of 2013 (H.R. 1821), crafted with input from ANA, has sponsors from both political parties who co-chair the House Nursing Caucus – Reps. David Joyce (R-OH) and Lois Capps (D-CA), a nurse.

“Nurse staffing has a direct impact on patient safety. We know that when there are appropriate nurse staffing levels, patient outcomes improve. Determining the appropriate number and mix of nursing staff is critical to the delivery of quality patient care,” said ANA President Karen A. Daley, PhD, RN, FAAN. “Federal legislation is necessary to increase protections for patients and ensure fair working conditions for nurses.”

Research has shown that higher staffing levels by experienced RNs are linked to lower rates of patient falls, infections, medication errors, and even death.

And when unanticipated events happen in a hospital resulting in patient death, injury, or permanent loss of function, inadequate nurse staffing often is cited as a contributing factor.

The bill would require hospitals to establish committees that would create unit-by-unit nurse staffing plans based on multiple factors, such as the number of patients on the unit, severity of the patients’ conditions, experience and skill level of the RNs, availability of support staff, and technological resources.

The safe staffing bill also would require hospitals that participate in Medicare to publicly report nurse staffing plans for each unit. It would place limits on the practice of “floating” nurses by ensuring that RNs are not forced to work on units if they lack the education and experience in that specialty. It also would hold hospitals accountable for safe nurse staffing by requiring the development of procedures for receiving and investigating complaints; allowing imposition of civil monetary penalties for knowing violations; and providing whistle-blower protections for those who file a complaint about staffing.

ANA backed a similar staffing bill in the last Congress. This version includes requirements that a hospital’s staffing committee be comprised of at least 55 percent direct care nurses or their representatives, and that the staffing plans must establish adjustable minimum nurse-to-patient ratios.

Additionally, ANA has advocated for safe staffing conditions for the nation’s RNs through the development and updating of ANA’s Principles for Nurse Staffing, and implementation of a national nursing quality database program that correlates staffing to patient outcomes.

To date, seven states have passed nurse safe staffing legislation that closely resembles ANA’s recommended approach to ensure safe staffing, utilizing a hospital-wide staffing committee in which direct care nurses have a voice in creating the appropriate staffing levels. Those states are Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington.

For more information on ANA’s safe staffing legislative efforts, please visit www.RNAction.org.

05.13.13
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MNA NewsScan, May 13, 2013: Fund set for RNs, colleagues lost in limo fire; ND highest in worker death

NOTES ON NURSING

Angels Fund Set Up for RNs and Co-Workers Lost in Limo Fire   This year’s Nurses Week was sadly darkened by the death of two RNs and three other caregivers in a tragic limousine fire on the San Mateo Bridge in the San Francisco Bay Area.

UMass Nurses Will Strike Over Poor Patient Care Conditions    After posting more than $88 million in profits, UMass Memorial Medical Center has slashed its nursing and support staff in the last two years.

LABOR UPDATES

Dairy Queen Offers Grads Their First Job – Without Pay    Edina-based Dairy Queen is giving new college grads the chance to shill for its Orange Julius brand.

North Dakota Leads Nation in Rate of Worker Deaths   North Dakota had a workplace fatality rate that was more than three times greater than the national average and more than five times greater than Minnesota’s rate.

HEALTH CARE

Health Care Plan Needed for End of Life   Never in human existence has dying been more complicated. Before the onset of modern medicine, most people died quickly from an acute event such as trauma or the effects of infection. Today most deaths are a slow process of decline.

The Skyhigh Price of Chemotherapy:  Why Do Cancer Drugs Cost So Much?  Overall, cancer drug prices are skyrocketing. Of the 12 drugs approved by the Food and Drug Administration for various cancer conditions in 2012, 11 were priced above $100,000 for a year of treatment.

Study:  Nearly One-Third of All Death Certificates Are Wrong   As to why doctors were reporting inaccurate causes of death, it actually appears to be a weirdly bureaucratic reason: Three-quarters said the system they use in New York City would not accept what they thought to be the real cause of death.

05.13.13
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Is it a Destination or a Theme Park?

The Mayo’s Destination Medical Center appears to be a done deal.  Hundreds of milliions of taxpayer dollars will transform Rochester into a gilded city worthy of hosting a gold standard of health care in the world, but something’s missing from all the talk – patients.

