In early June, the US House of Representatives’ Ways and Means Committee introduced legislation reauthorizing the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV). The program was enacted under the Affordable Care Act to fund efforts to pair new or existing parents with professionals.
The legislation, called the Increasing Opportunity through Evidence-Based Home Visiting Act, calls for a five-year extension at the current annual allocation of $400 million. The Home Visiting Coalition, a group of 48 early childhood and home visiting advocates and service providers, applauds the decision to reauthorize the legislation which was set to expire in September. However, the Coalition has also launched a public campaign calling for an increase in funding.
The Coalition’s official campaign announcement reads: “[The coalition] is calling for a five-year reauthorization with incremental funding increases until MIECHV reaches the funding level of $800 million per year.” This increase in funding, which the Coalition has asked to be reached by the final year of authorization, is intended to meet a growing need for effective evidence-based home visiting.
Home visiting has been proven to increase school readiness, family self-sufficiency, and decrease child maltreatment and domestic violence. First Focus Vice President Karen Howard, co-convener of the Home Visiting Coalition, says, “Regular visits by caring, experienced professionals and trained peers can help parents turn their good intentions into good, solid parenting and coping skills.” While the five-year extension gives states and communities stability and security to continue effective home visiting services to improve health and well-being of the nation’s most vulnerable children and families, major improvements could be made if the additional funding is approved.
To learn more about the Home Visiting Coalition’s stance on the MIECHV legislation, visit here.
Our Nurse of the Week is Yaneli Arizmendi, a University of Pennsylvania (Penn) nursing senior who is spearheading an after-school program for Latino high school students in South Philadelphia intended to drive improved academic success and build self-efficacy. The project titled Lanzando Lideres (Launching Leaders) will be funded via Penn’s Engagement and Innovation Prize program. Yaneli was one of eight undergraduate students to receive the honor following her internship with Puentes de Salud as part of the Independence Blue Cross Foundation’s Nursing Internship Program.
Yaneli will work with Alexa Salas and Camilo Toro, seniors in the College of Arts & Sciences, under mentorship from Toni Villarruel, the Margaret Bond Simon Dean of Nursing. These students want to position Latino high school students to reach their personal, educational, and professional goals through an experiential, bilingual, and culturally-inclusive curriculum which will serve as the touchstone for the Lanzando Lideres program.
To learn more about Yaneli’s leadership on the Lanzando Lideres project and her background in nursing, read our full interview with her here:
What made you decide to pursue a nursing degree?
I’m very hands-on, so I’ve always wanted to pursue a career that requires physical engagement and practical application. My experience at Puentes de Salud – through the Independence Blue Cross Foundation’s Nursing Internship Program – cemented my desire to pursue a career in nursing. At the clinic, I worked with the triage nurse to initiate the visits for the walk-in patients. The clinic was always full because of the demand for patient care services, so the wait times were long. After learning the structure of the clinic, I started to begin triage for the provider and gather information about the chief complaint to determine whether the patient needed to be seen and, in certain cases, prepare the patient to see a doctor.
Tell me about your involvement with the after-school program for Latino high school students in Philadelphia.
Right now, we are still in the early stages of collaboration with our partner, Puentes de Salud, a south Philadelphia-based nonprofit that promotes the health and wellness of the rapidly growing Latino immigrant population through high-quality health care, innovative educational programs, and community building. Our program will be rooted in three principles: education, enrichment, and engagement.
We plan to launch the program in September, so our first priority is to develop an experiential, bilingual, and culturally inclusive curriculum that will serve as the touchstone of our program. Eventually, we will disseminate our curriculum and resources through an interactive website for students, tutors, and a larger community of Latino youth worldwide.
Ultimately, we hope to create a culturally grounded, community-based program that helps drive improved academic performance and builds self-efficacy, so students are positioned to reach their personal, educational, and professional goals.
What is the mission or goal of the program?
The program’s mission is to continuously improve the long-term health and prosperity of the South Philadelphia Latino immigrant community by actively addressing social and systematic inequities.
Was your internship at Puentes de Salud your inspiration for the after-school project?
The internship was an inspiration for the after-school program because it exposed me to the need in the community and the strategies to address health disparities. The relationship between community work, education, and health has a lot of potential when addressing the social inequities. Currently, the education program only serves elementary school students, but it does not serve high-school students, and my team and I hope to expand the mission of Puentes de Salud.
