Empowering Nurses at the Bedside and in Business

Interview with Blayne Miley of ISNA

LAB:   Hey, everybody.  It’s Lorie Brown with empowerednurses.org and today’s special guest is Blayne Miley, Director of Policy and Advocacy for the Indiana State Nurses Association.  Blayne also is an attorney so I’m really excited to be with him because I want him to hear about how nurses can go about making change, how nurses can be active in the legislature and make the necessary laws to protect ourselves and our licenses.  Welcome, Blayne.

BLM:  Thank you, Lorie.  Glad to be here.

LAB:   Before we go on, tell us a little bit about yourself.

BLM:  My role with the Indiana State Nurses Association would be a resource for all nurses interested in advocacy and also to be their advocate in trying to improve health care policies for the betterment of nurses and patients.  A lot of my time is spent sharing information with nurses that is important to know about opportunities to be involved in the policy making process like pending legislation, that they should be reaching out to their legislators on.  And then to collect input from them about what direction we should be trying to push health policies.

LAB:   At the Indiana State Nurses Association we have like a political action committee.  How does that work?

BLM:  There are a number of different ways to try to get our members engaged in the policy making process.  One that you mentioned is the political action committee which does fundraising throughout the year and then decides on campaign contributions that the organization is going to make to the candidates that are running for office.  Additionally, we encourage all of our members as well as any nurse to be actively engaged with their state legislators so they are trying to make sure that they’re sharing their input and their expertise when the legislators are considering a bill that impacts nursing because we often find is a knowledge gap sometimes in certain specialties or areas of health care practice because many in the legislature are not health care professional themselves.  So, they can really benefit from the knowledge and expertise of their constituents or nurses helping to guide them in what’s going to be effective legislation.

LAB:   For those who are not in Indiana, do they have something similar with their state Nurse Association?

BLM:  Yes, there’s going to be a big Nurse Association in every state, all of which are members of the American Nurses Association and there are also specialty organizations for virtually every type of nursing practice: emergency nurses, the advanced practice nursing specialties, oncology.  All of these different subject areas have their own sort of specialty organizations and from state-to-state there’ll be a little bit of variance on how active those organizations are as a whole as well as how active they are in the advocacy sector.  Sometimes it’ll be sort of the State Nurses Association that is really the primary voice of nurses at the legislature and collecting input from individual nurses as well as all these different specialty organizations to try and speak with the voice of all nurses in the state.  There’ll be some variance across all the different states but there are plenty of opportunities for organizational support being more active in policy making regardless where you live.

LAB:   You said that you were the only organization that’s for all nurses because it’s not a specialty organization.

BLM:  The Indiana State Nurses Association represents registered nurses of all levels across any specialty, anyone with an R.N. license.

LAB:   If a nurse has an issue on which they would like to propose legislation, what would you recommend?

BLM:  I would recommend that that nurse first connect with their State Nurses Association or other organization that pertains to the involved specialty just to try to get some initial feedback on their idea for a policy proposal.  There may be some factors that they hadn’t considered that can help them improve the concrete action item.  The general life cycle of any policy change especially with the legislature is the legislator is to be convinced that there is a problem, that the problem is serious enough to require government intervention and that there is an effective developed evidence-based solution for that problem.  So, a nurse who is interested in addressing a problem should work with their State Nurses Association and other organizations and also should be reaching out to their State legislators, specifically the legislators for whom they are constituents to begin advocating for this policy change.

LAB:   What some of the initiatives that you are now working on?

BLM:  Right now, the Indiana State Nurses Association is working on a number of different issues.  We’re in the interim so we are looking forward to 2019 but the Indiana General Assembly currently is not in active session.  We are working our nursing workforce pipeline and trying to have regular State support for some of the schools that can limit our ability to produce enough and educate enough nurses at all levels, to be able to satisfy the growing demand for health care services.  So, we’re working at both the undergraduate and graduate levels, trying to improve State support for nurse faculty because in Indiana that’s one of the primary bottom issues, a lack of faculty.  We have plenty of students who want to be educated to become nurses but we struggle with recruiting and retaining enough faculty to meet that demand.  And then the second issue is that we’ve made a great deal of headway in the last 5 years or so in improving the provider neutrality of Indiana regulation so that nurses of all levels are able to practice to the full extent of their educational experience without arbitrary barriers limiting their practice.  One of the areas we’re still working on is retiring the Collaborative Practice Agreement Requirement for Prescriptive Authority for advanced practice registered nurses in the State of Indiana.

