Legislation &@

Nursing cuts 'minimal' in House budget bill H If you're bewildered by the debate over the federal health budget, don't feel alone. Rep Richard Bolling (D-Mo), chairman of the House Rules Committee, quoted in the American Medical News, said the House budget bill passed in early July was "the most remarkably complicated piece of legislation I know of that Congress has ever considered at one time." The nurse training amounts for the next three years are included in this 15-inch document.

The health section of the House bill was battered and scarred in an intense political battle between Democrats and Republicans. Although Democrats have a majority in the House, Republicans had managed to shape the budget to their liking by carefully mastering the process and courting conservative Demo- crats.

Republicans were victorious on the total House budget act. But when the dust cleared on June 26, Democrats had won the health battle. Health programs had fewer cuts than other government programs, and nursing "came out with minimal reductions," the American Nurses' Association (ANA) re- ported.

At first, it seemed that the health section, like the rest of the bill, would go President Reagan's way. Republicans won a vote to have their health package considered on the floor instead of the Democratic version.

But conservative Democrats did not line up with the Republicans on this part of the bill. Not having the votes, the GOP health package went down, and the Democrats' proposals were left standing.

As passed by the House, the totals au- thorized for nursing would be $93.5 million in 1982, $102.5 million in 1983, and $1 12 million in 1984. (The total available this fiscal year after rescissions is $74 million. The President had proposed $15.2 million for 1982).

The Senate health professions bill was still pending in early July. Not part of their budget bill, the education money was being consid- ered separately in Senate Bill 799. The ANA Washington office warned that floor amend- ments might be offered to reduce the au- thorized amount for nursing and other profes- sions.

Conference committees were the next step, with the House and Senate meeting to work out differences between their two budget bills. House and Senate appropriations committees were going to work as well, deciding how much to spend within the budgeted limits.

A nurse who was demoted because she refused to participate in abortions has a right to be compensated, a Florida appeals court ruled in July.

Margaret Kenny refused to participate in abortions at an ambulatory surgery center in Miami in 1976. She was asked to resign and refused. Then she was demoted to part-time status and lost some fringe benefits. She sued.

A district court ruled first that she could be demoted for reasons of fiscal management. The decision could "prevail in an atmosphere of free enterprise and unfettered management process," the judge ruled.

This ruling was overturned on appeal. The appeals court said a Florida law grants hospi- tals, doctors, and nurses the right to refuse to participate in abortions. The judges in their majority opinion said they were not attacking

AORN Journal, September 1981, Vol34, No 3 395

At a July hearing in Los Angeles, nurses at right show their opposition to extended interim permits. At left are pickets favoring the change.

abortion. "We make clear at the outset that questions relating to the right to conduct abor- tions are not at issue here: only the right of an employee to refuse to assist in performing abortions . . . is before the court."

They called on the district court to order her reinstatement and a "determination of the amounts owed her in unpaid wages, damages and for other appropriate relief."

At hearings in June and July, R N s in California vigorously opposed state nursing board proposals to loosen regulations for interim permits and the licensing exam.

Interim permits were the hottest item. The board would extend permits to 24 months-in effect allowing practice as an RN for two years without having demonstrated minimum com- petence through the licensing exam. Per- mitees must be under the supervision of a licensed RN, but the nursing board has made it clear that they view the permit as "a full and unrestricted license."

The hearings were heated, with charges and countercharges flying back and forth between RNs opposing the change and groups who favor the expanded permit. With the largest group of foreign nurses in California, Filipino

organizations are lobbying for the two-year period.

The California Nurses' Association (CNA) and other nursing groups have adamantly de- nounced the proposal. At the July 1 hearing in Los Angeles, CNA President Susan Harris said, "There is a high probability that incompe- tent persons will be allowed to practice under this proposal. Thus the Board is proposing making a mockery of its first duty-protecting the public from incompetent practitioners."

Patricia Patterson Associate editor

396 AORN Journal, September 1981, Vol34, No 3