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employers. National ratios legislation proposed by NNU includes the following: 1. Direct-Care Registered Nurse Patient Advocacy���Professional Duty of Patient Advocacy ��� Professional obligation and right: An RN has the professional obligation and therefore the right to act as the patient���s advocate. ��� Protection for the refusal of unsafe patient assignments: The direct-care RN is always responsible for providing safe, therapeutic, and competent nursing care to assigned patients. If the direct-care RN is not clinically competent to perform the care required for a patient(s) to be assigned for nursing care, she/he should not accept the patient care assignment(s). Such refusal to accept a patient care assignment is an exercise of the direct-care registered nurse���s duty and right of patient advocacy. ��� Free speech, whistle-blowing, patient protection: All directcare RNs responsible for patient care in a hospital facility shall enjoy the right of free speech. 2. Minimum, Speci���c, and Numerical Direct-Care Registered Nurse-to-Patient Staf���ng Ratios by Clinical Unit For All Units At All Times For Acute-Care Hospitals ��� A patient classi���cation system (PCS) to determine additional staff, based on a National Acuity Tool developed by CMS. ��� Direct-care LV/PN ratios study and its effect on patient care in hospitals. 3. Registered Nurse Workforce Initiative Purpose: Achieve immediate short-term mitigation and remedy of the nationwide nursing shortage. ��� Basic educational assistance bene���t and living stipend ��� Creation of an education assistance entitlement program for eligible associate and baccalaureate degree applicants. ��� Preceptorship and mentorship demonstration project to provide additional support to nurses entering the workforce 4. Enforcement ��� Action by the Secretary: Administrative action. The Secretary shall receive, investigate, and attempt to resolve complaints of violations. Types of Patient Advocacy National Nurses United members in all 50 states participate in necessary and appropriate actions and exercises of social, collective patient and professional advocacy to protect the public health. RNs must safeguard patient care standards from erosion, restructuring, degradation, deregulation, and abolition by the large healthcare corporations, hospital chains, HMOs, insurance companies, pharmaceutical corporations, and other powerful economic institutions and interests Individual Advocacy: Any time an RN intervenes on the patient���s behalf, the RN is being an advocate. RNs are accountable for patient outcome. The RN must be cognizant of and alert to circumstances requiring advocacy. Advocacy circumstances occur when the RN promotes and protects the patient���s interest, such as patient safety (insisting the hospital comply with the safe staf���ng by scope, ratios, and patient���s individual acuity standards) or the 30 N AT I O N A L N U R S E ��� ���nes for violating employee and patient rights: Acute-care hospitals that violate employee or patient rights under this act shall be subject to civil penalties���$25,000.00 ��� ���nes for violating employee and patient rights: Any individual employed by a hospital that violates employee or patient rights under this act shall be subject to civil penalties���$20,000.00 ��� ���nes for violating ratios���$25,000.00 Setting the Stage for National Standards: CMS Development of National Acuity Tool Clinical restructuring has resulted in the elimination of a signi���cant patient safety net provided by a transparent, direct-care RN-operated and assessment-controlled acuity system. Now, the newly restructured and mostly proprietary and costly patient classi���cation systems (PCS) institutionalize a fraudulent staf���ng methodology and practice for the hospital nursing service which wholly disregards patient needs and adheres to hospital budget and revenue generation mandates. The inevitable result has been a steady increase in patient loads for direct-care RNs far beyond the bounds of competent, safe, therapeutic, and effective hospital nursing care. The proliferation of these fraudulent patent classi���cation systems, concealment of determinative methodologies from responsible direct-care RNs and government regulators under ���proprietary seal,��� and intended use in providing ���scienti���c��� justi���cation for a reduced and overburdened direct-care registered nursing staff with excessive patient loads have effectively disabled state regulation and enforcement of safe hospital nursing staf���ng standards. A uniform national standard is necessary to restore effective enforcement authority by state licensing authorities and provide a basis for federal support of state enforcement through mandatory conditions of participation. For this reason, SB 992 (Boxer) and HR 2187 (Schakowsky) will set a uniform national standard. The Centers for Medicare and Medicaid Services (CMS) shall develop a National Acuity Tool that provides a method for establishing nursing staf���ng requirements above the minimum staf���ng ratios. This acuity tool shall provide a method for establishing nursing staf���ng requirements above the minimum staf���ng ratios, using the existing CMS computer-based ���open source��� acute-care patient���s wishes (honoring the patient���s directive not to engage in heroic measures���no code). Collective Advocacy: Any time RNs engage in concerted activities on their patients��� behalf, the RNs demonstrate their united power of collective patient advocacy. Such a show of power can range from the activities of facility-based professional practice committees (PPCs) or other union activist committees to mass demonstrations. Social Advocacy: Any time RNs engage in collective patient advocacy activities to protect the socio-economic conditions and healthcare needs of society at large, the RNs engage in social advocacy. As corporate healthcare is becoming more the norm, now creating a healthcare crisis, the RN���s advocacy role has become increasingly important; it has evolved to include collective patient and social advocacy. W W W. N A T I O N A L N U R S E S U N I T E D . O R G NOVEMBER 2012