2. 2014 WSNA Legislative Priorities WSNA Legislative & Health Policy Council http://bit.ly/1bZYmbb

3. WSNA Legislative and Health Policy Council Chair Edward Dolle, RN - Port Orchard Members Barbara Bly, BSN, RN - Everett Patty Hayes, RN, MN – Seattle Justin S. Gill, RN – Blaine Susan E. Jacobson, RN CCRN – Yakima- WSNA President, Ex-Officio Lynn Nelson, RN, MSN - Olympia Bobbi S. Woodward, RN - Spokane Lynnette K. Vehrs, MN, RN – Spokane WSNA Staff Judy Huntington, MN, RN, Executive Director Anne Tan Piazza, Assist. Executive Director of Governmental Affairs & Operations Sofia Aragon, JD, RN, Senior Governmental Affairs Advisor Richard Burton, Ph.D., Political Action Coordinator Melissa Johnson, JD, Contract Lobbyist Kate White Tudor, JD, Contract Lobbyist

4. Nursing leadership in demand Robert Wood Johnson Foundation survey from January 20, 2010 findings: From opinion leaders in insurance, corporate, health services, government and industry Nursing could have the most influence on: reducing medical errors (51%), improving quality of care (50%), and coordinating patient care in the health system (40%)

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6. Opportunities and Challenges in Nursing

7. Hospital errors are the 3 rd leading cause of death in the US

8. HEROES -- Nurses who work hard and look out for their patients Rest breaks– so that nurses can be sharp when it counts On-call only for emergencies Safe staffing standard: setting a maximum number of patients per nurse HEROES’ TOOLS What nurses need to care for patients

9. Lack of breaks and on-call abuse cause fatigue, jeopardize patient safety, and drive people out of nursing. 57% of nurses believe that lack of breaks, call requirements, and call back hours are causing nurse fatigue and jeopardizing patient safety at their hospital

10. Lack of breaks and on-call abuse cause fatigue, jeopardize patient safety, and drive people out of nursing. 50% of nurses say that a lack of breaks and concern for patient safety has caused someone they know to leave their unit or profession, or it has caused them to consider doing so themselves

11. Forced overtime causes fatigue and isn’t safe prevents hospitals from scheduling non- emergency procedures that require forced overtime Limits prescheduled on- call House Bill 1153 On-Call Nurses are for Emergencies Only

12. Real Breaks Keep Patients Safe Bill HB 1152 Nurses intercept 86% of medical errors before there is harm to patients Real breaks mean better care We can still put our patients first Allows interrupted for clinical circumstances that could lead to patient harm Is flexible Hospitals to work with staff RNs to make it work

13. Nurses have seen understaffing harm or kill patients, and many see it as a chronic problem. 45% of nurses who have experienced understaffing threatening care say the problem occurs often 41% who have encountered the issue only once or twice

14. Many nurses don’t believe their staffing committees, as currently formed, are effective in setting staffing levels. 41% of nurses say that their staffing committees are not effective in setting staff levels

15. Nurses strongly support a law to set minimum staffing levels for patients. 82% of nurses favor “a proposed law that would set minimum nurse to patient staffing ratios in each hospital unit”

16. A standard keeps patients safe The Facts Show: Patient Safety Standards Work – Every year, up to 400,000 patients die from preventable medical errors – as many as 4 plane crashes every day. – By adding just one more full-time RN per day, hospitals decreased the number of deaths in ICU’s by 9% and in surgeries by 16%. – A standard has already been implemented in California, and they’ve seen an 11-14% drop in post-surgical patient deaths. Patient Safety Standard Bill HB 1095

17. Safety Standards - Establishes minimum statewide staffing standards, maximum number of patients per nurse. Customization - Uses the current nurse staffing committees at each hospital to tailor staffing plans to the specific needs of each unit. Authority - Mandates that hospitals must implement the staffing plan approved by the nurse staffing committees above the minimum standard. Professional Judgment - Ensures that RNs are not assigned to other units without training and competency evaluation. Transparency - Collection and public disclosure of specific nursing sensitive patient outcomes data. Accountability - Prompt investigation of staffing complaints, corrective action required for violations with a potential civil penalty of $10,000 for violation. Patient Safety Standard Bill HB 1095

18. New Inslee administration Shift in Power in the Senate Revenue is flat McCleary decision – funding for K-12 A Challenging Political Landscape

19. Budget Crisis

22. School nurses Nursing education funding – Enrollment slots/scholarships – Faculty recruitment/retention Public health funding – Maternity Support Services Continue enhanced primary care reimbursement for ARNPs to provide care under health reform. Budget Priorities

23. Health needs are increasing among WA K-12 students Because there are not enough school nurses, personnel without any health care license are under pressure to administer risky medication. Examples are seizure medications and stock epinephrine The good news is that legislators are looking for ways to increase the number of school nurses. School Nurses

24. A Persistent Nursing Shortage demand will outpace supply in Washington over the next decade as RNs begin to retire and demand for health care escalates. The gap between RN practicing supply and demand will be more than 12,000 RNs in 2031, even under the most optimistic scenario. WWAMI Center for Health Workforce Studies

25. Nurse Educators wanted! An estimated 23% of nurse educators retired in 2012 and increased demand for nurses is estimated to persist through 2030. The gap between the salaries in practice and education have created a shortage of nurse faculty. Nursing programs will not be able to provide adequate opportunities. Advocate for affordable tuition for RN and advanced practice nursing programs Advocate for the Health Professions Scholarship Fund.

