By Genevieve M. Clavreul, RN, Ph.D.
Working Nurse Magazine
I know that for a lot of nurses, talking about politics is about as appealing as going to the dentist. However, legislation and policy decisions can shape the way we practice at every level, sometimes dramatically. That’s why it’s important for nurses to pay close attention to proposed laws or new regulations affecting our profession.
Let’s take a look at some current healthcare-related measures and what they could mean to you.
If you or any of your patients suffer chronic pain and have a liver condition that contraindicates acetaminophen (the active ingredient in Tylenol), you should be very alarmed by S.2134 and H.R.4241.
These bills, prompted by the recent fear-mongering about prescription opioid abuse, would ban Zohydro ER, the only FDA-approved opioid that doesn’t contain acetaminophen. The legislation would also prohibit the FDA from re-approving Zohydro “unless it is formulated to prevent abuse.”
Aside from its impact on chronic pain sufferers, this attempt by some members of Congress to usurp the function of the FDA would set a frightening precedent. If Congress can summarily ban a drug that’s already passed the FDA’s approval process, what’s to prevent legislators from banning other approved drugs, like contraceptives, in hopes of scoring political points? I shudder at the potential consequences.
Safe Staffing Ratios
There’s brighter news in the area of nurse staffing requirements. As most of us know, California has had mandatory nurse-patient staffing ratios for the past decade and Congress is now considering national requirements.
The federal Registered Nurse Safe Staffing Act (H.R.1821 and S.2353), which would apply to all Medicare-participating hospitals, is quite different from California’s rules, which mandate specific ratios for each type of unit. Instead, the proposed federal law would require each hospital to establish a committee — at least 55 percent of which must be RNs providing direct patient care — that will create staffing plans based on patient acuity, staff experience and other factors.
Longtime readers know that I’m very critical of California’s “one size fits all” approach to staffing ratios. I strongly believe that an acuity-based system makes more sense, allowing managers to match nurses to patients based on the nurse’s skills and training rather than arbitrary legislative dictates. The federal law would also give nurses a greater voice in those decisions.
Unfortunately, these bills wouldn’t change California’s current requirements. If this law passes, Medicare hospitals in our state would still need to organize the required committees and create staffing plans, but those plans would have to comply with existing state laws.
Lab Result Reporting
Till now, patients have always been told, “The doctor will call you when your test results come back.” However, in February, the Center for Medicare and Medicaid Services amended the Clinical Laboratory Improvement Amendments of 1988 (CLIA) to give patients the right to request test results directly from the laboratory. All entities subject to HIPAA must comply with the regulation by October 6.
It will be interesting to see how the new rule will affect the patient-provider relationship. Will patients be better informed or will they be panic-stricken after trying to interpret their test results based on Internet searches? Will patients even be informed of the new rule? (I know my and my daughter’s providers have yet to say anything about it.)
If your facility’s lab is subject to CLIA, have you been educated about the new regulation? How do you feel it’s working so far? Drop me a line and let me know.
MRSA and Worker’s Comp
If you’re unlucky enough to contract a methicillin-resistant Staphylococcus aureus (MRSA) skin infection while working in patient care, a proposed state law (AB 2616) would make it easier for you to file a workers’ compensation claim. The bill, which is supported by the California Nurses Association and National Nurses United, passed both houses of the Legislature in August and now awaits the governor’s signature.
AB 2616 states that MRSA skin infections contracted while providing direct patient care will now be presumed to be work-related unless there’s specific evidence to the contrary. That means if you file an MRSA-related claim, the burden of proof will no longer be on you, which is good news.
Workplace violence is an ongoing concern for nurses and other healthcare workers. There’s been some progress since Napa State Hospital psychiatric technician Donna Gross was strangled to death by a patient in 2010, but nursing organizations and unions have been calling for more.
SB 1299, which went to the governor’s office on August 28, is intended to light a fire under the state Occupational Safety and Health Standards Board and push state hospitals to take action. The bill would require acute care and acute psychiatric hospitals to establish plans to prevent workplace violence in both inpatient and outpatient settings.
The plans must include training and education for workers, procedures for investigating incidents, and policies for documenting and reporting incidents to the Division of Occupational Safety and Health, which would be required to post anonymized reports online starting in 2017.
Too many new RNs have passed the NCLEX, graduated from nursing school and started applying for work — only to wait and wait for the BRN to issue their licenses. A bill in the Assembly, AB 2165, seeks to address that problem by giving professional licensing boards a 45-day deadline to issue licenses to candidates who’ve completed all the requirements.
The 45-day clock wouldn’t start ticking until you have completed all the application requirements, so this law wouldn’t help if you had missing paperwork or problems with your background check. The point is to keep qualified applicants from being held up by bureaucratic backlog.
Using our Power
This list is by no means comprehensive. New measures come up all the time, including ones that aren’t specific to nursing, but may still affect our work.
The good news is that we don’t have to sit back and watch idly. With almost 400,000 active RNs in California alone, we have more political power than many of us realize. However, for us to use that power, we have to be aware of what’s going on and willing to get involved. We can’t afford to let politics be a spectator sport.
How to Stay Informed
If you want to find out more about these bills and others like them, check out the following links:
• The Library of Congress THOMAS database allows you to look up information about federal bills.
• GovTrack.us is another option for keeping track of happenings in Washington. It requires registration.
• The Official California Legislative Information webpage includes information on current state laws and proposed legislation.
• LegTrack is another search engine for state measures. It requires registration.
• Ballotpedia is “an interactive almanac of U.S. politics,” including neutral descriptions of federal and state measures.
• The Board of Registered Nursing (BRN) website often provides useful information on pending legislation. The BRN’s legislative committee examines all measures and decides whether the board should support, oppose or watch each measure.
• Professional organizations and unions such as the American Nurses Association, California and the California Nurses Association/National Nurses Organizing Committee also monitor relevant legislation, although these organizations’ information may be available only to members.
Some professional organizations also organize “lobby days,” which are a great opportunity for nurses to learn about important current issues and the political process in general.
Working Nurse Magazine – Issue