LAB:   What do you think about getting advanced practice nursing being a full practice authority in Indiana?

BLM:  I think it is a matter of when, not if, and it is just going to depend on how quickly we give some of that education back between the health care professionals and the APRNs and their State legislators to be addressed.  Because many legislators are somewhat unfamiliar with the education, training and all of the research about APRN practice.  And it’s also a matter of getting others outside of nursing who stand to benefit greatly from increased access to health care to take a more active role in the advocacy.  So, those are probably the 2 keys I think in making that happen sooner rather than later in the State of Indiana, but I do believe it is a matter of when, not if.

LAB:   I’m speaking at the American Association of Nurse Attorney’s Preconference to Nurse Practitioners on Medical Malpractice and what I have found is that all the studies show that the malpractice is much less against nurse practitioners compared to physicians.

BLM:  Yeah, there is definitely some research demonstrating that retiring the Collaborative Practice Agreement Requirement for Prescriptive Authority does not have any negative effect on patient safety or patient outcomes and only serves to increase the efficiency of our health care system.

LAB:   What about mandatory staffing requirements.

BLM:  Staffing is an issue that we get asked about a lot and is an issue also coming up in a lot of other states. I know Ohio is currently considering legislation to address mandatory overtime and that’s one of the ways that staffing can be addressed from a regulatory perspective.  I know there are a lot of different ideas about how to approach staffing, one of which is a set ratio, which Indiana currently has only for nursing homes, not in a hospital or any other type of setting and those are currently averaged on a weekly basis.  So, I know there’s some interest in putting a little bit more teeth in that mandate so that you don’t have as much variation in the staffing levels across a biweekly period, because we know we have dedicated research indicating that in any setting, better nurse staffing means better patient outcomes.  It is tricky trying to find, OK, how do we design a staffing regulation that allows for flexibility, because obviously the different units are going to have different patient acuity and varying levels.  But the more flexibility and variability there is, the less enforcement there is for the regulations.  That’s a careful balancing act.  Right now for any nurse interested in staffing I would say that the very first thing to do is to look at all of the research out there about how improved staffing leads to better patient outcomes and the American Nurses Association is a great resource for that, and trying to advocate organizationally within their employment for organization to choose to improve staffing levels on their own based on better patient outcomes and better long-term cost savings as an initial first step.  Beyond that, we can look at ways to try and craft regulation that both creates some enforcement to ensure that staffing levels are adequate and that allows for some variability within units and based on the type of patients.

LAB:   It seems to me that they want mandatory staffing, minimum staffing requirements, but they also want mandatory overtime.  And if mandatory staffing requirements improve patient care, but if you have mandatory overtime that probably decreases safety, because the nurse is exhausted.

BLM:  Right!  And I do certainly counsel nurses on occasion who feel like they are caught choosing between their job and their license because the job is requiring them to work hours that are putting them in a physical state of fatigue and that creating a danger to patients’ safety based on how thin they are being stretched, not only from their own hours, but also based on patient load and how many patients they are dealing with.  And, at times, that can lead to that nurse, if their individual organizational advocacy is trying to change that policy within the organization is unsuccessful then they have to choose between their job or their license and what I typically tell them that it is a lot easier to find a new job than it is to deal with disciplinary action on their licenses.

LAB:   That’s exactly what I say: you can always find another job, but you cannot get another license.  I so appreciate everything that you do for the Indiana State Nurses Association and the lobbying that you do for us.  I also really enjoy your weekly newsletter, I got one today.  And I’m very excited for the initiatives, the 2 that are coming out before the ISNA and especially Meredith Addison.  She has put her heart and soul in Regional State Trauma Centers of rural areas.

BLM:  Yes, she is a wonderful advocate for improving trauma preparedness and trauma care.  I really do want to encourage any nurse to take a more active role in advocacy and in shaping health policy, because it really does impact their profession and the patients and we need all nurses to be actively involved to ensure that crafting legislation is moving us in the right direction to improve nursing care and patient safety.

LAB:   That’s wonderful.  Blayne, it’s just been a pleasure talking with you.  Thank you for sharing your expertise with our nurses.

BLM:  Glad to be here.  I always will do everything I can to help be a resource for Indiana’s nurses. and all nurses.

LAB:   And all nurse.  Thank you.

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