If you live in Texas, you’ve probably noticed the healthcare system seems to be spread thin. Perhaps you’ve had a hard time getting an appointment, or the professionals you interacted with seemed to be juggling a lot at once. You would be right to think that something seems a bit off in our healthcare system. A great deal of what you are noticing is driven by a shortage of healthcare professionals.

Leading into the COVID-19 pandemic, Texas was estimated to face a deficit of 27,786 registered nurses. Two years into the COVID-19 pandemic, the shortage of nurses grew to an estimated deficit of 44,678 registered nurses. Over the same time period, Texas grew by millions of new residents. That growth is expected to continue given the relatively lower cost of living in Texas and our booming state economy.

The nursing shortage is projected to grow, too—to a deficit of 56,370 by 2036, unless the state makes drastic investments in nursing education and smart policy changes that will improve nursing retention efforts.

It's not just nurses who are struggling to keep up. Several other healthcare professions are also struggling to keep up with the growing demand for their services.

Legislators are currently meeting in Austin for the 89^th Regular Session of the Texas Legislature and trying to figure out how to address the challenges posed by the shortage of healthcare professionals and growth in residents, among many other pressing challenges. The Texas Nurses Association has been working with legislators to address these growth-associated issues and ensure high quality care throughout the state, but ultimately, the most important thing is for legislators to hear directly from their constituents.

Every legislative session, the Texas Nurses Association does its part to facilitate that direct communication between lawmakers and their constituents. We call on nurses throughout the state to join us at the Texas Legislature for a day of advocacy. We begin on March 3^rd with an education session on the policy issues facing Texas nurses, and on March 4^th we walk together to the Capitol and make our voices heard. Nurse Day at the Capitol, as we call it, is an opportunity for constituents to communicate directly with the Texas Legislature and highlight the key issues of the day.

The Texas Nurses Association is the largest nursing organization in the state of Texas and acts as the voice of nurses. Our purpose is to promote quality care and ensure excellence in the nursing profession.

Consistent with that purpose, TNA organizes the Nursing Legislative Agenda Coalition (NLAC), a coalition of nursing organizations around Texas that join together to share ideas, strategies, and priorities for nurses. Each legislative session, NLAC presents a list of urgent issues which need to be addressed by elected officials for the health and benefit of all Texans.

To promote the health of Texans, NLAC is asking the Texas Legislature to address a series of policy challenges. Nurses who join us for Nurse Day at the Capitol will learn the details of each of these policy issues and be asked to join us in communicating how these policy issues affect their patients and their professional practice.

Broadly speaking, the policy issues fall into four distinct categories:

• Investing in nursing education to ensure Texas trains an adequate number of licensed professionals to care for the state’s growing population;
• Improving the work environment to defend the rights of nurses and ensure a practice environment that retains the talent we already have in the workforce;
• Enhancing utilization of advanced practitioners by reducing regulatory barriers to cost-effective and high-quality care; and
• Supporting student health in Texas educational institutions.

Implementation of these policy priorities would advance the health of Texas while simultaneously promoting excellence in nursing practice. If these issues have impacted your life, we encourage you to contact your elected officials and share your story—and if you’re a nurse, we encourage you to join our organization and join us at Nurse Day at the Capitol. Make sure your representatives know what matters to you, your patients, and your community.

TNA CEO Dr. Serena Bumpus (center), joined by (from left) Texas Hospital Association President and CEO John M. Hawkins, Texas House Rep. Donna Howard, Travis County District Attorney José Garza, Texas Emergency Nurses Association Board President Dr. Shawntay Harris, and Texas Medical Association’s Dr. Elizabeth Duckworth, reads the official joint statement during a press conference.

On Friday, Aug. 23, 2024, the Texas Nursing Legislative Agenda Coalition (NLAC) hosted industry leaders and elected officials for a full-day workplace violence prevention summit to continue its efforts of ensuring safety in all Texas healthcare facilities. The summit dove deeper into the impact of SB 240, which requires “healthcare facilities to adopt, implement, and enforce a written workplace violence prevention plan to protect healthcare providers and employees from violent behavior and threats of violent behavior.” At noon, a press conference was held with the following speakers in attendance: 

• Texas House Rep. Donna Howard (District 48)
• Travis County District Attorney José Garza
• Dr. Shawntay Harris, Board President, Texas Emergency Nurses Association
• John M. Hawkins, President and CEO, Texas Hospital Association
• Dr. Elizabeth Duckworth, Texas Medical Association

You can watch coverage of the event and press conference from CBS Austin here and read the signed joint statement below. 

The Texas Nursing Legislative Agenda Coalition, a coalition of 23 nursing organizations administered by the Texas Nurses Association, along with the Texas Hospital Association, and the Texas Medical Association are dedicated to protecting patients and healthcare professionals from violence in healthcare facilities.

Today’s summit is an example of that collaborative effort.

In recent years, there has been a disturbing increase in the rate of violent incidents against healthcare professionals and those present at healthcare facilities. This is a national trend, and Texas is no exception.

In the 88^th Regular Session of the Texas Legislature, our members brought their concerns to their elected officials and advised legislators on the development of Senate Bill 240. In response, the legislation passed with an overwhelming majority and received the Governor’s signature indicating broad recognition of the problem and unity around addressing the issue.

The new law envisions all the state’s healthcare facilities working closely with local law enforcement to address violent incidents while the state oversees implementation of the law more broadly. Furthermore, covered healthcare facilities are charged with assembling committees of nurses, physicians, and security personnel to create policies and plans of action with the purpose of preventing violent occurrences.

We are committed to the effective implementation of this law and call on law enforcement throughout the state to join us in using this new legal tool to reverse the trend of increasing violence in healthcare settings.

There should not be any roadblocks toward a safer workplace, and a safer community. Healthcare facilities are places of healing, and no one should experience violence when seeking care.

Signed organizations

Texas Nurses Association, on behalf of Texas Nursing Legislative Agenda Coalition (listed)

• Association of PeriOperative RNs. Greater Houston
• Association of Operating Room Nurses North Harris Montgomery County       
• Consortium of Texas Certified Nurse Midwives       
• Houston Chapter of Oncology Nursing Society       
• Houston Organization for Nursing Leadership        
• Psychiatric Advanced Practice Nurses of Austin       
• Psychiatric Advanced Practice Nurses of Texas         
• Texas Association of Deans & Directors of Professional Nursing Programs         
• Texas Association for Home Care and Hospice         
• Texas Association of Nurse Anesthetists          
• Texas Association of Vocational Nurse Educators          
• Texas Clinical Nurse Specialists          
• Texas Collaboration of periOperative Nurses          
• Texas DNP        
• Texas Emergency Nurses Association          
• Texas Nurse Educators Alliance          
• Texas Nurse Practitioners          
• Texas Nursing Students Association         
• Texas Organization for Associate Degree Nursing        
• Texas Organization of Baccalaureate and Graduate Nursing Education        
• Texas Organization for Nursing Leadership         
• Texas School Nurses Organization

Texas Hospital Association

Texas Medical Association

TNA and TSNO filed an amicus brief with the Court to inform them of federal guidance on the intersection between HIPAA and the Family Educational Rights and Privacy Act (FERPA). These two privacy laws govern the privacy rights of patients in the healthcare setting and minors in the educational setting, and their overlap can be technical and confusing.

Amicus curiae is Latin for “friend of the court,” and amicus briefing is an opportunity for organizations, such as ours, to inform the Court of important considerations that will narrow the issues and assist their deliberations.

We deemed it imperative that the Court be apprised of the federal guidance on this matter, and the Court explicitly noted, “We have received an informative amicus brief from the Texas Nurses Association and the Texas School Nurses Organization contending [the nurse’s] disclosure in fact did not violate HIPAA.” Nonetheless, the Court ultimately decided the case on a narrower issue: whether the organization would have fired the nurse when it did for disclosing information to the school nurse even if the nurse had not made the report to CPS.

Ultimately, the Court decided the termination was lawful.

The Court explained, “[The] evidence must establish that the employer would not have taken the adverse action ‘but for’ the professional’s protected conduct, meaning no violation occurs if the employer would have taken the adverse action when it did even if the employee had not engaged in the protected conduct.”

The rule is strictly applied by Texas courts, and this case is an example of how difficult it can be to prevail on a wrongful termination claim when the evidence shows another basis for termination besides the protected activity. Texas courts look at whether the employer’s perception of its employee’s performance was the real reason for the employee’s termination, as opposed to the protected conduct.

Nurses have a duty to report suspected abuse or neglect of a minor within 48 hours of learning of it. As a result, there is little time to review employer policies before making the report. In this case, it was decided that the employer believed the nurse engaged in a personal-conduct policy violation, and that the employer’s belief was a lawful reason for the termination even despite the CPS report.

TNA and TSNO are concerned that the narrow protection offered by the anti-retaliation statute may cause a chilling effect on reporting and harm the state’s interest in protecting minors from abuse and neglect.

