159           
HOUSE OF REPRESENTATIVES             H.C.R. NO.            
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                     HOUSE CONCURRENT
                        RESOLUTION
ESTABLISHING A TASK FORCE TO CONDUCT A COMPREHENSIVE REVIEW AND
   IDENTIFY THE RESOURCES NECESSARY TO ENSURE A PATIENT'S RIGHT
   TO SAFETY AND QUALITY NURSING CARE IN HOSPITALS, CLINICS,
   AND HOME HEALTH CARE SETTINGS.


 1       WHEREAS, on March 31, 1998, the President's Advisory
 2   Commission on Consumer Protection and Quality in the Health
 3   Care Industry (Commission) submitted a final report to the
 4   President of the United States entitled "Quality First: Better
 5   Health Care for All Americans"; and
 6   
 7       WHEREAS, the Commission suggested that the purpose of
 8   health care "must be to continuously reduce the impact and
 9   burden of illness, injury, and disability, and to improve the
10   health and functions of the people of the United States"; and
11   
12       WHEREAS, the Commission also suggested that national goals
13   should include but not be limited to:
14   
15       (1)  Reducing the underlying causes of illness, injury, and
16            disability;
17   
18       (2)  Expanding research on new treatments and evidence
19            effectiveness;
20   
21       (3)  Assuring the appropriate use of health care services;
22   
23       (4)  Reducing health care errors;
24   
25       (5)  Addressing oversupply and undersupply of health care
26            resources; and
27   
28       (6)  Increasing patients' participation in their care;
29   
30   and
31   
32       WHEREAS, Hawaii's health care system is undergoing a
33   dramatic transformation due to an increased emphasis on managed
34   care, changes in health care financing and delivery of service,
35   and deregulation of the industry, resulting in unprecedented
36   competition and consolidation among providers; and

 
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                                  H.C.R. NO.            
                                                        
                                                        

 
 1       WHEREAS, these trends have resulted in an increased focus
 2   by many Hawaii providers on survival with a strong emphasis on
 3   financial performance, blurring their mission of providing
 4   accessible, high quality health care; and
 5   
 6       WHEREAS, as a result of the pressure of cost containment,
 7   Hawaii's nurses have increasingly identified difficulty in
 8   providing a professional standard of care to patients, which is
 9   the patient's right and the licensed nurse's responsibility;
10   and
11   
12       WHEREAS, the negative effects of health care system changes
13   on patients and patient care have been documented in Lewin-VHI
14   Inc.'s report for the American Nurses' Association (ANA) that
15   explored the nature and strength of linkages of nursing care
16   and patient outcomes; and
17   
18       WHEREAS, the report, entitled "Nursing Report Card for
19   Acute Care" contains, in part, research data indicating that
20   hospitals who employ fewer registered nurses or who short staff
21   their units have longer lengths of patient stays than hospitals
22   that employ registered nurses to provide all or most patient
23   care or that have higher nurse to patient ratio; and
24   
25       WHEREAS, these longer lengths of stay are associated with
26   poor patient monitoring, omission, or delays in certain
27   treatments, and an increase in medication errors and accidents;
28   and
29   
30       WHEREAS, the report also indicates that mortality rates are
31   related to the quality of nursing care, as measured by the
32   ratio of registered nurses to all nursing staff; and
33   
34       WHEREAS, the Institute of Medicine published "The Adequacy
35   of Nurse Staffing in Hospitals and Nursing Homes," a report
36   that recognized the need for data collection and the immediate
37   attention to issues related to the adequacy of nurse staffing
38   to assure the provision of safe, quality nursing care; and
39   
40       WHEREAS, combining the realities of cost containment and
41   cyclical nursing shortages with the priority of safe, quality
42   care has been difficult, in part, because of the paucity of
43   empirical data to guide decision-making; and

 
 
 
 
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                                  H.C.R. NO.            
                                                        
                                                        

 
 1       WHEREAS, ANA activities include the identification of
 2   nurse-sensitive indicators and the establishment of data
 3   collection projects using these indicators; and
 4   
 5       WHEREAS, changes in the delivery of health care have
 6   dramatically increased the complexity of a registered nurse's
 7   role and have caused the exodus of more experienced nurses from
 8   acute care facilities and other settings; and
 9   
10       WHEREAS, health care facilities on the mainland and in
11   Hawaii are now beginning to experience another nursing
12   shortage, particularly in the areas of intensive care,
13   emergency, and surgery; and
14   
15       WHEREAS, it is foreseen that cost containment initiatives
16   through a diminishment of Medicare, Medicaid, and private
17   health plan reimbursements will continue; and
18   
19       WHEREAS, ensuring a safe environment where nurses are able
20   to provide quality care for patients is essential to meeting
21   the goals of the Commission; and
22   
23       WHEREAS, Hawaii, as the "Health State," is committed to
24   providing its residents access to safe, quality health care
25   services, including services provided by licensed nurses; now,
26   therefore,
27   
28       BE IT RESOLVED by the House of Representatives of the
29   Twentieth Legislature of the State of Hawaii, Regular Session
30   of 1999, the Senate concurring, that a Task Force is
31   established to conduct a comprehensive review and identify the
32   resources necessary to ensure a patient's right to safety, and
33   quality nursing care in hospitals, clinics, and home health
34   care settings; and
35   
36       BE IT FURTHER RESOLVED that the Department of Health (DOH)
37   is requested to facilitate the Task Force to meet its
38   objectives; and
39   
40       BE IT FURTHER RESOLVED that the Task Force review and make
41   recommendations on, including but not limited to the following:

