Rhode Island nurses’ unions plan to lobby lawmakers this year for regulation
of temporary-staffing agencies, public disclosure of hospital staffing levels
and – once again – limits on the work schedules of nurses and other health-care
workers.
Legislation to cap nurses’ overtime has failed for several consecutive years, but union officials are emboldened by the bill’s impressive showing last year. Separate versions of the legislation – which had never before won approval in either chamber – passed both houses, although lawmakers never reconciled a final version of the bill before the 2001 session ended.
"We’re optimistic," Stan Israel, vice president of the New England Health Care Employees Union, District 1199, said of the overtime cap. "That bill has gained an awful lot of support from a lot of people along the way."
Rick Brooks, director of the Rhode Island-based United Nurses & Allied Professionals, said this year’s mandatory-overtime bill will be similar to past proposals, seeking to limit health professionals other than doctors and medical residents to 12-hour workdays and 60-hour weeks. Instead of hampering providers’ abilities to staff facilities, Brooks said capping nurses’ hours would help entice more nurses to work full-time, potentially stemming the trend toward part-time and per-diem schedules.
"We need to improve conditions so there are more nurses who are willing to work in hospitals and willing to work 40-hour weeks," Brooks said.
UNAP also is lobbying for legislation that has never before been introduced: requiring hospitals to publicly disclose staffing levels.
"We know that hospitals are constantly complaining about their fiscal pressures, and we’re sympathetic to that," Brooks said. "But we can’t tolerate them relieving that pressure by short staffing, which becomes a safety issue."
Brooks said staffing levels in some cases have a direct correlation on certain patient outcomes, such as post-surgical infection rates and incidence of pneumonia. He said the proposed measure would illustrate to consumers the importance of adequate staffing.
"If patients don’t know, then hospitals are not under quite the same pressure to make sure they’re staffing levels are competitive," Brooks said. He said the legislation would come as an amendment to the 1998 law that requires the Department of Health to measure quality at each hospital in the state.
While measures such as the staffing-disclosure legislation is likely to put unions at odds with providers, at least one proposal should have the backing of both groups: regulations to cap the rates that nurse-staffing agencies, or nursing "pools," charge providers.
The temporary agencies often charge significantly higher rates than providers pay their own nurses, which not only strains cash-strapped nursing homes but also entices nurses to leave their facilities to work for the pools. The agencies have been a target of criticism by both nurses’ unions and providers – especially as the nursing shortage has grown more severe in recent years.
"The nursing pools are driving (nurses) away from providers," Israel said. "You’re never going to be able to staff these (long-term-care facilities) until the pool situation is under control."
The Rhode Island Health Care Association, a nonprofit trade group for the state’s nursing home industry and other long-term-care providers, also counts nursing-pool regulation as one of its key legislative priorities for this year, officials said.
District 1199 also will be back at the General Assembly this year lobbying for better pay for direct-care workers in private long-term-care facilities.
A report issued last year by the state’s Long Term Care Coordinating Council linked the issue of low pay to the dearth of direct-care workers in the state’s nursing homes. The report said that nearly 20 percent of Rhode Island’s certified nurse assistant (CNA) positions are vacant. The report also said that CNAs in the state’s private nursing homes earn hourly wages of about $8 an hour, while state-employed CNAs make nearly $12.
U.S. Congressman Patrick J. Kennedy and Lt. Gov. Fogarty joined long-term-care providers last year in backing a proposal that would have earmarked $14.1 million in state funding – matched by about $16 million in federal money – for CNA salaries. Although that effort failed, Israel said the union would be backing a similar proposal this year.
