FOR IMMEDIATE RELEASE
Date: July 27, 1998

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AMERICAN NURSES ASSOCIATION ACTS ON PATIENT SAFETY AND QUALITY OF CARE CONCERNS AND TO SHAPE FUTURE ROLE OF NURSING PROFESSION

ANA House of Delegates Determines Policy in Several Major Areas

Washington, DC -- The American Nurses Association (ANA) House of Delegates, which meets annually, took action to reaffirm its commitment to patient advocacy and to shape the future of nursing when it set policy in several major areas at its meeting earlier this month in conjunction with ANA’s San Diego convention.

Among the areas on which the House of Delegates (HOD) set policy are interstate practice of nursing, shared accountability for quality of care, safeguarding nurses’ personal information, international health rights of women and children, women’s health, and health care accrediting organizations. The House of Delegates also affirmed the principles of patient and health care professional rights set forth in by a coalition of nurses and doctors calling themselves the Ad Hoc Committee to Defend Health Care. Other key issues tackled by the House of Delegates were home health care payment systems, quality of care in long term care facilities, and the future of Medicare.

Interstate Practice
With more and more nurses practicing across state lines, the notion of RNs having one license that would be recognized by all states continues to be a hot issue. Interstate practice was discussed extensively in a reference hearing and in a two-part education session.

The National Council of State Boards of Nursing (NCSBN) already has proposed a multistate compact that would allow a nurse to practice in several states based on a single license. Nursing organizations, including ANA and state nurses associations (SNAs), have had many questions regarding the compact, including how it is implemented and its effects on collective bargaining efforts and disciplinary action. So far, Utah is the only state that has approved the compact.

In considering this issue, delegates affirmed ANA’s continued commitment to consumer access to nursing services, recognizing that practice occurs across state borders. They called on ANA to develop model guidelines for SNAs that want to pursue legislation facilitating cross-state practice, and to address issues of interstate practice in ways other than compact agreements or other multistate license agreements.

Delegates also identified a number of guidelines that must be present in any mechanism for interstate practice, such as protecting the right of individual nurses to a fair hearing of any disciplinary matter and addressing interstate practice as an issue for all registered nurses (RNs), including advanced practice registered nurses.

In addition, delegates expressed concern that interstate practice should not be used as a mechanism to facilitate strikebreaking. The delegates similarly opposed use of interstate practice to circumvent existing requirements for initial and continuing licensure, such as educational requirements for entry to practice or continuing education for relicensure.

Shared Accountability
As a way to attract managed care dollars, health care facilities are placing a greater emphasis on patient satisfaction and outcomes. Many are increasingly holding individual health care providers accountable for adverse patient outcomes even though these institutions continue to implement cost-cutting measures that affect safety and quality, such as reducing RN levels. In addition, discipline for practice errors has become more severe. In response to this spreading “blame” culture, the ANA Board of Directors (BOD) brought before delegates a plan that calls for health care entities to study how systems and not individuals might be at fault when errors occur in the workplace.

Delegates approved the plan, which directs ANA, in part, to educate policy-makers and the public about the effects of downsizing, restructuring and reorganization and to support RNs as they try to correct system errors through quality improvement initiatives and through enactment of whistleblowing legislation. They further want ANA to develop model language for rules and regulations that will clearly define malpractice and criminal acts.

Safeguarding personal information
More and more organizations, from government agencies to private companies, are using the Internet to provide consumers with many types of information. As a result, a number of state boards of nursing have decided to share personal information about RNs, including home addresses and phone numbers, on their Web sites. At the ANA BOD’s urging, the HOD supported a plan aimed at protecting the privacy, and in turn, the safety of RNs.

Delegates specifically want ANA to provide SNAs with guidelines that will help them implement and evaluate safeguards dealing with the dissemination of personal and professional online information. They further want ANA to urge state and federal agencies to establish and comply with laws that protect the confidentiality of personal and professional online information.

International Health Rights of Women and Children
Women worldwide continue to have unequal access to basic health resources, including primary health services for the prevention and treatment of childhood diseases, malnutrition, anemia and communicable diseases, to name a few. They also often live in poverty and face violence and discrimination -- conditions that impact their health, as well.

At the convention, delegates approved an ANA-BOD recommendation to work toward empowering women so they can make their own health care decisions and have equal access to services for themselves and their children. Delegates also directed ANA to advocate for the ratification of a comprehensive treaty called the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) by the U.S. Senate. CEDAW establishes rights for women in many areas, including affirmative action, sexual harassment, reproductive rights and domestic violence.

Women’s Health
Advancing the health of women historically has taken a back seat to improving the health of men on many levels, from research and access to services to treatment issues and occupational health. In terms of research, for example, an ANA BOD report noted that fewer private and public research dollars are spent on diseases that disproportionately affect women.

To tackle the inequities, delegates directed ANA to advocate for increased research funding for studies that: target conditions unique to or prevalent among women of various age groups and ethnic backgrounds; include women in clinical trials or involve women only; and identify health hazards significantly affecting women in the workplace, to name a few.

Health Care Accrediting Organizations
When consumers enter an accredited health care facility, they generally assume that because the facility has met certain standards, their safety will be ensured. The standards established by accrediting organizations, however, are becoming more amorphous and open to broad interpretation. At the same time, the government might be moving toward less oversight, which could seriously impact patient safety.

To tackle this issue, delegates called for participation by professional nurses in the accrediting processes of all accrediting organizations and for strengthening those processes to reflect the essential role of professional nurses. Delegates also directed ANA to develop criteria for accreditation standards that would include protection of nurses’ legal scope of practice; the availability of professional nurses to provide direct patient care at all times; a definition of sufficiency of nurse staffing levels based on nursing standards and patients’ acuity and functional levels; nursing participation in facilities’ decision-making and planning bodies (as long as it does not undermine collective bargaining); and a requirement for a chief nursing executive as an equal partner in operations and corporate levels of health care facilities and agencies.

