Terri Johnson, KSNA President Testifies to CMS Director Tom Scully in Hays

Kansas Nurse, Jun/Jul 2003

Terri Johnson, president of the Kansas State Nurses Association, testified before U.S. Rep. Jerry Moran, R-Kan., and the administrator of the Centers for Medicare and Medicaid Services, Thomas Scully. Moran hosted Scully in Kansas to meet with Kansas health officials and see first-hand the circumstances facing health care in the state. In her testimony, Johnson said, "Kansas is currently experiencing a mild nursing shortage, between seven and 11 percent, depending on which part of the state you are in, with expectations that it will worsen throught 2006."

"I appreciate Terri's meeting with Mr. Scully to provide a clearer picture of what our Kansas nurses are facing," Moran concluded. "By meeting with leaders of health care in our state, I hope that we've shown the admiistrator our situation and can now work towards solutions."

Others who testified included a hospital administrator, nursing home director, doctor, home health director, ambulance operator, health educators and the director of the University of Kansas School of Medicine's telemedicine department.

Testimony Regarding CMS Policy Impact and Changes Recommended

May 27, 2003

Mr. Scully, Congressman Moran and colleagues, I am Terri Johnson ARNP, MSN a pediatric clinical nurse specialist from Roxbury, currently serving as the President of the Kansas State Nurses Association. Thank you Mr. Scully for coming out to Hays today to visit with all of us about Medicare and Medicaid policy. I grew up in western Kansas, a small community about 45 miles south of here and graduated from the Fort Hays State University Department of Nursing.

Kansas is currently experiencing a mild nursing shortage, between 7-11% depending on which part of the state you are in, with expectations that it will worsen through 2006. This coming fall will see the first "increase" in nursing school enrollments statewide since 1995, that's the good news. The bad news is that there is still tremendous nursing manpower needs which we are attempting to address. No doubt you know that the nursing shortage is multi-faceted, and that it will require definitive strategies that address the numerous factors contributing to what will be a sustained shortage.

Two of the shortages factors arc financially driven. The first factor is the "staffing ratio's" that have led to dissatisfaction, stress and burn-out within the nursing profession. Hospitals have increased patient workloads amidst expectations that the latest and most complicated technologies be used/implemented in the care of these same patients. Generally, the reduced nurse staffing strategies are linked to "cost cutting or cost reduction" goals of the institution.

The second factor is salary compression that exists for RN's employed at institutions over 5 years. The market place has driven starting wages and hiring incentives to enticing levels, but for the seasoned, experienced and loyal employees of acute care hospitals, the institutions are struggling to give marketplace cost of living wage adjustments, let alone merit raises. The margins that hospitals are operating within are being eroded by inadequate market adjustments for those patients who are Medicare and Medicaid beneficiaries, and this dramatically affects what financial compensation packages they can provide to registered nurses. The smaller rural hospitals have a disproportionate share of Medicare patients and are more significantly impacted by even small changes imposed by CMS and others. HIPAA is an example of a significant initiative, requiring extensive resources, where economics of scale cannot be realized for smaller institutions.

Patient safety in hospitals has been a locus since the two IOM reports on the subject, and the nursing profession has been attempting to quantify what role nurse staffing and working conditions play in appropriately monitoring and caring for patients to optimize care and healing.

A report prepared for HRSA in 2001 by Peter Buerhaus Ph.D., R.N, FAAN and Jack Needleman Ph.D., entitled Nurse Staffing and Patient Outcomes in Hospitals statistically significant correlations were established between nurse staffing and patient outcomes. Because the emphasis today is on policy issues for CMS I will not dwell on the outcomes of the study but rather the policy recommendations that CMS should consider.

A system for routinely monitoring outcomes of hospital patient care sensitive to nursing and nurse staffing should be seriously considered and expeditiously implemented including the following changes to data collection and current data systems:

1. Include specific secondary diagnosis on discharge abstracts that are hospital-acquired and are indicators of the performance of systems of care.

2. Expand and improve the coding of "present on admission" status for secondary diagnoses on discharge abstracts.

3. Improve the quality of nurse staffing data by adopting universal definitions of nursing categories and procedures to calculate full and part-time equivalent employees for RN's, LPN's, and aides, reporting nurse staffing data by inpatient and outpatient setting, and reporting data by specific nursing unit and nursing practice pattern (primary, team, functional, etc.), and