Maryland Emergency Nurses Association

Governmental Affairs

The Maryland car seat law is changing for better injury prevention for children effective June 30, 2008.

Maryland's car seat law will change effective June 30, 2008!

Children must be 8 years old before they are allowed to be restrained in a vehicle seat belt (without their car seat restraint) UNLESS they are over 4'9" tall or more than 65 pounds.

There is no longer an exemption for out of state vehicles.

Now Maryland's law will match the “8 year old” age that all the surrounding states (VA, DC, DE, NJ, PA, NC, WV) have had for awhile.

Click here for more information.

Victory in Maryland as New Booster Seat Bill in Maryland Passes

April 2008

The Booster Seat Bill, SB 789, requiring children to ride in car seats/booster seats through age 7, passed thanks to many of you who contacted your legislators and to our special injury prevention advocates for children and ENA-

Emilie Crown

Tamra White

Cyndy Wright-Johnson

We won one for the children of Maryland !

Maryland Emergency Nurses and Maryland ENA should be proud.
We also would like to extend our thanks to our colleagues at the American Trauma Society, Safe Kids and everyone else for their hard work. It's great to work with such a team.

Mary Alice Vanhoy
MD State ENA President

In cooperation with Advocates for Highway and Auto Safety, American College Emergency Physicians (ACEP) and many other agencies, the Maryland Emergency Nurses Association (MD ENA) overcame the last hurdle for the child booster seat bill, with the Senate passing a vote of 38 to 9. The bill was adopted in the Maryland House by a nearly unanimous vote. The Senate took up the measure late in the evening after the House had added an amendment to restore key provisions extending the law to children through age 7 and including a height and weight restriction. We now await the bill to be signed into law by Governor O’Malley, which he is expected to do.

Jackie Gillan, the legislative Manager for Advocates for Highway and Auto Safety, sent this note to MD ENA Government Affairs Chair, “We are grateful for the tremendous leadership of our sponsors Del. Bill Bronrott and Sen. Jenny Forehand. Del. Bronrott is a master political strategist. During this past week and particularly throughout the last 72 hours, he was working furiously with legislative leaders from both chambers to get the compromise amendment included in the House version and to ensure this bill was not abandoned when it became controversial.

Needless to say, this tremendous and miraculous victory is the result of all of your hard work, your untiring dedication to child safety and your relentless efforts to make calls, use your contacts, send emails to Maryland legislators and alerts to your colleagues every time you were asked. As the clock was ticking and the end of the session became our biggest challenge, it was your calls and contacts throughout the final days and hours that made the difference. Thank you and please know you were an essential part of this victory.”

Maryland’s Emergency Nurses Association (MD ENA) Government Affairs committee has been more re-active rather than actively seeking out legislation. This year begins a new turn of action as Maryland’s ENA grows politically active. After attending the Government Affairs workshop last year, I realized just important that nurses be involved with the making of the laws that affect us and how we practice medicine. We have to be politically alert and active, educating our legislators to the medical ramifications of the bills they pass. Our first initiative this year started off with success of combined efforts from all our members with emails, faxes and legislative visits to educate our elected officials.

MD ENA has represented ENA by testifying on the Helmet Repeal Bill and the Child Booster Seat Bill, this year. Tamra White, RN, Emilie Crown, RN, and Cyndi Wright-Johnson, RN were given the opportunity to testify before the Annapolis legislators. Besides being given support from our MD members, the Tennessee ENA, Beth Broering, RN, happily handed over all her research to assist Maryland from losing their helmet law. This type of cooperation and dedication to “fight the good fight”, between members, states and the use of national ENA to connect the experts is what makes nurses strong. We might not know all the answers, but we know how to get them! We have strength and power in our numbers and our knowledge.

This maybe the first time you have heard about Maryland’s political activity, but be sure, this will not be the last. Not everyone has the time to lobby our legislators, but we have to make time to write an email to our legislators. They do not have the medical knowledge or experience that you do. You have so much to offer, whether you are a first year nurse or a seasoned expert in a specialty field. Thankfully, we have our association to ties us together to make our society better. Look to your government affairs committee and 411program, we have to stay political active for the betterment of our patients lives and ours.

