Rep Maurice Hinchey (D-NY) introduc...

Rep Maurice Hinchey (D-NY) introduced the Patient Safety Act of 1996 (HR 3355) forward Apnl 30, 1996. The bill has been referr for consideration to the House Committee in succession Ways and Means, the House Committee in succession Commerce, and to the House Subcommittee upon Health and Environment. The bill, drafted at the American Nurses Association (ANA), consists of three major components: disclosure of nursing staff numbers through health care institutions, whistleblower protection for any nourish who reports unsafe care practices in his or her facility, and economic impact studies of any pending health care provider merger The bill does not have companion legislation in the Senate.

PUBLIC DISCLOSURE OF NURSING STAFF NUMBERS

The bill would require that

any provider in subordination to the

Medicare program shall,

as a condition of

continued participation in

of the like kind program, make

publicly available

information regarding

cherish staffing and patient

issues as specified

through the Secretary [of Health

and Human Services].(1)

This information would have to include the number of

* RN licensed practical festers (LPNs), and vocational nurses providing direct patient care;

* nursing assistants and unlicensed assistive personnel (UAP) providing direct patient care; and

* patients through RN providing direct patient care. In addition, health care facilities would have to disclose patient mortality rates; reports of adverse patient care; the manners facilities use to determine staffing levels; and any complaints filed with state health agencies, the Health Care Financing Administration, or accrediting agencies related to Medicare participation.

undivided goal of HR 3355 is to "educate the public and Congres onward quality of care problems that wounds in nurse staffing create."(2) The ANA undertook another orderly disposition of public education through its "Nursing Care Report Card for Acute Care Settings" research The study, which was reported in February 1995 explored the connection between nursing care and patient consequences by identifying nursing quality indicators (eg mix of RN LPN licensed vocational nurtures and UAP; RN education and qualifications; nursing staff turnover).(3)

The research revealed that

hospitals who employ

fewer registered nurses

or who `short staff their

units have longer

long durations of stay than

hospitals who employ

registered encourages to

provide all or most

patient care or who have

higher suckle patient

ratios

and that mortality rates are related to the ratio of RN to all nursing staff.(4)

The Institute of Medicine (IOM), a branch of the National Academy of Sciences, released its "Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?" contemplation in January 1996. The meditation the result of 1993 congressional action, reiterated the findings of the ANA report card investigation stating "[Hospitals] are . . redesigning and reconfiguring staffing patterns" and using interdisciplinary teams of RN LPN and other nursing personnel "to remain economically viable."(5)

The IOM committee also, however,

raise that little empirical

evidence is available to

support the anecdotal and

other informal information

that hospital quality of

care is being adversely

affected from hospital

restructuring and

changes in the staffing

patterns of nursing

personnel(6)

The committee believed this lack of evidence made it impossible to draw conclusions about the adverse quality of care in hospitals moreover that based on the scarcely any studies that were available "the quality of hospital care in general has not be acted uponed and may have even improved" after the Medicare prospective payment combination of parts to form a whole was implemented.(7)

The Patient Safety Act of 1996 would require the number of RN LPN licensed vocational fosters and the number of UAP who provide direct patient care to be

squeeze outed both in raw

numbers, in names of total

hours of nursing care per

patient (including

adjustment for case mix and

acuity), and as a percentage

of nursing staff, and shall be

halting down in terms of the

total nursing staff, each unit,

and each shift.(8)

This information would provide to a great degree needed documentation on nurse staffing levels

WHISTLEBLOWER PROTECTION

The inferior component of HR 3355 is designed to defend any nurse who reports unsafe health care practices. Any facility violating this law by dint of censoring a nurse who reports of that kind practice would be unable to participate in Medicare for a certain period of time.

The protection of nurtures and their jobs is especially important in light of the US principal Court's ruling on National Labor Relations Board v Health Care & Retirement Corp of America (No 92-1964) the and nothing else ruling on nurses' employment status in the past couple years. In this ruling, the court determined that LPN were supervisors, saying "in this case, the practical nourishs have the same duties as registered nurses"(9) This ruling, while not naming RN in particular, was unclear enough to cause matter among nurses because it effectively kept nourishs from federal labor law protections.