Our organizations will study the decision and develop recommendations for statutory amendments to better protect nurses and other licensed professionals who make reports to CPS in the future.

Texas Nurses Applaud Passage of Nurse Friendly Bills

Two bills aim to protect nurses in the workplace and the third benefits students and school nurses.

Austin, TX — The Texas Nurses Association is pleased to share that the Texas Legislature recently passed three bills that are responsive to nursing issues: SB 294 (which permits a school nurse to administer asthma medication to students in respiratory distress), SB 840 (which increases the penalty for assaulting health care workers from a misdemeanor to a felony), and SB 1004 (which increases the penalty for removing an electronic monitoring device if the individual was ordered to wear one as part of community supervision, parole, mandatory supervision, or release on bail).

SB 294 is responsive to problems school nurses saw in practice under existing regulations. School nurses were limited in their ability to provide albuterol, levalbuterol, and potentially other breathing medications. As a result of delays in access to breathing medication, there have been instances of school children dying from treatable respiratory attacks. This bill expands access to the medication as well as personnel authorized to administer the medication. “These breathing medications are safe and effective,” said Serena Bumpus, DNP, RN, NEA-BC, CEO of TNA. "We are pleased to see increased access which will support student health and well-being.”

SB 840 is named the Jacqueline “Jackie” Pokuaa and Katie “Annette” Flowers Act in memory of the nurse and social worker shot and killed by a violent criminal in Methodist Dallas Medical Center. The bill increases the penalty for assaulting hospital personnel, which includes nurses, physicians, physician assistants, maintenance or janitorial staff, receptionists, and other individuals who are employed by or work in a hospital, from a misdemeanor to a felony. “This is a long-awaited change from earlier legislation that applied this protection only to nurses working in the emergency department. Now, all nurses and healthcare workers have the support to hold those who assault them fully accountable under the law,” said Bumpus.

SB 1004, which is also responsive to the shootings at Methodist Dallas Medical Center, makes it a felony to remove an electronic monitoring device if the person was ordered to wear the device as a condition of community supervision, parole, mandatory supervision, or release on bail. The man who shot Jacqueline “Jackie” Pokuaa and Katie “Annette” Flowers cut off his ankle monitor before going to Methodist Dallas Medical Center.

“We appreciate the leadership of Senators Johnson, West, and Huffman who authored the bills, as well as their many coauthors and sponsors and cosponsors in the House,” said Jack Frazee, JD, TNA’s Director of Government Affairs. “These bills represent the collective advocacy of nurses throughout the state who worked closely with lawmakers to advance these issues. To all who supported their passage, we appreciate your advocacy.”

May 1, 2023

Contact: Lisa Maxwell
Texas Nurses Association
lmaxwell@texasnurses.org
512.452.0648 x 130

Download PDF here.

Texas Nurses Applaud Passage of Workplace Violence Prevention Bill for Healthcare Workers

Bill provides new avenues to stop on-the-job assaults and protections for those who report

Austin, TX — The Texas Nurses Association applauds the passage of SB 240, the workplace violence prevention bill.

“This bill will extend important protections to Texas healthcare workers, including providing them a more active role in the development of facility policies, anti-retaliation protections, and oversight from state licensing agencies, among other things,” said Jack Frazee, JD, TNA’s Director of Government Affairs.

In response to an alarming increase in incidents of workplace violence against nurses and other healthcare workers over recent years, TNA designated this bill as one of its top priorities for the session, and, recognizing the severity of the problem, so did the Legislature. “We greatly appreciate our champions in the House and Senate, Rep. Donna Howard, and Sen. Donna Campbell,” said Frazee. “These two legislators came across party lines to work together on this issue and brought their experience as a nurse and a physician to their advocacy to unite providers behind this important piece of legislation. We also want to thank Speaker Dade Phelan and Lt. Gov. Dan Patrick for guiding these bills through their respective chambers in collaboration with the legislative authors. Lastly, we want to thank all of our members who have advocated for this issue, all of our partners in the Nursing Legislative Agenda Coalition, and our colleagues at the Texas Hospital Association, Texas Health Care Association, LeadingAge Texas, and the Texas Medical Association.”

“This bill brought together stakeholders from across the healthcare spectrum to address the pressing issue of violence in the workplace,” said Serena Bumpus, DNP, RN, NEA-BC, CEO of TNA. “We look forward to advising public and private entities on proper implementation and further empowering nurses to speak out against violence in institutions of healing.”

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About Texas Nurses Association
The Texas Nurses Association (TNA) is a statewide membership-based professional association of registered nurses. Our vision is to empower Texas Nurses to advance the profession. Founded in 1907, TNA is the oldest and largest nursing association in Texas.

Contact us at tna@texasnurses.org. Follow TNA on Facebook  and Twitter for updates.

On February 28, more than 600 nurses walked into the Texas Capitol advocating for change and support with their state representatives and senators. When nurses come together like we did that day, lawmakers listen! The fruits of our labor that day, created a great deal of momentum with our legislative priorities.

Bill Progress

Workplace Violence. On Monday, March 6, the Workplace Violence Prevention Bill (HB 112) was heard in the House Public Health Committee. Several TNA members, representatives from the Memorial Herman Healthcare System and Parkland Hospital as well as the Texas Hospital Association provided testimony in support of the bill. On Monday, it was unanimously voted out of committee. Next, it will go to the Calendars Committee to be scheduled for second reading on the House floor. In addition, we received news that the Senate version (SB 240) will be heard in the Health and Human Services Committee this week on Wednesday, March 15. The stories you all shared raised awareness around workplace violence with our lawmakers.

Nursing Shortage. On March 10, the lieutenant governor unveiled SB 25, which incorporates language from our priority bill, SB 244, and adds additional scholarship opportunities for nursing students. The bill will provide scholarship opportunities, streamline the Nursing Faculty Loan Repayment Program (NFLRP), and extend the Nursing Innovation Program (NIGP) another four years.

 At the time of this writing, SB 25 has 26 senate authors out of 31 senators. Can you say, “consensus?” This bill has been referred to the Health and Human Services Committee for a hearing, which is chaired by the bill author Senator Kolkhorst. It is always beneficial to have the Chair lay out the bill in her own committee. We will notify you as we learn more about the progression of SB 25 and the House version, HB 901.

Most Influential

Nurses have been the most trusted profession for the last two decades. Unfortunately, our level of influence has not matched that level of trust - until now. While we still have a lot of work ahead, we broke down barriers on February 28 in the Texas Capitol. When nurses come together with an aligned voice, people listen. We must maintain this momentum and continue forging ahead to share our collective voices.

What You Can Do Now

Your work did not end at Nurse Day at the Capitol. We need you to continue nurturing and cultivating your relationships with your state senators and representatives. Call their offices to follow up on your meetings with them. Continue expressing how important it is that they pass our legislative priorities, not only for the sake of the nursing profession but for the sake of patient safety and the health of Texans. The future of our profession and the health of Texans is heavily dependent on the currently proposed legislative agenda.

To find out who your state senator and representative are, click here.

January 19, 2023

Contact: Lisa Maxwell
Texas Nurses Association
lmaxwell@texasnurses.org
512.452.0648 x 130

Texas Nurses Praise Texas Legislature for Paying Heed to Nursing Crisis

In base budgets published today, both Senate and House increased funding for nursing education.

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Austin, TX — Both the Texas Senate and House of Representatives issued base budgets for the 88^th legislative session yesterday which included increased funding for the Nursing Shortage Reduction Program (NSRP), a bill passed in by the_{­­­­-­­­} 77^th legislature which has proven to positively impact the number of qualified nursing students entering the education pipeline. In addition, the budget included funding for the Nursing Faculty Loan Repayment Program, another essential tool for addressing the state’s nursing faculty shortage. Today's announcement of the base budget represents a significant step in rebuilding from the pandemic.

“Having these funds proposed so early in the legislative session shows that Texas leaders understand the seriousness of the ongoing shortage and are rising to meet the demand,” said Serena Bumpus, DPN, RN, NEA-BC, CEO of the Texas Nurses Association. “It is a relief to know that our state leaders understand the urgency of addressing the nursing workforce challenges and are willing to invest in Texas nurses now and in the future. The NSRP will continue paying returns if the Legislature chooses to further fund the program.”

“We have existing programs that are proven to increase the numbers of working nurses in Texas,” said Jack Frazee, JD, Director of Government Affairs at the Texas Nurses Association (TNA). “Rather than creating new legislation, we can fully fund what we already know works. The state will continue to see returns on its investment in this crucial part of our healthcare system’s workforce.”

“We are pleased to see the sums allocated to nursing education and we appreciate House and Senate leaders who are clearly making nursing a priority this session,” said Bumpus. “The NFLRP is an essential tool for addressing the state’s nursing faculty shortage. The Legislature’s investment in this program will help remove a significant bottleneck in the number of qualified applicants our schools of nursing can admit per semester. In addition to these appropriations, it is essential for the Legislature to pass HB 901 by Klick and SB 244 by Kolkhorst, which would extend the Nursing Innovation Grant Program and streamline the Nursing Faculty Loan Repayment Program.”

