ACNL in Action: Lessons in Nursing Leadership
ACNL in Action: Lessons in Nursing Leadership
New Year, New Legislation w/Pam Allen and Alice Martanegara
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Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. The new year brings a lot of new health care legislation in California, covering a wide variety of topics that range from workplace safety in emergency departments to new regulations for community college nursing programs. To help make sense of it all, we have two members of ACNL's health policy committee joining us today. Pam Allen is the government affairs representative at Redlands Community Hospital, responsible for navigating the increasingly complex policy and regulatory landscape of healthcare legislation in which her facility operates. And Alice Martinagara is the Associate Dean and Director of Nursing for Golden West College, responsible for the leadership and operations of the nursing department and the regional testing center. Hello, Pam and Alice. Welcome to the podcast. Thank you so much for joining us today.
SPEAKER_02Thank you for having us here. Yeah, I'd also like to say the same. Thank you very much, Charlene, for inviting us to this podcast. I'm sure Alice agrees. It's a privilege to be part of this discussion on such an important topic. Healthcare legislation, you know, it's constantly evolving. It's critical that we understand the implications for our patients, our communities, and the professionals working within our hospitals and healthcare systems. I think we're both excited to share our insights on some of the new bills shaping healthcare in California.
SPEAKER_00Yes, absolutely. Thank you both so much. And we have a lot to talk about on that note. And really, when it comes to health policy and healthcare legislation in California, you know, let's start with workplace violence initiatives. And we talked about Assembly Bill 977 during our November ACNL podcast, but we're curious to discuss more about it. And for those who might not have heard the November podcast episode, Cam, can you provide an overview of Assembly Bill 977 and its implications for emergency departments?
SPEAKER_02Yes, I'd be glad to. AB 977, it's known as the Emergency Department Assault and Battery Bill. It establishes that any assault or battery committed against a healthcare worker in the emergency department is punishable by up to one year of imprisonment in a county jail andor a fine not exceeding $2,000. Additionally, emergency departments are required to post a notice stating the threatening or aggressive behavior towards staff will not be tolerated. So really, these acts are considered crimes and could result and may result in a criminal uh conviction.
SPEAKER_00Thank you for that. And in learning more about AB 977, I'm wondering if you could share more about why was that focused solely on the emergency department rather than the entire hospital?
SPEAKER_02I'd be glad to. This was a two-year bill. Similar legislation had been introduced over the past decade, but has been vetoed. Existing laws already address assault and battery against physicians and nurses providing medical care outside of hospital settings, with perpetrators facing up to one year in jail. Similar protections are in place for EMS personnel and lifeguards. While the decision to limit AB 977 to emergency department was very strategic, it was believed that broadening the scope to include all healthcare workers across the entire hospital would reduce the likelihood of the bill at all passing. Although violence in healthcare settings is a significant issue, evidence has suggested that increasing penalties alone may not effectively address the problem. So that said, I would not be surprised if in the coming years we see legislation introduced to extend similar protections to other areas of the hospital.
SPEAKER_00And that makes a lot of sense when we're thinking about, you know, how to strategically and meaningfully spread new initiatives like this, especially for such important initiatives to be in the healthcare setting, which could be quite challenging to change and change practice. And so I'm curious about Assembly Bill 2975 as well, and how will this impact hospital protocols and the use of weapons detection systems? Can you share more about that?
SPEAKER_02I'd be glad to. AB2975 requires hospitals to implement a weapons detection policy by March 1st, 2027. So we do have two years. This policy mandates the use of automated weapons detection devices at specific hospital entrances. This would include the main hospital entrance. It would include the emergency department. And if applicable, it would be a separate maternal child entrance. So those hospitals that have the three entrances, there would need to be a metal detection in each of those entrances.
SPEAKER_00Yes, thank you for sharing that. And I know that this could be a challenge for several healthcare systems. What are the kind of main challenges that you foresee in implementing these measures?
