Public Policy Update
AACN Commends Vote to Reject Overtime
AACN applauds the vote by the U.S. House of
Representatives in support of a nonbinding motion instructing House-Senate
conferees to block a proposed Department of Labor change to the Fair Labor
Standards Act that would have revised overtime protections. The 221-to-203 vote
reflected a switch in position for seven Republicans who previously had
supported the revisions. The House decision followed a similar, favorable vote
in the U.S. Senate.
Although nonbinding, the House vote does
provide instruction to the conference committee that will finalize the bill.
Despite the consensus by the House and Senate on this issue, President Bush has
announced he will veto the Labor-Health and Human Services appropriations bill
if it includes an amendment to bar implementation of the proposed FLSA
An overview of the proposed changes can be
> Employee Standards Administration Wage and Hour Division.
AACN opposes the proposed changes and,
along with other nursing organizations, submitted comments to the Department of
Labor outlining concerns. These comments are available online.
Education Levels Tied to Quality of Care
Hospitals with low percentages of nurses
who have bachelor's degrees have nearly twice as many surgery patient deaths as
those with high percentages of nurses with bachelor's degrees, according to a
study published in the Journal of the American Medical Association. Researchers
from the University of Pennsylvania examined the outcomes for 232,342 surgery
patients discharged from 168 hospitals in Pennsylvania between April 1, 1998 and
Nov. 30, 1999, along with administrative and survey data about nurses at each
Patient outcomes were studied for common
operations, including knee replacements, appendectomies and gallbladder
removals. At the hospitals studied, the percentage of nurses with bachelor's
degrees ranged from none to 77%. Researchers adjusted for hospitals' size,
teaching status, level of technology and nurse staffing, as well as for nurse
experience and board certifications of patients' surgeons.
The study found that hospitals with fewer
than 10% of nurses with bachelor's degrees had patient death rates of about 3%,
while hospitals where more than 70% of nurses had bachelor's degrees had patient
death rates of about 1.5%. For every 10% increase in the proportion of nurses
with bachelor's degrees, there was a 5% decrease in the likelihood of patient
death within 30 days of admission. According to national 2001 data, 61% of new
registered nurses came from associate degree programs, 36% came from bachelor's
degree programs, and 3% came from hospital diploma programs.
NQF Releases Nursing Care Standards
The National Quality Forum has released a
draft of a set of consensus standards for measuring nursing care in hospitals.
According to a draft of the standards, the 13 measures are based on a growing
body of evidence that demonstrates the influence of nursing personnel and the
stability of nursing personnel on patient outcomes, hospital costs and the
professional atmosphere in which care is provided.
The measures of nursing care were
sufficiently supported by scientific data to gain the endorsement of various
committees representing consumers, purchasers, researchers, providers and health
plans. They include prevalence of conditions or events suffered as a result of a
hospital stay, such as pneumonia, pressure ulcers and falls. The standards also
include total work hours by nurses per 1,000 patient days.
The NQF, established as a public-private
partnership in 1999, published consensus standards for overall hospital
performance earlier this year. The Leapfrog Group, the CMS and the Joint
Commission on Accreditation of Healthcare Organizations have said they plan to
incorporate NQF standards in their quality-measurement efforts. Additional
information and a draft of the standards are available online at
Study Shows That Healthcare Quality
A study, conducted by HealthGrades,
Lakewood, Colo., on medical outcomes at the nation's hospitals found that
healthcare quality varies widely state by state, with better-performing
facilities generally concentrated in northern or less populous states and
worse-performing facilities generally in southern states. The study compiled
information on 26 procedures and diagnoses at nearly 5,000 U.S. hospitals using
Medicare data adjusted for severity of illnesses. The data cover the years 2000
New York ranked the highest for quality of
hospitals, followed by Florida, Ohio, Michigan and Maryland. The rankings were
based on results of five procedures and diagnoses in the areas of angioplasty,
heart attack care, heart bypass surgery, heart failure and pneumonia. In other
findings, quality-improvement efforts at the state level were tied with higher
quality for coronary bypass surgery. Among the best performers were New Jersey,
New York, Pennsylvania, Michigan, Massachusetts and Virginia, which have
well-established efforts by Medicare quality improvement organizations or
support profiling physician outcomes. The report is available online at
California Nurse Staffing Enforcement
Legislation authorizing tougher enforcement
measures of California's nurse-staffing law was defeated in the final hours of
the legislative session in September. Nurses' lobbyists said they would "be back
next year" to push for heavier sanctions against hospitals that don't meet the
state's mandatory minimum nurse-to-patient staffing ratios, which take effect
The proposals in the state legislature
called for unannounced hospital inspections and fines of up to $5,000 per day
for violations of the staffing law that put patients in "immediate jeopardy."
