- Email: [email protected]
Texas nurses help resolve sticky problems in sunset review
Legislation
Texas nurses help resolve sticky problems in sunset review 8 Texas nurses have mastered the sunset review process. They not only had their own practice act renewed this summer, gaining new regulatory authority for the Board of Nurse Examiners, they also succeeded in having the medical practice act and pharmacy acts amended to help resolve some sticky problems in the practice of nurse practitioners in rural health clinics. Taking the process one step further, they worked with a state senator so that the floor debate-which goes into the permanent official record-would clearly reflect the legislature’s intent when future questions are raised. Susan J Grobe, RN, assistant professor at the University of Texas School of Nursing, Austin, summarized the nurses’ efforts. A central issue was standing orders, which have been controversialever since the federal Rural Health Clinics Services Act went into effect in 1978. The new legislation was intended to bring more services to poor people in outlying areas by authorizing direct Medicare and Medicaid reimbursement to nurse practitioners and physician’s assistants working under indirect physician supervision. The state’s attorney general issued an opinton that standing orders for medication were not permissibleand “would constitutethe practice of medicine and not a nursing act.” The nurses were stuck, and previous attempts to correct the situation through legislation and rule making did not succeed. One problem was that some said the Board
822
.ct;, %
of Nurse Examiners did not have rule-making authority. The renewed nursing practice act gives the nursing board legal standing to recommend to the medical board adoption of rules pertaining to physician delegation. The law says the nursing board may distinguish between nurses on the basis of “special training and education.” Further, the statute states that the nursing and medical boards must act on the rules so that the state may obtain its fair share of federal health funds. (This is a reference to implementing the rural health act.) Amendments in the medical practice act instruct the medical board to allow physicians to make their own judgments about delegating. Some penalties for the illegal practice of medicine were downgraded. Finally, the legislature created a special class of pharmacy with its own rules and regulations so nurse practitioners in rural areas may dispense medications. Grobe credited nurses’ success to grassroots participation. “When we needed to do some hard talking to legislators, we could call on nurses in their own communities,” she said. The nurses’ political action committee actively donatedto campaigns last year, “making it easier to walk into legislators’ offices and make our requests known,” she added. “Our financial contributions may have been miniscule compared with other groups, but having nurses out there working on campaigns really made a difference.” 8 A federal appeals court has ruled that collective bargaining units made up only of registered nurses cannot always automatically be considered appropriate. Rather, a bargaining unit might also have to include other professionals such as physical therapists or social
AORN Journal, November 1981, V o l 3 4 , No 5
workers. The cases concerned RNs in Denver hospitals who organized under the Federation of Nurses and Health Professionals of the American Federationof Teachers (FNHPIAFT)early this year. After nurses voted in the union, the hospitals refused to bargain with them, saying that a unit that included only RNs was not proper. The hospitals said they were following the intent of Congress when it brought employees of nonprofit hospitals under the collective bargaining law in 1974. Congress had cautioned against having too many bargaining units in an industry, as has happened in the constructiontrades. The hospitals argued that an all-RN unit violated this principle. The union filed an unfair labor charge against the hospitals with the National Labor Relations Board (NLRB), which administers major labor laws. The NLRB ruled that the all-RN unit was appropriate, and the hospitals took the NLRB to court. In its decisions in July concerning Presbyterian-St Luke’s Medical Center, Beth Israel Hospital, and St Anthony’s Hospital, the 10th Circuit Court of Appeals in Denver found that the NLRB was wrong in presuming an all-RN unit was consistentwith the intent of Congress. Further, the court said, the labor board had violated federal rules of evidence when it told hospitals they had the burden of proof in demonstrating that the unit was not proper. The judges ordered the NLRB to reconsider the case, using the direction the court had set. What happens now? Will RNs who organize be combined with other types of employees? It is too early to say, becausethe NLRB will need time to reexamine its policy, and the FNHPI AFT said it was considering an appeal to the US Supreme Court. Union president Albert Shanker called the hospitals’ court appeals “tactics and maneuvers” to draw out the bargaining process. Whatever the final outcome, the way will not be easy for organizations that bargain for nurses. For one thing, President Reagan has recently appointed two conservatives to the NLRB, who are likely to be strict in following Congress’s direction for unit determination. This was the assessment of Richard U Miller, professor of business and industrial relations at the University of Wisconsin, Madison.
