Nurses influence health policies

( Everyone knows nurses are on the frontlines when it comes to caring for the sick, but it might not be apparent to all that their caring hands also help write legislation.

Nurses represent one of the most trusted professions in the world. As part of their mission, nursing organizations like the American Nurses Association, National League of Nursing and locally, the New Hampshire Nurse’s Association track state and national legislative bills and choose those relating to health care, offering their support and sometimes their opposition.

Representing a large group of voters, the testimony of nursing associations carries significant weight. Recently, the nursing world came out in favor of President Barack Obama’s Affordable Care Act.

“In the last legislative session, we supported SB 286 and the bill passed,” said Avery Morgan, executive director of the N.H. Nurses Association. “The bill establishes a prescription drug monitoring program that allows pharmacists to save and share information that can reveal clients who may be shopping around for narcotics such as Oxycontin. New Hampshire was one of only two states without such a program.”

The new legislation authorizes the Pharmacy Board to establish a secure program to electronically collect controlled drug dispensing data from pharmacies. The legislation is designed to reduce diversion of controlled drugs as well as provide better patient care.

Judith Joy, president-elect of the NHNA, said the organization looks to support bills that are a preventative, rather than a reactionary measure, like SB 286. She said that allows for a focus on legislation rather than trying to go in eight different directions at the same time.

“We do the Humpty Dumpty well,” Joy said. “We daily put people back together and pull them from the brink of disaster in the emergency department, and through the so called golden hour, the hour where the most effective life saving techniques are deployed. But we are something like 26th or 28th in the world in terms of health care and that is not acceptable. We need to do better.”

The NHNA holds an annual town hall meeting to consider legislation. That takes place in January, as soon as the new session’s bills are known. The meeting is held via teleconference, to allow statewide participation. The state organization retains one paid lobbyist.

“It’s clear to us that many people consider health care strictly a business,” Joy said. “The motives for certain legislation may not be the same as how we see health care. It is part of how we evaluate and consider which bills to support and which to not support.”

In another example, many people are likely not aware that there is a difference between a nursing assistant and a medical assistant. The difference, in New Hampshire, is that nursing assistants are trained to specific, accepted criteria and are licensed by the state, but the requirement for a medical assistant is not the same. That concerns nurses because of the quality of care issues involved in working together.

“We are not trying to set up a situation of us against them, but we are working with them to resolve questions regarding their training and practices,” Joy said. “So, we sponsored the Nurse Practice Committee to look at how we relate to medical assistants in collaboration with the state nursing board. We have put together a tool kit on our Web site to help nurses know the ins and outs of working with medical assistants.”

The NHNA Government Affairs Commission sent a letter to the House committee regarding House Bill 1617, which would eliminate the requirement that a hospital must demonstrate a need for a clinical service before expanding. This bill included a separate bill, HB1642, which would have exempted specialty hospitals from the certificate of need process and payment of the Medicaid Enhancement Tax. Nurses felt each of these bills would have had a negative impact on patients and health care staff. As of June 1, the certificate of need process was extended for three more years.

The N.H. legislative session is over for the year and the NHNA has not yet seen upcoming bills. Joy said she does expect to see something in reaction to the hepatitis C cases coming out of Exeter Hospital.

“That was a case where a visiting, or temporary technician was used,” she said. “In that case, the hiring agency would have the assumption that the sending agency did their due diligence. Apparently that did not occur.”

The nursing groups do not blindly support every health care related bill. Nationally, in 2011, nurses decided not to support HR 3679, a bill to establish the full-time position of national nurse for public health to be filled by registered nurse within the Office of the Surgeon General.

Dr. Kathy Ream’s firm, KAR Associates Inc., represents the National League of Nursing and the Emergency Nurses Association in several ways, including government lobbying services for the groups’ public policy interests.

The national nurse for public health would have the same rank and grade as the deputy surgeon general of the Public Health Service. The position would provide leadership and coordination for nursing services, including providing representation to the government for nursing issues at the local, state, national and international levels. It is expected to appear, in an amended form, in the upcoming session.

Nursing groups believe the position is not necessary,” Ream said. “They already have an established scope of practice and each state has their own office of government affairs. The bill is well intentioned but agencies do not want to rely on Washington politics to set policy.”

In July, nurses helped pass national legislation that gave tougher control to the U.S. Food and Drug Administration over the growing problem of drug shortages from pharmaceutical companies.

“Now manufacturers have to report if they are anticipating a shortage where before it was voluntary,” Ream said. “This affects some critical care and cancer drugs. Shortages happen for many reasons. Sometimes hospitals are hoarding the drug. Other times manufacturers, working in tough recessional times, may take months to repair equipment, such as if a line breaks down. Because of financial reasons, they have no backup.”