Tamra White, RN

Maryland Emergency Nurses Association

Government Affairs Chair 2008

President 2006, 2007

Maryland ENA Mobilizes for Alcopop Bill

On April 24^th, Tamra White met with Governor O’Malley at his request after he received the following letter:

Dear Governor O'Malley,

Maryland Emergency Nurses Association and its 800 members would like give support to a VETO of the alcopops bill. We would like very much for Governor O' Malley not to sign this bill into law. We do not need any more influence for underage children to be enticed to drink alcohol. Our 800 Emergency Nurses do not want to see underage teenagers increasing the alcohol abuse and drunken driving problem our state faces. Please do not make it easier for underage drinkers by making these flavored malt beverages cheaper and easier for them to buy. These are distilled spirits and should be treated as such.

I understand that the liquor industry has a strong lobby interests and are very generous with their political donations. Do not let the special interest group of the liquor industry influence your decision to make Maryland a safer place. Common sense tells you that the target audience, teen underage drinkers, will have tragic consequences. I have seen too many teenagers drink and drive with fatal outcomes.

One night a few years ago, two sisters aged 13 and 15, from Urbana, MD were involved in a vehicular crash. The 15 year old was so drunk; she had her sister drive home from the party. Neither were old enough to drive, but took their parents second car when they were at a dinner party. The 15 year old was flown to shock trauma and lived. The 13 year old had sustained such major head injuries that she was placed on a respirator until her parents could say good bye, after the doctor's determined that she was brain dead.

Being an Emergency Department nurse, I see tragedy every shift. When I teach high schoolers about drinking and driving, I tell them about the sisters from Urbana. This night scarred me for life. When the father came into the room with his daughter, tears streamed down his face. I thought he was going to be angry with her for driving and drinking. He leaned over and kissed her. He said, "I thought I would have more time with you, more time to teach you from doing something like this. I just needed more time." The sister that survived has never fully recovered. She dropped out of school and has been through rehab all before the ripe old age of 16.

Please do not let another father say good bye to his daughter. These teenagers do not need to get alcoholic drinks any easier or cheapert. Veto this ALCOPOPS bill.

Sincerely yours,

Tamra White, RN

Maryland Emergency Nurses Association

Government Affairs Chair 2008

President 2006, 2007

Fortunately, it was also “take your daughter to work with you” day so Tamra took her daughter with her as she wanted her to see her mother at work for Maryland ENA and the children. It is the governor, Tamra’s daughter and Tamra you see pictured below.

The next day, the Baltimore Sun ran an article noting that the day after Gov. O’Malley announced he would “sign a bill ensuring that “alcopops” would continue to be taxed and distributed the same way as beer”.

‘The advocates, who had spent the past three months arguing that the bill would make it easier for teens to get fruity drinks such as Mike's Hard Lemonade, sprang into action. Within hours, the national leader of Mothers Against Drunk Driving was on a plane from Dallas for a meeting with the governor, activists and two Marylanders whose children were killed by drunken drivers. Additionally, the Maryland Association of County Health Officials, representatives of Advocates for Highway and Auto Safety and the Maryland Emergency Nurses Association were present.

By the time the governor emerged, he "had a lot to think about," he said, and he decided to shelve the bill. O'Malley said yesterday that he wanted to consider the extent to which the drinks are "gateway" alcoholic beverages for teenagers, a contention the manufacturers deny.’

Update On Alcopops Bill

Sadly, the bill passed without Gov. Malley’s signature. Click here to learn more.

Wakefield Act Passes the House

April 2008

The U.S. House of Representatives passed H.R. 2464, the Wakefield Act, a bill to reauthorize the Emergency Medical Services for Children (EMSC) program. The bill passed by an overwhelming margin, 390-1, with 40 Members not voting.