How do you think your internship and involvement with the after-school program will benefit and impact your nursing career in the future?
My internship and involvement with the after-school program have enriched my nursing career. I hope to continue to work with this population and serve the community holistically. I want to address the social determinants of health in my community and remain an advocate.
What are your future plans for a career in nursing?
In the short-term, I will continue my education via the University of Pennsylvania’s Family Nurse Practitioner Program.
Stethoscopes dangled around the necks of nurses wearing navy NursesTakeDC t-shirts and big smiles. “Where are y’all from? We’re from Arizona!” More than 800 nurses from 40 U.S. states congregated at the NursesTakeDC Rally on May 5th in Washington, DC. The rally was to support legislation establishing federally mandated requirements for safe nurse-to-patient staffing ratios, while drawing public attention to the staffing crisis in many U.S. hospitals. This was the second such rally; last May, the inaugural event drew about 250 participants to the steps of the U.S. Capitol.
The rally was cosponsored by the grassroots nursing movement Show Me Your Stethoscope, a group that formed spontaneously on Facebook after nurse Janie Harvey Garner watched The View host Joy Behar ask why a nurse in the Miss America pageant was wearing “a doctor’s stethoscope” around her neck. That group now has more than 650,000 members. Other rally sponsors and supporters included the Illinois Nurses Association, Hirenurses.com, Nursebuzz, The Gypsy Nurse, Century Health Services, and UAW Local 2213 Professional Registered Nurses.
The NursesTakeDC rally was originally scheduled to take place on the steps of the Capitol, but thunderstorms and downpours forced the meeting indoors at a hotel in nearby Alexandria, Virginia. Although the setting lacked symbolism, participants still raised handmade posters and shouted rally cries. Rally organizers estimated the weather had an impact on overall attendance, but they were still encouraged by the turnout. After the speakers wrapped up, a group of about 150 nurses headed to the U.S. Capitol steps for photographs and final thoughts.
© 2017 David Miller, RN
Two, Four, Six, Eight, Patient Safety Isn’t Fake
“We aren’t laughing, we want staffing!” Cheers and whistles erupted out of the crowd. After 10 minutes of rally cheers and chants, the gathering turned its attention to the first of many speakers who would highlight issues faced by nurses in every specialty and across the profession. Actress Brooke Anne Smith began by reciting a moving poem about nurse warriors on the front lines.
Event organizer Jalil Johnson then took the stage, giving a keynote speech that addressed the challenges bedside nurses face every day. He spoke about nurses as the foundation of health care, and the unrelenting pressure to perform in deteriorating conditions. While discussing dire staffing situations, Johnson said that he fought every day, “making sure I didn’t give anyone a reason to come after the license I had worked so hard for.”
He discussed the paradox that year after year, nurses are rated the most trusted profession, yet no one trusts nurses when they say they are overworked, overburdened, and practicing in unsafe conditions. Nurses alone are not enough to fight this battle, he said. “To the public, we say: Trust us when we say the industry makes it nearly impossible to deliver the care you need. Trust us when we say we need your support.”
Other NursesTakeDC rally speakers included Katie Duke, Terry Foster, Deena McCollum, Linda Boly, Julie Murray, Catherine Costello, Kelsey Rowell, Leslie Silket, Dan Walter, Nicole Reina, Monique Doughty, Doris Carroll, Charlene Harrod-Owuamana, Debbie Hickman, and Janie Harvey Garner.
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act
On May 4th, the day before the rally, Representative Jan Schakowsky (D-IL) and Senator Sherrod Brown (D-OH) reintroduced the latest iterations of the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 2392 and S. 1063). The bills seek to amend the Public Health Service Act to establish registered nurse-to-patient staffing ratio requirements in hospitals.
In a press release, Rep. Schakowsky’s office writes: “This bill is about saving lives and improving the health of patients by improving nursing care—ensuring that there are adequate numbers of qualified nurses available to provide the highest possible care.” The press release acknowledges that study after study has shown that safe nurse-to-patient staffing ratios result in better care for patients. “It’s time we act on the evidence and the demands of nurses who have been fighting to end to dangerous staffing,” the release continues. “I’m proud to be a partner with nurses across the country in promoting this bill and working to ensure quality care and patient safety.”