We know a little about what Rochester could look like, but it’s a lot more than we know what the Mayo could look like.  Rochester is slated to build new bridges, hotels, streets, and even a high-speed train from Minneapolis.   The DMC will create the optimal experience for patients and their families with world-class amenities to match their level of care.  That means hotels, restaurants, where patients and/or their families could enjoy lavish accommodations and entertainment while getting better.

In fact, both Minnesota Public Radio and the Rochester Post-Bulletin have reported that for more than two years, DMC was a top-secret project.  No one in the newspaper’s newsroom had even heard of the DMC, even though the P-B’s publisher was in on some of the meetings.  Evidently, a contract of confidentiality had to be signed just to be in the meeting.

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The Mayo even agreed on a logo for the DMC after putting the design out to competitive bid in April, 2010-more than two years before the DMC project became public knowledge.

The Mayo has only hinted, for example, that a new $100 m tower at St. Mary’s hospital is probably first to be built as it can dovetail from a current construction project.  What kind of care will be available in this tower, we don’t know.  The Mayo receives more than $100 million in competitive peer review grants into cancer research alone, but the public amenities seem more open to discussion than any cutting edge technology.

By contrast, the Cleveland Clinic’s medical campus extols the innovation alley that’s being created to foster new technology that will bring better care to new patients.

The Mayo says 30,000-40,000 people will be hired over the next 20 years to create a world-class medical campus to compete with the Cleveland Clinics and the Johns Hopkinses of the world.  There’s no talk of whether any of those new workers will be doctors and nurses or valets and food servers.  It appears that patient satisfaction surveys have become more important than the patient outcomes and that marketing has become more marketing than medicine.

The Mayo could be a Destination Medical Center by ensuring that enough nurses and staff are hired to safely care for serious patients and promote better outcomes.  The Mayo could be a destination for innovative care by seeking out the toughest cases the medical world sees and solving those cases, regardless of the patient’s ability to pay.

There are other questions too.  Such as, will these “new” buildings include current union employees? And will agreements be in place to assure labor peace before construction begins?

But the biggest question remains, will patients make Rochester a destination without knowing what level of care they’ll receive?

05.10.13
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The time has come to expand Medi-Cal

As California grapples with implementation of the Affordable Care Act, it’s worth emphasizing that the significant gaps in the federal law call out for stronger action in the states to address a healthcare emergency that is far from over.
 
One immediate step would be to expand the publicly-financed and administered California Medi-Cal program, the most efficient way to cover additional state residents still shut out by our broken healthcare system.
 
Examples of the ongoing crisis are everywhere.
 
The California Healthcare Foundation reported recently that over the past decade the percentage of California employers providing health coverage has fallen from 71 to 60 percent. Of those still providing health benefits, cost shifting to employees and benefit cuts is increasingly the norm.
 
Private health insurance companies remain the cause of cost and access problems. Premiums in the past decade in California have exploded by 170 percent, more than five times the inflation rate. Demands by the state’s biggest health insurance firms for double digit rate increases is a daily news story.  Average premiums for California families now average close to $17,000 a year, the report found.
 
Nationally, advocacy groups including the American Heart and Diabetes associations wrote to the Obama administration in early April objecting to rules allowing insurers to postpone compliance with rules capping lifetime limits on care. Another 40 other groups representing patients with AIDS, lupus, cancer, epilepsy warned delays in out-of-pocket limits will “disproportionately harm people with chronic diseases and disabilities.”
 
The Centers for Disease Control reported, also in early April, that one fifth of low income Americans skip needed medications because of the cost which can lead to “poorer health status and increased emergency room use, hospitalizations, and cardiovascular events.”
 
The U.S. now ranks dead last among 17 major industrial powers in life expectancy, according to a January report by the National Research Council and the Institute of Medicine.
 
Low income Californians are unable to count on the good will of “non-profit” hospitals to pick up the slack. A report by the California Nurses Association last August found that private, non-profit hospitals in California collected over $1.8 billion in 2010 in government subsidies beyond what they provide in charity care.  The cost to our hard pressed cities and counties alone topped $1 billion.
 
Adding up the toll of these various numbers, and more, indicate the importance of the Medi-Cal expansion.
 
Nurses on the front line see the deadly results of the lack of coverage, especially combined with the inability of patients who have lost their jobs, health coverage, and homes, to pay huge medical bills.
 
Expanding Medi-Cal would bring immediate help to many of those patients and families.
 