26. Opportunities for Advanced Registered Nurse Practitioners 2012 survey: 38% WA ARNPs in family practice ARNPs and P.A.s are 40% of primary care providers WA allows ARNP autonomous practice. This is critical to ensure access to care WA Legislature must sustain an enhanced reimbursement for ARNPs proving primary care under the Medicaid expansion.

27. Current practice only allows public health nurses to dispense medication under a provider with prescriptive authority HB 1538 allows public health nurses to dispense medications for the purposes of communicable disease control and family planning A coalition effort: in collaboration with DOH, WA State Association of Counties, local public health, and public health nurses to affirm this practice Politically sensitive Vote Yes for HB 1538 Public Health Nurse Dispensing

28. The Nurse’s Voice in Environmental Health Policy 2014 Implementing Florence Nightingale’s Tenets to Protect Children, Families and Communities

29. Historical Perspectives of Nursing and Political Activism

30. Nurses and Environment Health The American Nurses Association Washington State Nurses Association Health Care Without Harm and the Nurses Work Group The Alliance of Nurses for a Healthy Environment

31. Nursing: Scope and Standards of Practice: Standard 16 - Environmental Health Standard 16. Environmental Health states that: The registered nurse practices in an environmentally safe and healthy manner. It is based on ANA’s Principles of Environmental Health for Nursing Practice Knowledge of environmental health concepts is essential to nursing practice. The Precautionary Principle guides nurses in their practice to use products and practices that do not harm to human health or the environment and to take preventive action in the face of uncertainty. Nurses have a right to work in an environment that is safe and healthy. Ballard, Karen (2013) Environmental Health and ANA’s Standards of Nursing Practice: 101

32. Nursing: Scope and Standards of Practice: Standard 16 - Environmental Health Nurses participate in assessing the quality of the environment in which they practice and live. Nurses, other healthcare workers, patients, and communities have the right to know relevant and timely information about the potentially harmful products, chemicals, pollutants, and hazards to which they are exposed.

33. Safety & Environmental health Child Safe Products Act PBDE Bill Safe Baby Bottle Act E-Waste Bill

34. Children’s Safe Product Act 2008 Set limits on cadmium, phthalates and lead in children’s products The Reporting List of Chemicals of High Concern to Children (CHCC) http://www.ecy.wa.gov/programs/swfa/cspa /chcc.html

35. Our children deserve to inherit a safe and healthy world Today our homes, bodies, and environment are contaminated with cancer-causing toxic flame retardants that escape from foam products in our homes, like couches, changing pads, nursing pillows and car seats. (ESHB1294) www.watoxics.org

36. What the Toxic Free Kids and Families Act Will Do Bans all (6) toxic flame retardants found on the “List of Chemicals of High Concern for Children” Prevents makers of children's products and home furniture from replacing banned flame retardants with other toxic flame retardants. Exempts children's products/home furniture from the ban if there’s no safer alternatives available. Ensures compliance with the law by allowing the Dept. of Ecology to request certificates of compliance from products makers.

37. ( This is Needless Exposure to Toxic Flame Retardants The amounts of ineffective but toxic flame retardants is not PPM but rather ounces and pounds. There are safer alternatives like a thin layer of wool

39. Tell Your Legislators to Vote Yes for ESHB1294 because… They don’t work Safer alternatives Supported by firefighters Protects children, family members and pets Gets us off the Toxic Treadmill

40. Nurses… Nurses… put it back together Health+Environment

41. Nurses Lead Where We Stand “We assume most men and women choose to become nurses because they want to help people live well. Our hope is that they will see the unlimited possibilities of nursing to change the world." - Melanie C. Dreher, PHD, RN, FAAN; Dolores J. Shapiro, PhD, RN; and Micheline Asselin, MPA, MSN, RN, CHPN, co-authors, Healthy Places, Healthy People: A handbook for culturally competent community nursing practice (Sigma Theta Tau International 2006)

42. Nursing’s power for a better future Largest health care workforce in the state and in the nation with 85,000 registered nurses in WA and 3 million nationwide. Nurses are instrumental in realizing health reform, to transform its health care system Nurses are at the front lines Nurses practice in many settings, including hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers There are barriers: regulatory, business, organizational conditions

44. Talk to your legislator in Olympia today! Fill out the Patient Safety Reform flyer to leave behind with your Legislators Write a letter/send an e-mail/call their office – Legislative Hotline 1-800-562-6000 or e-mail your legislator at www.leg.wa.gov Watch WSNA e-mail action alerts Check wsna.org for updates Staff contact: saragon@wsna.org What You Can Do

45. A convenient meeting place