DNA Legislative Positions 2019-2020

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.

    • All nurses should practice to the full extent of their education and training without barriers.
    • Advanced practice registered nurses should be used to support and expand access to primary health and mental health care.
    • Provider-neutral language should be used and incorporate all APRN roles in legislation to expand access to care for patients.
    • Public health nurses should be recognized and use for their education and training to reduce health risks and promote, maintain, and restore health to identified populations and communities.

 Healthcare Billing

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:

    • has provider neutral language;
    • mandates insurers increase their total spending on primary care services to at least 12% by 2025 and cannot fall below the corresponding or ‘benchmark’ Medicare fee for service;
    • ensures that Medicare reimbursement falls no lower than 85% of the Medicare rate; and
    • ensures that nurse practitioners are reimbursed at the same rate as physicians for the same services rather than the rate of 80% of the lesser of the actual charge or 85% of the fee schedule amount for physicians.

 Nurse Practice

DNA supports legislation to modernize the Delaware Nurse Practice Act and regulations by identifying sections which are out-of-date and require revision, promote legislation that is inclusive of nurse input, and contribute to the development of regulations protecting the quality of care in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.

    • Enables nurses to practice in-person or provide telenursing services to patients located across the country without having to obtain additional licenses.
    • Allows nurses to quickly cross state borders and provide vital services in the event of a disaster.
    • Facilitates telenursing and online nursing education.

 Mandatory Overtime

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:

    • A nurse’s right to refuse overtime free from any fear of retaliation.
    • For nurses who choose to refuse overtime, their lawful decision cannot be construed as patient abandonment or neglect.
    • Employers cannot require nurses to work longer than the regularly scheduled hours outlined in a predetermined schedule or place nurses “on-call” to cover open shifts.

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.

 Environmental Health

Public Health

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.

Workplace Health

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.

    • Individuals have the right to make decisions that affect themselves and their significant others.
    • Incapacitated individuals’ health care decision made by a health care surrogate or durable power of attorney.
    • Individuals have the right to dignity at all stages of the health care continuum.
    • Adequate palliative care should be provided for persons with terminal illness.
    • Appropriate pain management should be provided for all persons.

 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:

    • Role clarity defined in statute and regulations to include a defined scope of practice, education, certification(s), and other credentials, and a title that accurately reflects the role.
    • Appropriate education and training that is a uniform standard of education and training consistent with the defined practice, the higher education program is accredited, and the minimum competencies are measurable.
    • Accountability should be consistent to that of other health care professionals licensed in Delaware.

 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.

 Safe Staffing

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 Education

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.

    • All educational pathways students take to enter into the nursing profession are valuable.
    • BSN in 10 legislation should not affect current RNs, those currently in a nursing program, nor should it eliminate the various pathways into the profession.


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