Rep. Schakowksy attended last year’s event, but was unable to attend this year. The Nurse Staffing Standards Act is the latest in a string of bills that have been introduced to Congress every session. Previous bills S. 864 and H.R.1602 died in committee last session. S. 864 was first introduced in May of 2009; H.R. 1602 was first introduced in 2004 and has been sponsored seven times so far. Rally co-chair Doris Carroll explained why: “The legislation is reintroduced session after session, and it continues to die in committee because there is no bipartisan support.”
In today’s environment, politics can be touchy. The day before the rally, the House of Representatives passed the American Health Care Act of 2017. Among nurses there are very polarized viewpoints on health care, abortion, assisted suicide, and other controversial topics. In his speech, Johnson acknowledged that not all nurses think alike. “We are a profession divided,” he admitted. “But when it comes to safe staffing, we all agree. This is a movement devoid of partisanship. Staffing is not a partisan issue.”
The proposed text and ratios for the Nurse Staffing Standards Act are below:
A hospital would be required during each shift, except during a declared emergency, to assign a direct care registered nurse to no more than the following number of patients in designated units:
1 patient in an operating room and trauma emergency unit
2 patients in all critical care units, intensive care, labor and delivery, and post anesthesia units
3 patients in antepartum, emergency, pediatrics, step-down, and telemetry units
4 patients in intermediate care nursery, medical/surgical, and acute care psychiatric care units
5 patients in rehabilitation units
6 patients in postpartum (3 couplets) and well-baby nursery units
Rally speakers encouraged nurses to reach out to their representatives in Congress to show support for safe staffing legislation, and handouts for participants detailed how to find representative names and numbers for letter writing campaigns and phone calls.
Where Is Everybody?
When one of the speakers asked why there wasn’t more involvement in the grassroots movement, and why there weren’t more nurses present, several voices called back from the crowd. “Everyone’s working!” one shouted. Another called out, “They don’t have the money!”
“Really, where the heck is everybody else?” one rally participant said. She gestured to the conference room, which at the time held about 100 nurses. This nurse was part of a group attending from New Jersey, including Kate McLaughlin, a registered nurse and founder of NJ Safe Patient Ratios, a group dedicated to the support of safe staffing in New Jersey and promotion of ratio law S. 1280 in New Jersey’s Senate.
“In New Jersey, multiple bills have been introduced, every single session, and nothing ever passes,” McLaughlin said. “In California it was the same thing, and then the tenth year, they involved unions and patients and it finally worked.” She said she started to pay attention to safe staffing laws in her state, and launched a petition on change.org. “I stalked nurses on Facebook and found people that way,” she continued. “Each week, we organize and post the contact information for two state senators.” She is starting a movement in New Jersey, hoping to motivate others to show support for these bills. “It’s an election year,” she said. “Now is the time.”
McLaughlin said her state’s ratio law was first introduced in February 2016, but there has been no vote and no hearings, “which just feels disrespectful.” She was told the governor didn’t support the bill, and “that we might need to wait until there’s a new governor.”
The problem, according to several nurses at the rally, isn’t a lack of awareness. “I think it’s apathy,” McLaughlin said. “This is a profession of predominantly women, and we are taken advantage of. They know we don’t get breaks, but they’re okay with the labor law violations. We’ve somehow accepted that this is normal—this is not normal.”
Carroll also expressed discontent that no one seems to care about this issue. “Why has this taken so long? Why hasn’t California’s success spread like wildfire?” she asked. “Well, health care changed, and it became a multi-billion dollar business for hospitals and insurance companies.”
Dan Walter, another speaker, acknowledged that sometimes nurses do not report safety issues because they fear retribution. Walter is a former political consultant and publisher of HospitalSafetyReviews.com, a web site that he established for nurses to anonymously post about patient safety issues where they work. In his speech, he explained the inspiration for creating the site: “You are the activists and you know what needs to be done. I want people to be able to go there, post, and we will keep it as anonymous as possible so we can protect you.” He expressed hope that this web site will be a powerful platform to improve patient ratios.
How Bad Is Staffing?
Nurses from a hospital in downtown Washington, DC, expressed frustration with the lack of support and resources from hospital administrators. “The other day, we had so many critical patients in the department we ran out of monitors,” one said. Another said that 80% of the nurses who work in her hospital’s emergency department have less than two years’ experience. “The turnover is so high,” she said. “People get so burned out because of the short staffing.”
