Tennessee Nursing Update
Tennessee Nursing Update | Nursing, Tennessee Nurses Association, TNA, Laura Beth Brown, legislative issues, patient safety

TNA Addresses Policy & Practice Issues

Each spring, America spends a week paying tribute to a group of dedicated healthcare professionals that are on the front lines. After all, nurses are often the face of medicine in the community, and today's professionals are involved in every aspect of healthcare from patient care, education and technology enhancement to policy-making, research and quality improvement initiatives.

While National Nurses Week kicks off each year on May 6 and concludes on May 12 –– Florence Nightingale's birthday, the real work of nurses and their representative organizations goes on around the clock.
Celebrate National Nurses Week

May 6-12, 2009


The Tennessee Nurses Association, the local affiliate of the American Nurses Association, has already been busy this year promoting access, safety and professional practice issues. Last month, the TNA took their message to the Tennessee General Assembly during the 2009 Legislative Summit.

Laura Beth Brown, MSN, RN, who is in her second year as TNA president, said there are several policy issues of particular interest to the nursing profession this legislative session. Brown, who also serves as vice chair of the Constituent Assembly Executive Committee of the ANA, is working with nursing colleagues, other healthcare association representatives and elected officials to protect and promote the profession at a state and national level.

In Tennessee, the TNA is supporting a measure to allow nurse practitioners and physician assistants to sign death certificates (SB-938, Watson, R-11/HB-464, Odom, D-55). "It's important to the consumer to have a timely process of having a death certificate signed because it often gets delayed," she said of the current process. By statute, death certificates are to be filed with the Department of Health within 48 hours of the pronouncement of death, although that mark is missed quite frequently.

"The Board of Nursing and the Board of Medical Examiners has established a task force to look at similar challenges throughout our state with practice and process," said Brown. She added the group of three physicians and three nurses unanimously voted to support this bill, "but they can only make recommendations."

Although the measure has garnered wide support, it has drawn opposition from the Tennessee Medical Association after Representative Joey Hensley, MD, (R-70) spoke out against the bill. According to Brown, Hensley –– who is both a physician and coroner –– has said cause of death can be difficult to determine and should therefore be left to a physician.

Brown argued that advanced practice nurses and physician assistants see many patients through the end of life and quite often fill out the forms completely but must await the signature of a physician... who might not have ever examined the deceased.

"We can diagnose and treat while someone is alive, but we can't diagnose death," Brown noted ironically, adding that APNs and PAs would still work in collaboration with a physician and would be required by their respective practice acts to consult a physician or request an autopsy if there was any question or concern about a death.

The TNA is also supporting legislation (SB-939, Watson, R-11/HB-465, Odom, D-55) that would allow APNs and PAs to sign disability placards and perform peace officer physicals (police physicals).

"Under current law, only a physician or Christian Scientist practitioner can sign the handicapped placard and only a physician can sign the peace officer physical," she said, adding that it makes sense to extend this right to APNs and PAs since they are often the primary care provider. "To my knowledge, no one is opposing this bill."

Brown and nursing colleagues are also gathering signatures to support the creation of a specialty license plate for nurses (SB-447, Overbey, R-8/HB-1567, Armstrong, D-15). "This would raise funds for the Tennessee Nurses Foundation," explained Brown She added the Foundation would use the money for nursing scholarships and to enhance research funding and leadership development. The Foundation also oversees the Tennessee Professional Assistance Program (TNPAP), which helps healthcare professionals struggling with addiction issues.

The TNA has also come out in strong support of the Tennessee Healthful Menu Act (SB-2314, Kyle, D-28/HB-2319, Mike Turner, D-51), which would require certain restaurants to disclose calories and calorie content values.

"We think it's a best practice in a comprehensive obesity program," said Brown. "We're a member of the Tennessee Menu Labeling Coalition, and we agree that obesity is a major public health issue. We feel this bill would allow consumers to make informed decisions about their dietary choices."

While the TNA is strongly supportive of the four measures outlined above, the group is opposed to a measure that would create certified medication technicians in nursing homes (SB-009, Black, R-18/HB-1607, Maggart, R-45).

