Nevada nurses at legislative session: Nevada Legislature report 2007 session.

The 2007 74th Nevada Legislative Session was extended briefly when Governor Jim Gibbons issued a Proclamation calling the Legislature into the 23rd Special Session at 5:00 p.m. on June 5, 2007. The 23rd Special Session of the Nevada Legislature adjourned at 8:49 p.m. on June 5, 2007. We are now in the interim period between legislative sessions.

During the 2007 Session, the Nevada Nurses Association, through the Legislative Committee, selected members, and the NNA Board along with our lobbyist, Neena Laxalt, followed many bills. Four, however, were near and dear to my heart.

Senate Bill No. 412, sponsored by, among others, Senator Joseph J. Heck, Republican representing Clark County Senate District No. 5, affected nursing in Nevada in two sections.

* Section 10 decreased the requirements for clinical nursing faculty in schools of nursing to a Bachelor's degree, along with other changes. I provided testimony to the legislative committee on behalf of NNA opposing these changes. After the testimony, I left my business card with Senator Heck, the bill's sponsor, to let him know that I was an interested party. Although I was not able to convince him to maintain the current requirement for a Master's degree in nursing or a related field, he did agree to increase the experience required from 3 to 5 years. He also agreed to drop allowances for pharmacists and physicians to teach in nursing programs.

* Section 12 mandated that the Nevada State Board of Nursing join the "Nursing Compact." This would have allowed nurses with licenses in other states to have a license in Nevada without necessarily meeting the requirements for Nevada licensure. On behalf of NNA, I also opposed this section, since fingerprinting is not required in all compact states; thus, this bill had the potential for lowering standards in Nevada. Based on the efforts of Neena Laxalt, others in the Legislative Committee, and the NSBN, this section was removed.

Assembly Bill No. 458 sponsored by, among others, Assemblywoman Ellen Koivisto, a Democrat representing Clark County Assembly District No. 14 offered hospitals two options. They could develop staffing ratios jointly with the nursing staff or the have mandated staffing ratios. NNA, along with SEIU supported this bill. Along with many nurses, I provided testimony and also spoke with Senator Koivisto. This bill did not make it out of the Assembly Health and Human Services Committee.

Assembly Bill No. 577 -Safe Handling--Would have required certain medical facilities to establish a program for safe handling of patients. It missed the May 25th deadline. NNA provided testimony in support of this bill.

Assembly Bill No. 187--Certified Medication Aides--Would have provided for regulation of certified medication aides. This bill missed the April 14th deadline. NNA provided testimony against this bill.

As you can see, we had mixed results from our efforts. I think that is called politics. I'm sad that we didn't get safe staffing and safe patient handling, but we were successful in helping avoid the pitfalls inherent in Certified Medication Aides and the Nursing Compact.

What follows is the specific testimony I provided regarding SB 412 and AB 458. As you can see, in order to testify, you have to do your homework and provide information that allows our elected representative the ability to make decisions on behalf of the people of Nevada. Overall, the experience was very enlightening and powerful. Testimony regarding assembly Bill No. 458, presented by Karen Fontaine, RN, MSN, Treasurer.

Nevada Nurses Association supports safe staffing for all healthcare facilities in Nevada because NNA supports all nurses in Nevada. There is adequate research to show that adequate nurse staffing improves patient outcomes. Safe staffing saves lives. Every nurse has many stories to tell about having to decide between an unsafe staffing situation and his or her job and license. That is not right. Assemblymen Koivisto, Parks, McClain, Claborn, Anderson, Atkinson, Gerhardt, Hogan, Kihuen, Kirpatrick, Leslie, Ohrenschall, Parnell, Pierce, Smith, and Womack are to be commended for supporting nursing in Nevada by sponsoring AB 458. NNA supports this bill.

There are some areas of concern to us.

Section 14, #1, 4, 5: We do not believe that mandatory staffing ratios will benefit all nurses equally (#1). Instead we support the development of a joint labor-management committee (#4) that contains equal numbers of management and staff to develop and document the staffing plan, and address how disputes will be resolved.

Section 18, #2. The outcome measures that are included in AB 458 are not nurse sensitive indicators. The National Database of Nursing Quality Indicators (NDNQI)[R], a repository for nursing-sensitive indicators, is a program of the National Center for Nursing Quality[R]. NDNQI[R] is the only database containing data collected at the nursing unit level. The list of indicators currently being collected includes: Patient Falls, Pressure Ulcer Rate, RN Satisfaction, Nursing Hours per Patient Day, Staff Mix and others. An indicator for nursing turnover is undergoing development. NNA recommends that nurse sensitive indicators sponsored by NDNQI be used.

Section 28: This bill should apply to all counties in Nevada. We do not believe that only nurses who Washoe or Clark counties should be protected from being forced to chose between advocating for patient safety and a job.

In 1990, the ANA Board of Directors approved a national recognition program recognizing health care facilities who are "Magnets" for nurses. These facilities promote quality by supporting professional practice and identifying excellence in the delivery of nursing care to patients. Kramer & Schmalenberg 2002 found that what created the magnetism that attracted nurses to work in a particular hospital, provided them with job satisfaction, encouraged them to give high-quality care, and made them want to stay was adequate nurse staffing. The answer was one of eight responses chosen by almost two-thirds of participating staff nurses. Professional nurses consider Magnet organizations the "gold standard" when looking for positions. Aikens, Havens, & Sloane, (2000) found that Magnet institutions have higher nurse to-patient ratios and lower turnover. Currently, there are no Magnet Designated hospitals in Nevada, although I myself am on the Magnet Steering Council for Renown Medical Center in Reno as it actively pursues this status. The Nevada Nurses Association encourages all hospitals in Nevada to pursue Magnet Recognition as a way to attract and retain qualified nurses who will be committed to each institution and to improving the overall quality of care in Nevada.