SPEAKER_02Well, there's actually, I think, going to be quite a few challenges as far as accessibility of all individuals. We need to ensure that all of all patients and visitors, including those in wheelchairs, on gurneys, or with mobility aids, can be effectively and respectfully screened through the weapons detection system without causing delays. And you certainly don't want to cause discomforts. There could be also an operational workflow impact where you're incorporating weapons detection into the hospital's daily operations, may lead to longer wait times and entrances, potentially affecting patient flow and visitor access during peak hours. You also have to do staff training and compliance. Stress training need to be able to operate and manage the detection system effectively, while maintaining a welcoming and non-intimidating environment for patients and visitors can, you know, that can be a little challenging. Managing alarms triggered by medically necessary devices like prosthetics or other benign items requires clear protocols to minimize the inconvenience and anxiety for patients and visitors. Also, financially, installing and maintaining advanced detection equipment across designated hospital entrances represents a significant financial investment. You know, additionally, you're ensuring the availability of personnel for consistent monitoring and response as to operational cost. And you also have uh privacy and sensitivity concerns. So you got to be able to balance security measures with the need to respect the privacy and dignity of all individuals, especially in sensitive cases involving patients and families.
SPEAKER_00Yes, uh appreciate that overview. And it does sound like a lot of the challenges are really going to be focused on operations, you know, implementation, finances, staffing. Even if it's just for those specific entrances and specific areas of the EBs or some of these higher acuity areas, it does sound like it could be quite a challenge to implement.
SPEAKER_02So I think it's very helpful that we are all being given two years to be able to implement this legislative bill.
SPEAKER_00Yes, absolutely. And you know, for those who may have missed this in our November podcast, could you tell us what long-term impacts we could expect to see with these laws on hospital safety culture?
SPEAKER_02Well, there definitely is going to be uh several long-term implications for hospital safety culture. I think the first, when I think about this, is enhanced awareness and deterrence. You know, by explicitly criminalizing assault and battery against healthcare workers in emergency departments, AB 977 reinforces a message that violence won't be tolerated. This could lead to a greater sense of security for staff, also empowering them to focus on patient care, which I think is definitely an advantage. We also have a proactive risk management. You know, the installation of these automatic uh weapons detection systems required by AB9 by T975 fosters a proactive approach to managing threats. The presence of these systems at entrances may act as a deterrent to individuals carrying dangerous weapons, which would then reduce the likelihood of violent incidences. I think it will also strengthen our safety culture. I think together these measures emphasize the importance of creating a safety environment for both patient and uh staff. And this can foster a culture where safety is viewed as a shared responsibility and a core hospital value. I know recently we were testing a couple of metal detectors to determine which one our hospital was going to go with. And we were testing at the emergency department. We actually had patients that really appreciated it that we were taking this seriously, and they actually felt safer sitting in our um waiting rooms or lobbies uh with knowing that they felt they felt safer. So I think that really is a win-win for our patients and also for our staff. I think it will I think it will also really help improve um, you know, it just staff retention in morale, because we're addressing workplace violence and prioritizing staff safety. And these laws may contribute to higher job satisfaction, staff retention, particularly in high stress areas like emergency departments. But you know, while these laws aim to improve safety, they also require hospitals to adapt their operations, which may initially strain resources and workflow. So over time, these changes could lead to streamlined processes in a more secure environment.
SPEAKER_00Yes, and there were a lot of great uh insights that you shared there and reflections. I do think it's powerful to see the impact that these bills can have on hospital safety culture in particular. And that goes two ways for the staff and the patients. So really incredible to see that work is being done to get this started. It is a start, right?
SPEAKER_02Even with the challenges. Absolutely. Absolutely. And I think these laws could potentially inspire further legislation action to extend protections to all healthcare workers and expand the use of security measures, you know, throughout hospital campuses.
SPEAKER_00Yes, and it is promising to see that already you have some good feedback from patients and and uh staff too who are looking at these processes and seeing how it can help increase the safety measure. So uh really exciting to hear that. And I do want to talk uh a little bit more too about, you know, speaking of patient safety, there are there's a collection of bills actually that will address the other side of safety policies that include patient safety. And so specifically these are Senate Bill 963, Senate Bill 1385, Assembly Bill 1316, and Assembly Bill 2319. So it's quite a bit to talk about, and we could take it step by step, uh, starting with SB 963, which introduces systems for identifying victims of human trafficking and domestic violence in emergency departments. So I'm curious what role do healthcare workers play in ensuring the success of this initiative in particular?