 
 
 
 
 
 
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                                  H.C.R. NO.            
                                                        
                                                        

 
 1       (1)  Patient safety and quality of care concerns identified
 2            by licensed nurses in hospitals, clinics, and home
 3            care settings;
 4   
 5       (2)  Concerns identified by licensed nurses about
 6            retribution and harassment by administration when
 7            reporting what is considered unsafe patient care
 8            situations;
 9   
10       (3)  Staffing standards and acuity systems currently
11            utilized by hospitals, clinics, and home care
12            entities;
13   
14       (4)  Nursing licensure and standards of nursing care
15            documents;
16   
17       (5)  Current and projected nursing workforce information to
18            include but not be limited to the supply and demand
19            for various categories of licensed nurses;
20   
21       (6)  Exploration of the literature on varying methods of
22            developing staffing standards and methodologies, and
23            identification of new models of nurse staffing
24            currently being used by health care facilities or
25            agencies on the mainland;
26   
27       (7)  Confidential reporting methods for employees
28            implemented by other states or private corporations;
29   
30       (8)  Current and projected financial concerns of hospitals,
31            clinics, and home care entities that affect the
32            ability to provide safe, quality licensed nursing care
33            to patients;
34   
35       (9)  Identification of nurse staffing standards that
36            Hawaii's hospitals, clinics, and home care entities
37            could utilize to ensure safe, quality nursing care to
38            patients;
39   
40      (10)  Identification of communication mechanisms that could
41            be utilized by licensed clinical staff nurses, nurse
42            managers, nurse administrators, and chief executive
43            officers to afford ongoing problem-solving in relation
44            to the provision of safe, quality nursing care; and

 
 
 
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                                  H.C.R. NO.            
                                                        
                                                        

 
 1      (11)  Identification of communication mechanisms to the
 2            consumers of health care to ensure that they are aware
 3            of their right to nursing care and the appropriate
 4            standards of nursing care in hospitals, clinics, and
 5            home health care settings;
 6   
 7   and
 8   
 9       BE IT FURTHER RESOLVED that the Task Force be composed of:
10   
11       (1)  Two representatives from HNA;
12   
13       (2)  Two representatives from HAH;
14   
15       (3)  Five clinical staff nurses:
16   
17            (A)  Two identified by the Hawaii Government Employees
18                 Association; and
19   
20            (B)  Three identified by HNA;
21   
22       (4)  Two executive nurse administrators:
23   
24            (A)  One from a private institution; and
25   
26            (B)  One from a public institution;
27   
28       (5)  One hospital chief executive officer;
29   
30       (6)  One administrator from an out-patient clinic setting;
31   
32       (7)  One administrator from a home health care
33            organization;
34   
35       (8)  One representative from the Hawaii Health Information
36            Corporation;
37   
38       (9)  One Representative appointed by the Speaker of the
39            House of Representatives;
40   
41      (10)  One Senator appointed by the President of the Senate;
42   
43      (11)  One representative from the University of Hawaii at
44            Manoa, School of Nursing;

 
 
 
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                                  H.C.R. NO.            
                                                        
                                                        

 
 1      (12)  One representative from the Hawaii State Board of
 2            Nursing;
 3   
 4      (13)  Three consumers of health care services, or their
 5            family member, as follows:
 6   
 7            (A)  One who has had recent experience in a hospital
 8                 setting;
 9   
10            (B)  One who has had recent experience in a clinic
11                 setting; and
12   
13            (C)  One who has had recent experience in the home
14                 health care setting;
15   
16      (14)  Three representatives from major prepaid health care
17            plans in Hawaii; and
18   
19      (15)  One representative from DOH, who will assist in the
20            facilitation of the Task Force;
21   
22   and
23   
24       BE IT FURTHER RESOLVED that the Task Force submit a report
25   of its findings and recommendations, including any proposed
26   legislation, to the Legislature no later than twenty days prior
27   to the convening of the Regular Session of 2000; and
28   
29       BE IT FURTHER RESOLVED that certified copies of this
30   Concurrent Resolution be transmitted to the Director of Health;
31   the Executive Directors of the Hawaii Nurses' Association, the
32   Health Care Association of Hawaii, the Hawaii Health
33   Information Corporation, the Hawaii State Board of Nursing, the
34   Hawaii Government Employees Association, the Hawaii Association
35   for Home Care, and the Hawaii Medical Service Association; the
36   Dean of the University of Hawaii at Manoa School of Nursing;
37   and the Presidents of Kapiolani Health Hawaii and Kaiser
38   Permanente.
39 
40 
41 
42                         OFFERED BY:  ____________________________