safe staffing policies in virginia: traditions, policy and political implications and possibilities...
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Safe Staffing Policies in Virginia: Traditions, Policy and Political
Implications and Possibilities for the Future
Becky Bowers-Lanier, RNVNA lobbyist
becky@macbur.com
What we’ll cover
• The Virginia history (traditions) related to staffing policies
• Current staffing policies (regulations)
• Possibilities for the future
The Virginia history
• Right to work state• Nurses as commodities• Role of special interest groups in
influencing policies– VNA– VHHA– VHCA– TLC4LTC– VAH
Right-to-work
• Two types of workplace advocacy: unions and through individual nurse advocacy
• State laws: workers have right to organize– “Union” states: must become members OR pay fair
share membership– “Right-to-work” states: unions must represent all
members regardless of whether they belong or not.– VNA decertified as union in 70s. – The myth persists
Nurses as commodities
• Until 90s supply exceeded demand.– A nurse is a nurse is a nurse.
• Since then, demand forces change in perception of the nurse– Commodity customer valued asset– Magnet movement
Special interests: VNA
• Mission: promote advocacy and education for RNs to advance professional practice and influence the delivery of quality care
• Philosophy: . . . nurses are autonomous, prepared practitioners who are accountable for their practice and who are advocates for the consumer.
Special interests: VHHA
• Mission: help our members improve the health status of the communities they serve.
• Vision (in part): Virginia . . .the healthiest state in the nation
• Strong workforce (contributes to health)– Essential to high-quality care.– Seek ways to make hospitals employer of choice– Use care systems that maximize value of clinical skills– Support educational system that meets
needs of students– Scorecard for workforce: number of
newly licensed RNs per year.
Special interests: VHCA
• Mission: to provide leadership in the areas of continuing education for long-term care professionals, to be a major contributor to the health care debate through advocacy for member facilities, and to define quality in extended care services for the public.
• Dedicated to providing highest standard of care.
Special interests: TLC4LTC
• Committed to achieving quality care for nursing home residents in the Commonwealth of Virginia.
• Support increased staffing levels; better training and improved supervision for direct care workers.
• Support increased reimbursements to nursing facilities that will be used only for staffing, training and supervision purposes.
Special interests: Virginia Assn for Hospices
• support hospice patients and their families
• address the needs of hospice care providers
• promote the concept of hospice care in the Commonwealth of Virginia
Types of staffing legislation introduced in Virginia since 90s
• 1994: Review staffing guidelines and determine whether staffing requirements in effect protect health, safety and welfare of residents (nursing facilities). – Passed. No action.
• 1999: Two resolutions requiring Joint Commission to study staffing. – Passed.
More legislation on LTC
• 2000: Required Board of Health to develop staffing standards (5 hrs/24). Failed.
• 2001: Same as 2000. Failed.
• 2002: 3.5 hrs/24. Failed.
• 2003-6: Same as 2002. Failed.
• 2007-8: Staffing standards and reporting out of staffing data: failed.
Perioperative staffing legislation
• 2002: One perioperative nurse to one surgical patient. Failed.
• 2006: One perioperative nurse to one surgical patient. Failed.
Tensions among special interest groups
• Professional practice of RNs and safe patient care inextricably linked (VNA)
• Staffing one among many issues, inextricably linked with reimbursement and funding (VHHA, VHCA, and VAH)
• Increased productivity, reducing inefficiencies to contain costs
linked with staffing levels.
Current staffing policies
• Institutional policies– Internal to facility– Linked with accreditation standards and
Medicare CoP– Part of state licensure regulations.
Virginia statutes regarding staffing
• Department of Health– Standards for “operation, staffing and equipping of
hospitals, nursing homes and certified nursing facilities.
– Standards for neonatal services . . requirements for staffing credentials, staff/patient ratios. . . .
– Board of Health to prescribe regulations governing . . . staffing and equipping of hospice program.
• DMHMRSAS: – Inspector General’s written reports of state facility
inspections . . include staffing patterns.
Virginia regulations include staffing ratios
• Specific staffing ratios for:– Cardiac catheterization services– Open heart surgery services– Radiation therapy– Hospices– OB (L&D, postpartum and nursery)
Virginia regs include staffing plans
• Nursing facilities
• Hospitals
• Hospices
• Home and community-based care providers (DMAS)
Proposed staffing regs for hospital licensure
• Not revised since 1980s• Stakeholder committee working with VDH to
update regulations• Proposed staffing language: 12VAC5-411-180.
Personnel and employment practices.C. Each department within the hospital shall implement a staffing plan that reflectsthe types of services offered and that provides qualified staff in sufficient numbers tomeet the treatment needs of all patients in the department.
Political/legislative considerations
• Progressive versus conservative
• Climate in Virginia– Legislative branch– Executive branch– Other considerations
• Budget• Degree of involvement of special interests
Possibilities for the future: nurses as advocates for safe staffing
• Competition, collaboration, co-optation, compromise
• Consumer involvement
• Funding
• Data to support safe staffing
Improving our policy contributions through organizational advocacy
• Contributing dues toward the organization.
• Developing and implementing a policy-legislative-advocacy agenda
• Organizational participation in coalitions
• Developing an advocacy infrastructure of committed members and lobbyists
Improving our policy contributions through individual advocacy
• Cultivate and maintain relationships• Use the web • Join coalitions and associations• Develop diverse networks• Share• Become knowledgeable and participate in
telling the story• In meetings, play the devil’s advocate
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