SPEAKER_02Well, Senate Bill 963 already builds on existing protocols. This bill is requiring, you know, the emergency departments to implement a system that allows patients to self-identify as victims of human trafficking or domestic violence. Well, there's already a requirement to ask every patient if they feel safe where they live. This bill specifically calls for establishment of a system that ensures patient confidentiality, which is incredible, you know, that's really important. It also mandates that a medical personnel conduct a reasonable, prompt, private interview with a patient in a voluntary and sensitive manner. Um, and healthcare workers really play a key role in ensuring the success of this initiative by creating a safe and supportive environment for patients to disclose their experiences without fear of judgment or repercussion. Their training, awareness, and responsiveness are critical in identifying insistent uh victims effectively.
SPEAKER_00Yes, and this bill in particular is really exciting because we know how impactful human trafficking can be in communities that are, you know, all across our country, our state. And we know that healthcare workers do play that important role uh when it comes to addressing those um challenges with their patients. So um so very interesting to see what will come and what will progress from that initiative. And I am also curious about um whether you could explain Senate bill, you know, 1385 and how it ensures ongoing funding for programs like California Bridge.
SPEAKER_02Well, Senate Bill uh 1385 ensures, as you mentioned, ongoing funding for programs like California Bridge because it establishes a billing mechanism for substance use navigators, and we call them sons in the emergency department. So back in 2022, there were nearly 21,000 emergency department visits for related to opioid overdoses, underscoring the ED emergency department as a critical access point for treating substance use disorders. Well, the California Bridge program combines immediate access to medication for addiction treatment with the support of the substance use counselors or navigators in the emergency department. And these navigators play a huge part in screening patients, providing referrals to treatment, ensuring follow-up care and discharge. And their involvement significantly improves patient outcomes by connecting individuals to long-term treatment, reducing the risk of overdose and prompt recovery. So once they're discharged, they usually already have appointments where they can continue on and get the treatment that's needed and sometimes the medication that's needed. The creation of a sustainable funding stream for navigator services through this bill will definitely help to ensure these essential services continue to be available in emergency departments across the state.
SPEAKER_00Yes, and that's huge. It's great to see initiatives that are specifically focusing on these different um populations of our patients in the community. So whether that's victims of human trafficking or whether those are patients who have um challenges with substance abuse. So so very exciting to see that that is in the works. And uh and I'm also, you know, I know there's a lot to talk about too. So I do I do also, you know, speaking of other uh types of emergencies. Uh let's talk about psychiatric emergencies. And I know that Assembly Bill 1316 addresses those types of emergencies. And how will this legislation help hospitals overcome delays in transferring um psychiatric patients?
SPEAKER_02Well, this bill requires Medi-Cal managed care plans to cover hospital and physician emergency department services provided to the Medi-Cal patients with psychiatric emergencies, whether the patient is voluntarily seen or involuntarily detained. You know, Medi-Cal reimbursement rates remain a challenge for hospitals. This legislation really empowers hospitals to promptly transfer patients to inpatient psychiatric care without delays by counties and health plans. This is ensuring quicker access to the specialized care these patients need.
SPEAKER_00Yes, I see. And uh and it's really great to see that this is in place as well. I know that there are challenges, significant challenges that can come when there are psychiatric emergencies, and and it's it could be difficult for hospitals to address these types of challenges. So it sounds like this legislation could really help to uh give hospitals some of those, I guess the initial initial uh resource or or some information for how to overcome the transfer process for these patients. Transitioning to Assembly Bill 2319, can you explain what that assembly bill is and what it means for perinatal care providers?
SPEAKER_02Yes, Charlene, I'd be glad to. This bill 2319 actually expands provisions of the California Dignity and Pregnancy and Childbirth Act. So I think I think what I might do first is just kind of address the why behind this bill. Um, it's really felt, and I think we all can agree that patients, all patients, should receive the best care regardless of their race, their gender, their age, their class, sexual orientation, gender identity, disability, nationality, immigration status, gender expression, or religion. And the United States has the highest maternal mortality. And it's uh with the data, it has shown that women of color, particularly black women, maternal mortality is three to four times higher than white women. 41% of all deaths are preventable, and black women are likely to be miscoded as other deaths. So they feel implicit bias is a key cause that drives health disparities in communities of color. So what this bill is requiring hospitals, outpatient clinic, anyone that interacts with perinatal patients to have implicit bias training to all employees. So if you are working a maternal child, if you're working in the emergency department, you will need to have this training. Um, in addition to that, hospitals will be required to submit proof of compliance to the attorney general in the state of California. Um if there shows that employees have not completed the training, um facility is liable for a fine of $5,000 for the first violation and $15,000 for each subsequent violation. So they are definitely taking this serious.
