New Hampshire nurses are caught in ‘buzz saw’ of state’s sunset review .Sunset review has led to dark days for nurses in New Hampshire. The state legisla- ture let the nursing practice act expire July 1, along with authority for the board of nursing, when it could not agree on two versions of a new act. The legislature adjourned June30 and will only meet for a few days in th fall to con- sider budgetary matters. The full session will not meet again until 1983.

The nursing board’s authority continues until April 1982. Unless action is taken this fall, the board will cease to exist at that time. That means there will be no nursing licensure, no accreditation for schools, and no provision for the board’s other functions, such as handling complaints against practitioners.

Sunset review is a relatively new process that state legislatures use to evaluate whether regulatory boards and commissions are necessary. In New Hampshire, review became a “political buzz saw,” said Lois Murphy, RN, executive director of the New Hampshire Nurses’ Association. Some members of the legislature wanted to use the opportunity to reorganize regulatory bodies under one de- partment. The size of the nursing board and its staff would have been reduced.

Advising the legislature, a sunset review commission told the lawmakers they did not believe a separate nursing board was neces- sary because nurses are not “independently employed and not directly responsible to the patient.” Nurses protested, and two versions of the bill emerged. The matter could not be

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resolved before adjournment. Nurses are forming a coalition of individuals

and groups to organize an effort to reinstate the board and the nursing practice act. “This is something everyone thought would never happen,” Murphy said. “Nursing was not or- ganized and lost the initiative.” Only 9% of the state’s nurses belong to the state nurses asso- ciation, and there was no other group to speak for the profession.

“Don’t wait until sunset review happens in your state,” she advised. “Get to know the law. Get to know key legislators. Make sure your testimony is ready.” As New Hampshire nurses have learned, “nursing care and nurs- ing practice issues will be decided in the politi- cal arena.”

Effects are already being felt in schools of nursing, Murphy said. “Parents and students are seriously questioning attending a school that may not have accreditation within a short time.”

If you would like more background on sunset laws and a status report on the states where they are in effect, see the article by Susan J Grobe, RN, in the July American Journal of Nursing. . When all was said and done, President Rea- gan didn’t get as much of what he wanted for his health budget as he did for other programs. House and Senate conference committees worked out acompromise budget in late July. It was the end of a long process, beginning with the President’s recommendations last Feb- ruary. The process of appropriating money within these limits is now underway.

Although not overjoyed about the budget for nursing education, the American Nurses’ As- sociation (ANA) was pleased with final

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amounts that were considerably higher than the President's initial proposal of $1 5.2 million (see box). "One encouraging thing is that we now have a three-year authorization" for 1982, 1983, and 1984, noted Virginia Bauknecht of the ANA Washington office. Recently, nurse training has been funded for one year only. A loss was the capitation grants to schools of nursing. The grants were ended for all the health professions.

On other health budget items, Congress did a cut-and-paste job on Reagan's proposal for block grants to the states. These lump sums were intended to take the place of earmarked federal grants. Reagan had wanted two block grants for health-health services and preven- tive health. In the end, there were four block grants-maternal and child health, preventive health, health services, and community health. Six other programs remain as they are now, categorical programs administered by the fed- eral government. These are family planning, immunization for children, venereal disease, tuberculosis, migrant health, and primary care research and development.

Congress did not go along with the Presi- dent's cap on Medicaid spending. He had wanted to put a cap on the federal share of the program, saying costs could go up no more than 5% in 1982. Instead, Congress favored a percentage reduction in federal payments of 3% in 1982, 4% in 1983, and 4.5% in 1984. States would be entitled to less of a reduction if they met certain criteria.

m Physicians and surgeons have informed the US Department of Health and Human Ser- vices (HHS) that they are opposed to the agency's developing a list of surgical proce- dures that can be safely be performed in an outpatient setting. HHS had published a notice in the federal Register May 22 asking for sug- gestions to be used in setting criteria for ex- panding Medicat%! reimbursement for outpa- tient surgery.

Congress amended the Medicare law last year to encourage use of ambulatory surgery instead of inpatient surgery in appropriate cases. The law says the HHS Secretary, in consultation with others, must develop a list of procedures that can be covered under these new provisions. The American College of Sur- geons (ACS), the American Medical Associa-

Budgeted amounts for nurse education These are the amounts agreed upon by the House and Senate for authorizing federal funding for nursing education in fiscal years 1982, 1983, and 1984. (AH figures are in millions of dollars.)

1982 1983 1984 Capitation 0 0 0 Special projects $10 $10.5 $11 Advanced nurse training $1 4 $1 5 $1 6 Nurse practitioners $12 $13 $14 Trainees hips $10 $10.5 $11 Student loans $14 $16 $18 Financial distress

grants $ 3 $ 2 $ 1

tion (AMA), and other physician groups op- pose the move.

"We agree with ambulatory surgery, but we don't think that surgical judgment can be re- placed,"said Virginia Pitcher of the ACS Wash- ington office. The group was concerned that, with rapid advancements in medicine, such a list would be rapidly outdated.

"It is AMA's view that any such list would be counterproductive," said an editorial in Ameri- can Medical News (July 24). "There is great potential for interference with the decision- making process that takes place between physician and patient." It would be more ap- propriate to develop patient safety criteria, the editorial suggested, considering such factors as the patient's condition, anesthetic risk, and need for preoperative and postoperative care.

M Don't forget AORN's first national legisla- tive seminar Oct 24 and 25 at the Oakbrook Hyatt near Chicago's O'Hare Airport. Write to the Education Department at AORN Head- quarters for details.

Patricia Patterson Associate editor

AORN Journal, October 1981, V o l 3 4 , No 4 615