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The Role of Professional Nursing in the Origin of the Newborns' and Mothers' Health Protection Act of 1996 from a Feminist Perspective, 1981-1996

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The Role of Professional Nursing in the Origin of the Newborns' and Mothers' Health Protection Act of 1996 from a Feminist Perspective, 1981-1996 THE ROLE OF PROFESSIONAL NURSING IN THE ORIGIN OF THE NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT OF 1996 FROM A FEMINIST PERSPECTIVE, 1981-1996 A Dissertation Presented By JAN-LOUISE LEONARD Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment Of the requirements for the degree DOCTOR OF PHILOSOPHY September 2006 Ph.D. Program in Nursing University of Massachusetts Amherst Copyright by Jan-Louise Leonard 2006 All Rights Reserved PROFESSIONAL NURSING’S ROLE IN THE ORIGIN OF THE NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT OF 1996 FROM A FEMINIST PERSPECTIVE, 1981-1996 A Dissertation Presented by JAN-LOUISE LEONARD Approved as to style and content by: _______________________________ Eileen T. Breslin, Chairperson _______________________________ Gail Russell, Member _______________________________ Joyce Berkman, Member ________________________________ Eileen T. Breslin, Dean, School of Nursing DEDICATION To my children, Michael and Mark, who encouraged and took pride in me. And to my parents, who encouraged perseverance in any daunting task. ACKNOWLEDGEMENTS I wish to thank my committee chair, Eileen T. Breslin, for the many years of patience, support, and encouragement in this research project. Her critical questions about the who’s and the why’s in this research made me think about the origins of professional nursing’s input into health care policymaking. I hope this study’s research method serves as a model for other nurses the University of Massachusetts Amherst School of Nursing doctoral program to which they can improve upon. Many thanks also go to Joyce Berkman of the History Department, and a member of my committee. As my methods advisor, I was particularly impressed with her ability to find a missing linkage (1950s’ unionization of nurses) on the path to nursing’s self- determination as a profession. Her depth and breadth of historical knowledge provides an inspiration for all future professors. Gail Russell, a nurse health care policy expert, recalled events in professional nursing that re-directed the course of nursing history. She saw those events as crucial in making linkages with the role of nursing in health care policymaking and the research question. Dr. Linda Kahn-D’Angelo, a dear friend and colleague, is acknowledged for the access she provided to numerous documents and books in my research for this project. I also want to acknowledge the secretarial staff at the School of Nursing for their assistance during this research project, Karen Ayotte and Ann York. v ABSTRACT THE ROLE OF PROFESSIONAL NURSING IN THE ORIGIN OF THE NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT OF 1996 FROM A FEMINIST PERSPECTIVE, 1981-1996 SEPTEMBER 2006 JAN-LOUISE LEONARD, BS, UNIVERSITY OF ROCHESTER MS, BOSTON UNIVERSITY Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Eileen T. Breslin This social historiography tells the story of the origin of the Newborns’ and Mothers’ Health Protection Act of 1996. In the 1980s when the federal government reduced allocations to states’ Medicaid programs as a cost saving measure, hospitals, initiated early discharge of patients to save costs. Given four million births annually, childbirth is the most frequent reason for hospitalization in the United States. Hospitals discharged Medicaid insured mothers and newborns very early at twenty-four hours for a normal birth and seventy-two hours for a cesarean. Other insurers adopted similar managed care strategies in the early 1990s. By 1995, unionized nurses from New Jersey, bolstered by a national outcry against early maternal discharge, and individual states legislative actions, met with staff in Senator Bradley’s (Democrat, NJ) Washington, DC office to request a federal law that would extend hospital length of stays for maternity patients. The result was the creation of the Newborns’ and Mothers’ Health Protection Act of 1996 (Newborn’s Act). Insurers must now reimburse hospitals a minimum length of maternity stay of forty- eight hours for a normal birth and ninety-six hours for a cesarean birth. vi This historical investigation found that a revival occurred in professional nursing organizations’ voice in health care policy. The American Nurses Association, the National Association of Pediatric Nurse Practitioners, and the Association of Women’s Health, Obstetric and Neonatal Nursing, not only testified at the congressional hearing for the Newborn’s bill, but also helped craft the bill that became law. One nursing specialty, Public Health Nursing, at one time a cornerstone for autonomous nursing practice, was omitted from the NMHPA policymaking. As a nursing section of the American Public Health Association, it is now considering options to become more visible in health care policy development. Second, this study suggests that the federal government may have attempted price- fixing when it recommended in 1982, and again in 1983, that other insurers also limit reimbursements to hospitals to contain costs. In one last finding, congressional lawmakers omitted costly Medicaid insured mothers from the NMHPA law, but regulations formulated in 1999 captured this vulnerable group of mothers and newborns. vii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS…………………………………… ..................................... v ABSTRACT……………………………… ..................................................................... vi LIST OF TABLES……………………………… ........................................................ xiii LIST OF FIGURES…………………………................................................................ xiv LIST OF ABBREVIATIONS……………………………… ......................................... xv INTRODUCTION………………………………………………………………………..1 Endnotes……………………………………………………………………………7 CHAPTER 1. STATEMENT OF THE PROBLEM…………………................................................9 Statement of the Problem.........................................................................................9 How Laws are Made in the United States......................................................10 Background of Maternity Length of Stay in the United States .............................11 Position Statements on Maternity Length of Stay .........................................11 Professional Nursing and Maternity LOS..............................................................13 Professional Nursing Defined.........................................................................13 Relevance of Maternity LOS to the Future of Professional Nursing..............15 Ethics in Nursing ............................................................................................16 National Public Health Objectives..................................................................16 Research Questions................................................................................................19 Summary................................................................................................................19 Endnotes.................................................................................................................23 2. REVIEW OF THE LITERATURE ...........................................................................28 Introduction ............................................................................................................28 Research into Maternity Length of Stay.................................................................29 viii Quantitative Research Studies on EMD for Mothers and Newborns..............31 Qualitative Research Studies on EMD for Mothers and Newborns................48 Quantitative Research Studies on Newborn Early Discharge.........................50 Psychosocial Impact of EMD Studies That May Have Been Available to Congress.......................................................................53 Summary …………................................................................................................56 Endnotes …………................................................................................................66 3. METHODOLOGY.....................................................................................................73 Social History and Feminist Theory as Methods...................................................73 The Science and Art of Historical Inquiry.............................................................73 Social History of Maternity LOS .....................................................................75 Sources for Data Collection....................................................................................76 Oral History......................................................................................................76 Primary Data.....................................................................................................77 Secondary Data.................................................................................................78 Trustworthiness, Validity and Reliability.........................................................79 Data Analysis: A Theoretical Framework..............................................................80 Feminist Theory Framework ............................................................................80 Why Use Feminist Critique in This Study .......................................................81 Feminist Research Method...............................................................................82 Summary.................................................................................................................83 Endnotes .................................................................................................................85
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