SPEAKER_00Yes, and and that makes a lot of sense because those statistics were very significant just in terms of yeah, our maternal, our the status of our maternal care in the United States and the outcomes that you had just shared with where we're at there. So it is good to see that that this assembly bill has been in place or it's uh in the queue to support the care that we provide for uh for patients when it comes to their maternal health. And this uh assembly bill is a little bit different from the others because it does include, you know, outpatient clinics, not just emergency departments, but you know, it's inclusive of all of the areas where there are perinatal care providers. So that that is a really interesting focus as well.
SPEAKER_02Agreed. And I just wanted to share too that the initial uh basic training needs to be done uh June 1st, 2025. And there will be a reporting to the Attorney General that starts February of 2026.
SPEAKER_00Yes, great to know. So so definitely down the pipeline for this year, and and definitely uh something that is coming up for in the queue for healthcare systems as they address this assembly bill. And and actually, um Alice, did you want to c comment on that as well?
SPEAKER_01It's it's really the the existing laws, you know, it makes um it's really the existing laws um doesn't really explicitly cover this in such detail, but basically it's really uh facilitating the services towards uh reducing infant mortality and improving the health of mothers and children. And it is for the it currently the existing law allows the Office of Health Equity within the department to serve as a resource for ensuring that the programs collect and keep data and information regarding ethnic and racial health statistics, strategies and programs addressing multicultural health issues, um, but lim not limited to infant and maternal mortality.
SPEAKER_00Yes, it will be it'll be interesting to see how how all of it does play out. I know it's quite a bit that's coming up, so um so really excited to see the focus on patient safety, you know, workplace safety and addressing. Some of these critical populations.
SPEAKER_02You know, just thinking back though, I think the biggest takeaway from all of this is committees are going to be needed to be formed and they're going to need to kind of spread across. So just talking about the last bill we spoke about, which is AB 2319, when a committee needs to form and you need to have maternal child emergency department, who's going to follow up? Because all this implicit training needs to get done and you need to be able to track it. So that's probably the education department, HR. You need to have your outpatient clinics, if you have outpatient clinics that are caring for these perinatal. So, you know, that's just one, you know, one bill that hospitals need to be thinking, and who needs to be at the table, who are the stakeholders involved in each of these bills and make sure that they're sitting around a table discussing.
SPEAKER_00Yes, very important piece of the implementation for these bills is really considering those operations, who would be the appropriate staff to support the implementation and to ensure that it's effective and that it's working as it's intended. Well, I really appreciate that summary and those insights, Pam. And I thank you so much for your expertise there. And I do want to transition to talking a bit about nursing education and academia as well. And so we have a couple of bills that are addressing new regulations for nursing schools, which is very interesting. And to start, we could talk about Assembly Bill 1577, and that aims to address the growing demand for clinical placements in nursing programs. And so turning over to you, Alice, can you explain more about AB 1577?
SPEAKER_01Yes, thanks, Shadeline. Um AB1577, it's um related to health facilities and clinics and clinical placements, and it's a uh uh assembly member low uh bill. And so this bill requires health facilities and clinics to meet with a community college or a California State University with an approved school of nursing upon the college's request and work in good faith to meet the needs of the college's nursing program. And that's including adding additional clinical placement slots to accommodate the nursing program. So, what that means is this requires the hospital or the clinic, if they're unable to provide additional clinical placement slots, to inform the Department of Healthcare access and information for its lack of capability or capacity using a form developed by the department and may be subject to a $1,000 fine for failure to provide the information. The bill would require the health facility or clinic following that meeting to inform the department if it cannot provide additional clinical placement slots no later than the following January or annually on or before each January thereafter. So this was a two-year bill at the time. And the essence is really it requires the health facility or clinic to inform the department of healthcare access and information on its inability and state the reasons why it cannot meet the needs of the California Community College or the California State University for each type of clinical rotation requested, such as obstetrics, pediatrics, among others.
