Testimony of the New York State Nurses Association, delivered by Deputy Executive Officer Deborah Elliott, MBA, RN, to the joint hearing of Assembly Ways and Means and
Senate Finance Committees, February 9, 2010.
Good afternoon. My name is Deborah Elliot, and I am a registered nurse and the Deputy Executive Officer of the New York State Nurses Association. Joining me today is Shaun Flynn, Director of Governmental Affairs for the Association. The Nurses Association is the oldest and largest professional organization for registered nurses in New York State. It represents the interests of more than 240,000 registered nurses and serves as the collective bargaining agent for more than 36,000 RNs at 150 healthcare facilities. On behalf of our members and the patients they serve, I appreciate the opportunity to address the Governor’s 2010-2011 Executive Budget as it relates to health issues.
The Nurses Association appreciates the complexity of allocating public funding during such dire financial times. However, the state’s fiscal crisis cannot be allowed to result in an unprecedented healthcare crisis in the name of a balanced budget.
There are a number of recommendations that if passed, could have a negative impact on both the practice of registered nurses and the health and well-being of New York’s residents. I will speak briefly about the impact of each.
$1 billion in proposed cuts to health care that include hospitals, nursing homes and home care services cuts have the potential to severely limit access to care and endanger patient safety. This is not a blanket statement crafted to save jobs, but instead a harsh reality we must face when considering the health and welfare of New York’s citizens.
Under the current proposal, hospitals, nursing homes and public health programs would see a combined reduction of more than $562 million in payments for services and an increased assessment on services delivered. The Department of Health would also be authorized to link Medicaid rate reductions to quality-related measures pertaining to preventable readmissions and complications.
Historically, reducing provider reimbursement rates and increasing taxes will prompt facilities to mitigate these shortfalls by reducing direct care staff, primarily nurses. And because New York State lacks regulation to ensure safe staffing ratios, the nurses that are spared will continue to be forced to take on more patients than they can safely care for.
While the Nurses Association supports quality measures to prevent negative patient outcomes, the very issue of quality care depends on staff that provides that care. Financial penalties for not reaching established benchmarks will result in layoffs of nursing staff necessary to achieve these standards.
As a rule, hospitals often have functioned with less staff and resources than is required to safely do the job. This is evident at facilities like St. Joseph’s Medical Center in Yonkers where nurses must begin their day fielding phone calls instead of caring for patients because the hospital can no longer afford a receptionist.
A hiring freeze at Coler and Goldwater Specialty Hospitals and Nursing Facilities has lead to increased patient infection, as the nursing staff struggle to treat scabies and bedsores that are result of unsafe nurse-to-patient ratios. Protest of Assignments, which document the nurse’s belief that the patient assignment that shift is unsafe, are up to 75 a month at the facility.
Perhaps the most recent example is that of St. Vincent’s Catholic Medical Center in Greenwich Village, an acute-care facility now struggling to stay open. For more than 150 years, St. Vincent’s has built its reputation on providing care for New York’s poorest citizens. Deeply rooted in public health, the facility has served the state through countless calamities --- from the cholera epidemic of 1849 to the attack on September 11 -- and is an anchor for AIDs treatment and psychiatric care on the lower westside.
These scenarios, though recent, are not new and no facility is immune. Asking our hospitals and nursing homes to sustain further cuts to vital health services will stretch an already overburdened workforce to its breaking point. Should the proposed budget be approved, the frequency and severity of these unsafe patient care situations will escalate.
The resilience and efficiency of our public health infrastructure has been tested time and again with response to terrorist attacks, natural disasters, and most recently with the outbreak of the H1N1 virus. It is our nurses who answer questions in the field from concerned citizens seeking care. Ensuring capacity of our emergency rooms, hospital beds and acute-care facilities is essential to maintaining the public’s welfare in times of crisis. One need only look to recent catastrophic events to realize that we must protect our public health infrastructure and shore up our network of resources for when we may need them the most.
Home care is a vital component of the state’s public health system and one that is relied heavily upon by our most vulnerable population. The recommended 12 hour cap per day for fee-for-service payments will place the burden of care on New York’s citizens; requiring them to seek treatment in alternative settings. This plan carries with it the potential for harm as patients and families attempt to navigate an overwhelmingly complex healthcare system.
The Health Resources Services Administration predicts that the state’s nursing shortage will reach 17,000 registered nurses by the end of this year. Without highly-qualified, competent RNs in the pipeline, that number is expected to grow to 30,000 by 2020. An increased supply of newly licensed nurses is critical to meet current shortages and future demands in New York State. Demand for nursing education programs is on the rise, yet there still aren’t enough programs to meet the growing need.
New York State must address the nursing shortage by supporting an educational system that produces highly qualified and competent RNs. While the proposed budget includes continued funding of private nursing education, it cuts funding to the program to expand SUNY nursing education by $143,100. This reduction would severely diminish the state university system’s ability to meet the needs of the nursing workforce over the next decade. The proposed budget recommendation of $212 million in operating cuts to SUNY/CUNY education programs would put an otherwise affordable option out of reach for many. These programs cannot be discounted as integral to easing the nursing shortage and we ask the Legislature to support tomorrow’s nurses by restoring cuts to these programs.
Under the current proposal, TAP awards would also be reduced from $5,000 to $4,000 for two-year degree programs and eliminated for graduate students. Many nursing students rely heavily on this award to supplement unique expenses associated with their education, such as the purchase of uniforms and transportation to clinical sites. Elimination of this award for graduate students would discourage an already small pool of nurses who obtain the master’s degree necessary to become nursing educators.
Nursing Faculty Scholarship Programs
A major contributing factor to the nursing shortage is a lack of qualified nursing faculty. A minimum of a master’s degree is required to teach most nursing programs. Studies have shown that baccalaureate-educated RNs are more likely to obtain their master’s degree or higher, yet a very small percentage of associate degree-educated RNs go on to obtain a higher degree. The average age of a nursing student is 31, as many non-traditional students are entering nursing schools. These adult learners often have outstanding personal debt (cars, homes, child care, and college loans) that make it difficult to pursue higher education opportunities.
We appreciate the Governor’s proposed renewal of the Senator Patricia McGee Nursing Faculty Scholarship Program through 2015 and the recommendation to fund the program at its current level for the 2010-2011 fiscal year. Support of this program signals to the healthcare community that we value our nursing educators and their educational advancement benefits us all.
The Nurses Association supports the proposed $650 million in excise taxes on cigarettes and unhealthy beverages. These taxes will discourage the unhealthy habits that strain health spending and promote public health by encouraging New Yorkers to make healthier choices. The added savings will be reflected in dollars, but more importantly, in lives.
We also encourage the legislature to explore some of the revenue-generating ideas proposed by New Yorkers for Fiscal Fairness and A Better Choice for New York:
In conclusion, the New York State Nurses Association understands that the state is facing deteriorating economic conditions and revenue shortfalls. However, we hope you’ll agree that patient safety and the future of New York’s healthcare system cannot be sacrificed in order to close a budget gap.
As you continue your deliberations, we urge you to pass a budget that will protect the public health infrastructure and ensure access to quality healthcare for all of New York’s citizens.
Thank you for your time and consideration.
For more information, contact the New York State Nurses Association Governmental Affairs Department at 518.782.9400, ext. 283 or by e-mail.