Just how short are units staffed? “In our ED [emergency department], someone the other night was taking care of seven patients,” one nurse from this group said. “And these were sick patients, people with LVADs [left ventricular assist devices], and ICU patients.” This is common all over the country. A medical-surgical nurse may be taking care of up to eight or more patients at a time.
Llubia Albrechtsen, a registered nurse and family nurse practitioner at the rally, said there have been times she has refused to take on additional patients in the emergency department where she works. “When I have five patients, I need to take a step back and pay more attention, because their conditions may worsen,” she said. “It’s hard, because we could be providing excellent care to many of our patients, but with limited resources we have to do the best we can and hope nothing bad happens.”
Albrechtsen said that although hospital administration makes an effort to listen to nurse concerns about staffing, through town halls or open meetings, not much has changed. “Many areas still work understaffed,” she said.
Why Does Staffing Matter?
A policy brief disseminated at the rally lists the effects of inadequate nurse staffing, including the overwhelming evidence that safe staffing saves lives. High patient-to-nurse ratios lead to poor outcomes and a demonstrated increase in patient morbidity and mortality. Inadequate staffing has been associated with an increase in hospital readmissions, falls, pressure ulcers, hospital-acquired infections, and medication errors.
Poor staffing is expensive. In addition to causing poor patient outcomes, nurse burnout causes injuries, illness, and contributes to the growing nursing shortage. Replacing nurses due to turnover takes between 28 to 110 days, and costs the average hospital $6.2 million per year.
“The health care industry generates $3 trillion annually,” Johnson said in his address. “We are living in an age of greed, where the health care industry measures patient satisfaction by a customer service model. This is prioritized over quality and safety. Reducing burnout, staff retention, and caring for your staff are at the bottom of the barrel of priorities.”
The grassroots movement behind safe staffing is fighting for environments that allow nurses to do their work in the way in which they were trained. “[A nurse’s] work has been diminished to defensive practices; it has been reduced to a list of tasks to complete,” Johnson said. “That is not nursing.”
In Johnson’s final remarks, he spoke to empower nurses to return to their states, hospitals, and colleagues with a message to inspire change. “We have to show up in person, put boots on the ground, and be ready to engage and pull more nurses into this movement,” Johnson said. “Most importantly, we have to believe that with over 3 million registered nurses and over 1 million licensed practical nurses, our profession can come together as one. We will take back our profession and regain control of our practice.”
Another rally is already in the works for next year. The organizers of NursesTakeDC will now direct their focus toward supporting any state that has pending policy and legislation aimed at improving nurse-to-patient ratios and safe staffing. Organizer Carroll said that this year is a learning curve for the organizers, and they hope that next year they will have something even better with an even bigger audience.
“We encourage all nurses, practicing at all levels and in all settings, to unify and support beside nurses in the fight for safe staffing,” said Johnson to a room full of applause and cheers. “We fight for recognition—we will not justify our existence! There is no health care industry without us, and we will determine what is best for our practice and for our patients.”
Operation Smile is an international medical charity that provides free surgeries for children and young adults in developing countries who are born with cleft lip, cleft palate, or other facial deformities. In honor of National Nurses Week, Operation Smile is celebrating the nurses who volunteer on their medical missions to change the lives of thousands of children.
Founded in Virginia in 1982 by Dr. Bill and Kathy Magee, a former nurse, the organization has provided hundreds of thousands of surgeries over the years. Operation Smile has a global reach to more than 60 countries through their network of surgeons, pediatricians, doctors, nurses, and student volunteers. Their goal is to mobilize volunteer medical teams to conduct surgical missions in countries that don’t have the resources to perform these procedures themselves while adhering to high standards of safety and care.
Kathy Magee, co-founder and current president of Operation Smile, stated in a press release that, “It is heartbreaking to know how many children around the world cannot receive access to safe surgical care and have to suffer in pain because of it. Every child that has a facial deformity is our responsibility. If we don’t take care of that child, there’s no guarantee anyone else will.”
Over 600 compassionate medical and nonmedical volunteers participate in mission trips with Operation Smile each year. Karina Razo, a nurse from Los Angeles, is one of their star volunteers who says she wouldn’t trade her profession for anything. According to Razo, “Every patient rewards us with a new experience. Each and every one of them is different but the immediate results that we see, and the faces of the parents, are a gift.”