Presentation to the Senate Commerce and Labor Committee 74th Session

By the Nevada Nurses Association Karen Fontaine, RN, MSN, Treasurer March 27, 2007 RE: Senate Bill No. 412

The Nevada Nurses Association is a professional organization that represents all nurses in Nevada.

Section 1, Items 1-4

Issue: Governor appoints to the Nevada State Board of Nursing

* NNA opposes the requirement.

* There is no need to have this in statute.

* NNA is already represented on the NSBN.

* NNA has good rapport and an excellent working relationship with the NSBN.

* Both have generally congruent philosophy and mission.

Section 10, Item 1

The Nevada Nurses Association strongly opposes decreasing the educational standards for instructors in approved schools of nursing.

Item 1:

* Proposed: A clinical instructor with 2 years experience and a bachelor's degree in nursing may be hired to teach in a registered nursing education program.

* Current: A Master's in Nursing (MSN) or a Related Field (25% of faculty may have a Master's in a related field) is required.

* Current: The NSBN may grant a waiver for Bachelor's in Nursing (BSN) enrolled in a MSN program.

Issue: This bill supports the belief that Nevada's registered nursing shortage is partly caused by a nursing faculty shortage and that this can be alleviated by increasing the pool of faculty.

* The registered nurse shortage is a complex issue. Lowering educational standards is not appropriate.

* Current professional, accrediting, and regulatory standards do not support lowering educational standards for faculty.

The current waiver process of the NSBN allows BSN faculty to teach.

* 7 waivers were granted (Jan, 2007), only 2 denied

* The Deans & Directors of Nevada's schools of nursing do not see the current waiver process as a barrier to graduating more nursing students.

* The shortage of qualified Master's prepared faculty is being addressed. Nevada colleges are addressing this issue.

* Projected MSN graduates from UNLV, UNR, & Touro University--44 in 2007

* This should double in 2008 Other nursing faculty shortage issues are salary, tuition reimbursement, time constraints and incentives.

Source: Nevada State Board of Nursing survey, January 2007

Issue: Other states allow BSN for registered nursing clinical instruction with no adverse impact.

Of 36 states responding to a "Faculty Shortage Survey" by the National Council of State Boards of Nursing (NCSBN):

* 24 required a Master's degree in nursing or other fields for teaching in clinical courses.

* 12 required a BSN as minimum education for clinical education.

* Many with a minimum of BSN required waivers or enrollment in MSN program.

* Some required supervision by MSN, or only in Associate degree program.

Source: National Council of State Boards of Nursing

Section 10, Item 1 continued

Issue: BSN nurses are adequately prepared to provide clinical instruction.

* BSN nurses are not immersed in the profession of nursing and advanced practice.

* Clinical practice is not merely the acquisition of skills.

* It is the most important piece of nursing education, since it's where actual patient care takes place.

* Clinical Decision Making requires the integration of pathophysiology, prioritization, evidenced-based practice, and the nursing process

* Decreasing the credentials required for this important educational process is not appropriate.

* Requires synthesizing and application of classroom learning

* BSN nurses are not prepared to be nurse educators; the degree is entry into the profession.

Issue: Accrediting bodies for nursing programs require a MSN for registered nursing education programs.

* The National League for Nursing Accrediting Commission:

* "Nursing faculty is credentialed with a minimum of a master's degree with a major in nursing."

* The American Association of Colleges of Nursing' accrediting body, the Commission on Collegiate Nursing Education:

* "Clinical instructors, at minimum, are master's-prepared with a practice focus."

Issue: Regulatory bodies for nursing programs require a MSN for nursing education programs.

* The National Council of State Boards of Nursing, Inc. (NCSBN)--membership comprises the boards of nursing in the 50 states.

* "It is preferable that the nursing faculty members have a Master's degree with major in nursing or a nursing Doctorate degree"

Section 10, Item 2

* Proposed: Instructors for pharmacology-may be a doctorate in pharmacy.

* NNA opposes this change.

* Nursing courses should be taught by qualified instructors with appropriate credentials in the field. Degree requirements may vary. This should not be in statute.

Section 10, Item 3

* Proposed: May hire as instructor in ethics or law, an MD, RN, or Osteopath with a medical license and degree from a school of law.

* NNA opposes this change.

* Nursing courses should be taught by qualified instructors with appropriate credentials in the field. Degree requirements may vary. This should not be in statute and is not needed.

Section 12--Nurse Licensure Compact

NNA opposes the Nurse Licensure Compact

Nevada Nurses Association supports patient safety.

NSBN is charged to protect patient safety, therefore requires fingerprinting of candidates.

Not all current compact states require fingerprinting.

Section 46-Repeal of NRS 632.450

Nevada Nurses Association supports this provision.

Nursing education must be provided creatively while meeting state and national standards.

New approaches to nursing education may offer different approaches and opportunities.

Current "Fast-Track" programs may not require two years to complete.

Karen Fontaine, CMSRN, MSN, NNA Treasurer