National Nurses United

CE:Final 5/27/08 11:58 AM Page 22 registered nursing practice in order to transfer registered nurse functions to unlicensed personnel and other non-RN caregivers; (c) elimination of the direct-care registered nurse assessmentcontrolled, transparent, and verifiable patient acuity system methodologies for determining registered nurse staffing levels based on individual patient needs; (d) implementation of new, "proprietary" patient classification systems for determining nurse staffing levels and "skill mix" which purport to rely on registered nurse assessment of patient needs, but conceal methodologies and determinative functions from staff nurses and government licensing authorities, that are incapable of scientific verification and validation, and routinely produce outcomes forecasting nurse staffing levels which objectively serve revenue generation targets and bear no relation to registered nurse patient assessments; and (e) introduction of new technologies which override the independent professional clinical judgment of direct-care registered nurses. The healthcare industry's restructuring and downsizing of hospital nursing services decimated the ranks of hospital direct-care registered nurses. At the same time, managed care-imposed barriers to hospital access produced an inpatient population that is far sicker and more medically fragile than ever before, requiring more intense, experienced, and specialized direct registered nursing care. Managed care strategies to increase revenue generation by downsizing the direct-care registered nurse workforce and restructured patient care methods also set in motion a continuing deterioration of working and practice conditions which have accelerated registered nurse flight from hospital direct patient care positions and effectively discouraged new registered nurse interest in hospital direct-care positions. Hospital direct-care registered nursing practice today is severely burdened by excessive patient assignment loads, mandatory extended work hours, unsafe patient handling practices, and routine exposure to risks of professional license, discipline, and/or malpractice liability inherent in working and practice conditions created and maintained in derogation of prevailing community standards of hospital and professional registered nursing care. ESSENTIAL ELEMENTS OF THE MAGNET RECOGNITION PROGRAM •strategic avoidance of hospital direct-care nursing regulation; •application of "evidence-based" deceptions to hospital nursing service patient care/practice standards; •rip-off of high public trust in nurses (to provide care in the exclusive interests of patients) to cover commercially-motivated, deceptive redesign of direct-care practice standards intended to restrain independent judgment and action by direct-care RNs, obstruct patient advocacy, and subvert the direct-care nursing process with the mandate to serve commercial interests over patient interests; •marketing gimmicks to promote false appearances of superior hospital nursing practices and quality patient outcomes (the "gold standard"); •strategies to gain market advantage for public and private reimbursement for hospital nursing services; •and most importantly, a strategy to compromise the direct-care RN duty of exclusive loyalty to patients by making commercial enterprise loyalty to hospital employers a condition of RN employment for the purpose of eliminating a significant barrier to 22 REGISTERED NURSE unchecked profiteering on individual and family healthcare risk as presented by an independent direct-care RN voice, professional responsibility, and duty patient advocacy in the exclusive interests of patients. Conclusion: The conflicts between commercial and revenue generation interests and patient interests cannot be reconciled by marketing gimmicks and workplace deceptions. Direct-care RN participation in schemes to conceal this reality and enable industry priorities is a fundamental conflict of interest and repudiation of professional ethics. CNA/NNOC POSITION Oppose any and all accreditation or recognition (including "Magnet" designation) schemes that; Directly, or indirectly interfere or compromise direct-care RN professional responsibilities to provide care in the exclusive interests of patients and take all necessary and appropriate actions to ensure patient safety, even if such actions conflict with employer interests, policies, or orders. Establish or permit sanction or recognition of different standards of nursing service or patient care performance which allow for recognition of substandard or different classes of competent care in derogation of the universal health principle of one standard of care. Purport to replace or, in effect, operate to replace governmental regulation of hospital services for the public health and safety. Directly or indirectly coerce, intimidate, induce, or encourage frontline caregivers to accept assignments, duties, or responsibilities which require enterprise loyalty and/or apparent assumption of managerial or supervisory authority that would disqualify them for collective bargaining representation. Apply TQM/Shared Governance schemes for the strategic purpose and effect of individual and collective patient advocacy suppression and union avoidance. Deploy technologies to override the independent professional judgment of the RN and restrict the RN duty and right to advocate; that are skill degrading; and are purposely developed to maintain a healthcare industry driven by private interest rather than the individual healthcare needs of the patient. Fail to establish and promote safe staffing standards based on individual patient acuity of which objective, unit-specific hospital RN-to-patient staffing standards are the minimum. Fail to establish or allow for an objective, transparent process for determining and establishing direct-care RN control over working and practice conditions demonstrated to improve the quality of the RN-patient therapeutic relationship, reduce errors and adverse outcomes, and improve recruiting and retention. Deceive and confuse direct-care RNs with TQM/Shared Governance schemes, including pay-for-performance incentives; to engage, support, and suppress direct-care resistance to benchmarking schemes that redefine disease, treatment, and outcomes; as well as cutbacks in safe, therapeutic, and competent direct-care nursing service, reductions in staff, and nursing service budgets; priority of surplus revenue generation and other anti-patient practices under the deceptive cover of "gold standard" redesign of patient/nursing care standards. Hedy Dumpel, RN, JD is Chief Director of Nursing Practice and Patient Advocacy for CNA/NNOC. W W W. C A L N U R S E S . O R G M AY 2 0 0 8

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