Iowa Nurses Association 1998 Resolutions

WHEREAS, the Balanced Budget Act of 1997 will have dramatic impact on home health care services; and

WHEREAS, new Health Care Financing Administration mandate provide for an interim payment system (IPS) that will limit home health agency reimbursement to the lower of:

1. ) actual fiscal year 1994 costs,

2. ) the per beneficiary cost limit applied in the aggregate or

3. ) the agency cost caps in the aggregate.

WHEREAS, the IPS has the potential to limit access to care for chronically ill or elderly needing home health care services.

WHEREAS, cost savings should not be pursued at the expense of quality; therefore be it

RESOLVED, that INA advocate for the protection of patient access to quality home health services; and be it further

RESOLVED, that INA endorse a payment system that:

1. is based on nurse sensitive outcomes
2. reflects case – mix intensity and appropriate levels of care
3. is commensurate with the intensity of services provided; and be it further

1. Provide information to Iowa’s Congressional delegation on the impact of the interim payment system (IPS).
2. Monitor payment systems proposed by Health Care Financing Administration (HCFA) for their impact on Iowa’s home health services.
3. Disseminate information to members through the INR

WHEREAS, the health care industry is under going rapid changes that transform the system into highly complex and sophisticated enterprises; and

WHEREAS, many health care institutions are creating an atmosphere of "blame" in which individual health care providers are increasingly held accountable for adverse patient outcomes; and

WHEREAS, mistakes by health care providers are reviewed as individual failures rather than system failures and are dealt with in a punitive framework; and

WHEREAS, in some states, nurses are being held criminally negligent when adverse patient outcomes occur; therefore be it

RESOLVED, that INA educate policy makers and the public on the effects of downsizing, restructuring and reorganization which break down traditional quality and safety processes; and be it further

RESOLVED, that INA participate in efforts with other health care organizations that focus on correcting system failures through shared accountability; and be it further

RESOLVED, that INA support the essential role of professional nurses in efforts to correct system failures through quality improvement initiatives, and through the enactment of whistle blowing legislation; and be it further

RESOLVED, that INA work with regulatory and accreditation bodies to clarify the implications of the trend toward criminalizing of "errors" made in the health care arena; and be it further

RESOLVED, that INA utilize ANA’s model language for rules and regulations that will clearly define malpractice and criminal acts; and be it further

RESOLVED, that INA supports appropriate disciplinary processes, advocating for discipline specific peer review and input. This includes but is not limited to holding administrators accountable for staffing and other decisions resulting in adverse outcomes.

1. Participate in coalition efforts with other health care organizations that aim at removing "individual" blame from health care systems and focus on correcting systems errors.
2. INA collaborate with the Iowa Board of Nursing to be aware of any impending threat in Iowa to criminalize nursing errors.
3. Strengthen the role of the professional nurse in identifying system inefficiencies in hospital systems and regulatory processes (i.e. JCAHO) that could lead to errors by health care professionals.
4. Continue INA’s collaboration with ANA in their efforts to quantify the linkage between nurse staffing and quality health care including the increase and/or decrease in errors as a result of nurse staffing.

WHEREAS, women’s health requires attention as a distinct issue because of historic and current discrepancies in research, access and treatment, matters peculiar to reproductive health, occupational health problems, and in recent years, the changes associated with managed care; and

WHEREAS, women have traditionally been unrepresented or underrepresented or their unique health care needs have been unattended in the above areas; and

WHEREAS, women’s reproductive health issues, while extremely important, are only one component of women’s health research that is needed for women of all ages and races; and

WHEREAS, significant information about women in specific disease areas, mental health and response to prescription drugs is still lacking; and

WHEREAS, access to quality health care is hampered because of lack of health care insurance as a result of poverty, change in marital status, and/or change in employment; and

WHEREAS, new Medicaid managed care plans fall short in protecting women Medicaid recipients in several areas such as allowing women direct access to ob-gyn services or ensuring that clinical practice guidelines address gender differences; and

WHEREAS, health plans must not discriminate in any way against members or providers on the basis of gender or health status including genetic information or being a victim of domestic violence; and