Implications may be serious for all groups that bargain for nurses. The American Nurses’ Association (ANA), which has a policy of only representing RNs, intends to submit a brief to the NLRB asking them not to extend “the very poor reasoning,” in these cases nationwide, said labor counsel David Bahn. The NLRB has the option of extending the decision or limiting it to the facilities involved. He saw the ruling as an “attempt by employers to make organizing as difficult as possible and a way to deny employee rights to organize.” The ANA would be actively involved in challenging the decision “in whatever forum at whatever time,” he added. Other unions, such as the FNHPIAFT, the Service Employees International Union, and National Union of Hospital and Health Care Employees (District 1199) do not have a policy of only bargaining for nurses. But if the decision is extended, they may face the practical problems of bargaining for multidisciplinary units with diverse interests. Miller noted. Congress returned from its summer vacation in early September to tackle appropriations. They had spent most of the summer establishing budget limits. In the early fall, attention turned to providingactual dollars within authorized limits. Pausing briefly to celebrate the new threeyear authorization that the Nurse Training Act received from Congress, the American Nurses’ Association Washington office then began working for an appropriation equal to the budgeted amount. ANA pointed out that while Congress has authorized $63 million for nursing education in fiscal year 1982, President Reagan had originally asked for only $14.2 million. Nurses were concerned that, with renewed pressure for budget-trimming, Congress might appropriate less than the full amount. Even the $63 million would be less than what nursing education got this fiscal year-$75.2 million. Nurses were also working for a modest increase in nursing research grants and fellowships, as well as full funding of a programto aid financially distressed nursing schools.
AORN Journal, November 1981, V o l 3 4 , No 5
Patricia Patterson Associate editor
823
Texas nurses help resolve sticky problems in sunset review 8 Texas nurses have mastered the sunset review process. They not only had their own practice act renewed this summer, gaining new regulatory authority for the Board of Nurse Examiners, they also succeeded in having the medical practice act and pharmacy acts amended to help resolve some sticky problems in the practice of nurse practitioners in rural health clinics. Taking the process one step further, they worked with a state senator so that the floor debate-which goes into the permanent official record-would clearly reflect the legislature’s intent when future questions are raised. Susan J Grobe, RN, assistant professor at the University of Texas School of Nursing, Austin, summarized the nurses’ efforts. A central issue was standing orders, which have been controversialever since the federal Rural Health Clinics Services Act went into effect in 1978. The new legislation was intended to bring more services to poor people in outlying areas by authorizing direct Medicare and Medicaid reimbursement to nurse practitioners and physician’s assistants working under indirect physician supervision. The state’s attorney general issued an opinton that standing orders for medication were not permissibleand “would constitutethe practice of medicine and not a nursing act.” The nurses were stuck, and previous attempts to correct the situation through legislation and rule making did not succeed. One problem was that some said the Board
822
.ct;, %
of Nurse Examiners did not have rule-making authority. The renewed nursing practice act gives the nursing board legal standing to recommend to the medical board adoption of rules pertaining to physician delegation. The law says the nursing board may distinguish between nurses on the basis of “special training and education.” Further, the statute states that the nursing and medical boards must act on the rules so that the state may obtain its fair share of federal health funds. (This is a reference to implementing the rural health act.) Amendments in the medical practice act instruct the medical board to allow physicians to make their own judgments about delegating. Some penalties for the illegal practice of medicine were downgraded. Finally, the legislature created a special class of pharmacy with its own rules and regulations so nurse practitioners in rural areas may dispense medications. Grobe credited nurses’ success to grassroots participation. “When we needed to do some hard talking to legislators, we could call on nurses in their own communities,” she said. The nurses’ political action committee actively donatedto campaigns last year, “making it easier to walk into legislators’ offices and make our requests known,” she added. “Our financial contributions may have been miniscule compared with other groups, but having nurses out there working on campaigns really made a difference.” 8 A federal appeals court has ruled that collective bargaining units made up only of registered nurses cannot always automatically be considered appropriate. Rather, a bargaining unit might also have to include other professionals such as physical therapists or social
