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Issues Update

American Journal of Nursing - March, 2001 - Volume 101, Issue 3

All for One and One for All
Using state legislation to secure federal protections

By Anna Gilmore-Hall, MSN, RN

Long before needlestick protections for health care workers became federal law in late 2000, nurses were fighting for, and in many instances receiving, comparable protections at the state level. As has been the case with many legislative issues, the success of needlestick legislation at the state level played a central role in securing a federal legislative victory.

“Having legislation in the states can help us when we’re lobbying for similar protections on Capitol Hill,” notes ANA president, Mary Foley, MS, RN.

Over the past several years, the ANA and its constituent member associations (CMAs) have achieved historic legislative successes that have secured new protections for nurses and patients (such as whistleblower laws) and have contributed to the recognition of the nursing profession (such as Medicare reimbursement for nurse practitioners). In fact, a unique aspect of the ANA is the strength of its CMAs’ legislative programs—a force that can be successfully built upon at the national level.

“No other nursing organization or health care union has the political influence that our constituent member associations have in the state legislative arenas,” Foley said.

A Success Story

State legislation can play a key role in moving crucial issues to the national level. The work of the ANA and the CMAs on needlestick protection is a good example. While the ANA worked with other health care groups and members of Congress to secure passage of federal needlestick prevention legislation, the CMAs sought protections at the state level. To date, 17 states have enacted legislation aimed at protecting health care workers from needlestick injuries.

“Public policy is not made in isolation,” said Terri Roberts, JD, RN, executive director of the Kansas State Nurses Association. “So when legislators are looking to embark on a piece of legislation, they look to see what other states have done and what legislation has been successful. When legislators see a trend of other states passing legislation, they get more comfortable with the idea of passing a similar measure. We saw that with whistleblower legislation,” she added, citing another issue that several CMAs were successful in addressing through state legislation.

The passage of state needlestick legislation not only spurred passage in other states but it also provided valuable support in getting federal legislation passed this past year. The Needlestick Safety and Prevention Act was introduced in the Senate by Senators James Jeffords (R-VT), Edward Kennedy (D-MA), Michael Enzi (R-WY), and Harry Reid (D-NV), and in the House by Representatives Cass Ballenger (R-NC) and Major Owens (D-NY). Congress passed the legislation after a long campaign by the ANA and its CMAs to educate the public and lawmakers. Because many states had already enacted their own protections, members of Congress from those states were already familiar with the issue.

“Federal lawmakers pay close attention to the legislation that passes in their states,” Foley said. “State laws on issues of concern to nursing are a key part of our educational strategy with members of Congress.”

Next Stop: Staffing

To capitalize on the strengths of pushing comparable legislation at the state and federal levels, the ANA and the CMAs are formalizing this approach and setting their sights on nurse staffing. For the past few years, the ANA and its members have been sounding the alarm about the dangers of short staffing and the strategies hospitals use to staff or fill in scheduling holes, including mandatory overtime, floating, and replacement of RNs with unlicensed personnel. At the ANA House of Delegates last year, delegates called nurse staffing in this country a “public health care crisis” and overwhelmingly voted to oppose mandatory overtime.

Late last year, the ANA and its CMAs began developing and implementing a nationwide state legislative agenda that focuses on nurses’ concerns about how inadequate and inappropriate staffing is adversely affecting the safety and quality of patient care as well as their own health and safety. This agenda will be used to promote state legislation and regulation across the nation.

“The ANA believes that while the issues of staffing and the potential shortage require a multipronged approach to address the many issues, state legislation will be a primary component of that overall strategy,” Foley said.

Building on solid ground

The groundwork for a nationwide state legislative agenda on staffing issues has already been laid in several states. In 1998, for example, Kentucky and Virginia passed legislation to set appropriate staffing methodology. In 1999, California followed with legislation requiring nurse-to-patient ratios in acute care hospitals. That same year, New Hampshire approved data collection on the rates of RNs per bed.

Efforts to secure legislation mandating hospitals to provide adequate nurse staffing continued in the 2000 legislative sessions; 34 such bills were introduced in 16 states. Legislation focused on requiring sufficient staffing, setting nurse-to-patient ratios, and the public reporting of data. For example, the Hawaii senate adopted a resolution urging the Hawaii Nurses Association and the Hawaii Health Care Association to find solutions to the patient safety and nursing shortage issues.

State laws passed and legislation introduced over the last few years will serve as a foundation of the nationwide agenda. The ANA and the CMAs also will use the ANA’s Principles of Nurse Staffing to help develop language for desired legislation and regulations. This document provides nine principles of appropriate staffing and states that it should be based on achieving high-quality patient care, meeting organizational outcomes, and ensuring that the quality of the nurse’s work life is appropriate.

As the nationwide state legislative agenda continues to be developed and implemented, the ANA will be working at the national level with various members of Congress to secure the introduction and passage of federal legislation addressing nurse staffing concerns.

“Nurses have an exceptional opportunity right now to join together and demand adequate and appropriate staffing to ensure safe, quality patient care,” Foley says. “Speaking with one strong voice will be good for nurses and the patients for whom we care.”

For more information on how you can become involved, call your state nurses association, or contact the ANA at (800) 274-4ANA.

UAN Safe Staffing Campaign Powers Up

Putting a stop to unsafe practices.

As the ANA and its constituent member associations (CMAs) begin implementing a nationwide state legislative agenda to address nurse staffing, the ANA’s labor arm, the United American Nurses (UAN), is also targeting the critical conditions that patients and RNs face as a result of inadequate and inappropriate staffing. Launched last fall, the UAN’s Safe Staffing campaign aims to help RNs everywhere make their collective voice heard. The UAN is providing CMAs with planning kits, Safe Staffing Campaign organizing materials for nurses, informational materials for the public, and media kits. It’s also carrying out a national media campaign, with nationwide activities and events scheduled to take place during National Nurses Week in May.

“Putting an end to staffing practices that endanger nurses and patients will take the energy of every CMA and thousands and thousands of staff nurses,” says UAN chair Cheryl Johnson, RN. “For UAN, this is far more than a campaign, it’s a crusade—a crusade we can win, and will win for our patients and our profession.”

The first big Safe Staffing Campaign activity, a national petition drive, is under way now. Coordinated by CMAs, the goal is to gather thousands of signatures of RNs calling on state and federal legislators to enact legislation that:

• requires health care facilities to provide appropriate staffing levels without mandatory overtime
• makes public the staffing level, staff mix, and patient outcome information on each health care facility
• protects nurses from retribution when they voice concern about unsafe patient conditions
• holds health care administrators accountable for management decisions that affect the quality of patient care