Massachusetts Report on Nursing - December 2020

More documents

Recommendations

Info

6 • <strong>Massachusetts</strong> <strong>Report</strong> on Nursing November 2020 interviews Representative Kay Khan, BS, MS Jessie Brunelle, Staff Director Office of State Representative Kay Khan Inge B. Corless, PhD, RN, Co-Editor State Representative Kay Khan was born in Cherokee, Iowa and raised primarily in Wellesley, <strong>Massachusetts</strong>. She earned her Bachelors’ degree from the Boston University School of Nursing in 1965. Her first position as a nurse was at the Boston Children’s Hospital. Thereafter, she became an instructor for undergraduate students on a pediatric rotation at the Boston University School of Nursing. Later she worked in Kay Khan an adolescent psychiatric unit at the Gaebler Children’s Unit at Metropolitan State Hospital in Waltham, before earning her Masters’ degree in Psychiatric Mental Health Nursing from Boston University School of Nursing, graduating with honors in 1981. Representative Khan worked in a private psychiatric group practice in Newton for close to 20 years. Representative Khan has lived in Newton for more than 40 years, where she and her late husband, Dr. Nasir Khan, raised their three children and now enjoys her seven grandchildren. She served on the Newton Parent Teacher Organization, was a member of the city’s Arts Committee, a volunteer writer for a local newspaper, and an active member of the women’s auxiliary of the <strong>Massachusetts</strong> Medical Society. She joined the Board of the New Philharmonia Orchestra in Newton and became a founding member of the Newton Cultural Alliance. One of her passions is Classical Ballet and supporting the arts has always been an important value to her. As a member of the Newton Democratic City Committee, Representative Khan spent many years helping numerous candidates run for local, statewide, and federal offices. Always civically engaged and a proud risk-taker, she decided to run for office when a State Representative seat in her district opened up. She was subsequently elected and has served her community in the <strong>Massachusetts</strong> House of Representatives since 1995. In 2009, Representative Khan was appointed by Speaker Robert DeLeo to serve as the House Chair of the Joint Committee on Children, Families, and Persons with Disabilities, and she has served in this capacity ever since. Throughout her career as a State Representative, she has been an unshakable advocate for celebrating diversity and protecting the Commonwealth’s most vulnerable populations. She has filed many bills to promote public health, mental health, and the nursing profession. In response to my request that Representative Khan share information on a bill she is sponsoring. She was kind enough to share the following. “As a State Representative and an Advanced Practice Psychiatric Nurse, I am excited to have the opportunity to highlight my legislation: H.2664, An Act relative to the governance of the Health Policy Commission. If passed, this bill would add the critical perspectives of a registered nurse to the state’s Health Policy Commission (HPC), the independent state agency that shapes policy and tracks cost-control measures across our public health and health care sectors. Nurses have a unique understanding of what really happens on an emergency room floor, a psychiatric hospital, a hospice bedside, or a research facility. The professional perspectives a nurse would offer the HPC is vital if we are to meet the goals of containing costs, improving patient outcomes, and reducing disparities in health care. In February of 2019, State Auditor Suzanne M. Bump appointed Barbara Blakeney, an experienced public health nurse, and past president of the ANA to the HPC. With this appointment, Auditor Bump took a critical step in recognizing the important experiences nurses in leadership can bring to our health care system. H.2664 will ensure that professional nurses have permanent representation on the HPC so that we can continue to benefit from their insights and contributions to improving health care in the Commonwealth. I am grateful this legislation enjoys the ANAMASS’s full support. If you are interested in advocating for the advancement of this bill, I encourage you to contact your State Representative and State Senator in support of its’ favorable release from the Joint Committee on Health Care Financing. You can find the contact information for your elected officials at www.wheredoivotema.com. To learn more about this effort and my other nursing bills, I encourage you to visit my website at www.kaykhan.org.“ Representative Denise Garlick, RN Collin Fedor, Chief of Staff, Office of State Representative Garlick Inge Corless, PhD, RN, Co-Editor Representative Denise Garlick’s journey to serving as State Representative for the 40,000+ people of Needham, Dover and Medfield began like many of ours – in nursing school. A graduate of New England Baptist Hospital School of Nursing in 1975, she received her critical care certification in 1978 before going on to graduate summa cum laude with her BSN from Fitchburg State in 1984 – all while giving birth to her four Denise Garlick children and working as a Staff Nurse. As a nurse, she considers learning a life-long endeavor that provides the background to be “qualified to care.” As a member of the <strong>Massachusetts</strong> Nurses Association (MNA), she advocated for her colleagues, co-workers and patients on issues related to indoor air quality at a major tertiary care facility. Ultimately, the