WHEREAS, occupational health problems specific to women have been largely ignored or underestimated because occupational health hazards have focused on exposure to large amounts of one or two toxic materials, most of which are found in male-dominated industries; therefore, be it

RESOLVED, that INA support ANA’s activities relative to women’s health including:

1. Advocating for increased research funding that:
   • targets conditions unique to and/or prevalent among women in various age groups
   • explains cultural conditions and socialization practices that differentially affect women
   • includes women in clinical trials of prescription drugs and medical regimes
   • identifies health hazards significantly affecting women in the workplace
   • determines interventions that will enable women to live in a violence free environment
2. Asserting the rights of women to be fully informed about occupational health safety risks that differentially affect them and develop strategies for the reduction and elimination of these risks.
3. Promoting access to health care interventions including, but not limited to matters related to reproductive health.
4. Championing women’s informed choice of health care interventions.
5. Advancing equal treatment of women in the health care system including utilization of evidenced-based gender-sensitive clinical guidelines.
6. Promoting consumer protections, in all health care financing systems, that take into account the particular health care needs of women.

1. Participate in coalition with other organizations that share commitment to women’s health care issues.
2. Work with ANA to advocate for women’s health through activities on the federal level.
3. Maintain INA’s leadership in advocating for women’s health through activities on the state and community level.

WHEREAS, the INA has historically supported Medicare as a comprehensive, universal social health insurance program; and

WHEREAS, Medicare must remain strong and viable because this system impacts all health care services; and

WHEREAS, the population of the United States has an increasing number who will be Medicare eligible; and

WHEREAS, the funding presently for Medicare may not be sufficient to cover this population; therefore be it

WHEREAS, Iowa has the highest percentage of elderly over 85 years of age in the nation and the third highest percentage of population over age 65.

RESOLVED, that INA advocate for legislation and policy that will assure Medicare’s long term solvency; and be it further

RESOLVED, that INA advocate for provision of universal access for all older Americans and identified disabled populations regardless of income; and be it further

RESOLVED, that INA also advocate that Medicare maintain and advance current levels of quality, service and eligibility.

1. Work in collaboration with consumer and provider groups to support the continuation of a strong and viable Medicare program.
2. Advocate through the legislative and regulatory process for a Medicare program that provides access, quality and cost effective healthcare

WHEREAS, Information Systems provide data such as profiles of health care providers patterns of treatment and health care expenditures and the Internet appears to be the vehicle of choice through which to disseminate information to the public; and

WHEREAS, Boards of Nursing are moving forward to make licensure information available to the public via the Internet; and

WHEREAS, access to personal information such as home address and telephone number could affect nurses’ personal safety; and

WHEREAS, controversy continues around how and when the public should know if a complaint has been filed against health care provider; therefore be it

RESOLVED, that INA endorse the guidelines established by ANA to implement and evaluate safeguards for personal and professional online information; and be it further

RESOLVED, that INA urge state agencies to establish and comply with laws protecting the confidentiality of personal and professional online information.

1. Continued advocacy efforts aimed at safeguarding professional and personal online information.
2. Participate in coalition efforts with other health care organizations that strive to safeguard professional and personal online information.
3. Continue to monitor state efforts to disseminate public information.
4. Educate policy makers on the need for health care providers to review and approve information contained in the professional information profile prior to public dissemination.

WHEREAS, the aging population in Iowa is increasing in numbers and the issues of end of life are dealt with on a frequent basis; and

WHEREAS, often the patient/family or other decision makers are uniformed about his/her choices in end of life decisions; and uninformed/misinformed.

WHEREAS, at times the specific wishes of the patient and family are not followed for a variety of reasons; and

WHEREAS, many people do not have access to information on advanced directives and living wills until a time of need which interferes with a deliberative decision making process and may result in unwanted end of life procedures; and

WHEREAS, these unwanted end of life procedures often cause unnecessary pain, suffering and emotional stress on patient/family and financial hardship on family and third party payers

RESOLVED, that INA promote dissemination of information on advanced directives and living wills; and be it further

RESOLVED, that INA promote the use of advanced directives and living wills including information on the effects and outcome of treatment choices; and be it further

RESOLVED, that INA advocates for thorough documentation and communication of patients’ end of life treatment options and preferences.