AORN Journal, November 1981, V o l 3 4 , No 5
workers. The cases concerned RNs in Denver hospitals who organized under the Federation of Nurses and Health Professionals of the American Federationof Teachers (FNHPIAFT)early this year. After nurses voted in the union, the hospitals refused to bargain with them, saying that a unit that included only RNs was not proper. The hospitals said they were following the intent of Congress when it brought employees of nonprofit hospitals under the collective bargaining law in 1974. Congress had cautioned against having too many bargaining units in an industry, as has happened in the constructiontrades. The hospitals argued that an all-RN unit violated this principle. The union filed an unfair labor charge against the hospitals with the National Labor Relations Board (NLRB), which administers major labor laws. The NLRB ruled that the all-RN unit was appropriate, and the hospitals took the NLRB to court. In its decisions in July concerning Presbyterian-St Luke’s Medical Center, Beth Israel Hospital, and St Anthony’s Hospital, the 10th Circuit Court of Appeals in Denver found that the NLRB was wrong in presuming an all-RN unit was consistentwith the intent of Congress. Further, the court said, the labor board had violated federal rules of evidence when it told hospitals they had the burden of proof in demonstrating that the unit was not proper. The judges ordered the NLRB to reconsider the case, using the direction the court had set. What happens now? Will RNs who organize be combined with other types of employees? It is too early to say, becausethe NLRB will need time to reexamine its policy, and the FNHPI AFT said it was considering an appeal to the US Supreme Court. Union president Albert Shanker called the hospitals’ court appeals “tactics and maneuvers” to draw out the bargaining process. Whatever the final outcome, the way will not be easy for organizations that bargain for nurses. For one thing, President Reagan has recently appointed two conservatives to the NLRB, who are likely to be strict in following Congress’s direction for unit determination. This was the assessment of Richard U Miller, professor of business and industrial relations at the University of Wisconsin, Madison.
Implications may be serious for all groups that bargain for nurses. The American Nurses’ Association (ANA), which has a policy of only representing RNs, intends to submit a brief to the NLRB asking them not to extend “the very poor reasoning,” in these cases nationwide, said labor counsel David Bahn. The NLRB has the option of extending the decision or limiting it to the facilities involved. He saw the ruling as an “attempt by employers to make organizing as difficult as possible and a way to deny employee rights to organize.” The ANA would be actively involved in challenging the decision “in whatever forum at whatever time,” he added. Other unions, such as the FNHPIAFT, the Service Employees International Union, and National Union of Hospital and Health Care Employees (District 1199) do not have a policy of only bargaining for nurses. But if the decision is extended, they may face the practical problems of bargaining for multidisciplinary units with diverse interests. Miller noted. Congress returned from its summer vacation in early September to tackle appropriations. They had spent most of the summer establishing budget limits. In the early fall, attention turned to providingactual dollars within authorized limits. Pausing briefly to celebrate the new threeyear authorization that the Nurse Training Act received from Congress, the American Nurses’ Association Washington office then began working for an appropriation equal to the budgeted amount. ANA pointed out that while Congress has authorized $63 million for nursing education in fiscal year 1982, President Reagan had originally asked for only $14.2 million. Nurses were concerned that, with renewed pressure for budget-trimming, Congress might appropriate less than the full amount. Even the $63 million would be less than what nursing education got this fiscal year-$75.2 million. Nurses were also working for a modest increase in nursing research grants and fellowships, as well as full funding of a programto aid financially distressed nursing schools.
AORN Journal, November 1981, V o l 3 4 , No 5
Patricia Patterson Associate editor
823