ew York and New Jersey nurses are being noticed by their state legislators. From making it a felony to assault a nurse in New York to elevating simple assault to aggravated assault for nurses in New Jersey, both states have been working to protect the profession people trust most.
New York nurses have pushed for years for stronger penalties for assaulting nurses, and this year they succeeded in making it a felony. Its part of our overall program to reduce violence in the workplace for nurses, says Shaun Flynn, director of governmental affairs at the New York State Nurses Association in Latham, N.Y. The association, along with the Healthcare Association of New York State and New York Organization of Nurse Executives, launched a public awareness campaign that led to assaulting a nurse becoming a crime Nov. 1.
The NYSNA also considered passage of the Family Health Care Decisions Act a victory. The law empowers family members and others close to the patient to make medical decisions for them when incapacitated. It establishes who in relation to a patient can make those [medical] decisions, so nurses and other healthcare professionals are not caught in a back-and-forth tug of war over who can make decisions, Flynn says.
In 2011, NYSNA plans to continue its decadelong advocacy for safe staffing ratios, as the issue becomes more acute in the face of tight budgets.
Our hope is people will start looking out of the box for solutions to address these big issues, Flynn says. Times of crisis tend to be the best time to tackle big issues. Its an area we will be pushing hard for in 2011.
Lawmakers passed the Midwifery Modernization Act (SB 5007/AB 8117), eliminating the requirement that a physician or hospital sign a contractual agreement with a nurse midwife, which will increase consumer access to nurse midwife care.
We hope that bodes well for legislation next year that would remove collaborative practice agreements for nurse practitioners, says Flynn, adding the state will begin addressing issues associated with implementing the Institute of Medicine report on the Future of Nursing, such as increasing education requirements and removing scope of practice barriers. In New York, that means passage of a bill requiring RNs to obtain a BSN within 10 years of licensure, allowing nurse anesthetists to continue practicing independently and removing the requirement for collaborative practice agreements.
The big thing for next year is the Patient Access and Advocacy Act. This bill would allow nurse practitioners to practice without mandatory collaboration, says Mary Beth Koslap-Petraco, DNP, PNP-BC, CPNP, legislative issues chair of the Nurse Practitioner Association of Long Island in Hauppauge, N.Y. Were feeling hopeful this year because mandatory collaboration was removed for nurse midwives.
Koslap-Petraco reports the organization achieved passage in the senate and assembly of a bill allowing nurse practitioners to sign DNR orders, but former Gov. David Paterson vetoed it. Many laws were passed before NPs became an important part of the healthcare delivery system and now those statutes need updating to allow NPs to sign DNR orders, death certificates and immunization forms. The association also will work to ensure insurance companies include NPs on their panels and reimburse for their services. It also will push for NPs to fully participate and be reimbursed by the workers compensation program.
New Jersey passed a bill to upgrade striking a healthcare worker from a simple to an aggravated assault, legislation Patricia Barnett, RN, JD, chief executive director of the New Jersey State Nurses Association, says her group supports.
Issues related to the independent practice of advanced practice nurses also are playing out in New Jersey. Even though the state does not require collaborative agreements, NPs are required to prescribe medications and devices in accordance with a joint protocol signed by a collaborating physician. The Department of Health and Senior Services and the legislature are in the midst of debate about the need for physician supervision of APNs/anesthesia, formerly certified registered nurse anesthetists. The department held a public hearing this fall before ruling on whether to change hospital licensure regulations to allow independent practice by APNs/anesthesia. At the same time, bills were introduced requiring physician supervision. They likely will be reintroduced in 2011.
There are a lot of changes going on in the administration, and there have been battles over the budget that have taken the attention away from other issues, Barnett says.
New Jersey nurses will continue their fight to give more money to schools to hire school nurses. The NJSNA also is working with Jeffrey Brenner, MD, to establish a Medicaid Accountable Care Organization demonstration project, which would create ACOs groups of healthcare providers who agree to be accountable for the quality, cost and overall care of Medicare beneficiaries. Many ACOs will be run or coordinated by nurses. An example would be professional caregivers going into the community to work on health issues with patients, such as the homeless and other high-cost users of medical services. Savings would flow to the state and the providers.
Its an interesting approach and one that could dramatically improve healthcare, Barnett says. In some ways this is like nursing at the beginning of the 20th century, when nurses would go into the tenements and help people. Its like we are coming back to our roots.
Barnett says legislation pertaining to implementation of the IOM report is not ready yet and foundations must be laid before putting forward changes, such as eliminating the need for APNs to practice under joint protocols. The states IOM Study Group will meet to develop an action plan.
There is a lot of great energy going on, talking about how we are going to move nursing forward, Barnett says. The IOM report gives us a platform to work from.
Debra Anscombe Wood, RN, is a freelance writer.
Send comments to [email protected]Mary Beth Koslap-Petraco, RN