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About Texas Nurses Association
The Texas Nurses Association (TNA) is a statewide membership-based professional association of registered nurses. Our vision is to empower Texas Nurses to advance the profession. Founded in 1907, TNA is the oldest and largest nursing association in Texas.

Contact us at tna@texasnurses.org. Follow TNA on Facebook  and Twitter for updates.

By TNA Staff

SECTION 2. Not later than September 1, 2024, a facility subject to Chapter 331, Health and Safety Code, as added by this Act, shall adopt a workplace violence prevention policy and adopt and implement a workplace violence prevention plan in accordance with Sections 331.003 and 331.004, Health and Safety Code, as added by this Act.

– HB112

Workplace violence toward healthcare workers has been on the rise. A Press Ganey report in September found that more than two nurses were assaulted every hour across the US – roughly 57 per day. These assaults can range from verbal abuse to physical harm, and can come from patients, their families and even co-workers.

In the upcoming Texas legislature’s 88^th session, two identical bills have already been filed in the House (HB 112) and Senate (SB 240) by Representative Donna Howard and Senator Donna Campbell that require certain healthcare facilities to implement workplace violence prevention programs. During the last session, this bill fell victim to other legislative priorities, leaving nurses with less protection in the workplace. It is important that these bills pass in 2023 to help stem the rising tide of violence against nurses.

Our thanks to Senator Campbell and Rep. Howard for the work they're doing to help keep nurses and healthcare professionals safe. As you know, once session starts, things can evolve quickly and your voice needs to be heard at the Capitol to ensure that reinforcing Texas nurses remains an important issue.

There is no more important and opportune time than now to make sure your voices is heard by elected officials. Make plans to attend Nurse Day at the Capitol, Feb. 27 and 28 where you will learn about the Texas legislature, what issues are being discussed, and meet in person with legislators and their staff to talk about what matters to you.

By Kanaka Sathasivan, MPH

This article first appeared in Texas Nursing Magazine Issue 4, 2021.

Download the PDF here.

Several years ago, the Board of Nursing (BON) added a simple question to the licensure renewal form: “In the past five years, have you been diagnosed with or treated for schizophrenia or other psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder or borderline personality disorder, which impaired or does impair your behavior, judgment, or ability to function in school or work?”

While the question was intended to protect public welfare and was considered standard and used by other licensing entities at one time, it reinforced stigma and perpetuated discrimination against certain health conditions.

“It was unfair and frustrating,” recalls Andrea Knott, BSN, RN, CPN. Following the birth of her daughter, Knott experienced postpartum psychosis, which led to a diagnosis of bipolar disorder. She worked carefully with her doctor to find a treatment that worked for her and had been doing fine at work. She was applying for renewal a year after her diagnosis. “At first, I saw the question and thought ‘I get it. I get that they want a letter from my doctor.’”

After she applied to renew her license in July 2019, answering the question honestly, she was stunned to receive a letter from the BON requesting documentation and proof of compliance with the Nursing Practice Act.

THE LETTERS

“I felt like I had done something wrong,” Knott said. “But in reality, there was nothing I could do to control what I went through. The only thing I could control was seeking treatment.”

Knott immediately complied with the request, providing documentation and information including work history and year-end evaluations; a resume; a letter outlining the circumstances of her hospitalization; and a response to the allegations of violating the Nurse Practice act to the BON. She also consulted an attorney who shared stories of other nurses who face similar barriers. Some had to wait months for their license to be reinstated, during which time they could not work.

However, Knott was confident she had done nothing wrong and that legally, there would not be grounds to remove her license.

Then the second letter came. On Aug. 13, 2019, the BON requested even more information. Knott began to ask more questions. She hired an attorney, and with their help put together a response packet that included yearly evaluations from manager and coworkers, letters of reference from community members, family, and her pastor attesting to her character.

“With the help of my doctor, I felt safe and confident to not just be a mom but also a health care provider. The packet included great reviews from my peers— they would be the first people to speak up if they were concerned,” she said. Her peers also reinforced that she was doing the right thing by being honest.

However, the BON’s response was discouraging: “They wanted me to be seen by one of their doctors.”

THE EVALUATION

Confused and upset, Knott decided to call the BON and talk directly to her case manager to understand their rationale. She learned that refusal to comply with evaluation could lead to administrative hearing. So, she tried to use their list of doctors to set up an appointment.

“I called a number of the pre-approved providers in the Dallas–Fort Worth area,” she explained. “The evaluation would have been $800. But when I asked them who they normally evaluated, it was usually nurses with substance use disorder. I asked specifically if they had any experience with bipolar or postpartum psychosis and none of them did. I know it’s my right to see someone that specializes what I need.”

Since Knott was not comfortable seeing any of their providers, she went back to her attorney at beginning of October. In addition, she sought support from her colleagues and employer. “I’m so blessed to have an amazing support system, bosses, coworkers—able to talk about feelings and feel supported. Not everyone has that.”

Knott also served on the committee for mental health in the med-surg unit, where she worked alongside former Texas Nurses Association Board Director Shakyryn Napier, DHSc, RN, CPN, NEA-BC. She shared her situation and her frustration: “I did nothing wrong, and I felt like I was being interrogated like a criminal.”

Napier, also chair of the TNA Policy Council, immediately brought the issue to the attention of TNA, including the council members, Chief Executive Officer Cindy Zolnierek, PhD, RN, CAE, and lobbyist Kevin Stewart, JD. In a heartfelt letter in January 2020, Knott explained how problematic the question had become. Crucially, she wrote: “[The BON’s] actions serve only to encourage nurses to hide their mental health issues and not seek medical care for fear of losing their license.”

THE CHANGE

Zolnierek and Stewart agreed that the question created undue hardship for nurses and further perpetuated stigma against people with mental health conditions. Jumping into action, they alerted the BON regarding Andrea’s experience speaking directly with the BON general counsel and executive director asking them to remove or change the question. TNA’s efforts paid off.

First, in early 2020, Knott’s case was closed—the evaluation by Andrea’s treating provider should have been adequate. There had been a breakdown in the BON’s processes, and they clarified their investigation procedures to prevent further occurrences. The BON also acknowledged that the question on their application and renewal forms regarding mental health issues was not aligned with the Americans With Disabilities Act and agreed to research more appropriate language. At its July 2020 quarterly meeting, the BON approved replacing the question with “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice nursing in a competent, ethical, and professional manner?”

“I don’t want any nurse to go through what I’ve been through,” Knott said. “It was not just demeaning, but stressful to have to relive that traumatic event and worry that my livelihood and license could be on the line.”

When Knott learned through a coworker that the question had changed, she almost started crying. “I was so thankful no one else would have to go through that, and I knew that if I had a relapse or needed hospitalization, I wouldn’t have to go through it again. I have control over my medications, see my therapist regularly, and take care of my health, but something could happen later that meant seeking treatment or hospitalization again.”

The change in the question meant that Knott and others would now be able to seek treatment without fear of losing their license.

“I’m so glad it changed at that time,” she said. “With COVID, there has been an increase in nurses needing help and now they don’t have to fear getting it. I want to erase the stigma behind people with mental health conditions. You can still be a productive and giving member of society.”

For nurses who need help with a mental health condition or substance use disorder, visit tpapn.org to learn more about the Texas Peer Assistance Program for Nurses.

February 23, 2021

Contact:

Lisa Maxwell
Texas Nurses Association
lmaxwell@texasnurses.org

Download PDF Press Release

Texas Nurses Association Statement On Interpretation of Gender-Affirming Care as Child Abuse

Potential for far-reaching negative consequences for children, families, medical professionals.

Austin, TX — On February 18, 2022, Texas Attorney General Ken Paxton issued an opinion letter interpreting “whether the performance of certain medical and chemical procedures on children… constitute child abuse.” The opinion letter concludes that various gender-affirming healthcare procedures “can legally constitute child abuse under several provisions of chapter 261 of the Texas Family Code.” On February 22, Texas Governor Greg Abbott sent a letter to the Texas Department of Family and Protective Services directing the agency and all other state agencies to enforce the Texas Family Code according to the attorney general’s opinion letter.

These letters do not reflect the policy position of the Texas Nurses Association. TNA advocates for quality, evidence-based, culturally congruent health care for transgender and gender diverse youth and their families. TNA condemns actions or acts that create health disparities such as social marginalization, discrimination, and denial of civic and human rights based on gender identity and gender expression, which directly contributes to poor physical and mental health outcomes and results in increased illness and higher mortality rates within the TGD youth population.

It is unfortunate that the executive branch of the state of Texas interprets the law to impose a duty to report gender-affirming healthcare as child abuse. This will have negative consequences on the psychological and physical health of TGD youth and their families. It will also produce a chilling effect in healthcare, imposing ambiguous legal consequences on medical professionals’ independent judgments of how to care for their patients.