The bill's author -- Representative Jim Matheson (D-UT) -- delivered excellent remarks on the House floor and mentioned ENA''''s support of the legislation. Representative Earl Pomeroy (D-ND) delivered a moving tribute to his constituents, the Wakefield family, for whom the bill is named. No one spoke in opposition. This strong vote for passage sends clear messages to both the Senate and the White House that the program has the full support of the House. As a result, we are hopeful that the Senate will act speedily upon the bill and that it can move on to the White House.

The corresponding bill in the Senate is S. 60 introduced by Senator Daniel Inouye (D-HI) on January 4, 2007. The current Senate co-sponsors are:

Akaka, Daniel K. [HI]
Boxer, Barbara [CA]
Brown, Sherrod [OH]
Clinton, Hillary Rodham [NY]
Conrad, Kent [ND]
Dodd, Christopher J. [CT]
Dorgan, Byron L. [ND]
Durbin, Richard [IL]
Hatch, Orrin G. [UT]
Kennedy, Edward M. [MA]
Landrieu, Mary L. [LA]
Sanders, Bernard [VT]

To move this bill to the Senate Floor, it is critical that we get more Senators to co-sponsor S. 60.

ACTION REQUIRED: PLEASE FAX, CALL, OR E-MAIL YOUR SENATORS TODAY ASKING HIM/HER TO SIGN ONTO S. 60 AS A COSPONSOR. PERSONALIZE YOUR MESSAGE BY TELLING YOUR SENATORS WHAT THIS BILL MEANS TO YOU, YOUR PATIENTS, AND THE FACILITY IN WHICH YOU WORK.

EN411 Capitol Brief
May 31, 2008

Action Needed on Mental Health Parity Bill
ENA has been working with the Mental Health Liaison Group to enact full mental health parity, and victory is finally within reach. Following the Senate's historic passage of the S.558 by unanimous consent in September, and House passage of H.R.1424 on March 5, informal negotiations commenced to reconcile differences between the two bills. EN411 Key Contacts should contact their Members of Congress by phone, fax, or e-mail to urge the congressional leadership to help conclude negotiations on a mental health parity bill that can pass in both the House and the Senate and become law this year. To view the action alert and template language go to http://capwiz.com/ena/issues/alert/?alertid=11437861&PROCESS=Take+Action.

Advocacy Tip - Establishing a Relationship with the Health LA
As a nurse, you are well aware that the effectiveness of your work often depends on the quality of your relationships with patients and colleagues. So it is true as an EN411 Key Contact. You must develop relationships with legislators and their Health Legislative Assistants (LA) long before you turn to them for an understanding of your point of view on an issue. Strong personal relationships with Health LAs are the best means of influencing legislative decision making. Personal visits, letters, phone calls, faxes, and e-mails also are important, especially when they come from constituents such as EN411 Key Contacts who are well-known, highly regarded, and have gone out of their way to be helpful in a variety of ways in the past. Building relationships takes time and careful effort, but it's the most effective way to shape the thinking of those who decide public policy.

How do you go about building such relationships? In much the same way as you cultivate friendships: by being friendly and personally helpful. "Personally helpful" cannot be emphasized enough. For more information on building relationships with Health LAs, visit the ENA Legislative Action Center at http://www.ena.org/government/Nurse_411/BuildingRelationships.pdf.

Upcoming Town Hall Meetings
Since 2008 is an election year, Senators and Representatives are holding town hall meetings to hear from their constituents. For a list of upcoming Congressional town meetings during June, please click here.

Reporting EN411 Advocacy Activities
EN411 key contacts are urged to report back to ENA's government relations staff about contacts made between you and your legislator and/or the legislator's staff. With the upcoming town hall meetings and the current Action Alerts on the ENA website, reporting your interactions are quick and easy. All you need to do is fill out the Advocacy Activity Form located on ENA's Legislative Action Center (LAC). To access the LAC's EN411 Advocacy Activity Form, visit http://capwiz.com/ena/lrm/feedback.tt.