1. Work with multiple groups who provide services to Iowa’s population to disseminate information and educate the public on advanced directives and living wills.
2. Publish an article in INR on advanced directives and living will.
3. Prepare and send letters to editors.
4. Collaborate with groups of involved professionals on end of life issues.

WHEREAS, Registered Nurse First Assistants are an affordable alternative source of quality health care; First assisting is within the scope of practice of all fifty state Boards of Nursing and that many major professional organizations recognize the RNFA role including the American College of Surgeons (ACS), the Association of Operating Room Nurses, Inc (AORN), National League of Nursing (NLN), the American Nurses Association (ANA), and the National Association of Orthopedic Nurses (NAON); therefore be it

RESOLVED, that the INA collaborate with the Association of Operating Room Nurses to strive for reimbursement for the Registered Nurse First Assistants who have achieved their certification, clinical, didactic education and experience through recognized educational programs.

1. Publish an article in INR on RNFA.
2. Research and design information packet on current status of reimbursement with Iowa insurance companies.

The American Nurses Association will:

1. Continue commitment to consumer access to nursing services, recognizing that nursing practice occurs across state borders.
2. Develop model guidelines for state nurses associations (SNAs) that desire to pursue legislation, which allows agreements with other states to facilitate nursing practice across state borders and assist in other ways than the mutual recognition regulation approach.
3. Continue to allocate resources including, but not limited to, legal analysis, to assist states in evaluating proposed compact components.
4. Utilize the following ANA policy guidelines in all discussion or actions regarding approaches to state licensure and support to, Interstate Practice, The Interstate Compact, Multi-state Licensure or Mutual Recognition, only if:
1. Interstate practice legislation should clearly define key terms and be precisely drafted to ensure that the primary objective to be accomplished by interstate practice is achieved, e.g. asserting jurisdiction over out-of-state nurses practicing in a state.
2. The rule-making process to implement any interstate practice legislation should be clearly spelled out in the legislation, and proposed implementation regulations of key provisions should be developed simultaneously with any legislation.
3. Clear parameters should be established related to the confidentiality of any information shared with other states as well as who shall have access to such information.
4. The sharing of any information related to disciplinary matters, other than final orders and emergency suspensions, should be prohibited unless there is a clear and convincing need to do so to protect the public.
5. The process for selecting an entity to conduct data collection or provide other services related to implementation of interstate practice shall be open and competitive.
6. Before any immunity from liability is extended to non-governmental entities, there should be careful scrutiny to ensure those entities are appropriately accountable for their actions.
7. Mechanisms should be established to ensure that the process used by any entity collecting data be reconciled with state law and procedures regarding collecting, maintaining and distributing licensure and disciplinary information.
8. The right of individual nurses to a fair hearing of any disciplinary matter must be protected; and, no unfair or undue burden, financial or otherwise, should be placed on a nurse’s exercising his/her right to a fair hearing.
9. Approaches to interstate advanced practice nursing should be addressed for consistency in connection with interstate practice for other RNs.
10. Mechanisms should be in place that ensures nurses have ready and ongoing access to practice-related information, including current Board of Nursing policies.
11. Mechanisms should be in place to ensure that a Board of Nursing knows who is practicing in its state under authority of a license granted by another state or through an interstate practice agreement.
12. The state of predominant practice should be the state of licensure. If the nurse is not practicing, the nurse should be licensed in his/her state of residence.
13. Employers must be held accountable for ensuring that they utilize staff who are licensed (or otherwise authorized to practice) under state law.
14. Interstate practice must not be implemented in a way that allows persons to circumvent or contravene existing public policy as expressed by a state’s laws or policies or initial and continuing licensure requirements.

MOVE, that the INA House of Delegates amend Resolution # 10, "Nursing Licensure Across State Lines", adopted October 1997 to include the following:

RESOLVED, that INA utilize the ANA House of Delegates policy guidelines (see attached) in all discussion or actions regarding approaches to state licensure, including but not limited to, Interstate Practice, the Interstate Compact, Multi-State Licensure or Mutual Recognition.

1998 Resolutions as Assigned to Commissions