IMMEDIATE RELEASE/July 11, 1996 CONTACT: Anita Baumann [202/651-7048] ANA House of Delegates Approves Actions to Strengthen Nursing Workforce, Reaffirm Commitment to Patient AdvocacyWASHINGTON, D.C.--During its June 14-19 meeting in conjunction with ANA's Convention and Centennial Celebration, the House of Delegates thoughtfully and sometimes hotly debated and approved several proposals that would serve to increase nursing's role in patient advocacy while at the same time strengthening the nursing workforce. Together, these actions seek to more firmly establish nursing's presence and clout in the health care delivery system, while preserving the safety and quality of patient care. Preserving the health care practitioner and patient/client relationshipThe House agreed that ANA should reaffirm the responsibility of registered nurses (RNs) and other health care practitioners as patient advocates and oppose any activities by health care plans to directly or indirectly require a health care practitioner to withhold information about care options from patients. In addition, the House also directed ANA to oppose any employment language in the health care industry prohibiting or punishing whistleblowing and to lobby Congress to protect health care consumers from antidisclosure practices through statutes.Advocating for the rights of individuals enrolled in health plansIn its most contentious debate, which spilled into a second session, the House ultimately approved a motion that ANA should support the development and enforcement of state and federal legislation and rules that require all health plans to fulfill their contractual obligations to beneficiaries. Debate centered around an amendment to the original proposal that directed ANA to seek such legislation that would "ensure the health care needs of beneficiaries are addressed along with the interests of plan sponsors and providers so that consideration of quality, cost and access mutually drive decision-making." Numerous delegates were concerned that this wording would appear to place the plan sponsors' interests above those of the patients and objected to the language on that basis.Supporters of the wording argued that it realistically took into account the needs of other groups with which nursing would need to work, thereby contributing to nursing securing a "place at the table" when decisions are made that affect care. After tabling the recommendation for a day, the House approved compromise language that clearly recognized the patient's interests above all others. The House also directed ANA to support full disclosure to the beneficiary of contract provisions or other arrangements between purchasers, plan sponsors, providers and any others who could influence decisions or care options. In addition, ANA will seek federal regulations and support state regulations to provide beneficiaries with clear and understandable benefits package information and that require the collection and reporting of standardized information, assure beneficiary access to claim data and provide for independent review and appeal of denied claims or services. Maintaining federal quality protections for nursing home residentsRecognizing the aging of the population and the resulting needs, the House approved in a unanimous voice vote several recommendations to protect the nation's nursing home residents. First, ANA should support critical protections within and continued congressional funding of federal requirements established by the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987. Second, ANA should support maintenance of federal regulations that continue federal oversight of nursing homes in every state to assure minimum standards of nursing care and other appropriate services to maintain or improve cognitive and functional capacity of residents, maintain use of a uniform resident assessment system that includes prescreening and ongoing evaluation across the care continuum and prevent discrimination and financial exploitation of current and future nursing home residents.Finally, ANA should support development of federal legislation that will require nursing homes to have RNs onsite providing direct care 24 hours a day, enhance established training standards for nursing assistants, establish guidelines that protect nursing home residents from transfer or discharge without their consent or that of their advocate and standardize training of state surveyors to provide consistent review of nursing homes. Progress on preparation of the nursing workforceAfter only minor rewording, the House unanimously approved recommendations to strengthen preparation of the nursing workforce. ANA should delineate the future needs for preparation of nurses and clarify the characteristics that distinguish the discipline of nursing from other health care disciplines and continue to educate nurses regarding the relationships between educational preparation and professional opportunities, roles and mobility. The House directed ANA to provide centralized support, which was clarified as administrative, to state nurses association (SNA) initiatives to support career progression for RNs, including the use of articulation models. Recognizing the need for funding, the House mandated that ANA support redirection of Medicare Part A Graduate Medical Education (GME) funds currently used for diploma nursing education to graduate nurse education programs while maintaining support of those baccalaureate programs that currently receive GME money. In addition, ANA will continue to support the longer range goal of redirection of 20 percent of the GME funds being used for medical education to a newly created graduate nurse education fund to be used for advanced practice nurse education and RN-MSN "bridge" programs.Regulation and