This may lead to prosecutions or actions against professionals’ licenses if they provide gender-affirming healthcare, increasing burdens on both medical professionals and the judicial system. Nurses and the public must be aware of the legal impact of these letters, even if their rationale does not reflect TNA’s policy position. These letters inform the public about how the executive branch intends to enforce chapter 261 of the Texas Family Code and related criminal provisions of the Texas Penal Code. Nurses should seek legal advice from their employers or attorneys if they are unclear on how these letters affect their practice.

September 9, 2021

Contact:

Caitlyn Gonzales
Texas Nurses Association
cgonzales@texasnurses.org
512.452.0648 ext. 121

Download PDF Press Release

Senate Bill 8 Makes Nurses a Target

Texas Nurses Association opposes legislation that could harm providers

The Texas Nurses Association stands in solidarity with our provider colleagues in opposition to Senate Bill 8, from the 87th Legislative Session. This bill creates civil penalties for providers acting within their ethical guidelines and standards of practice. Worse, it “deputizes” Texans who are expected to be the enforcement mechanism under this bill.

Nurses who “aid and abet,” or are even suspected of aiding and abetting, an abortion procedure could be subject to up to $10,000 dollars in fines. At a time when providers, and particularly nurses, have put everything on the line to care for Texas patients, it is unfathomable that the legislature would even consider putting politics before the wellbeing of nurses in this way.

Texas is facing one of the most severe nursing shortages in history. The state has responded by putting a bounty on their head. We proudly echo the sentiment of our physician colleagues: enough is enough.

For Immediate Release

For more information, please contact:

Download PDF Press Release

Nursing Organizations Ask Governor Abbott to Add Nursing Issues to Special Session Agenda

In light of a disappointing lack of action by the 87th Legislature to address an ongoing nursing shortage, alleviate regulatory burdens, and provide protections from workplace violence, a coalition of 16 nursing organizations today requested Governor Abbott add these issues to the agenda for the upcoming special session, set to begin July 8.

“Even as we move past the COVID-19 pandemic, Texas continues to face a mounting, overwhelming shortage of nurses and general access to healthcare across the state,” the coalition said in a letter to Governor Abbott. “To help address this, nurses need support in educational opportunities, a productive and safe work environment, and the repeal of unnecessary mandates that are preventing Texas patients from accessing high-quality health care.”

The Texas Legislature declined to pass any bills that would have addressed the state’s critical shortage of nurses, in fact cutting the budget for the Nursing Shortage Reduction Program, which is allotted biennially to schools of nursing to help them increase enrollment.

Please read the coalition’s letter, in full, below.

For more information, please contact:

Katherine Wise, Texas Nurse Practitioners
katherine@castlecommunications.com

Kanaka Sathasivan, Texas Nurses Association
ksathasivan@texasnurses.org 

Download PDF version

Texas faces the second worst nursing shortage in the country and ranks 51st nationally in health care access and affordability. After one of the most harrowing years in modern health care history, nurses across Texas were exceedingly hopeful that lawmakers would prioritize health care and pass policies and reforms to support patients, support nurses and improve our working conditions. Instead, the 87th Legislative Session proved a staggering disappointment.

After a year spent frequently and emphatically extolling the importance of nurses on the front lines of the pandemic, lawmakers failed to address urgent issues that have made it harder for nurses to provide care and for Texans to access care. 

The past year of historic highs in nursing shortages demonstrated a dire need to expand the health care workforce. However, lawmakers cut the budget for the Nursing Shortage Reduction Program, allotted biennially to schools of nursing to increase enrollment. In addition, lawmakers refused to make permanent some of the waivers that made it easier for nurses to practice during the pandemic, further exacerbating the shortage. 

Legislators also neglected to pass bills that would have helped protect nurses from workplace violence. In addition, Texas has now fallen even further behind most other states after lawmakers declined to increase our state’s competitiveness for top primary care talent by removing outdated mandates on advanced practice registered nurses. 

The last year taught us both the critical importance of nurses and nursing care in our state and the overwhelming degree of dedication our nurses commit to the patients who need them. While several lawmakers worked hard on behalf of Texas patients and nurses, we are deeply disheartened by the lack of progress this legislative session.

The 87th Legislature left unpassed a great deal of important legislation that would have eased the state’s health care workforce shortage, improved working conditions for nurses, and resulted in more health care access for all Texans. In addition to budget cuts, the following bills and measures did not pass:

• HB 2029 (Klick), SB 915 (Hancock) — Would have removed anti-competitive regulations for APRNs to expand access to care for Texans.
• HB 1524 (Lucio) — Would have allowed APRNs to prescribe Schedule II medications under delegated authority from a physician. 
• HB 326 (Howard) — Would have required facilities to adopt workplace violence prevention plans, encouraged reporting of incidents of workplace violence, and ensured that providers receive the care they need after an incident.
• HB 396 (Moody), SB 433/499 (Zaffirini and Blanco) – Would have created a presumption that nurses who contracted COVID-19 did so in the scope of their employment. 
• HB 2409 (Dean) – Would have codified the COVID-19 measure waiving CE requirements and reactivation fees for nurses who came out of retirement/reactivated their license during a disaster. 
• HB 982 (Howard and Darby) — Would have created an expedited licensure process for APRNs who are licensed out of state.
• SB 146 (Powell), HB 2062 (Klick) — Would have created a loan repayment program for nurses who work in long-term care.
• HB 3819 (Klick and Powell) – Would have allowed school nurses to administer prescription asthma medicine to a student in emergency situations

We will continue to advocate for nurses and patients throughout any special sessions and during the interim. 

Signed by the following Texas nursing organizations:
Texas Nurses Association
Texas Nurse Practitioners
Consortium of Texas Certified Nurse Midwives
Texas Clinical Nurse Specialists
Texas DNP
Psychiatric Advanced Practice Nurses of Texas
Psychiatric Advanced Practice Nurses of Austin
Texas Association of Deans & Directors of Professional Nursing Programs
Texas Emergency Nurses Association
Texas School Nurses Organization
Texas Organization for Nursing Leadership
Texas Organization of Associate Degree Nursing
Texas Organization of Baccalaureate and Graduate Nursing Education
Texas Collaboration of periOperative Registered Nurses
Association of periOperative Registered Nurses of Greater Houston
Association of Women’s Health, Obstetric and Neonatal Nurses - Texas
Houston Chapter Oncology Nursing Society

Feb. 3, 2021

Contact:

Rick Levy
AFL/CIO
Rick@texasaflcio.org
512..695.1148

Kanaka Sathasivan
Texas Nurses Association
editor@texasnurses.org
512.452.0648 x 130

Bills Would Ensure Nurses With COVID-19 Can Access Workers Compensation Benefits

HB 396 by Representative Joe Moody (D-El Paso), SB 433 by Senator Zaffirini (D-Laredo), and SB 439 by Senator Blanco (D-El Paso) would create a presumption that nurses who contract COVID-19, while directly caring for coronavirus patients, did so in the course of employment.

The Workers’ Compensation system provides benefits to persons who get injured or sick from a work-related cause. To access these benefits, the claimant needs to prove that they were injured in the course of employment. Given the nature of COVID-19, meeting this burden of proof is difficult. It can take a significant amount of time, may require hiring an attorney and can lead to an inappropriate denial of benefits.

These bills would create a legal presumption that, when a nurse contracts COVID, it was contracted in the course of employment. A nurse would not need to prove that they contracted COVID during employment; instead, the benefits carrier would be required to prove that the nurse did not contract COVID in the course of employment in order to deny benefits. Further, any claims that were denied on or after February 1 of 2020 could be resubmitted with this new presumption in place. These bills would immediately make benefits more accessible, ensuring that sick and injured nurses are taken care of in their time of need.

“Nurses have been heroes through this whole pandemic,” Texas AFL-CIO President Rick Levy said. “They have taken unimaginable risks, navigating great danger to treat their patients and fulfill their calling. These bills recognize the heightened risk nurses have taken on under incredibly trying circumstances.”

“Nurses are putting their lives on the line every day they show up to care for people afflicted with COVID-19,” said Cindy Zolnierek, PhD, RN, CEO of the Texas Nurses Association. “Providing assurance that we will care for them if they get sick is the least we can do. These bills will ensure that nurses can access the benefits they deserve when contracting COVID-19 in the line of duty.”

Representative Moody added, “Nurses are on the frontline risking everything to protect all of us during this
pandemic. They deserve us returning the favor by making sure that if the worst happens, getting fair workers’ compensation isn’t something they have to worry about.”

“Texas nurses have put their lives at risk to combat the worst pandemic we have seen in 100 years,” said Senator Zaffirini. “It is imperative we remove barriers for them to access worker's compensation benefits when they contract COVID-19 while treating their patients. Senate Bill 433 would be an important sign of our appreciation for nurses' heroic and inspirational work during the pandemic and our commitment to their health and safety in the future.”

Do you ever wish you could change things? Maybe reduce workplace violence? Increase access to care in rural areas? Get a school nurse in every school in Texas? Or get more funding for nursing faculty to educate more nurses?