MNA became the first state nurses’ association in the nation to develop a department of occupational health and safety. The American Nurses Association also then initiated a department, which strengthened nurses’ ability across the country to advocate for their own health and safety. Denise served as the President of the MNA from 2000- 2001. In 2004, Denise was elected to the Needham Board of Health. She served as Chair and co-founded and cochaired the Needham Coalition for Suicide Prevention when four Needham adolescents died of suicide in an 18-month period. She believes that as Chair, but most importantly because she was a nurse, she was able to address the many issues and concerns of families, friends, and her deeply shaken and grieving community. The coalition informed communication in the Town for both suicide prevention and all crisis situations, and is a model for community coalitions in <strong>Massachusetts</strong> and beyond. With a deeper understanding of municipal government, Denise learned that “policy without money is just a good idea.” She was elected to the Needham Select Board where the decisions for allocation of resources is made. Again, utilizing her knowledge as a nurse, she led a campaign to successfully develop the Center at the Heights, which houses the Council on Aging and is now a center of vibrant, robust public life and comprehensive supports for older adults and their loved ones in Needham. Seeking a broader platform to work for positive change, Denise was elected as a State Representative in 2010. In the time since, she has served as a member on every health care committee, including the Joint Committee on Health Care Financing, and in multiple leadership positions, including as Chair of the Joint Committee on Elder Affairs and Chair of the Joint Committee on Mental Health, Substance Use and Recovery, where she authored the pivotal 2018 opioid bill, An Act for prevention and access to appropriate care and treatment of addiction. Informed by her knowledge and experiences as a nurse, the legislation steers the Commonwealth’s public policy to deal not only with care and treatment of those engaged in substance use but also to focus on prevention. Building on her experiences as a nurse, chair of the Needham Board of Health and seasoned legislator, she sponsored the State Action for Public Health Excellence (SAPHE) Act, which was signed into law earlier this year to strengthen the Commonwealth’s 351 local boards of health – and takes on enhanced importance in light of the coronavirus pandemic. Currently, she serves as Vice Chair on the House and Joint Committees on Ways and Means, which is pivotal in the final budget and policy decisions of the House of Representatives. In addition, she has been asked to lead the “Caring Collaboration for Vulnerable Children and Families,” a House initiative created by Speaker Bob DeLeo to examine ways to strengthen the Department of Children and Families (DCF) in <strong>Massachusetts</strong>. Through this initiative, Rep. Garlick works with Chair Kay Khan – who is the only other Nurse in the Legislature – and Rep. Paul Donato. In July 2020, the House of Representatives unanimously passed Rep. Garlick’s bill that contains quality improvements to DCF agency operations, supports foster parents, and increases data reporting and accountability at DCF. At the onset of the COVID-19 pandemic, House Speaker Bob DeLeo charged Representative Garlick as one of five members to lead the House COVID-19 Working Group. Throughout the pandemic, the Working Group has played a key role in amplifying the local concerns of House members to the Command Center, ensuring clear communication throughout levels of government, and ensuring that the House could continue operations remotely in light of physical distancing and other CDC guidelines. When asked why it matters to have a nurse as a legislator, Rep. Garlick notes that nurses’ expertise contributes to the development of policy related to access to safe, affordable, quality care, as well as the issues that impact our profession. Nurses work hard to advocate, but the truth is we need to stop being the “askers” and instead be the “deciders” in the halls of the State House. She feels strongly that nurses need to run for office – “nurses need to know and believe that they are qualified to care and ready to lead.” To that end, Representative Garlick has led on health care, public health and issues specific to the practice of nursing. She secured the mandatory overtime ban in the 2012 health care cost containment legislation (commonly referred to as Chapter 224), the 2014 law setting ICU nurse staffing ratios (the only law in the country on safe staffing) and legislation requiring newborn pulse oximetry screenings for congenital heart defects. She continues to focus on health care workplace safety, in light of the considerable health risks nurses face during COVID-19 and broader workplace violence issues, as lead sponsor of H1416, An Act requiring health care employers to develop and implement programs to prevent workplace violence. With her many accomplishments, Denise’s loves are her high school sweetheart husband, Russell, and her four young adult children and growing family. It is being a nurse – caring for patients without judgement, addressing complicated issues, listening to people’s voices, defining the facts, assessing situations and developing and implementing a plan – that strengthens Representative Garlick’s service to her community and Commonwealth. It is a nurse’s courage and ability to advocate, a nurse’s stamina to “stay with the job” and, above all, a nurse’s ability to hold and share hope. Rep Garlick believes she is like every nurse, and knows that every nurse should run for office. Nurses are leaders, and our Commonwealth and country will be stronger when nurses are the “deciders.”