licensure of the health care workforceWith delegates voicing opposition to anything that would further regulate nursing, the House unanimously affirmed a core value of the profession that nursing must control the preparation and practice of its practitioners, reaffirming the profession's opposition to second licensure requirements for advanced practice nurses. The House also reaffirmed opposition to efforts by hospitals, health systems, health care corporations or other nurse employers to control nursing practice, education or licensure. In addition, the House voted that ANA continue to assist SNAs to oppose efforts to weaken nurse practice acts and the regulatory structures that protect and promote the public's health and support nursing practice. The House directed ANA to develop proposals for promoting, demonstrating and measuring continued competency of RNs in collaboration with appropriate nursing groups.Competency of staff nurses facing reassignment or role expansionAfter much discussion about ANA's role in helping nurses deal with reassignments, the House voted that the association should develop guidelines and create models for RNs to promote a successful transition when experiencing reassignment or role expansion. In addition, ANA will determine strategies to help RNs in such situations to obtain assistance from the employer in the form of time, resources and educational support so that they may continue to provide safe nursing care to clients.Collection of nursing workforce dataThe House voted that ANA should develop and disseminate national and state strategies to access nursing workforce data essential for validation and linkage to outcomes of care and health care quality. ANA was directed to assist SNAs to strengthen relationships with state health data organizations to promote the inclusion of nursing's quality indicators in state health data collection and identify collection and use of workforce data.In addition, ANA also should provide models for developing legislative and other approaches to ensure the collection of and access to health and nursing workforce data and assist SNAs to intervene with appropriate state and national organizations to collect, analyze and disseminate such data. The House also approved two collaborations: with the National Council of State Boards of Nursing to support the Pew Commission report recommendation that state boards maintain nursing workforce data in accessible and understandable formats for public use and with the American Organization of Nurse Executives to implement the Nursing Minimum Data Set. Quality InitiativeThe House approved a motion that ANA work to influence the research communities and the public and private funding organizations to prioritize health systems research oriented to health outcomes and the role of nursing in achieving those outcomes. In addition, ANA was directed to empower and educate RNs to collaborate in the conduct of health systems research that supports the role of RNs in achieving positive outcomes.Telenursing and telehealthFollowing a discussion urging ANA to take the lead in addressing telecare, the House voted almost overwhelmingly to develop model guidelines and policies for professional nurses participating in telenursing and telehealth that address education and legal issues, ethical concerns and reimbursement issues. In addition, the House directed ANA to advise the profession regarding appropriate state and federal legislative or regulatory oversight for telenursing and telehealth practice.Compensation methods that threaten to diminish nursing practice standardsNoting ANA's responsibility to monitor nurse compensation methods, the House voted almost unanimously to promote professional and public awareness of the inherent conflict for the RN as patient advocate when compensation methods for nurses are linked to the withholding of health services. The House directed ANA to monitor emerging compensation methods to determine whether they produce cost savings at the expense of quality health care and to provide data-based criteria to RNs to evaluate the impact of such methods on ethical and professional standards of care and health care costs.ANA also will determine and articulate national and state strategies to deter or prohibit compensation methods that threaten the quality of nursing care. The House approved a measure that ANA support initiatives that protect RNs from pressures related to compensation methods that may adversely affect their ability to advocate for their patients and deliver quality care in an ethical manner. Other actionsThe House of Delegates also directed ANA to confirm and continue to support the Lynda Arnold National Campaign for Health Care Worker Safety, particularly by assisting the SNAs with strategies for the implementation and use of protective needle devices and "hands free technique" in surgery. In addition, ANA will continue to monitor regulations and/or activities of the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention.Aware of the growing rash of arson fires at churches serving communities of color throughout the south and southeast, the House directed ANA to express its outrage at this desecration by urging the U.S. Attorney General to use the full authority of the office to investigate and prosecute any violation of civil rights associated with the incidents. "This association and this country must have zero tolerance for acts of violence spawned by bigotry and hatred, which threaten the very fabric of our democratic society," the House-approved motion states. House action also mandated that ANA identify and make visible health care as a critical issue in this election year and move forward Nursing's Agenda for Health Care Reform.
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