They further want ANA to push for public disclosure of accreditation information, recommendations and citations, including staffing levels, patterns and patient outcomes.

A Call to Action
In a graphic protest against corporate greed, a coalition of nurses and doctors calling themselves the Ad Hoc Committee to Defend Health Care dumped annual reports of for-profit hospitals into Boston Harbor. The same group, which includes Massachusetts Nurses Association (MNA) members, developed an article, “For our patients, not for profits: A call to action,” which was published in the Journal of the American Medical Association Dec. 3, 1997, the day after the “tea party” reenactment. The article, signed by 3,000 Massachusetts health care providers and endorsed by several SNAs, warned that “doctors and nurses are being prodded by threats and bribes to abdicate allegiance to patients, and to shun the sickest, who may be unprofitable.” It called for an immediate moratorium on for-profit takeovers of health institutions.

Delegates directed ANA to endorse and promote the principles contained in the ad hoc committee’s call to action article. The HOD subsequently agreed to five areas of common ground with the ad hoc committee:

• Nursing and medicine must not be diverted from their primary tasks: the relief of suffering, the prevention and treatment of illness, and the promotion of health. The efficient deployment of resources is critical, but must not detract from these goals.
• Pursuit of corporate profit and personal fortune have no place in care giving.
• Potent financial incentives that reward over-care or under-care weaken patient-nurse and patient-physician bonds and should be prohibited. Similarly, business arrangements that allow corporations and employers to control the care of patients should be proscribed and efforts should be made to prevent the imposition of gag orders on providers of care.
• A patient’s right to a clinician of choice must not be curtailed.
• Access to health care must be the right of all.

Home Health Care Payment Systems
Currently, more than 20,000 providers deliver home health care services to some seven million persons, and Medicare is the single largest payor of home care services. The Balanced Budget Act of 1997 (BBA), however, included provisions that impact the use of home health services -- including a change in how providers are reimbursed and who is eligible for home care.

An interim reimbursement system, the Interim Prospective Payment System (IPPS), went into effect Oct. 1, 1997 and will be implemented over a two-year period. The Health Care Financing Administration then plans to implement a final new payment system, the Prospective Payment System (PPS), effective Oct. 1, 1999.

Many critics argue that IPPS decreases access to care for the oldest, poorest and sickest Medicare beneficiaries by placing new financial pressures on home health care providers to reduce the number of visits and the length of time beneficiaries receive home health care.

Delegates agreed to a plan that includes directing ANA to advocate for the protection of patient access to needed, quality home health care services; that recommends repeal or substantial reform of the IPPS for home health care; and that advocates for mandated consumer, nurse and provider participation in the design and implementation of an equitable and efficient PPS for home health care.

Quality of Care in Long Term Care Facilities
By taking action on this ANA BOD-submitted report, the association will continue to oppose efforts to weaken long term care reforms that were included in the Omnibus Budget Reconciliation Act of 1987, reforms that ANA believes represented a historic advance in protecting the quality of care and quality of life for residents in long term care.

These protections have been threatened by attempts to remove standard-setting and enforcement responsibilities from the federal government and return them to the states. In addition, many advocates are concerned about the potential effect of the Balanced Budget Act’s repeal of the Boren Amendment, which provided for “reasonable” reimbursement rates for providers under state Medicaid programs. With the Boren Amendment gone, many fear that states will precipitously lower their payment rates to nursing homes, thus endangering access and quality of care and creating additional pressure to weaken the OBRA ’87 protections.

In approving the report, delegates provided that ANA would continue to support clear, consistent federal regulations for quality of long term care, and in turn, oppose the return of standard-setting to the states.

They also voted to support federal legislation and regulation that require long term care facilities to have a sufficient number of professional registered nurses on site providing direct patient care 24 hours a day.

The Future of Medicare
Thirty-three years ago, ANA stood out as a strong and vocal supporter of a proposal to create a program that guarantees health care coverage for older Americans.

The future of the Medicare program increasingly has been called into question amid predictions that funding for the program will dry up in the early years of the next century, partially as a result of the nation’s rapidly aging population. Currently, the bipartisan Commission on the Future of Medicare is debating proposals for maintaining a strong, viable Medicare program.

In response to this issue, delegates called on ANA to develop an advocacy campaign that would provide nursing’s recommendations to the commission. Delegates declared that Medicare should remain a social insurance program that provides universal access for all older Americans and identified disabled populations, regardless of income. They also supported maintaining and advancing Medicare’s current levels of quality, service and eligibility; broadening its funding base; maintaining federal oversight; and encouraging mechanisms to allow individuals currently ineligible for the program, including those aged 55-64, to opt into the program.

Delegates further approved conditions that all Medicare providers must meet: public disclosure of staffing and outcome data; support for the right of nurses and others to speak out on behalf of safe, quality patient care; maintenance of quality, safety and access levels in any proposals for mergers and acquisitions; and ongoing outcome measures of quality, safety and access.

The HOD also insisted that Medicare beneficiaries must maintain a number of guarantees, such as the right to make informed choices between fee-for service and managed care plans and the right to protections included in the President’s proposed Patients’ Bill of Rights.

To see the full actions of the HOD, visit ANA’s Web site at http://www.nursingworld.org/about/summary/98hodact.htm.

The American Nurses Association is the only full-service professional organization representing the nation's 2.6 million Registered Nurses through its 53 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

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