Razo, originally from Honduras, will be spending National Nurses Week caring for cleft patients on her sixth mission through Operation Smile in Lima, Peru. Speaking about what she’s learned through her volunteer nursing work with Operation Smile, Razo says:
“What has really impacted me the most throughout my time as a volunteer nurses is how extremely lucky we are to have access to safe care and safe surgery in the United States. We don’t have to worry about our children suffering when they are born with a cleft because we simply take them to the hospital. This, unfortunately, is not the case in other countries and I think we take that for granted.”
Operation Smile recently launched a campaign called Until We Heal, urging advocates from around the world to sign a pledge encouraging health leaders to address the global lack of access to safe surgery. To learn more about Operation Smile and sign their pledge, visit www.UntilWeHeal.org.
Yesterday afternoon the House of Representatives voted to pass the American Health Care Act (AHCA), a GOP-backed bill intended to repeal and replace the Affordable Care Act (ACA; otherwise known as Obamacare). The bill was passed by a vote of 217 to 213, with 20 Republicans opposing the bill and all Democrats voting no as reported by Business Insider.
The American Health Care Act, as outlined by the Trump administration, would roll back Obamacare’s expansion of Medicaid, eliminate tax penalties for those do not have health insurance, allow states to opt out of requirements for providing a minimum set of health benefits (like maternity care or emergency services), and repeal a payroll tax to provide tax cuts for high-income people.
Many members of the healthcare community made their voices of opposition heard as the voting date approached, and have continued to do so following the passing of the bill. Dozens of nurse, physician, and patient-advocacy groups have spoken out including the American Nurses Association (ANA), American Medical Association (AMA), and the American Hospital Association.
National Nurses United released an opposition statement which has been widely shared this week: “The original version of the [AHCA] posed a mortal threat to the health and well-being of our patients, and to the health security of our country. The new version…will be even worse for our patients.” The American Nurses Association also released the following statement, which you can read in full here:
“The [AHCA] threatens health care affordability, access, and delivery for individuals across the nation. In its current form, the bill changes Medicaid to a per capita cap funding model, eliminates the Prevention and Public Health Find, restricts millions of women from access to critical health services, and repeals income based subsidies that millions of people rely on. These changes in no way will improve care for the American people.”
Now that the House has approved the new healthcare bill, it will become an uphill battle to pass it through the Senate. The Washington Post reports that “At a minimum, the House bill is expected to undergo major changes in the Senate, where it will be subjected to unlimited amendments,” a process which could take weeks. DailyNurse will be monitoring the healthcare bill’s progress along with the rest of the healthcare community.
Two nursing students from Kent State University recently attended the American Association of Colleges of Nursing (AACN) Student Policy Summit in Washington, DC to meet with legislators and learn about how to make a difference in the nursing profession. Jason Fisher, BSN, RN-BC, CCRN-CMC, MSN/FNP graduate student, and Suzanna Thiese, BSN student, were in attendance with more than 200 College of Nursing deans, undergraduate, masters, and doctoral level students from across the country.
The three day AACN conference hosted speakers from the National Institutes of Health (NIH), AACN, and individuals with experience in policy involvement. As attendees, Fisher and Thiese were given the opportunity to learn about their peers’ goals and dreams for the nursing profession and delivery of healthcare.
The second day of the conference was spent at Capitol Hill, with activities focused on sharing concerns about policy issues and learning how to build a relationship with legislators. Fisher and Thiese were able to participate in meetings with the offices of Senator Sherrod Brown and Senator Rob Portman, and Congressman David Joyce. Recalling her experience at the conference, Thiese tells Kent.edu:
“We visited Capitol Hill at a unique time in healthcare. The healthcare proposal was being debated that week and the budget [would be] approved soon. We spoke with our Representatives and Senators about our concerns on both of these topics, and the next week the Healthcare Proposal was redacted. It was very empowering to feel like we were part of the influence that caused those events to take place.”
Attending the Student Policy Summit was a pivotal career experience for both Fisher and Thiese. Health policy is an intimidating topic, especially for those looking to make real changes. However, it helped make both students more aware of the policy challenges they will face as nursing professionals, inspiring them to get involved in any way they can and stay politically aware so that they can best advocate for their patients.
To learn more about the AACN Student Policy Summit and Kent’s student involvement in nursing policy, visit here.