Currently, state health officials can fine a hospital $50 per patient per
violation if the hospital fails to comply with its own plan for correcting
California labor organizations said they
have formed a watchdog group to track hospital compliance with the new state law
that mandates minimum nurse-to-patient staffing ratios. Hospital Watch, made up
of 11 labor groups, including the Service Employees International Union, will
ask hospital employees for reports on their hospitals' staffing levels and will
educate the public about the law, a spokeswoman said.
ANA and UAN File Amicus Brief on
Definition of �Supervisor'
The American Nurses Association and its
affiliate, United American Nurses, AFL-CIO, collaborated to file an amicus brief
with the National Labor Relations Board regarding its review of the statutory
definition of "supervisor." The board asked for briefs to address how and
whether employees use "independent judgment" and "assign and direct" work so as
to be viewed as supervisors that must be excluded from bargaining units. Two of
the three cases that the board is focusing on involved nurses.
ANA and UAN addressed from a policy
perspective the impact of the potential exclusion of RNs who work as charge
nurses or who delegate work to unlicensed assistive personnel. The amicus brief
cited the literature highlighting that positive working conditions are an
important piece of addressing the nursing shortage. In addition, many workplace
gains have been acquired through collective bargaining. Given the historical
support for the ability of professional nurses to organize, the ANA and UAN
urged the board to adopt an interpretation of the law that recognized the
professional norms of nursing, which through state laws and the Code of Ethics
for Nurses, authorize and require delegation to others on the nursing team,
without the employer giving nurses true managerial prerogatives associated with
For more information, read the brief online
AHRQ Releases New Study on Medical
According to a new study by the Agency for
Healthcare Research and Quality, medical injuries in hospitals claim more than
32,500 lives in the United States each year, and that such complications lead to
at least 2.4 million extra days on the wards and up to $9.3 billion in added
costs. A 1999 report from the Institute of Medicine claimed that medical errors
lead to between 44,000 and 98,000 deaths a year in the United States, at an
annual cost of $17 billion.
The new study, which looked at 18
categories of hospital complications and not the entire gamut, doesn't challenge
those estimates. But it does refine the numbers in a way that the previous
report could not.
In the last two years, AHRQ, a division of
the U.S. Department of Health and Human Services, has used a system for
identifying medical injuries in hospital patients that relies on hospital
billing records. The method is less taxing and more cost-effective than sifting
through medical records, which has been the gold standard of patient safety
For the latest study, researchers looked at
nearly 7.5 million billing records from 2000. The cases covered 994 hospitals in
28 states, representing about 20 percent of all the nation's hospitals. The
researchers limited their study to 18 categories of complications, called
patient safety indicators. These included serious blood infections, bad
reactions to transfusions, botched surgeries and trouble during delivery. They
tallied the extra days of hospital care attributable to the problems and what
they cost to control.
Serious blood infection, or sepsis,
following surgery was the most draining complication, leading to an average of
nearly 11 extra days in the hospital at a cost of more than $57,000 per patient.
Almost 22% of patients who suffered postsurgery sepsis died of the infection.
The second most serious medical injury was
a rupture, or "dehiscence," of a wound after surgery. Patients with this
complication spent an average of about nine more days in the hospital, and
racked up $40,000 in extra costs, while nearly 10% died of the injury.
Infections caused by medical care rounded out the top three, adding more than
nine days to a hospital stay at a cost of nearly $39,000 per patient, with a
risk of death just over 4%.
Overall, the researchers say that the 18
types of patient injuries could account for 2.4 million extra hospital days,
between $4.6 and $9.3 billion in added costs and roughly 32,500 deaths each
year. Future studies may be able to flesh out how many of these truly are
preventable, Zhan says. The researchers estimate the share of preventable
injuries at between 50 percent and 75 percent of the total. The problem,
however, is figuring out what the total truly is. One way to do that is to
implement a confidential, nonpunitive reporting system for medical errors
modeled on that covering the airline industry. Legislation establishing such a
program is now making its way through Congress. The study, "Excess Length of
Stay, Charges, and Mortality Attributable to Medical Injuries During
Hospitalization," was published in the Oct. 8, 2003, issue of the Journal of the
American Medical Association.