November 2020 <strong>Massachusetts</strong> <strong>Report</strong> on Nursing • 7 Advocating for Expanded Scope of Practice in the Legislature Laura K. Duff, RN, BSN, Clinical Nurse II DNP Candidate University of <strong>Massachusetts</strong> Amherst, lkduff@umass.edu ANAMASS has long been advocating for expanded scope of practice for Advanced Practice Registered Nurses (APRNs) who, until very recently, were required to prescribe under the guidance of a supervising physician. (Certified Nurse Midwives are the exception as they already have full prescriptive authority.) In March as a response to the COVID-19 pandemic, Governor Baker signed an executive order temporarily granting this expanded scope of practice to APRNs in order to help meet the sudden increased need of providers in the Commonwealth. Then, in June, the Senate incorporated this provision into Bill S.2796, An Act Putting Patients First. The Bill was moved to the House in July, where in a rush to meet the Legislative Session deadline, it was quickly passed through a series of committees. The House made amendments and published H.4916 in response. A caveat of S.2796 and H.4916 is that APRNs must still have two years of supervised experience before they are granted full practice authority; however, any independent provider can provide that supervision. Effectively, an APRN with full practice authority can supervise a new APRN. Allowing a profession to supervise itself is more appropriate than mandating a different and separately regulated profession, physicians in this case, to oversee the work of APRNs. Ideally, APRNs would not legally require any supervision. The Consensus Mode of APRN Regulation, a 2008 report created by a collaborative nursing workgroup and endorsed by a long list of nursing organizations, clearly states that Boards of Nursing will “license APRNs as independent practitioners with no regulatory requirements for collaboration, direction or supervision” (p. 14). 1 Requiring supervision runs contrary to this widely backed statement. Receiving a license from a Board of Nursing indicates that APRNs have already fulfilled their educational and clinical requirements and can safely operate independently in a provider role. Requiring supervision in any capacity, whether it is for two years or an entire career, reduces efficiency and productivity in the healthcare system. 2 First, if a new APRN is unable to find an experienced practitioner to supervise her or his practice, then her or his entry into the workforce is delayed, which negatively affects those in need of care. This issue is further exacerbated in rural areas where there is a general provider shortage. Second, slowing the entry of new APRNs into the independent provider role decreases competition. When demand for care remains high but the supply of providers is low, cost for services can increase, thus benefitting those who advocate for this restricted entry into full practice authority. As this readership likely already knows, the case for independent APRN practice is well established in the literature. There is no difference in the quality of care delivered by an APRN versus a physician, and the cost of care by an APRN is often lower. 3,4 At the time of writing, the bills (S.2796 and H.4916) currently sit in a Committee of conference, a joint committee between the Senate and House created to resolve differences between the versions of the bills passed by the two chambers. The House and Senate have extended the formal Legislative Session, which normally ends in July, through the end of the year meaning that there is still a chance for these bills to move forward. However, even if they don’t, similar versions of these Bills are likely to resurface in the 2021-2022 Legislative Session. You can find your local Senators and House Representatives and their contact information by accessing malegislature.gov and clicking on Legislators for a list of Representatives and Senators and their contact information. Please consider reaching out and expressing your opinion as a nurse of the Commonwealth now and in the future. Securing independence for APRNs is a change that will elevate not only our profession but also the lives of those we serve. References 1. APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. https://www. nursingworld.org/~4aa7d9/globalassets/certification/ aprn_consensus_model_report_7-7-08.pdf 2. Ritter, A., Bowles, K., O’Sullivan, A., Carthon, M. & Fairman, J. (2018). A policy analysis of legally required supervision of nurse practitioners and other health professionals. Nursing Outlook, 66(6), 551-559. https://doi.org/10.1016/j. outlook.2018.05.004. 