With the 107th Congress under way, the ANA is advocating federal legislation and regulations that will address inadequate and inappropriate nurse staffing and will offer long-term solutions to the current nursing shortage.
"Members of Congress have become acutely aware of nurse shortages and are investigating ways to address the problem," states ANA President Mary E. Foley, MS, RN. "The ANA will seek to educate Congress about the causes-including cost-cutting that has removed nurses from the bedside-of current and emerging shortages. We also will advocate the kinds of solutions, in both recruitment to the profession and retention of registered nurses, that will result in a stronger profession."
STRENGTHENING NURSING EDUCATION OPPORTUNITIES
The ANA is seeking federal legislation and funding to increase nursing school enrollments and ensure that schools of nursing have adequate faculty, recruit a more diverse student population to serve an increasingly diverse patient population, and help students to complete nursing studies.
Traditionally, the Nurse Education Act (NEA) programs have provided assistance in all these areas but generally to advanced practice registered nursing. As reauthorized in 1998, however, the NEA gave the Division of Nursing more flexibility to ensure that the programs are targeted toward areas of nursing in which the need is greatest. This means more opportunities for entry-level nurses and more potential recruitment for needed nursing specialties and of minorities. For example, since the NEA programs help nursing educators to prepare educational programs, more nurses could be schooled to meet the health care needs of an increasingly diverse population.
The NEA provides direct student support to disadvantaged nursing students as well as to students in advanced practice programs. Also, the NEA has provided seed money for many nurse-managed centers that, as part of the clinical teaching process, deliver primary care to high risk and vulnerable populations.
The ANA is also seeking substantially higher funding for the Nurse Loan Assistance Program where applicants far outnumber dollars available.
APPROPRIATE NURSE STAFFING
For the past several years, the ANA has publicized results from research studies, including its own, that show that nurse staffing levels and skill mix make a difference in the outcomes of hospitalized patients. The ANA will build on this ongoing awareness campaign in the coming year by advocating legislative mandates for upwardly adjustable minimum nurse-patient ratios. Currently, no effective national staffing requirements exist for acute care settings. Medicare regulations are vague and inadequate. The regulations state, "The nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed." This lack of enforceable staffing standards and quality measurements has resulted in hospitals making dramatic staffing changes based on their own interpretation of the regulations.
Some state legislatures are already addressing this. In Kentucky and Virginia, laws exist to set appropriate staffing methodology, and in California legislation passed in 1999 to require nurse-patient ratios in acute care hospitals. According to the National Conference of State Legislators, 21 states recently identified "nurse staffing ratios in hospitals" as a legislative priority. The ANA will work with its constituent member associations as it pursues this agenda at the federal level. (See Issues Update, page 59.) The ANA is pursuing federal mandates for standard, public reporting of nurse staffing levels and mix, and patient outcomes to allow valid quality measurement of nursing care.
The ANA is also advocating congressional action on mandatory overtime, often used by hospitals as a quick fix for short staffing. Last June, the ANA's House of Delegates opposed mandatory overtime under any circumstances. The ANA convinced Congress at the end of its last session to provide funding for a study on the impact of extended work hours on patient safety and medical error, to be conducted by the Agency for Healthcare Research and Quality. During this congressional session, the ANA is seeking introduction and passage of legislation abolishing mandatory overtime.