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Washington Watch | Issues Update | Health & Safety

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American Journal of Nursing - February, 2003 - Volume 103, Issue 1

From Overtime to Understaffing
The ANA works with states to secure nurse-friendly legislation.

By Susan Whittaker, MSN, RN

As the ANA works at the federal level to secure legislation that prohibits mandatory overtime, protects nurse whistle-blowers, addresses nurse staffing, and offers nursing education incentives, it also supports its constituent member associations (CMAs) in seeking similar measures at the state level through the Nationwide State Legislative Agenda, created three years ago.

Over the past two years, the ANA has worked with several CMAs on proposed state legislation, press conferences, shared strategies and resources, and promotion of the agenda at national meetings of state legislators. Following are state victories achieved through implementation of the agenda in 2001 and 2002:

Prohibition of mandatory overtime. In Maryland, legislation was enacted stating that an employer may not require a nurse to work more than the regularly scheduled hours according to the predetermined work schedule. Exceptions include an unforeseen emergency or work that requires a nurse’s critical skills or expertise. A New Jersey law prevents a health care facility from requiring an employee to work in excess of an agreed-upon, predetermined, and regularly scheduled daily work shift, not to exceed 40 hours per week. Texas regulations require hospitals to develop policy and procedures for mandatory overtime. In Washington, legislation was enacted stating that a nurse’s acceptance of mandatory overtime is strictly voluntary and that refusal is not grounds for adverse actions. Minnesota legislation prohibits action against a nurse who refuses mandatory overtime because it would jeopardize patient safety, while Maine legislation would prevent a nurse from being disciplined for refusing to work more than 12 consecutive hours except in certain circumstances. Oregon enacted legislation that prevents a nurse from being required to work more than two hours beyond a regularly scheduled shift or 16 hours in a 24-hour period.

Whistle-blower protection. Whistle-blower laws prevent employers from taking retaliatory action, such as suspension, demotion, harassment, or discharge, against nurses who report improper quality of patient care. Whistle-blower legislation has been enacted in Florida, Maryland, New York, Oregon, and West Virginia.

Nurse staffing plans. The ANA and its CMAs proposed state legislation to hold hospitals accountable for developing and implementing a valid and reliable nurse staffing system based upon the ANA’s Principles for Nurse Staffing. In Florida legislation was enacted that specifies the establishment of minimum staffing standards and quality requirements for a subacute pediatric transitional care center to be operated as a two-year pilot program. Texas regulations require hospitals to adopt, implement, and enforce a written staffing plan, under the administrative authority of a chief nursing officer and in accordance with an advisory committee comprising nurse members. Oregon legislation requires that hospitals be accountable for developing and implementing nurse staffing plans and establish internal review processes.

Collection of nursing supply and demand data.This is vital for states to accurately assess the nursing crisis and develop comprehensive short- and long-range state workforce planning strategies. Legislation was enacted in Florida, Georgia, Idaho, Kentucky, Mississippi, North Dakota, South Dakota,™Tennessee, and Texas that requires the collection of nursing workforce data through nursing centers, boards of nursing, state agencies, or foundations.

Nursing education incentives. State legislatures introduced more than 117 bills in 2002 to increase the number of graduates from nursing programs. Approaches include offering student loan forgiveness; grant and scholarship programs; and provision of funds to schools of nursing to exàand nursing programs, staff, and faculty; as well as standardization of nursing programs. Legislation has been enacted in Arizona, California, Colorado, Florida, Idaho, Kentucky, South Dakota, Virginia, and West Virginia.

In 2003 the Nationwide State Legislative Agenda will build on these successes and continue to focus on nurse staffing. In addition, the 2003 agenda will include four additional goals: protecting nurses from musculoskeletal injuries in the workplace, addressing issues relating to the appropriate delegation of nursing tasks, promoting hospitals’ adoption of the principles outlined by the American Nurses Credentialing Center’s Magnet Recognition Program, and ensuring that hospitals and other institutions are held accountable for using an appropriate nurse staffing system.

For more information, contact your state nurses’ association.

Susan Whittaker is an associate director in the ANA’s Department of Government Relations.


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