Bill Introduced to Reduce Medication
Rep. Amo Houghton (R-N.Y.) has introduced a
bill (H.R. 3035) to reduce medication errors by improving the computer systems
of hospitals and healthcare providers who deliver inpatient and skilled nursing
care. Nurses and other healthcare providers could improve patient safety by
avoiding medication errors under the bill, which would set up a competitive
grant program for hospitals and skilled nursing facilities. Funds from this $1
billion, 10-year program could be used to purchase or improve computer software
and hardware or provide education and training to staff on patient safety
programs. The bill specifically sets aside 20% of the grant money for rural
providers, who often have the greatest need and the smallest budgets for
obtaining the latest technology.
For more information, contact Houghton's
office at (202) 225-3161.
Public Policy Snapshot
AHRQ Evidence Report on Working
Conditions and Patient Safety
As part of its Evidence-based Practice
Program, the Agency for Healthcare Research and Quality is developing scientific
information for other agencies and organizations to base clinical guidelines,
performance measures and other quality improvement tools. Contractor
institutions review the relevant scientific literature on assigned clinical care
topics and produce evidence reports and technology assessments, conduct research
on methodologies and the effectiveness of their implementation, and participate
in technical assistance activities.
The systematic literature review on the
Effect of Health Care Working Conditions on Patient Safety provided sufficient
evidence to make specific recommendations about strategies for improving patient
safety. Following is a summary of these recommendations:
� Strategies to increase staffing levels of
licensed and unlicensed nurses in both acute care hospitals and nursing homes
will likely lead to improved patient outcomes.
� Preventable complications are lower when
complex technical procedures are performed by physicians who conduct them
� Duration of experience of the health
professional is associated with better patient outcomes for some types of
� Systems to reduce interruptions and
distractions will likely reduce the incidence of medical errors.
� Systems to improve information exchange,
transfer of responsibility, and continuity of care between hospital and
nonhospital settings decrease medication errors and, in some settings, hospital
� Levels of ambient noise in healthcare
settings do not adversely affect patient safety.
Dec. 1 Is Deadline to Apply for 2005
Distinguished Research Lecturer Award
Dec. 1 is the deadline to submit
nominations for the Distinguished Research Lecturer Award for 2005. The
recipient will present the Distinguished Research Lecture at the 2005 NTI in New
Orleans, La. The lecture is sponsored by a grant by Philips Medical Systems.
The ideal candidates for this award should:
� Be nationally recognized for
publications, presentations, and/or mentorship in research relevant to acute
and/or critical care clinical practice
� Be viewed as a consultant in their area
� Have made significant contributions to
acute and critical care nursing practice through research
� Be a dynamic and interesting speaker
(nominators should cite an example of nominee's expertise in public speaking)
The Distinguished Research Lecturer Panel
will select the recipient for 2005 in January. The awardee receives a $1,000
honorarium and $1,000 toward NTI expenses, as well as a plaque.
The 2005 Distinguished Research Lecturer
nomination form is available online. For more information, call (800) 394-5995,
ext. 321; e-mail,
2003-04 AACN Grants Support Clinical Projects and Research
Clinical Inquiry Grant
This program provides awards of $500 each
to fund projects that directly benefit patients and families. Interdisciplinary
projects are of special interest. Grant applications, which are accepted twice a
year, must be received by either Jan. 15 or July 1.
End-of-Life Palliative Care Small
This program provides $500 each for
projects that address a range of topics, including bereavement, communication,
caregiver needs, symptom management, advance directives and life-support
withdrawal. Grant applications, which are accepted twice a year, must be
received by either Jan. 15 or July 1.
To find out more about AACN's research
priorities and grant opportunities, visit the AACN Web site. The grants handbook
is also available from AACN Fax on Demand at (800) 222-6329. Request Document
Sepsis Education Program Available
Identification and Management of the
Patient With Severe Sepsis," AACN's national sepsis education program for
nurses, is now available in a self-paced CD-ROM format. Funded by an
unrestricted educational grant from Eli Lilly and Company, this program is
sponsored by AACN and is accredited for 5.0 contact hours of CE credit for
Narrated by clinical expert Barbara McLean,
RN, MN, CCRN, CCNS-NP, FCCM, the new program offers clinicians a comprehensive
view of the latest information on the diagnosis and care of patients with severe
The 170-page, audio/slide CD-ROM study
guide includes pathophysiology of severe sepsis; identification of acute organ
system dysfunction; antibiotics, source control and monitoring in severe sepsis,
including investigational and newly approved therapies; hemodynamic, ventilatory,
renal and other aspects of care; and nursing care of patients with severe
sepsis. Case studies are also included in the presentation.
To order this cutting-edge learning program
for only the $7.50 shipping and handling fee, call (800) 899-2226 and request
Item #004060. Quantities are limited.