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.

Hospice staffing legislation

• 2006: One LPN rather than one RN on each shift. Stricken.

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

Questions?