SPEAKER_00And this is a really interesting assembly bill, too, because we know that clinical placement has been a growing challenge in various nursing programs. And is this accounting both undergraduate programs and graduate, or is it focused on one or the other?
SPEAKER_01This is the accounting mostly pre-licensure program, because the pre-licensure program does need the clinical rotations such as pediatrics and obstructrics and mental health, uh, in addition to medical surgical.
SPEAKER_00Right. And it does sound like if these uh pre-licensure programs are not able to meet the requirements, then they do have to report that to the Department of Healthcare Access and to disclose some more information behind that, which would be a big change, I'm guessing, from what a lot of programs have done.
SPEAKER_01Well, it'll it'll be a big change for both the program as well as the hospital and the clinic. So both have are required to report, and they have to define uh regarding as to the rationale regarding why they cannot, you know, provide the clinical placements. And um, there is an administrative uh cost or penalty actually to the health facility uh of $1,000 for failure to provide the information as required.
SPEAKER_00Right. So so definitely a change that's coming on the pipeline for for programs and nursing. It is a very challenging problem. So it is uh it is good to see that there's efforts being made uh through the legislation to address that. Um definitely different things to look out for for healthcare programs who are implementing this.
SPEAKER_01Absolutely. And they also require that the department uh post this on their website.
SPEAKER_00Right. I see that. Yeah. Yeah. I and it'll be interesting to see the outcomes of this if it does, you know, how what that would mean for students. I'm sure that would be huge in terms of the outcomes there. Yes. And shifting gears over to Assembly Bill 2015, can you explain the process by AB 2015 for faculty approval in nursing programs?
SPEAKER_01This is actually a very interesting bill. Um, you know, the bill establishes a process for approved schools of nursing, except for those who are uh actively accredited by an institutional or programmatic accreditation body to recognize by the United States Department of Education to obtain approval from the Board of Nursing to serve as a faculty member, assistant director, or director at any approved pre-licensure nursing program throughout the state. Um, at this time, I it has passed, and this bill is for the BRN to establish the process. That's where we left it at.
SPEAKER_00It's a very interesting assembly bill. And how would you say that this benefits educational institutions and students?
SPEAKER_01Well, it benefits the educational institution in regards to uh finding faculty. Um, you know, so currently, uh when uh faculty apply uh to a nursing program as an instructor, the program is required to request for an approval for faculty to be able to teach in a pre-licensure program. Now, with this process, it's actually the faculty can apply directly to the BRN and uh establish themselves whether or not that they are approved to teach in a specific content. And thereafter, for the other schools, if you are searching for a med search faculty, for example, that person that school can have the advantage of saying, Hey Charlene, um you're approved for medical surgical, I see that on your license. Um would you be interested in teaching in this program as well? This is actually a benefit to address uh faculty shortage, uh, where we are always searching for good faculty in order to serve more students in uh our nursing programs.
SPEAKER_00Got it. So it it can really serve as a almost a validation or verification of expertise for the faculty that are in nursing programs.
SPEAKER_01Yeah, it's almost similar to a teaching credential.
SPEAKER_00Yes, very interesting to see what will come from AB2015. So um really, really a lot that's happening too in nursing education and academia. And and I know in addition to what we've discussed earlier related to patient safety and nursing education, there is also legislation that's still under discussion. And so uh I'm referring to you know Senate Bill 895 and then Assembly Bill 2104. And so, Alice, if you don't mind for those two bills, um, can you explain more? Because they both propose the offering of baccalaureate nursing degree pilot programs in community colleges. And so these bills are really focused on targeting the nursing shortage. Uh, can you explain more about how these initiatives may help to alleviate the nursing shortage in California?
