National Nurses United

18 J U N E 2 0 0 5 C A L I F O R N I A N U R S E orders for home infusion. Many of the home health nurses did not have experi- ence with setting up this equipment. The RNQLs worked with the organization's management to create appropriate com- petencies and standard procedures so that the RNs could safely perform this proce- dure in the home setting. Out-Patient: Medical assistants in the OB/GYN department were performing Non-Stress Testing (NST). The job description and education of medical assistants does not allow for patient assessment, which is a crucial component of NST for high-risk pregnant women. The RNQLs identified the safety issues and qualified RNs, whose job description and education include the responsibility for assessing and advocating for the patient, now provide these services. Nurse Practitioner: Nurse practition- ers (NP) furnishing medications in the state of California are required to partici- pate in a peer review process. The RNQLs have worked to create and implement a peer review process across the Northern California region. Peer review is necessary to guarantee that identified standards of care are understood by all NPs, ensuring that all patients receive high quality care. In working with neophyte NPs, or NPs moving into specialty areas, the RNQLs recognized the need for a mentoring pro- gram to ensure needed competencies and to provide a smooth transition into the new clinical role. The prevalence of this need led to a contractual agreement to create a NP mentoring program within the organi- zation. RNQLs were key participants in development of the formal "Mentoring Program" because of their knowledge of, and access to, multiple practice settings throughout the region. In-Patient: An insulin order form cre- ated by a bariatrics service department was difficult to interpret, leading to a medica- tion error. The RNQLs identified the prob- lem and instigated a revision of the form that is in the final stages of approval. An education program entitled "Staff Nurse Quality Awareness Program" (SNQAP) was designed by an RNQL to increase the level of awareness of staff nurses about the orga- nization's Quality Structures and motivate them to become involved. Kaiser/Hayward: This Kaiser facility was issued a cease and desist order by the Department of Health Services (DHS) for allowing Unlicensed Assistive Personnel (UAPs), classified as care partners employed by the Nursing Department, to perform phlebotomy/venipuncture. The DHS made an unannounced visit to this facility as a result of a complaint filed by the Kaiser/Hayward RN leadership—the PPC and the RNQL. The DHS investigated the circum- stances surrounding the complaint through interviews and review of docu- ments. Through this process the DHS was able to substantiate the allegations. This citation came about as a result of the Kaiser/Hayward leadership's per- sistence through collective action to uphold the law, protect the patient, and prevent further encroachment on our advocacy role. Robert Marth, RNQL was instrumental in shepherding this collec- tive patient advocacy process. This process included an extensive Assignment Despite Objection (ADO) drive, discus- sions with the DHS, Kaiser/Hayward administration, and coordination with the Nursing Practice Program. The RN lead- ership requested that Nursing Practice speak with and educate the DHS inspec- tor as to the new provisions to the Nursing Practice Act which prohibit UAPs from performing venipuncture/phlebotomy in lieu of a registered nurse, or under the supervision of a registered nurse, and the requirement that in order to be able to perform these tasks, the UAP must be employed in a clinical laboratory in the hospital. In other words, the UAP must be under the direction and supervision of the clinical lab director. In its Plan of Correction, Kaiser/Hay- ward stated that "Upon receipt of this statement of deficiency, an administrative decision was made to stop the practice of having care partners perform venipunc- tures. All venipuncture trainings for new care partners stopped." It also stated the laboratory was in the process of obtaining appropriate staff to take over the respon- sibilities. In conclusion: All these previous pa- tient advocacy cases affirm the power of education, the power of individual advo- cacy, and the ultimate power which comes with unity in collective patient advocacy. ■ References: "Quality is Everybody's Business: Collective Advocacy Through The RN Quality Liaison Program," (2004) Bonnie Martin, RN and Laurie Hoagland, RN. "Nursing Solidarity in the Hospital Matrix" (California Nurse, October 2004 edition), DeAnn McEwen, RN. "Advancing RN Patient Advocacy Through Col- lective Bargaining," (California Nurse, March 2005 edition), Hedy Dumpel, RN, JD. Copies of articles available through the Nursing Practice Department, upon request. Hedy Dumpel, RN, JD, is Chief Director of Nursing Practice and Patient Advocacy for the California Nurses Association. Bonnie Martin, RN, works in Kaiser Permanente's Skilled Nursing Facility in Stockton, Ca. and ser ves on the CNA Board of Directors. Laurie Hoagland, RN, works in the Medicine division for Kaiser in Napa, Ca. and serves on CNA's Legislative and Regulatory Committee. CE | Home Study Course "A new pump was introduced for use in the Bone Marrow Transplant (BMT) unit with inadequate orientation for the nurses. Patients were upset because their nurses were not familiar with the new equipment and the pumps had major technical problems. The PPC got all the nurses on the unit together to summarize the problems. A meeting with nursing administration resulted in a return to the former pump, which the nurses thought was a superior product." —KATHY PATANE, PPC CO-CHAIR, CITY OF HOPE

• Cover