All politics are local and local is the individual. Yet individuals seldom have the resources to affect policy, and organizations such as TNA cannot effectively affect public policy without the individual member. Successful influence requires organizations and the individual member working together to make meaningful change.

But nurses need a bigger voice to better advocate for patients and nursing practice.

The Policy Arena in Texas

In the world of Texas politics, the Texas Medical Association is one of the powerhouses of policy, for one simple reason: Out of 66,000 doctors in Texas, 90% of them belong to TMA. In contrast, out of 300,000 nurses, only 7% belong to any professional association. During the legislative session, this means a small number of physicians have a much louder voice than the huge number of nurses in the state.

To try to remedy that, we have two things to ask of our members:

• Encourage your friends to attend Nurse Day at the Capitol.
• Encourage them to join Texas Nurses Association.

While individual nurses have great ideas about making patient care safer and improving nursing practice, one nurse alone cannot do much. “Collectively, nurses define excellence in practice, develop innovations, and translate these into care provided to populations,” says Policy Council member Edtrina Moss, PhD, RN-BC, NE-BC, CLSSGB. “An association advocates for patients and the profession and influences policies that impact decisions related to the profession and healthcare overall.”

With TNA, one nurse’s good idea can become a legal protection for all nurses.

During the last legislative session, Tonya Poore had to advocate for her patient in the middle of a procedure. While safe harbor protections were made for exactly this situation, Poore could not leave her patient’s side to fill out the forms. When she was written up and reported to the board, she came to TNA to make sure this would never happen again. Within months, TNA helped get a law passed so now all nurses in Texas have the option of oral safe harbor when they cannot leave a patient’s side.

Poore was just one nurse, but she saw an issue and used TNA’s influence at the Capitol to improve nursing and patient care statewide.

Tools for Nurses, Resources for Legislators

In 1999, several dozen nurses came together for the first Nurse Day at the Capitol. In the years since, thousands of nurses have participated in Nurse Day, showing legislators at the Capitol how passionate nurses are about health care and their patients.

While this year’s virtual event won’t resemble previous ones where nurses flooded the Capitol chambers, both events still have a core mission in common: empowering nurses and giving legislators a look at nursing. As Moss explains: “Nurse Day allows nurses to participate in the legislative process and serve as ‘subject matter experts’ on issues and legislation that directly impacts communities, populations and the profession.”

This year’s event has three different ways for nurses to learn about policy and advocacy.

1. Our free Advocacy Toolkit, developed by our Government Affairs Committee’s Wisdom Council
2. Nurse Day at the Capitol live event on Feb. 8
3. On-demand courses in the Learning Curve on Advocacy 101 and Advanced Advocacy

In addition, while we would normally have attendees stop by legislator’s offices, this year we’ve arranged for eight virtual sessions where any nurse in Texas can register to meet their legislator and ask them questions. Even if you can’t make it to Nurse Day, attend the legislator’s session for your area so we can show them how many nurses appreciate their support! (And listen to our 2021 #NursePolicy podcast to get an overview of important issues to nurses this session.)

Nurses in Numbers Get it Done

“When nurses come together, their voices are impossible to ignore,” says Kevin Stewart, JD, TNA’s lobbyist. For many years, Stewart has worked with a number of nursing organizations and the Nursing Legislative Agenda Coalition to get policy changes made at the legislature and the Board of Nursing. “Joining an association and attending events like Nurse Day at the Capitol is an opportunity to amplify your message alongside your peers.”

During Nurse Day at the Capitol, attendees will hear from speakers like Stewart, along with Dr. John Hellerstedt, Commissioner of the Texas Department of State Health Services, and two nurse legislators: Rep. Donna Howard and Sen. Stephanie Klick. In addition, the two on-demand courses feature both Moss and Stewart, along with TNA CEO Cindy Zolnierek, PhD, RN, CAE, Stephanie Morgan, PhD, RN, FNP-BC, from the University of Texas, and Andrew Cates, JD, TNA’s former director of government affairs.

We hope you find the day inspirational and make use of the free tools on our website. As Moss puts it: “We are a movement as individual nurses, but we are a force when we join together! We are better —  greater — in numbers!”

Today’s practice tip of the week is a bit unconventional, but it may be the single most important action you, as nurses, take all year. This one action will have almost immediate impact on your practice and your patients. It will also shape nursing in the state and the nation for many years to come. That action and today’s practice tip of the week is to get out there and vote!

Today is election day, and presumably many of you have taken advantage of early voting, but if you haven’t, we would like to take this opportunity to make one more plea for you to go cast your ballot. Voting is not just a privilege but a responsibility, and every vote matters.

Everyone knows that the stakes are high in every presidential election, and choosing the leader of the country now, during a global pandemic, is certainly more important than ever. But there are also critical state and local races, which arguably have even more impact on your practice and everyday life. Your state officials, for example, make the overwhelming majority of the decisions about nursing practice and licensure in Texas. Casting your ballot in these races is the only way to ensure that your voice is heard, and it will shape the state legislature for years to come.

In the Texas House, Democrats are nine seats away from taking the majority. Plus, regardless of who holds the majority next time around, the House will be selecting a new speaker. The makeup of the House, and in turn who is selected as speaker, depends entirely on the outcome of this election. While the Texas Senate is more stable, Republicans currently have the exact number of seats they need to hold the 60% supermajority necessary to bring bills to the floor. If Senate Republicans lose a seat, they will either have to change the chamber rules dramatically or work across the aisle to get legislation passed.

Your vote also has broader, although more subtle, impacts. Each election, nursing organizations conduct surveys and gather information to determine how many nurses voted. When TNA goes to the State Capitol to defend your practice, we are able to share that information with legislators and their staff. Legislators know how many nurses in their district vote, and they certainly take that into consideration when voting on bills and deciding what legislation to support. In practice and in politics, nurses are stronger when we work together.

Given the COVID pandemic, we expect this legislative session to be overwhelmingly focused on health care. There will be new legislators and stakeholders who are interested in nursing issues. Representatives and Senators will want to hear from nurses in their district about how they can provide support through legislative action. This session will be, without a doubt, one of the most pivitol sessions for Texas nurses.

So please, if you haven’t already, go out and vote. Encourage your peers and coworkers to vote as well. It is critical that elected officials across the nation hear the voices of nurses louder than ever. Let’s make 2021 the year of the nurse vote!

By LaTashia Kiel, DNP, RN, CEN

Hota Kotb, Robin Roberts, Olivia Newton-John, and Alex Trebek all have something in common that many of us would know if asked about it on Jeopardy! A cancer diagnosis. But, even if many of us know about these folks’ public cancer fight, most Texans don’t have to go beyond close social or family circles to pinpoint an example of this potentially deadly disease.

The American Cancer Society estimates that almost 125,000 Texans will be diagnosed with cancer this year. As Texans, we voted to help our great state continue the fight against cancer by passing Proposition 6 last week. Proposition 6 was an amendment proposal that re-allocated $3 billion dollars to the Cancer Prevention and Research Institute of Texas (CPRIT).

I vividly remember my very first close encounter with cancer. When I had been married for less than a year, my mother-in-law announced that she had been diagnosed with colon cancer. The mere word cancer meant fear, panic, stress and anxiety. The news was unexpected and terrifying.

I am a nurse, but nothing had prepared us for the coming battle.  Besides reminiscing about her ability to make perfect red velvet cupcakes with homemade icing, I will always remember how hard she fought, how worried she was about leaving us behind, and the toll it took on our family as we watched her slowly and painfully die.

I cursed cancer, prayed for a miracle and hoped with all my might for a cure. Cursing cancer made me feel better only for a moment, the miracle was not granted on this side of heaven, and the cure wasn’t found in time.

The nurse in me encouraged my family to continue to hope—to dream about a world free of cancer. I challenge you to imagine it for a second — no more color-coded ribbons to raise awareness, cancer-themed runs or long, sincere Facebook posts wishing peaceful rest to loved ones. This may seem far-fetched, because it is rare to find anyone untouched by cancer in some way. But the good news is that, with advances in cancer research, many cancers are no longer an automatic death sentence. People are living longer, surviving, and flourishing after a cancer diagnosis.

It comforts me to know that there are people in our world, people in the United States, and people in Texas that do care. They care so much about finding a cure for cancer, preventing its spread, and ameliorating the lives of cancer survivors that they have dedicated their lives to doing just that.

They are people like Dr. Margaret “Ruth” McCorkle of Yale, a trailblazing pioneer nurse who spent her life making cancer care better, and Dr. Mary Louise Adams of The University of Texas at Austin, an ambitious nurse who created culturally appropriate screening programs for Texans. They give all of us hope. And, while they were unable to see cancer defeated, it’s not too late for our children or for us.