SPEAKER_01Yes, this is a very uh hot topic last year during the legislative uh calendar, uh, especially the Senate Bill uh 895. This is a Roth bill, and what it does is it proposes BSN pilot programs in community college. The bill would require that California Community College Chancellor's Office develop a backlurate of degree in nursing pilot program that authorizes more than 15 community college districts with a priority to districts located in an underserved area to offer a BSN degree. The bill would also require legislative analyst office to conduct an evaluation of the pilot program to determine the effectiveness of the program and the need to continue or expand the program. And um, the reason for the bill, um, I just like to add the author, uh Senator Roth, for decades, California, he mentioned California has suffered from a shortage of registered nurses. And this is a problem that's been exacerbated in recent years due to the pandemic, and it is expected to worsen due to an increase in RN retirement. While nursing shortage is a national program, uh I'm sorry, a national problem is particularly acute here in our state, right, ranking about 40th out of the 50 states. A key factor contributing to this crisis is that California's nursing school capacity has not been able to keep up with the demand. In 2018, more than 85% of hospitals in California reported that the demand of RNs was greater than the available supply, a situation that has not improved. But there is a path forward to help solve some of these problems, and that path cuts right through our California community college. The SB 895 creates a pilot program allowing community college to offer bachelor's degree in nursing, which is increasingly the industry standards and the requirement for employment in many of our hospitals in the state.
SPEAKER_00Thank you for sharing that.
SPEAKER_01Yeah, so it's it's really the SB 895. Uh, you know, currently the three college offer the associate degree program, and this is just an extension to be able to offer the RN2BSN component of it. So then by the time the students graduate, they will have a bachelor's degree where they are able to serve most of the majority of our hospitals here in California.
SPEAKER_00Yes, and and and speaking of the pilot programs too, uh can you share more about AB2104 and that pilot program?
SPEAKER_01So AB2104 is specifically for community colleges, similar to SB 895. And this is by Assemblymember Soria. So the bill would require that the California Community College Chancellor's Office develop a bachelor's degree in nursing pilot that authorizes no more than 15 community colleges to offer a BSM degree. The bill would require also the legislative analyst to conduct an evaluation of the pilot program to determine the effectiveness of the program and the need to continue and expand the program. So these two bills really is quite interesting because we want to hopefully be able to pilot this program and see how these bills can truly alleviate the nursing shortage in California.
SPEAKER_00Yes, it'll be really interesting to see the results of some of these pilots and and what that might mean for the impact on the nursing shortage. So, so very interesting to see all of these uh bills that are underway for 2025 and beyond. And as we wrap up for today, I just wanted to see if there were any final comments that you all wanted to share, just in terms of what healthcare leaders should know. Maybe how can they stay up to date with all of these updates on legislation?
SPEAKER_01You know, interestingly enough, um, you know, to all our members of ACNL, we invite you to uh explore your benefits of being a member of ACNL. We do have a tracker that ACNL has on the website, um, and it is for all members to use. Of course, it has a login. You have to be a member to use this tracker, but it's a wonderful tool for us as members of this uh community, of the state, to keep up with our what's happening as far as legislative bills. There's a lot out there, and um sometimes we are so busy with our practice that we we truly want to provide a tool that it's easy for you to understand and summarize and and be aware and and also raise your voice. Um, you know, you are the experts out there uh in practice and in academics, whether in clinical practice, and I implore for you to use the tools and the benefits of being an ACNL member.
SPEAKER_00Thank you so much, Alice, and and Pam?
SPEAKER_02And you know, Charlene, I just like to echo what Alice had said. I can't say enough great thing things about the tracker. Um there's a lot of manpower that is put into that volunteer hours by uh members of the healthcare uh committee that Alice and I are part of with ACNL. But not only uh do we talk about or do we give updates to the California legislative bills, obviously both assembly and Senate, but we also uh address and we talk about, we update the federal bills, and there's actually quite a few out there. So um if you're it's just a great tool, and it is a you know, a perk of being a member, so definitely take a look at it.
SPEAKER_00Thank you so much, Pam. And thank you both so much for sharing your insights, your expertise. I know that this is a lot of information to take in when it comes to California legislation and what's coming up the pipeline. So truly appreciate you both, and uh thank you both so much for coming in today.
SPEAKER_02Thank you, Charlene.
SPEAKER_00Our guests today were Pam Allen, government affairs representative at Redlands Community Hospital, and Alice Martanagara, uh Associate Dean and Director of Nursing for Golden West College. So we'd love to hear your feedback. Email us at socialmedia atacnl.org and connect with us on LinkedIn and Facebook at ACNLNurse. And as always, if you like the show, please remember to rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes on the first Friday of every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.