One Year Moratorium on Administration's Medicaid Regulations Included in Supplemental Spending Bill
The House of Representatives voted on May 15th on the Iraq supplemental spending bill. The third amendment considered by the House added additional domestic funding and included the moratoria on seven Medicaid regulations proposed by the Administration. Before adjourning for the Memorial Day recess, the Senate passed its version of the supplemental spending bill that also included a one-year moratorium on the Medicaid regulations issued by the Department of Health and Human Services (HHS). In addition, a federal judge has blocked a regulation that would reduce Medicaid payments to safety net hospitals, saying that the Bush administration tried to circumvent Congress' intent. The Centers for Medicaid and Medicare Services (CMS) said it is confident that the rule will be upheld.

ENA supports congressional attempts to block the seven Medicaid regulations proposed by the Administration. For more information about ENA's position on the proposed Medicaid regulations, please read the first article in the April 2008 edition of the ENA Washington Update.

Health Care Leaders Discuss Ways to Improve Health Care in New Interview Series
A new interview series, Viewpoints: The Health Care Debate, from the Kaiser Family Foundation features interviews with leaders of organizations representing health care providers, insurers, policymakers, employers, labor unions and consumers sharing their views on shortcomings in the nation's health care system and how it could be improved. In the interviews, health care leaders discuss their priorities for change, including covering some or all of the 47 million uninsured Americans, reducing health care costs, improving access to care, enhancing the quality of health care and changing the tax structure to allow more people to purchase their own insurance. These leaders also share their views on the prospects for change after the 2008 election and what the next President and Congress should do to make the health system work more efficiently.

Information from the series listed above provides rich opportunities for key contacts. Busy legislators and their health legislative assistants welcome receiving information from experts, especially experts such as their own EN411 key contact. To read the series, please visit http://www.kaisernetwork.org/health_cast/health2008hc.cfm?hc=2599

Major Medication Practice Changes

The Emergency Nurses Association, the American College of Emergency Physicians and the American Academy of Emergency Medicine representing more than 60,000 emergency healthcare providers, sent a letter to The Joint Commission regarding deep concerns over the interpretation of standard MM.3.20 EP1. (Standard MM.3.20 applies when medications are ordered, dispensed or administered.)

The standards interpretation division of the Joint Commission has held that under MM.3.20 EP1:

"Protocols can be initiated by a registered nurse once the protocol is ordered by a licensed independent practitioner. Initiation of a protocol which includes a medical intervention (i.e. decision to administer a medication) requires an order by an independent licensed practitioner. "

It is clear that this interpretation of MM.3.20 EP1 can delay patient treatment, exacerbate crowding, and is an infringement on nursing's scope of practice as well as on the authority of the state boards of nursing to regulate the scope of nursing practice in their respective states.

The letter requests that The Joint Commission immediately reverse its position on nurse initiated protocols in the ED and offers the Joint Commission the opportunity to meet face to face with representatives from each of the signing organizations to discuss the consequences the implementation of this standard causes in the ED.

I encourage all ENA members to read the letter in its entirety so that you can fully understand the issues we face under this interpretation of MM.3.20 EP1.

To see a copy of the letter, go to: http://www.aaem.org/emtopics/NurseInitiatedProtocols.pdf

ENA will continue to monitor this situation and keep all of our members informed.

Sincerely,
Donna Mason, RN, MS, CEN
2007 President, ENA

Sign Up for E-Mail Alerts on Issues Related to Your State

New features have been added to ENA's Legislative Action Center that enable "E-Mail Alerts" to be sent directly to those ENA members who reside in the state or district of the congressional members that we need to target. These alerts provide strategic information to affect key policy issues of interest to ENA and emergency nursing. Go to http://capwiz.com/ena/home/ to sign up for future alerts.

Wanted - A Few Good Nurses
ENA Launches EN411 Program

ENA is establishing the Emergency Nurse 411 Program (EN411) to encourage our members to cultivate long-term relationships with federal legislators, convey ENA’s legislative and regulatory priorities, and affect the final outcome of federal legislation important to emergency nursing. Our goal is to have at least one ENA member in each of the 435 congressional districts across the country, as well as assigned to each of the 100 Senators, to help promote ENA's legislative agenda.

For information regarding the Program and for a copy of the application, go to http://www.ena.org/government/Nurse_411/default.asp.

Prior political advocacy experience is not necessary to join the EN411 Program!