1. Safe Staffing Policies in Virginia: Traditions, Policy and Political Implications and Possibilities for the Future Becky Bowers-Lanier, RN VNA lobbyist becky@macbur.com

2. What we’ll cover The Virginia history (traditions) related to staffing policies Current staffing policies (regulations) Possibilities for the future

3. The Virginia history Right to work state Nurses as commodities Role of special interest groups in influencing policies –VNA –VHHA –VHCA –TLC4LTC –VAH

4. 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

5. 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

6. 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.

7. 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.

8. 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.

9. 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.

10. 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

11. 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.

12. 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.

13. Perioperative staffing legislation 2002: One perioperative nurse to one surgical patient. Failed. 2006: One perioperative nurse to one surgical patient. Failed.

14. Hospice staffing legislation 2006: One LPN rather than one RN on each shift. Stricken.

15. 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.

16. Current staffing policies Institutional policies –Internal to facility –Linked with accreditation standards and Medicare CoP –Part of state licensure regulations.

17. 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.

18. 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)

19. Virginia regs include staffing plans Nursing facilities Hospitals Hospices Home and community-based care providers (DMAS)

20. 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 reflects the types of services offered and that provides qualified staff in sufficient numbers to meet the treatment needs of all patients in the department.

21. Political/legislative considerations Progressive versus conservative Climate in Virginia –Legislative branch –Executive branch –Other considerations Budget Degree of involvement of special interests

22. Possibilities for the future: nurses as advocates for safe staffing Competition, collaboration, co-optation, compromise Consumer involvement Funding Data to support safe staffing

23. 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

24. 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

25. Questions?