Registered nurse Dorothea Meinecke brought the voice of experience to a state budget hearing this month.

Meinecke was the only health professional working directly in the field to testify at the hearing of the Joint Senate/Assembly budget-making committee.

Foremost on her mind is the need to recruit and retain qualified health care professionals to deal with a critical shortage, safe nurse-to-patient staffing ratios, passage of a school-nurse bill to meet changing needs of student care, and more funding for home health care and visiting nurses.

Meinecke, chairwoman of the Federation of Nurses and Health Professionals/New York State United Teachers Advisory Committee, praised the passage of the Health Care Reform Act of 2002, which provides $1.8 billion over a three-year period to hire and keep non-supervisory health care personnel. However, she said, members are disappointed that the new federal law does not provide direct funds for home health care workers or registered professional school-based nurses.

Working conditions

"It fails to give financial support for recruitment and retention of visiting nurses and other home health care professionals delivering skilled care," Meinecke said. "Visiting nurses and home health care professionals need financial support to assist with improving their working conditions."

Low pay, poor working conditions and problems with administrative rules all contribute to stress in the workplace.

Meinecke suggested that the state establish incentive programs, such as a reward system for nurses and other health care professionals who stay within their field; scholarships for health care workers to upgrade their skills; and loan-forgiveness programs for professionals going into nursing or other health professions.

School nurses

On school grounds, nurses face different challenges. Meinecke, a member of the United Federation of Teachers who is a nurse at Lutheran Hospital in Brooklyn, painted a picture for the members of the hearing committee: "The registered school nurse is often the primary care provider for school-age children, especially in areas of the state with high proportions of uninsured families. Today's registered professional school nurse interacts with students confronting problems such as drug and alcohol abuse, eating disorders, suicide, pregnancy and AIDS."

Duties can now include caring for medically fragile students needing catheterization, gastrostomy feeding, blood glucose monitoring, mechanical ventilation, suctioning and tracheostomy care.

Similar to conditions in hospitals and in the home health care profession, school-nurse staff ratios have not kept pace with the exponential growth in the number of children with special medical needs, Meinecke said. She urged passage of the "School Nurses in Attendance" legislation which would require each district to have a duly registered nurse on staff in each building when medically fragile students are in attendance, or when students are at major risk of injury.

Meinecke also argued for adequate staff at hospitals, including the elimination of mandatory overtime.

"Inadequate or marginal staffing levels can lead to higher mortality rates, increased risk of injury to both patient and staff, as well as increased use of both inpatient and outpatient facilities," Meinecke said. "As a result of pressure to cut costs and the shortage of qualified health care professionals, many facilities are decreasing the number of registered and licensed practical nurses on staff."

It should be a crime for an unlicensed person to perform nursing duties in lieu of a registered nurse, Meinecke said. Furthermore, funding should be provided to the state Department of Health to adopt written procedures for training, orienting and continuing education to nursing staff.

- Liza Frenette

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