Excerpts from the National Nurses Week 2009 Message from ANA President Rebecca M. Patton, MSN, RN, CNOR

Greetings! As we celebrate National Nurses Week 2009 (NNW) May 6 - 12, the American Nurses Association (ANA) and its constituent member associations (CMAs) salute nurses across the country with the theme Nurses: Building a Healthy America.

Nursing is often described as both an art and a science; this year's theme reflects the commitment nurses make every day for their patients and the compassion and quality of care they provide for their community. Today's nurses must have the strength to care for patients during times of disaster and crisis; the commitment to remain involved in continuing education throughout their careers; and the compassion to provide hands-on patient care at the bedside – as they have done throughout the centuries.

Moreover, at 2.9 million strong, nurses represent the largest group of healthcare workers in America, and we have the power to achieve much-needed reform in nursing and in healthcare. That is why it is important to take time out during National Nurses Week to thank nurses for what they do and to remind the public just how vital our nation's nurses are to patients, their families and society.

As you celebrate National Nurses Week this year, I hope you will also take a few moments to reflect on some of the challenges that also face nursing today, and the advocacy efforts of ANA in these areas:

• Establishing staffing levels that promote a safe and healthy working environment for nurses and to ensure the highest possible patient care. To support safe staffing, ANA has launched a national campaign to help fight for safe staffing legislation. To find out more about what you can do to advance safe staffing, please visit www.safestaffingsaveslives.org.

• ANA favors a restructured healthcare system that does the following: Enhances consumer access to services by delivering primary healthcare in community-based settings; Fosters consumer responsibility for personal health, self care, and informed decision making in selecting health care services; Facilitates utilization of the most cost-effective providers and therapeutic options in the most appropriate settings.

• The American Nurses Association (ANA) announced its endorsement of President Barack Obama and looks forward to working with the new administration and new lawmakers to affect positive change for nurses and the patients we serve. President Obama believes, as ANA does that healthcare is a basic human right, not a privilege.

• Increasing interest and support for addressing educational preparation for the RN workforce. Evidence shows that higher levels of nursing education are linked with lower patient mortality rates, fewer errors and greater job satisfaction among RNs.


Brown said the bill allows anyone who is 18 years of age and has a high school diploma or GED, one year of experience as a certified nurse technician, and 75 ours of training (50 classroom, 25 clinical) to be able to administer certain medications to nursing home residents.

"We think it's a patient safety issue," she said, adding that the training hours component is a major sticking point. "We think the education is insufficient. We think there is a high risk for medication errors. We believe only a trained nurse or physician can detect drug interactions or reactions."

Additionally, Brown noted, administering medicine brings nurses and patients together, which provides the opportunity to monitor the overall health of the nursing home resident. "The patients are not going to get the exposure to a registered nurse that they once did," she said of a byproduct of this bill.

Brown noted the TNA was part of a multidiscipline healthcare group that came together to discuss this specific issue. Throughout the process, she was impressed with way the stakeholders came to consensus. However, when the TNA signed off on the measure, it contained a provision requiring 460 hours of instruction (300 classroom, 60 clinical).

"We were not included in the change in education," she stated. "We did not get the amendment from the sponsor until the bill was modified and presented in the Legislature. We do not feel we can support only 75 hours of training to become a medication technician."

Despite the seemingly strong support among legislators, Brown is hopeful that healthcare professionals will join the TNA in voicing concern over patient safety in the state's nursing homes, which have already come under national scrutiny.

Brown noted the mission of the Tennessee Nurses Association is to protect the nursing profession and their patients. While membership has grown about 10 percent in the past two years, which she called "remarkable in a time when there is an economic downturn and no forced membership," Brown is very focused on expanding the member rolls. Although less than 5 percent of the state's 75,000 registered nurses are members, the TNA speaks for all of them.

"Our decisions affect every nurse... member or not. I think it's a professional obligation to support the organization that is supporting you," she concluded.

For more information on the TNA's legislative positions and professional activities, go online to www.tnaonline.org.