In 2007, Texans voted to allocate $3 billion in bonds to conquer cancer by creating CPRIT. CPRIT was designed to make Texas a world-renowned destination for cancer research and prevention.  In the 12 years since, CPRIT’s accomplishments have been remarkable.  In Texas, more than 10,500 lives have been saved as cancer deaths decreased by 8% from 2011 to 2016. Over 19,000 patients have received life-saving treatments through CPRIT’s services, and 5.7 million prevention services have been provided to Texans. CPRIT funding also helped recruit 2018 Nobel Prize winner Dr. Jim Allison to Texas to continue his great work in immunotherapy. 

These advances are due largely to the decision Texans made in 2007 to defeat cancer. With the re-allocation of funds voted in by Proposition 6, this vital work will continue. Thank you, Texas Nurses for taking a stand against cancer!

If you have an idea that could help Texas conquer cancer, more information about CPRIT can be found at: https://www.cprit.state.tx.us

LaTashia Kiel is a Clinical Assistant Professor at the University of Texas at Austin, Co-Founder of the Kiel Colon Cancer Foundation, and a Member of the National Colorectal Cancer Policy Leadership Council.

Editorial support with manuscript development was provided by the Cain Center for Nursing Research and the Center for Transdisciplinary Collaborative Research in Self-Management Science (P30, NR015335) at The University of Texas at Austin School of Nursing. 

By: Ellen Martin, PhD, RN, CPHQ 
Director of Practice, Texas Nurses Association

Every odd-numbered year, the Texas Legislature convenes for a 140-day regular legislative session. Because the session is a flurry of activity, it is easy to forget about all the work that is done between sessions, called the interim, during the even-numbered years. The Speaker of the House and Lieutenant Governor task the committees of their respective chambers with studying a variety of issues of priority and public interest.

These tasks, termed “interim charges,” give a clue to which issues will be important for that committee in the next session. Advocacy organizations take the opportunity to educate the legislators on issues and submit recommendations for interim charges. For example, the Texas Public Health Coalition recommends the House Public Health Committee monitor implementation of House Bill 1848 related to communicable diseases in long-term care facilities.

Once interim charges are issued, the committee then examines the issue in accordance with their charge and writes a report, all of which are archived. The charges can be quite lengthy, and sometimes involve a joint charge between two committees. For example, the 85th legislative charges included a joint charge to the House Committee on Human Services and House Committee on Public Health, directing them to:

Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian's substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Public Health)

Nurses who followed the 86th legislative session will recognize that children with mental illness was a one of many legislative priorities. The House Committee on Public Health Interim Report, published in December 2018, informed legislators on key issues in advance of the 86th legislative session.

Each interim report includes an executive summary which summarizes the findings on an issue. For example, the charge above was summarized in the report as:

Regarding Charge 6, related to the prevalence of children involved with Child Protective Services (CPS) due to the child having a mental illness and/or a substance use disorder or due to the child's guardian having a substance abuse disorder or an untreated mental illness, the Department of Family Protective Services (DFPS) reports that risk factors such as substance abuse, mental health concerns, and domestic violence are common factors in confirmed child abuse and neglect fatalities. Efforts by the state emphasize family preservation programs, including specialty courts and family-based services.

The full report includes detailed information on each charge with background on the issue, statistics, challenges and recommendations.

Sometimes nurses ask how they can get involved in an issue they care about. The first step is to know who else is working on that issue and what efforts are already underway. These interim reports provide a window into who is involved with an issue because the report includes a summary of the hearing and who was invited to testify (recognized state leaders on the issue) and the public is also invited to comment. All witnesses who testified are listed in the interim report, providing a starting place for the nurse to make connections.

For example, in summer 2018, an opportunity arose for nursing to give input on House Public Health Committee Charge 5 related to population health and care delivery in rural and underserved areas, telemedicine and rural hospital challenges. Certified Nurse Midwife Erin Biscone (D9) provided public testimony at the hearing on June 28, 2018, speaking on improving access to care through full practice authority for APRNs. Archived video of the interim committee hearings are available online. (Erin’s testimony starts at 4:25.)

The report and video archives can provide a valuable historical perspective on an issue.

We expect interim charges to be issued in the next few months and will share the charges of interest to nursing at that time. Meanwhile, which issues spark your passion for policy? Let us know in the comments below!

 April 9, 2019

Contact:

Kanaka Sathasivan
Texas Nurses Association
ksathasivan@texasnurses.org
512.452.0648 x 130

Nurses Need Workplace Violence Prevention

When 1 in 2 Texas Nurses has experienced workplace violence, prevention programs and education are crucial to keeping health care workers safe.

Austin, TX (Nov. 20, 2018) — Many nurses do not have the tools to empower themselves and prevent violence. Current law does not require health care employers to train staff such as nurses in prevention techniques. All health care environments should implement measures to prevent violence against health care workers.

Of all assaults that occur in U.S. workplaces, 70 percent occurred in health care and social service settings. House Bill 1146 by Rep. Donna Howard will require health care facilities to develop a workplace violence prevention plan, conduct safety training with employees and implement a system for responding to and investigating violent incidents.

A 2016 study by the Texas Center for Nursing Workforce Studies shows that nearly half of all nurses will experience physical violence in the course of their careers, and over 40 percent of nurses don’t receive any training on workplace violence. When training is offered, employers often focus on awareness rather than prevention.  

Workplace violence can be prevented. Effective violence prevention strategies exist, yet these approaches have not been implemented across Texas. HB 280 in 2017 provided grant funding for organizations to implement innovative solutions to workplace violence. This session’s HB 1146 will further this effort by requiring health care facilities to involve front line nurse in developing violence prevention plans.

By: Andrew Cates, JD
Director of Government Affairs, General Counsel, Texas Nurses Association

We’re right at the halfway point in the 86th Legislative Session and the capitol is finally in full swing. This session, TNA has a number of priority bills as well as a number of budget initiatives. And we need your help to make this session successful!

The Big Bills

HB 1146 by Rep. Donna Howard — Awaiting hearing in House Public Health Committee

In 2015, TNA worked with Rep. Donna Howard to pass a study bill on workplace violence against nurses. The study polled health care practice sites as well as nurses themselves, and it showed that 1 in 2 nurses reported an incident of violence in the workplace at some point in their career. Freestanding emergency centers and long-term care sites were the most prevalent settings of workplace violence in the study and the least likely to have protections in place for nurses.

TNA worked with Rep. Howard once again to file landmark legislation on workplace violence. This bill includes additional reporting requirements and audits for practice sites, training requirements for workplace staff, and mental health services for nurses who experience violence in the workplace.

After working with stakeholders, we anticipate having little to no opposition by the time the bill is heard in committee. If passed, this will be a huge win for TNA and all healthcare workers across the state!

HB 2410 by Rep. Stephanie Klick — Awaiting hearing in House Public Health Committee

Currently, in order to call safe harbor, a nurse must stop what they are doing and fill out a form to document the issue and their objection to it. Based on calls received by nurses at TNA, we understand that this is not a viable option in emergency situations where immediate care is needed.

This bill would allow nurses to orally request peer review by notifying a supervisor if the nurse is unable to complete the peer review request form due to immediate patient care needs.

TNA worked with the Texas Hospital Association on favorable language to ensure THA is comfortable with the bill. We should have no or little opposition when heard by the committee.

HB 2980 by Rep. Donna Howard — Awaiting hearing in House Higher Education Committee

This bill includes a budget rider to appropriate $13.75M to the GNE innovation grant program as well as any money that is returned to the Higher Education Coordinating Board from the Nursing Shortage Reduction Program.

One of the largest barriers to training nurses is a lack of available clinical space. Too frequently, nursing schools must refuse applicants, and health care facilities limit the number of available clinical slots due to high demand.

HB 2980 creates a new innovative grant program, administered by the the Higher Education Coordinating Board, to award grant funds for pioneering approaches to increasing the availability of clinical education practice sites for graduate nurses.

HB 1401 by Rep. Donna Howard — Awaiting hearing in House Appropriations Committee

The funds from the permanent tobacco fund dedicated for health-related programs are crucial for nursing education in Texas to meet the needs of Texas’ rapidly growing population. Texas patients need qualified Texas nurses. Fiscal support of nursing education is a common-sense measure to accomplish this goal and maintain a healthy Texas.

The current statute is set to expire in 2019.This bill extends the current dedication of funds for nursing education programs to 2023.

Grants from the fund go to programs that prepare students for RN licensure, as well as higher nursing education pursuits and programs that employ innovative approaches to recruiting and retaining students and qualified nursing faculty.

HB 3111 by Rep. Stephanie Klick — Awaiting hearing in House Human Services Committee

A 2016 joint study by the Texas Department of State Health Services and the Texas Center for Nursing Workforce Studies determinedthe state will be 60,000 nurses short of demand by 2030. That same study showed demand for nurses in long-term care settings such as nursing homes will double by 2030.

HB 3111 begins to address the shortage by establishing a loan repayment program for RNs who meet certain criteria, including full-time employment by a long-term care facility for at least one year. This bill includes a $4 million appropriation in the budget for operation of this new program.