3. Swan, M., Ferguson, S., Chang, A., Larson, E. & Smaldone, A. (2015). Quality of primary care by advanced practice nurses: A systematic review. International Journal for Quality in Health Care, 27(5), 396-404. doi: 10.1093/ intqhc/mzv054 4. Timmons, E. J. (2017). The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care. Health Policy, 121, 189- 196. http://dx.doi.org/10.1016/j.healthpol.2016.12.002 Focus on Health Reform and Health Equity in <strong>Massachusetts</strong> A webinar jointly provided by ANAMASS and UMass/Amherst Christine Schrauf, PhD, RN, MBA The ANAMASS Health Policy Committee presented a webinar focusing on health reform with an emphasis on health equity in a first-time collaboration with UMass/ Amherst College of Nursing. Due to pandemic restraints, the event was redesigned as a virtual offering held in late September that provided all members the opportunity to participate. The webinar began with welcome comments by Alison Vorderstrasse, DNSc, APRN, FAAN, Professor and Dean of the UMass/Amherst College of Nursing and Julie Cronin, DNP, RN, OCN, President of ANAMASS. Health Care Financing and Health Equity Health Policy Committee co-chair and UMass/Amherst alumnus Christine Schrauf began with a review of reasons why Americans want (and need) health care financing reform. A review of health care financing issues included (1) increasing costs of health care and associated insurance, (2) inability of some families to actually use their health care insurance, and (3) inequity among different income and racial groups in ability to access health care insurance. Additionally, the COVID-19 pandemic has increased the portion of the US population who have lost health insurance due to lost employment, although the full measure of this effect won’t be known until later when the country returns to a new “normal.” Federal proposals for single payer coverage Dr. Schrauf also reviewed a sample of current proposed federal legislation that seeks to improve coverage of health care costs through either enhancement of the Affordable Care Act and the current health insurance model or the transition to single-payer health care financing such as a Medicare for All program. Senator Bernie Sanders (VT) and Representative Pramila Jayapal (WA) have each proposed a Medicare for All bill in their respective federal legislative branches, and although similar in many ways, the differences in the two bills were also discussed. Also reviewed was a bill passed by the House of Representatives in the current legislative session which enhances the current Affordable Care Act and “fixes” some aspects of the current law which had not been foreseen. The Affordable Care Act has allowed more than 20 million people to obtain health care insurance since passage. Some of the highlights of this law were reviewed during the webinar as well as the most significant court challenges to several components. State proposals for single payer coverage Dr. Schrauf summarized current Senate and House proposals for single payer coverage in <strong>Massachusetts</strong>, also called Medicare for All sponsored by Senator James Eldridge, Representative Lindsay Sabadosa, and Representative Denise Garlick and colleagues. Representative Sabadosa joined the webinar to describe her personal experience and reasons for supporting this legislation. Both Senator Comerford and Representative Sabadosa fielded questions from participants. Health care financing and health equity Dr. Raeann LeBlanc, PhD, DNP, AGPCNP-BC, CHPN eloquently described the link between health care financing reform and health equity. Dr. LeBlanc is the Seedworks Endowed Clinical Assistant Professor for Social Justice in the UMASS/Amherst College of Nursing and represents the College’s commitment to programs and activities that highlight various ways that all nurses can work toward health equity and social justice. Her remarks began with the description of health equity as a reality where “…Everyone has a fair and just opportunity to be as healthy as possible.” Poverty and discrimination are obstacles that may cause powerlessness and reduce access to good jobs with fair pay, quality education and housing, safe environments, and accessible health care. Thus, social determinants of health have as much to do with health equity as the provision of direct care services. Dr. LeBlanc referred to food shortages, lost or low-paid employment, and isolation during the pandemic that exacerbate already high risks for poor health, especially among rural communities. Dr. LeBlanc also described equitable health care provision in the context of human interdependency and interconnectedness when care provision is neither discriminatory nor dehumanizing. She emphasized that interpersonal health care delivery promotes health equity and mentioned additional challenges in the areas of longterm health care quality and access to telehealth services. As a conclusion to her presentation, Dr. LeBlanc described nursing roles that can contribute to health care equity. Measuring the impact of health equity on health disparities The last speaker in this program was Senator Joanne Comerford, who represents several western <strong>Massachusetts</strong> districts and co-chairs the Public Health Committee. She briefly discussed a bill she proposed during this session that would require preparation of a health equity impact statement evaluating the likely positive or negative impact of each major state initiative on promoting health equity and eliminating or reducing racial and ethnic health disparities. Senator Comerford also reiterated her support for a single-payer health care financing system for the Commonwealth. The webinar offered a snapshot of current health care financing and delivery system issues and problems, and future possibilities. As the largest group of health care providers, nurses can play a key role in advocating for plans and policies that ensure health equity for everyone.
Page 1 and 2: MASSACHUSETTS REPORT ON NURSING Qua
Page 3 and 4: November 2020 Massachusetts
Page 5: November 2020 Massachusetts

Massachusetts Report on Nursing - December 2020

Create successful ePaper yourself

Delete template?

Save as template?