Government affairs.
Subject: Nursing
Author: Davis, Wilhelmina
Pub Date: 12/22/2011
Publication: Name: Tennessee Nurse Publisher: Tennessee Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2011 Tennessee Nurses Association ISSN: 1055-3134
Issue: Date: Winter, 2011 Source Volume: 74 Source Issue: 4
Accession Number: 275576702
Full Text: As we have begun making preparations for the fast approaching 2012 session of the Tennessee General Assembly, it might appear to some that the previous session never ended. It has been a very busy summer and fall for TNA staff. We've attended ongoing legislative committee meetings, rulemaking hearings, Board of Nursing meetings, meetings with other advocacy groups, and regular TNA committee meetings. We also put forth an enhanced effort to engage the membership in grassroots advocacy, keeping in mind the importance of meeting and involving our elected officials on the home front. So, to say TNA has been busy is really an understatement.

In September, the Subcommittee of the House Health Committee met for a "summer study" of House Bill No. 1896, the Interventional Pain Management legislation. As a reminder, the bill as written specifies that an Advanced Practice Registered Nurse (APRN), Certified Nurse Anesthetist (CRNA) and Physician Assistant (PA) shall only perform invasive procedures involving any portion of the spine, spinal cord, sympathetic nerves or block of major peripheral nerves under the direct supervision of a licensed physician who has been certified in certain medical specialties, including anesthesiology, neurological surgery, orthopedic surgery, or physical medicine and rehabilitation. During the scheduled meeting, testimony was allowed on the subject of interventional pain management, but not on the substance of the proposed legislation. As a result of no action being taken, the bill remains in the same posture, meaning the bill will be back on the House Health subcommittee's agenda in January. TNA continues to oppose the bill as written and will work with the CRNAs and PAs to offer an appropriate compromise amendment.

In October, we were back at the Legislative Plaza to participate in the full standing House Health Committee meeting on bills referred to summer study. One particular bill of interest was House Bill No. 977, by Rep. Sparks. This legislation, as written, would require direct supervision by a physician in outpatient cosmetic clinics. We are working with the legislator on amendatory language.

In November, the House and Senate Joint Government Operations committee met to discuss and make recommendations regarding new sunset legislation for the Board of Nursing (BON). The proposed legislation for 2012 will be to extend the sunset date, thereby re-authorizing the BON. The legislation would also re-configure membership to include Advanced Practice Registered Nurse and Registered Nurse representation in each of the nine congressional districts, one Licensed Practical Nurse (LPN) member and one consumer member. Additional elements of the bill would limit members to serve for two four-year terms, mandates that seven members be physically present for any summary suspension actions, and permit all current members to fulfill their terms.

Also in November, the Senate and House Joint Government Operations Committee on Rules met to hear presentation of the Emergency Rules relating to Pain Management Clinics. Although this committee could not make any changes to the proposed rules, the committee did hear testimony from TNA members whose clinics could be inadvertently affected by the changes. There will be a permanent Rules making hearing in December. TNA urges those who may be interested in the implementation of these rules to present their concerns to the Department of Health.

TNA also held its Annual Convention in Franklin,Tenn., in October, and it was a tremendous success. As part of this year's Tennessee Nurses Political Action Committee (TN-PAC) agenda, a Legislative Panel was facilitated by Martha Clinton, TN-PAC Chair. The topic of discussion was centered on improving the access, safety and quality of healthcare for all Tennesseans. The legislators addressed concerns relating to the removal of legislative barriers to practice, the importance of reauthorizing the Tennessee Board of Nursing, addressing the nursing faculty shortage, and the issue of violence in the healthcare workplace. Our panel consisted of Senators Overbey, Barnes and Roberts and House Health Committee Chairman Glen Casada. The dialogue was a great vehicle for exchange of thoughts and ideas as our members were afforded the opportunity to hear from legislators away from the political arena of the Legislative Plaza. We extend a special thanks to each participant of the legislative panel and we look forward to having even greater involvement at next year's convention.

In an effort to address the concern relating to incidents of violence in the workplace, the House of Delegates adopted the following resolution which authorizes TNA to bring forth legislation.

Resolution # 2011 - 01

Adopted 10-15-2011

2011 TNA Resolution on Workplace Violence

WHEREAS, The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace. (NIOSH 1966); and,

WHEREAS, The healthcare sector leads all other industries, with 45% of all nonfatal assaults against workers resulting in lost work days in the US, and;

WHEREAS, From 2003 to 2009, 8 registered nurses were FATALLY injured at work (BLS, 2011); and,

WHEREAS, 2,050 assaults and violent acts were reported by RNs requiring an average of 4 days away from work, (BLS, Private Industry, State and Local Government, 2011); and,

WHEREAS, The Emergency Nurses Association (2009) reported that more than 50% of emergency center (EC) nurses had experienced violence by patients on the job and 25% of EC nurses had experienced 20 or more violent incidents in the past three years; and,

WHEREAS, ANA works to protect nurses from workplace violence in a variety of ways, including lobbying for an enforceable Occupational Safety and Health Administration (OSHA) standard and pushing for informed state legislation; and,

WHEREAS, some states have implemented legislation for mandatory comprehensive prevention programs for healthcare employers and increased penalties for those convicted of acts of violence against nurses; and,

WHEREAS, Tennessee Nurses Association has had a long history in supporting initiatives that provide a safe work environment for nurses and other healthcare providers;

THEREFORE TNA will continue to advocate for the protection of healthcare providers from Workplace Violence.

