DNA advocates for the enactment and implementation of legislation that will preserve and advance the identity and integrity of the nursing profession. DNA also supports legislation promoting the health and welfare of Delawareans.
Access to Quality Health Care
DNA promotes access to quality, affordable, accessible, and equitable health care services for all Delawareans including mental health care. Nurses are an integral part of health care delivery and should be recognized as qualified providers of health care services.
Primary care is the essential backbone of an efficient and patient-centered healthcare delivery system and is crucial to maintaining a healthy Delaware population. Decreased incentives to enter or maintain a primary care practice, increased patient loads, and dramatic decreases in reimbursement rates are leading to primary care shortages in Delaware. DNA supports legislation that:
DNA supports legislation to modernize the Delaware Nurse Practice Act and regulations by identifying sections which are out-of-date and require revision, promote legislation that is inclusive of nurse input, and contribute to the development of regulations protecting the quality of care in Delaware.
Nurse Licensure Compact
DNA supports the Enhanced Nurse Licensure Compact (eNLC) and the APRN Compact.
The number of hours nurses work correlates to job satisfaction, nurse health and safety, and patient outcomes. Nurses who work excessive hours risk fatigue, poor sleep quality, impaired vigilance, lack of alertness, and burnout. Studies have shown that nurses who work excessive hours have increased risk of musculoskeletal injuries, needlesticks, and near motor vehicle accidents. Currently, eighteen states have passed legislation or instituted regulations on mandatory overtime for nurses. DNA supports:
Exceptions: to complete a procedure, emergency situations in which a patient’s safety is in jeopardy and no reasonable alternative can be found, catastrophic event declared as such by a federal, state or municipal authority.
The primary dictum for registered nurses, as health care professionals, is first, do no harm. DNA supports legislation and/or regulations that reduces or eliminates harmful chemicals, products, pollutants, and hazards detrimental to the overall health of Delawareans and the environment and will employ the precautionary principle when there are limitations to scientific evidence.
According to Standard 17 of the Standards of Professional Nursing Practice found in Nursing: Scope and Standards of Practice, 3rd Edition, “The registered nurse practices in an environmentally safe and healthy manner.” DNA supports the overall environmental protection and health of the nurse while practicing and in the workplace. This includes, but is not limited to, workplace protection from exposures to unknown substances or chemicals and infectious diseases.
Ethics and Human Rights
DNA supports consumer participation in health care decision-making and the nurse’s right to conscientiously object to a “particular decision or action that exceeds moral limits or that violates moral standards in any nursing practice setting” without formal or informal retribution. (American Nurses Association, 2015). Further, DNA supports a standard for health systems and individual practices to ensure prompt, easy access to critical health care services if an individual provider has a moral or ethical objection to certain health care services.
Newly Created/Expanded Healthcare Workforce Roles
It is expected that registered nurses will be doing much more care coordination for different types of patients; managing transitions of care across acute, ambulatory, and community settings (including the patient’s home); and continue creating care plans; engaging and educating patients and family; performing outreach and population health management; connecting patients with community‐based services, as well as provide supervision and oversight for care delivered by other health care workers, whose roles are changing.
New or expanded healthcare roles should have the following considerations:
Safe Patient Handling
The single greatest risk to nurses’ physical well-being are the resulting musculoskeletal injuries from the lifting, moving and repositioning of patients. This may be an even greater concern for those nurses working in the operating room who also lift and hold patient limbs and manual retraction in place. DNA supports the establishment of a safe patient handling committee with at least 50% of the members health care workers representing disciplines employed by the facility. The safe patient handling program and policy should be made available for all units and include a plan for prompt access to patient handling equipment.
DNA further supports a nurse’s right to refuses a patient handling task due to reasonable concern about worker or patient safety, or the lack of appropriate and available patient handling equipment with no retaliatory action by the employer.
Safe patient handling means use of mechanical patient handling equipment, including, but not limited to, electric beds, portable base and ceiling track-mounted full body sling lifts, stand assist lifts, and mechanized lateral transfer aids; and patient handling aids, including, but not limited to, gait belts with handles, sliding boards and surface friction-reducing devices.
DNA supports the development and implementation of valid, reliable, unit-by-unit nurse staffing plans that are based upon the ANA Principles for Nurse Staffing. These plans should be created in coordination with direct care registered nurses and based on each unit's unique circumstances and changing needs. Staffing plans should also consider staffing levels recommended by specialty nursing organizations and ensure that RNs are not forced to work in units where they are not trained or experienced.
No-Fault Error Reporting
Reporting errors and near misses is the key to safety improvement and prevention of similar errors from being repeated. According to the report To Err Is Human: Building a Safer Health System, “more commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them”. Error reports should be collected and evaluated for the causes of errors leading to process revisions or creation to reduce the risk of errors. DNA supports safe, non-punitive error reporting.
Nursing has become more robust with more nurses in leadership roles, the introduction of new nursing specialties and roles, the impact of healthcare accessibility through telemedicine and mobile health, and expanded competency requirements to match the complex health issues of acute and chronically ill patients. The Institute of Medicine's Future of Nursing report found that nurses with a “BSN are critical to accommodate public health needs and maintain quality care measures”. The report also recommended that 80 percent of the nursing workforce should have a BSN by 2020.