Under the ACA, the federal government is committed to covering 100 percent of the costs of the expansion for the first three years and 90 percent of the costs after that. We also need to resolve any barriers to access under Medi-Cal, such as visit limits.
 
But there are other economic and humane reasons why it benefits all Californians. Those include increased worker productivity by a healthier population that also strengthens the state budget with additional tax revenues, and the reduced spread of communicable diseases as more low income people are able to get medical care.
 
Expanding Medi-Cal is only part of the answer. We need to hold all sectors of the healthcare industry accountable, such as proposed in AB 975, by Assembly members Bob Wieckowski and Rob Bonta. It would establish uniform standards for private, non-profit hospitals to meet their obligation to provide charity care, and provide them with a financial incentive to reduce the burden of providing care on local governments and public safety net hospitals.
 
Ultimately, nurses believe over-turning the private insurance-based system is the only comprehensive solution. That’s why we will continue to advocate for updating and expanding Medicare to cover everyone, the type of rational approach that has allowed every other industrial nation to control costs and surpass the U.S. in most health barometers.
 
In the meantime, let’s work together on the important reforms we can enact today, such as expanding Medi-Cal.
—

Malinda Markowitz is a registered nurse and co-president of the California Nurses Association/National Nurses United

 

05.10.13
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MNA Legislative Update, May 10, 2013

Standards of Care Campaign

Yesterday, Governor Dayton signed HF588/SF471 into law after it passed its final hurdle on the first day of Nurses Week when the House took a last procedural vote on Monday.  The bill requires the Department of Health to conduct a thorough study of the correlation between nurse staffing and patient health outcomes, and mandates every Minnesota hospital to publicly report their staffing plans.

When the study is complete, we will have Minnesota-specific data to underscore the stories nurses have been telling legislators for years: that unsafe staffing is a serious problem in Minnesota hospitals. Our ultimate goal is still a minimum standard of care for patient assignments in Minnesota. To that end, we must continue to advocate for safe staffing in every hospital, every day, every shift. Continue to submit Concern for Safe Staffing forms – they do make a difference – especially to legislators who may be skeptical that inadequate staffing is a problem.

Please thank the Governor for his support of nurses and of patient safety by sending an email.

Minimum Wage

Last week the Minnesota state House passed a long-overdue increase in the state’s minimum wage to $9.50. At the current federal minimum wage of $7.25, a couple with two children would have to work 155 hours a week to meet basic needs. Families headed by minimum wage workers are stressed, and an increase in minimum wage would lift many out of poverty. Click here for more information about the minimum wage in Minnesota.

This week the Senate passed their version, increasing the minimum wage to $7.75. Neither the House nor Senate version contains a “tip penalty” (a lower minimum wage for tipped workers like restaurant servers). The House version of the bill also indexes the minimum wage to inflation, ensuring raises for minimum wage workers as costs go up in the future.

The bill will now go to a conference committee to work out the differences between the two bills. MNA supports the House position, which brings minimum wage workers closer to a living wage.

The minimum wage increase may affect you, because many MNA nurses have contract language that is tied to the minimum wage. Check your contract by logging in to the MNA member portal at www.mnnurses.org.

State Employee Contract

The contract that includes over 700 MNA nurses at multiple State of Minnesota facilities will receive a vote on the Senate floor soon, possibly today. It has already been passed by the House, and should pass the Senate and go on to the Governor for his signature.

State Budget

Leaders of the House and Senate have been in meetings with the Governor this week to work out the differences between their budget and tax proposals. Among other items, the Health and Human Services budget depends on these talks, so we will continue to monitor the process.

Marriage

Yesterday the House of Representatives voted 75-59 to allow all Minnesotans the freedom to marry, while protecting the freedom of religious institutions and clergy to practice their religion based on their values. Next, the bill will go to the Senate for a floor vote, expected on Monday, and then to Governor Dayton who has pledged to sign it into law. MNA supports the freedom to marry as an important step in ensuring equality under the law for all Minnesotans and their families.

You’re Invited: MNA Legislative Wrap-Up on June 11

Come learn about the impact of the legislative session on issues related to nursing practice, health care policy and finance, and the state budget, Tuesday, June 11, 4:00 – 5:30 pm at MNA office in St. Paul or via webcast. This event is for MNA members only and requires an RSVP. Please contact Eileen Gavin at eileen.gavin@mnnurses.org and let her know if you plan to participate in person or online. (Online participants will need an RSVP code to join the event.)