Be it further resolved that:

TNA propose legislation to enhance protection of healthcare providers in the healthcare workplace by increasing penalties for assault and battery.


The Tennessee Nurses Association (TNA) is the professional association representing Tennessee's 83,101 registered nurses. This position paper outlines the basic philosophy of the TNAs House of Delegates relative to health care policy which may be addressed by the Tennessee General Assembly and the U.S. Congress.

Mission: The mission of TNA is to improve health and health care for all Tennessean, to promote and protect registered nurses and to advance the practice of nursing.

TNA supports initiatives that assure the protection of human rights as outlined by the American Nurses Associations Code of Ethics. (2010)

TNA supports a restructured health care system that ensures:

* Equitable and affordable access to essential health care services for all citizens and residents of the state;

* A standardized package of essential health care services provided and financed by public and private plans, including protection against catastrophic costs and impoverishment; and

* Direct access to a full range of professional registered nurses and other qualified health care providers who offer their services in a variety of delivery systems.

TNA supports the development and implementation of health policies that reflect the six Institute of Medicine aims; (safe, effective, patient-centered, timely, efficient, and equitable healthcare, 2001) and involvement of professional nurses in all aspects of policymaking related to health and health care.

TNA supports initiatives to remove barriers that prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system through:

* Assuring an adequate and competent nursing workforce to meet current and projected health care demands;

* Collaboration with other professional and regulatory bodies to protect and advance nursing practice and quality patient care;

* Support of the Board of Nursing's role as the states sole regulatory authority over all nursing education and nursing practice;

* Elimination of financial, regulatory, and institutional barriers to the practice of professional nursing;

* Participation of registered nurses on all local, state, and national health care advisory and policymaking boards and committees; and

* Oppose any activities intended to restrain the ability of professional advanced practice registered nurses from providing quality, cost-effective, and accessible health care to all citizens and residents of Tennessee to the full extent of their education and training.

TNA supports and advocates that both Federal and State dollars be made available to address the shortage of nurses with the following funding priorities:

* Funding of additional slots for nursing students;

* Funding for additional faculty positions for nursing schools in the state of Tennessee;

* Continued funding for the loan forgiveness program for graduate nurses.

TNA supports the implementation of the Institute of Medicine's Future of Nursing: Leading Change, Advancing Health recommendations (2010), including but not limited to the following priorities:

* Ensure that nurses can practice to the full extent of their education and experience in the delivery of health care and decision-making about health care.

* Promote higher levels of education and training through seamless academic progression, interdisciplinary education of health professionals, and lifelong learning.

TNA supports the adoption of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. (2008)

TNA supports efforts to have at least one school nurse available for every 750 students in Tennessee, consistent with ANA recommendations.

TNA supports initiatives that encourage adoption of the principles of the Magnet Recognition? leading to nurse excellence.

TNA supports programs and initiatives that provide a safe work environment, and advocates for facility rules that are consistent with ANA's Principles of Staffing and Handle with Care programs (2009), including but not limited to the following priorities:

* Promotion of nurse safety in the patient care environment;

* Staffing effectiveness plans;

* Whistleblower protection;

* Ban on the use of mandatory overtime; and

* Advocacy to protect nurses from workplace violence

TNA supports ANA's Scope and Standards of Practice (2010) for registered nurses and advanced practice registered nurses through:

* Enactment of statutory and regulatory revisions that will remove barriers to practice and enhance the role of RNs and APRNs in the care of people in Tennessee;

* Inclusion of APRNs as licensed independent provider (LIPs) in hospital licensure rules, health plans, and health care facilities;

* Support "any qualified provider" legislation; and

* Enforcement of insurance laws in public and private sectors.

TNA is committed to increasing the participation of registered nurses in policymaking activities through:

* Promotion of continuing education to prepare registered nurse to become candidates for state and local elective offices and political appointments;

* Efforts to seek key appointments for qualified registered nurses as members of policymaking committees, commissions, boards and other entities; and

* Initiatives to educate, engage, and activate registered nurses across the state.

As a reminder, the next session of the 107th Tennessee General Assembly will reconvene at Noon on Tuesday, January, 12, 2012. Please visit the Government Affairs link on TNA's website at for legislative updates and other information as new bills will be introduced and considered.

by Wilhelmina Davis, Manager, Government Affairs
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