The legislative process is in full swing for 2009, both in the state and federal governments, and it appears nursing and healthcare legislation is at the top of everyone's agenda. It is becoming more evident nurses need to become educated and involved in the political and policy process. However, I don't believe we have done as good a job as we can, nor have we demonstrated just how powerful a group we are as a collective profession. We have been referred to as the sleeping giant. Its time we wake up!
As we are all acutely aware, the U.S. economy is in one of the worst recessions we have seen since World War II, with an unemployment rate that continues to grow on a daily basis. However, healthcare remains to be an industry where job growth is predicted to continue. According to the Bureau of Labor Statistics, is estimated that jobs for registered nurses will grow by 23 percent (or 587,000 positions) through 2016. The federal government also predicts education and health services will account for more than three out of every 10 jobs created in the next 7 years.
The American Recovery and Reinvestment Act signed by President Obama Feb. 17, 2009, contains funding for several areas that are key to nursing and healthcare. Some of the spending is dedicated in the following ways.
Adoption of health IT systems for healthcare systems - The legislation provides $12 billion over the next 10 years to help healthcare systems modernize their information technology. It is hoped that through this distribution of funding, billions will be saved by reducing medical errors, which in turn will improve the quality of care.
Protection of healthcare coverage - Providing $87 billion to states as a temporary increase to the Federal Medical Assistance Percentage so no state is forced to cut eligibility of Medicaid or the State Children's Health Insurance Program due to state budget shortfalls. It is estimated these additional dollars will protect nearly 20 million people who otherwise might be at risk of losing this coverage.
Protecting healthcare coverage for more than 6.5 million Americans - For those Americans who lose their jobs, the stimulus will provide them with a 60 percent tax credit to keep their healthcare insurance through COBRA.
Evidence-based prevention to Americans - The bill contains $1 billion in spending to provide clinical preventive services and community-based prevention programs. Each year, it is estimated nearly half the American population (or 156 million) go without getting flu vaccinations; money will be provided to remove barriers associated with this cost. The plan also provides money to tackle some of the growing chronic issues Americans suffer from such as obesity and smoking.
Strengthening the health workforce - The bill provides $500 million that will enable the National Health Service Corp. to provide services to underserved communities. It will also help to provide additional funding to Title VII and Title VIII programs, which are imperative to training the next generation of physicians and nurses.
NIH - An additional $10 million will be provided to the NIH. This will help fund numerous research projects that have been on hold due to inadequate funding. Since 90 percent of the research funding goes to colleges, universities and research institutions in local communities, it is estimated this investment could create 70,000 new jobs and stimulate the economy.
Comparative effectiveness research - According to the Congressional Budget Office, this $1.1 billion investment could be seen as a savings of $6 billion. These monies will arm consumers and providers with better information on the relative value and worth of different treatment options.
Community health centers - The distribution of $2 billion to the community health centers for necessary renovations and repairs, and investment in healthcare information technology to allow for better services to critically underserved areas.
Indian Health Service - The $500 million provided to the Indian Health Service will help modernize health clinics and hospitals along with investment in health information technology.
Health and Human Services IT security - This $50 million will allow the Department of Health and Human Services to update information technology security.
One additional item to note (which was included in the final version of the bill) is a 1-year moratorium on the hospice rate cuts, retroactive to Oct. 1, 2008. This will help ensure that access to compassionate and high-quality end-of-life care for all Americans remains available. To access this legislation (or other healthcare and nursing legislation) visit the Library of Congress search services named THOMAS.
Two Texas initiatives are important to note. Because of the continuing and worsening nursing workforce shortage, the Texas Nurses Association (TNA) has joined forces with the Texas Hospital Association to become lead members in the Texas Nursing Workforce Shortage Coalition. This coalition (made up of more than 100 healthcare and business groups) will ask for an additional $60 million in special item funding during the 2009 Texas Legislative session, which will allow schools of nursing to do the following:
- Increase capacity - Allow for the addition of additional faculty resources
- Improve efficiency - Create incentives for state schools of nursing to admit and graduate more registered nurse students
- Assist nursing students - Providing financial aid and other incentives to encourage enrollment and graduation.
For Texas to meet its demand for nurses, schools will need to increase the number of graduates from the 7,000 (graduated in 2007) to 13,000 by 2013. By achieving this goal, the output of nurses will almost double for the state. To learn more (as well as track this progress on the funding), visit www.TexasNeedsNurses.org.
Additionally, the TNA (with the support of the Texas Hospital Association) will work to pass legislation that will strengthen the nurses of Texas voice in hospital staffing. The legislation has been authored by Sen. Jane Nelson (R-Flower Mound) and Rep. Donna Howard (D-Austin). The legislation will build on the current statute originally passed in 2002; this being the first legislation in the country to require hospitals in Texas to establish nurse staffing committees. The bill would provide for a legal requirement that all hospital governing boards adopt, implement and enforce a nurse staffing policy.
Somekey components are as follows:
- The role and status of the nurse staffing committee will be elevated by making it a standing committee that must report directly to the hospital board.
- The nurse staffing committee would consist of at least 50 percent registered nurses who provide direct patient care. However, a key change is that now the direct care RNs will be elected by their peers and represent their voices in the staffing plan.
- The nurse staffing committee would be responsible for selecting the nurse-sensitive outcome measures that would be used in evaluating the staffing plan.
- Semiannually, the committee would evaluate the effectiveness of the plan in regard to patient outcomes, as well as any variances between the plan and actual staffing.
- Hospitals would be required to report certain data concerning their nurse staffing plan to the Texas Department of State Health Services.
"TNA knows that when direct care nurses are allowed to use their own professional judgment regarding the level of care their patients need, taking into account the variables that can impact care, then each patient benefits," stated Susan Sportsman, PhD, RN, president of TNA.
To conclude, the legislation contains several other measures that will extend nurses' patient advocacy protections. These measures include:
- providing nurses working in hospitals operated by government entities the same patient advocacy protections from retaliation as those nurses working in private hospitals; and
- a prohibition in hospitals on mandatory overtime (except in emergency circumstances).
For more information on these legislative initiatives as well as to track the progress and become involved, visit www.texasnurses.org.
As you can see, it's early in 2009 and nursing and healthcare is already getting a great deal of attention in the legislative and policy arenas, both on the state and local levels. I encourage you to get involved and become an active participant in these (or other activities) to do your part as a professional nurse to help shape our profession and the healthcare delivery system of the future.
David A. Eubanks is manager, continuing education, Odyssey Healthcare, Dallas, and a board member of the Texas Nurses Association, District No. 3.