SB 358 by Sen. Chuy Hinojosa — Awaiting hearing in Senate Higher Education Committee

Last session, TNA successfully fought to create a $3 million line item in the state budget to fund the Nursing Faculty Loan Repayment Program. This program provides loan repayment assistance to nurses who choose to leave the care setting and go into faculty positions at nursing schools.

TNA, with Sen. Hinojosa’s help, put forth SB 358 to increase funding and expand funding to more nurses by allowing part-time faculty to apply for loan repayment awards. Texas has seen a trend in full-time vs. part-time nursing faculty positions converging over time. This is a common-sense solution to a growing nursing shortage problem. SB 358 includes a budget rider to increase the appropriation from $3 million per biennium to $10 million per biennium.

HB 1792 by Rep. Stephanie Klick — Subcommittee action pending in House Public Health Subcommittee on Health Professions

TNA supports full practice authority for all advanced practice registered nurses. Currently, Texas laws prevent APRNs from providing health care to the full extent of their licensure and training.

APRNs must sign a delegation agreement with a collaborating physician in order to practice, even though that physician is not required to be on site or see any of the APRN’s patients. This delegation agreement adds to health care bureaucracy and red tape, reduces time spent with patients and increases costs for businesses and providers.

Twenty-four states, the VA and all branches of the military have repealed these laws to expand access to care to patients. Texas should do the same.

Nursing Shortage Reduction Program – TNA works each session to ensure that the NSRP is adequately funded in the state budget. Last legislative session, the program was cut by 40% along with a number of other programs in order to balance the budget. This session, we hope to restore those cuts and make the program operate more efficiently to maximize its impact across the state.

How to Help

As you can see, we are very busy at the capitol this Spring and, as always, we will need your help to make it successful as we close out the final 60 days of session. Here are a few ways you can help us make an impact at the capitol:

1. Check your email and make sure that TNA and our Action Alerts are whitelisted. We send out periodic action alerts to our members to send their legislators emails, calls and tweets in support of our bills. As our bills start getting set for hearings, we will utilize these action alerts more and more, so make sure that the following email addresses are whitelisted so they don’t go to spam – tna@texasnurses.org, governmentalaffairs@texasnurses.org,  acates@texasnurses.org
2. Make sure to follow @TexasNursesAssn and @TXNursesLege on Twitter. We regularly post on twitter about the capitol and issues we support. Make sure to get a twitter account and follow our activity and be sure to engage with us there, too, through comments and retweets! Twitter is also a great way to keep up with legislators.
3. Use the legislative action center, under the Policy tab at texasnurses.org. All of our possible action alerts live here on our website. You can go to take action on any bill in the action center at any time. Your voice needs to be heard, so please go to our page today and take action.
4. Join Capitol Corps and keep YOUR state legislators informed of current nursing issues. Be the legislative liaison between your TNA Government Affairs Committee (GAC) representative and the lawmakers who represent your region. Don’t worry, we have plenty of resources to help you hone your grassroots advocacy skills, and TNA’s GAC members and Government Affairs staff are always available to answer questions and ensure you’re well-equipped to discuss issues of importance. Send an email to governmentalaffairs@texasnurses.org.
5. Invest in the TEXAS NURSE PAC to support state lawmakers who support Texas nurses. TEXAS NURSE PAC uses the contributions it receives from nurses of all scopes of practice, to invest in candidates and lawmakers of both parties that deserve the endorsement and financial support of nurses. For Texas nurses to empower the profession, we MUST support state legislators who understand the value of the nursing perspective when making decisions about state health care. Invest in the future of the nursing profession in Texas. Invest in the TEXAS NURSE PAC.

March 7, 2019

Contact:
Kanaka Sathasivan 
Texas Nurses Association
ksathasivan@texasnurses.org
512.452.0648 x 130

Comprehensive Workplace Violence Prevention Measures Could Address 70% of all Workplace Assaults

One in two nurses has experienced verbal, physical or sexual assault in the workplace

Austin, TX (March 7, 2019) — Most workplaces provide training for fires, active shooter events and natural disasters like tornadoes. However, compared to the small number of workers who have experienced these rare events, one in two nurses has experienced workplace violence, including verbal, physical and sexual assault. Of all assaults in U.S. workplaces, 70 percent occurred in health care and social service settings.

Yet many health care workplaces do not address workplace violence in their facility safety plan and fail to provide violence prevention training. A 2016 study by the Texas Department of State Health Services and the Texas Center for Nursing Workforce Studies shows that over 40 percent of nurses receive no training on workplace violence, and of those that did, a large number only received awareness training, rather than preventative training.

Texas Nurses Association and the Nursing Legislative Agenda Coalition are working with Rep. Donna Howard to pass HB 1146, which will help protect nurses and other front-line health care providers.

HB 1146 would require facilities to develop a workplace violence prevention policy and plan and include nurses in the process to ensure the plans are based on real-life situations and consider practical solutions. This sweeping reform will require health care workplaces to prioritize the safety of their employees and patients by establishing a committee (or authorizing an existing committee) to develop a plan that includes:

• Training for providers and employees who provide direct patient care.
• A system for responding to and investigating violent or potentially violent incidents.
• Consideration of factors that may increase or decrease incidents of workplace violence.
• Examination of security risks in publicly accessible areas of the facility.

Most healthcare organizations already have safety committees, and hospitals are required to have nurse staffing committees, so violence prevention planning can easily be incorporated into this existing structure. Workplace violence prevention training programs are widely available, including free online trainings offered by the Occupational Safety and Health Administration, so access and cost of resources should not be a barrier.

Our lawmakers have already shown interest in this issue with a 2017 bill establishing a grant program for organizations to implement violence prevention programs. This bill would be the most comprehensive step yet to address the issue for all workers in all types of facilities. We ask Texas health care workers to urge their lawmakers to support this bill to prevent workplace violence in Texas.

"Every day should bring a sense of urgency. Because each day makes an impact on someone's health." - Dr. Wakefield

Monday, Feb. 18, over 400 nurses came together at the Sheraton Austin to kick off 2019 Nurse Day at the Capitol. The first speaker, Dr. Mary Wakefield, brought home the influence of policy on nursing and how nurses can influence policy. Access to health care is often at the forefront of health discussions, including nurse policy. From getting legislators to expand access to Medicare and lift advanced practice nursing restrictions, nurses can use their knowledge to educate and advocate for patients.

Wakefield spoke to the importance of data in spurring policy change. Emphasizing the importance of access to healthcare, Wakefield shared the positive patient outcomes resulting from Medicaid expansion and the negative effect from rural hospital closures.   

She closed by emphasizing and that nurses in clinical settings or community health settings can’t do much on their own.

“Nurses engaging in policy is a necessity,” Wakefield said. “Your making contact about health challenges people face and the potential solutions to those problems can make a difference. Own your voice. Own your expertise. And feel confident in sharing it.”

Following Wakefield, Dr. John Hellerstedt from Texas Department of State Health Services discussed the role the state agency plays in tracking mumps, improving maternal and infant health, and providing emergency response support, such as during Hurricane Harvey. Texas has a very large rural population, and one of the biggest challenges is the border region.

“It’s a very dynamic area of the state. Pretty much any health outcome you might think of doesn’t fare as well in the border communities as it does in the rest of the state,” he said.

Maternal mortality and morbidity is also a large focus at the state level. After a report suggested the rate of maternal mortality had jumped in Texas, DSHS investigated the new electronic system that doctors used to report deaths and realized the numbers were about half that. However, state officials still wanted to do better and developed Texas AIM bundles to reduce deaths associated with pregnancy and delivery.

“The first thing we tackled was maternal hemorrhage,” Hellerstedt said. The AIM bundle supports team-based care, so that signs of excessive blood loss can be aggressively treated. DSHS is also working on opioid use in mothers, maternal hypertension including pre-eclampsia, and community initiatives to address maternal and child health after delivery.

In addition, Hellerstedt covered emerging diseases, vaccinations, newborn screening, tuberculosis and drug-resistant organisms. Across Texas, nurses address these broad health topics through prevention, treatment, reporting and educating.

Ultimately, the services DSHS and nurses provide rely on state funding. Securing funding means emphasizing the importance of public health to state legislators.

To that point, the final speaker of the evening was TNA’s Director of Government Affairs, Andrew Cates. Cates walked all the nurses through the progress already made this session in line with the Texas Nursing Legislative Agenda, and what work was still left to be done. In addition to meeting with legislators on Tuesday, Feb. 19, he encouraged nurses to talk to their legislator on their own, such as calling them to ask for support on an issue.

One big bill to watch out for this session is the APRN Full Practice Authority bill filed by Rep. Stephanie Klick. HB 1792 has 28 co-authors, nearly one-fifth of all Texas Representatives. For some legislators, Tuesday’s visits will be their first chance to learn more about nursing and nurse needs straight from the people affected.

By bringing nurses together in Austin, Nurse Day at the Capitol shows how nurses standing strong together can make a difference in the policy arena. And the work continues long after today as well. 

