New Safe Staffing Legislation Introduced to Congress

New Safe Staffing Legislation Introduced to Congress

On February 15, 2018, the newest safe nurse staffing bill was introduced to the U.S. Congress. The bill (H.R.5052 and S.2446) has bipartisan support, and is championed by Reps. David Joyce (R-OH), Suzan DelBene (D-WA), Suzanne Bonamici (D-OR), and Tulsi Gabbard (D-HI), as well as Sen. Jeff Merkley (D-OR).

In the past, several safe staffing bills have been presented in previous Congresses but have failed to pass committee. This bill, the Safe Staffing for Nurse and Patient Safety Act of 2018, is slightly different than previous iterations. Under this staffing legislation, Medicare-participating hospitals would be required to form committees that would create and implement unit specific, nurse-to-patient ratio staffing plans. At least half of each committee must comprise direct care nurses.

“It is so important for nurses on the front lines to be able to have a say in what they believe is safe staffing,” says Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, the president of the American Nurses Association (ANA). “This bill benefits bedside nurses by giving them decision-making power, control, and the ability to influence the delivery of safe care,” Cipriano continues.

A committee made of staff nurses—who would make staffing decisions that directly affect their own units—is so important because it is nurses who can best assess patient needs and the resources required to provide safe patient care. Staffing committees would be able to address the unique needs of specific units and patient populations by involving specialty nurses in the decisions, and would have the ability to modify the hospital safety plans as needed.

Overwhelmingly, research supports adequate nurse staffing. Over the last several decades, literature has demonstrated a decrease in patient morbidity and mortality and an increase in patient safety when units are well staffed. “With adequate amounts of staffing we see mortality go down and patient complications can be prevented or diminished,” Cipriano says. “It is important for nurses to have sufficient resources to care for patients, because nurses experience moral distress when they cannot provide the care they know a patient needs.”

Short-changing patients also contributes to nurse burnout, and low nursing retention is expensive. Additionally, adequate nurse staffing leads to reduced health care costs, as a result of fewer hospital readmissions, hospital-acquired infections, medical errors, and other significant measurable patient outcomes. “Patients deserve to have the right care,” Cipriano says. “They need to be kept safe, and the best way to prevent problems and complications is to have the right nurse staffing.”

Is there hope that this bill will pass, when so many previous iterations have not? “It may be difficult to pass the legislation, even this time around,” Cipriano admits. “But the most important impact is that every time we have an opportunity to have this legislation discussed, it’s another opportunity to educate another decision maker. Whether it is congresspeople, their staff, or other leaders in their communities, it gives us the opportunity to continue to reinforce why it is so important to have the right nursing care.”

It is ethically challenging when a nurse is asked to take staffing assignments that do not feel safe. On many units, nurses are expected to care for several acute and critically ill patients at a time, and are given patient loads that stretch them far beyond their reasonable care delivery capabilities. What should a nurse do when faced with an unsafe assignment? Nurses should raise immediate concerns by following the chain of command, and talking with immediate supervisors to express that they believe the situation is unsafe. “The first obligation is to make sure that no patient is left uncared for,” Cipriano says. “Short term, use the chain of command and do everything you can within in your power to make sure that you’re providing at least the minimum care the patient needs.” Longer-term, if nurses truly believe that their organization is not supporting the right staffing ratios, the ANA encourages an active dialogue with leadership, such as a conversation with responsible nursing leaders, quality directors, or patient care committees or councils to focus attention to the issue.

“Nursing care is like a medication,” Cipriano says. “You wouldn’t withhold a life-saving medication, so why would you withhold the right amount or right dose of nursing care?”

If you are passionate about safe staffing laws, consider calling or writing your congressperson and encourage them to support the Safe Staffing for Nurse and Patient Safety Act of 2018.

House Votes to Pass American Health Care Act, Bill to Repeal and Replace Affordable Care Act

House Votes to Pass American Health Care Act, Bill to Repeal and Replace Affordable Care Act

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.

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