For many nurses, Monday’s shooting is just another example of the threat of violence they face every day while trying to care for their patients. According to coverage in the Chicago Tribune, Mercy Hospital had emergency plans in place and conducted an active shooter drill just last month. Staff and authorities were able to evacuate the immediate area and barricade behind locked doors.

These plans certainly helped prevent additional injuries and loss of life. However, many workplaces in Texas do not offer the same level of emergency preparedness.

A 2016 study by the Texas Department of State Health Services and the Texas Center for Nursing Workforce Studies shows that nearly half of all nurses will experience physical violence in the course of their careers, and over 40 percent of nurses don’t receive any training on workplace violence. A large number of nurses only received awareness training, rather than preventative training.

To address workplace violence for nurses and other staff at health care facilities, TNA will introduce a bill this spring to amend the Texas Health and Safety Code to include workplace violence prevention. This sweeping reform will require health care workplaces to prioritize the safety of their employees and patients by establishing a committee (or authorizing an existing committee) to develop a plan that includes:

• Training for providers and employees who provide direct patient care.
• A system for responding to and investigating violent or potentially violent incidents.
• Consideration of factors that may increase or decrease incidents of workplace violence.
• Examination of security risks in publicly accessible areas of the facility.

To ensure the plans consider real-world situations and solutions, the committee would need to include a direct care nurse and solicit input from providers and other employees. Employers would need to provide a way for staff to report incidents of workplace violence. Employers would also need to provide for adjustments to their staffing plan in a situation where an employee faces a threat of violence from a patient.

The bill would also mandate that facilities offer post-incident services for any health care worker directly affected by workplace violence, including psychological support.

Longstanding regulations already require hospitals to have safety plans, and 2013 legislation enhanced penalties for assaulting emergency room personnel. Our lawmakers have already shown interest in this issue with a 2017 bill establishing a grant program for organizations to implement violence prevention programs.

This bill would be the most comprehensive step yet to address the issue for all workers in all types of facilities, not just hospitals. We ask all health care workers to urge their lawmakers to support this bill to prevent workplace violence in Texas.

FOR IMMEDIATE RELEASE                                      

June 12, 2017                                                                              

Contact:  Erin Cusak, erin@texasnp.org | Andrew Cates, acates@texasnurses.org

In Case You Missed It

Amarillo Globe-News:

Amarillo VA Nurse Practitioner First in Texas to Get Full Practice Authority

AUSTIN – An Amarillo nurse practitioner with the U.S. Department of Veterans Affairs is the first in Texas to be granted full practice authority.

“Charlene Seale, a certified family nurse practitioner at the Thomas E. Creek VA Medical Center in Amarillo, has been granted full practice authority, allowing her to provide a wider range of care to her patients, which includes making a diagnosis,” according to an article by Lauren Koski in the Amarillo Globe-News (http://amarillo.com/news/local-news/2017-06-07/amarillo-va-nurse-practitioner-first-texas-get-full-practice-authority) .

Texas law currently restricts Advanced Practice Registered Nurses (APRNs) from practicing to the full extent of their education and training. The Department of Defense, U.S. Department of Veterans Affairs and 22 other states grant full-practice authority, and states like New Mexico and Arizona are actively recruiting Texas-trained APRNs, where they face fewer regulatory burdens and lower practice costs.

“For the approximately 23,000 veterans served by the Amarillo VA, privileging NPs will also open more slots for veterans to receive care,” Seale told the Globe-News.

APRNs are registered nurses who have a master or doctorate degree in nursing, passed a national certification exam, and achieved advanced licensure in the state. APRNs include nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists.  Their education and training enable most to offer primary care and diagnose and prescribe medications in states that allow them to practice nursing to the full extent of their degree and experience.

Twenty percent of Texans lack access to a primary care provider, and Texas was recently listed as 51st in the nation – on access to and affordability of – health care by the Commonwealth Fund.  As Texas’s population increases, the growth in new physicians are not keeping up with demand. Medically underserved areas and regions with low-income populations are most negatively impacted by regulations on APRNs. Without access to primary care, patients end up in costly emergency rooms, or with more serious, un-treated illnesses.

A group of more than 21 diverse organizations representing consumers and business, and a broad range of health care stakeholders support granting APRNs full-practice authority. During the 85^th Regular Session, Rep. Stephanie Klick and Sen. Kelly Hancock carried House Bill 1415 and Senate Bill 681, respectively, which would have expanded access to health care by removing outdated and costly regulatory barriers for APRNs.

To read the full article, please visit: http://amarillo.com/news/local-news/2017-06-07/amarillo-va-nurse-practitioner-first-texas-get-full-practice-authority

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The Coalition for Health Care Access is comprised of 21 organizations representing consumers, business, and a broad range of health care stakeholders. Coalition members include AARP, APRN Alliance (Consortium of Texas Certified Nurse-Midwives, Texas Association of Nurse Anesthetists, Texas Clinical Nurse Specialists, Texas Nurse Practitioners, and Texas Nurses Association), Center for Public Policy Priorities, Leading Age Texas, Methodist Healthcare Ministries of South Texas, National Alliance on Mental Illness Texas, Nursing Legislative Agenda Coalition, Physician Assistant Business Alliance of Texas, R Street Institute, Texas Association of Business, Texas Business Leadership Council, Texas Impact, Texas Organization of Rural Community Hospitals, Texas Public Policy Foundation, Texas Silver Haired Legislature and Veterans Deserve Care. Learn more at www.putpatientsfirsttx.org  Twitter: @Patients1stTX #PutPatientsFirstTx

First time a full-practice bill is heard in a Texas legislative committee

(AUSTIN) – Advocates representing consumers, business, and a broad range of health care stakeholders are testifying in Austin today in support of expanding access to primary health care for Texans. House Bill 1415 by Representative Stephanie Klick would remove remaining barriers to full practice by registered nurses with advanced degrees.

“Updating the state’s antiquated practice laws will be a powerful tool to reduce delays in receiving basic health care and lack of access to reliable and affordable care Texans experience today,” said Anne Dunkelberg, associate director of the Center for Public Policy Priorities.  “Nationwide, 22 states and the District of Columbia allow Advance Practice Registered Nurses – or APRNs – full practice and it is time for Texas to learn from their experience.”

APRNs are registered nurses who have a master or doctorate degree in nursing, passed a national certification exam, and achieved advanced licensure in the state. APRNs include nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists.  Their education and training enable most to offer primary care and diagnose and prescribe medications in states that allow them to practice nursing to the full extent of their degree and experience.

“There is a vast and growing body of research showing favorable outcomes and higher satisfaction for patients cared for by APRNs in states that allow full practice,” said Andrew Cates, general counsel and director of government affairs for the Texas Nurses Association and director of the Coalition for Health Care Access.  “Yet Texas still maintains artificial practice barriers that impede access to care for elderly and other vulnerable populations, discourage the pursuit of an APRN career and drive Texas-educated nurses to states without the burdensome regulations.”

The need for more primary health care providers in Texas is stark: Twenty percent of Texans lack access to a primary care provider, and Texas was recently listed as 51st in the nation – on access to and affordability of – health care by the Commonwealth Fund.  As Texas’s population increases, the growth in new physicians are not keeping up with demand.

HB 1415 and its companion, Senate Bill 681 by Senator Kelly Hancock, remove the burden of an unnecessary physician supervision requirement known as a Prescriptive Authority Agreement, end expensive pay-to-play contracts, and eliminate dual regulation of APRNs by the Texas Board of Nursing and the Texas Medical Board.

"Maintaining a requirement for physicians to contract with highly educated advance-degreed registered nurses not only fails to improve patient care it reduces access," said Dr. Deane Waldman, MD MBA and director, Center for Health Care Policy at the Texas Public Policy Foundation. "Research shows that APRNs provide excellent care in independent practice but cannot afford to go where there is no care because of the prohibitive cost they have to pay doctors for a supervisory agreement that does nothing for patients. Removing the Prescriptive Authority Agreement is good for patients. Not only does the evidence prove that point, but so does the number and wide range of organizations supporting this bill.  Patients' access to care comes before physician income.”

The Coalition for Health Care Access is comprised of 21 organizations representing consumers, business, and a broad range of health care stakeholders. Coalition members include AARP, APRN Alliance (Consortium of Texas Certified Nurse-Midwives, Texas Association of Nurse Anesthetists, Texas Clinical Nurse Specialists, Texas Nurse Practitioners, and Texas Nurses Association), Center for Public Policy Priorities, Leading Age Texas, Methodist Healthcare Ministries of South Texas, National Alliance on Mental Illness Texas, Nursing Legislative Agenda Coalition, Physician Assistant Business Alliance of Texas, R Street Institute, Texas Association of Business, Texas Business Leadership Council, Texas Impact, Texas Organization of Rural Community Hospitals, Texas Public Policy Foundation, Texas Silver Haired Legislature and Veterans Deserve Care. Learn more at www.putpatientsfirsttx.org  Twitter: @Patients1stTX #PutPatientsFirstTx