C159: POLI WGU 159C159 edited Final 10 - 5.docx

C159: POLI WGU 159C159 edited Final 10 - 5.docx Policy Proposal Topic Title Connie Gulick Western Governors University C159: Policy, Politics, And Global Health Trends September 28, 2019 Policy Proposal Registered ...

C159: POLI WGU 159C159 edited Final 10 - 5.docx Policy Proposal Topic Title Connie Gulick Western Governors University C159: Policy, Politics, And Global Health Trends September 28, 2019 Policy Proposal Registered Nurse Safe Staffing The importance of sufficient nurse staffing in hospitals is widely known. For years the nursing profession has been fighting for safer staffing policies. The purpose of this paper is to explore how policy, politics, and global health trends affect the quality of care a person receives. The survey of current policy and trends serves as an assessment and a thorough analysis of a policy proposal, how to garner support, the financial implications, and how health care policies impact healthcare organizations and healthcare workers. This writer focuses on safe staffing through nurse staffing legislation in the acute care setting. A1. Public Policy Issue The public policy I have chosen to explore and discuss is Colorado's lack of legislation regarding nurse-to-patient ratios and adoption of the Registered Nurse Safe Staffing Act. The Safe Staffing for Nurse Patient Safety Act of 2018 legislation requires Medicare-participating hospitals to form committees with at least fifty-five percent of the members to be direct care nurses (Congress.gov n.d.). The composition of the group to include at least one nurse from each specialty unit. The committee's purpose is to create and implement unit specific nurse-to-patient ratio staffing plans. The adoption of unit-specific nurse-to-patient ratios would maintain staffing flexibility through the accounting for the acuity of patients, the number of admissions and discharges during a shift, the level of nursing staff experience, and availability of resources. A1a. Issue Selection Colorado currently has no existing state law, which supports nurses and safe staffing. The adoption of such legislation, whether on the state or federal level, would create a culture of safety and empower nurses to be direct participants in how they ensure patient safety and quality of care. Federal regulation has been in place (42CFR 482.23(b)) that requires Medicare-certified hospitals "have adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel to provide nursing care to all patients as needed" (American Nurses Association [ANA], n.d.-a). The terminology is ambiguous and leaves what is considered adequate staffing open to interpretation by hospital administrators. Without a state or national law, nurses will continue to face unsafe working conditions. Nurse-to-patient ratios have long been associated with higher rates of negative patient outcomes and nurse burnout. In the past, countless safe staffing bills have been presented to Congress but have failed to pass the committee. In 2018 the newest safe nurse staffing bills were introduced to the U.S. Congress. The bill (H.R.5025 and S.2446) has a provision that provides nurses with a place at the table and to have a say in what they believe is safe staffing. In 2007 Senator Lois Tochtrop, a registered nurse, sponsored SB10 a bill to require Colorado’s hospitals to develop and implement staffing plans and disclose nurse-to-patient staffing ratios to the public (The Denver Post. January 31, 2007). The bill has not yet passed and was postponed indefinitely by the Senate Health and Human Services Committee. Further review of previous legislation on safe staffing revealed most of the legislation introduced to the Congress and the Senate has yet to become a law and are languishing on the docket. California is the only state to have a safe patient ratio law. The California Nurses Association lobbied for the law for thirteen years. When the bill passed, the hope was that it would lead the way for other states to adopt similar laws. Unfortunately, other states have yet to follow suit. A1b. Issue Relevance The ANA contends that ensuring adequate staffing levels has been shown to reduced medical and medication errors, decrease patient complications, and mortality. From a nursing satisfaction perspective, safe staffing reduces nurse fatigue, burnout, and improved job satisfaction and retention (ANA, n.d.-a). Linda Aiken is a nurse researcher who has pioneered evidence-based research showing the importance of nurses caring for fewer patients. Since the 2002 study by Aiken and colleagues linking nurse staffing with patient mortality rates, nurse burnout, and job dissatisfaction there has been a watershed of studies to confirm what direct care nurses already know, nurse staffing affects patient care (Aiken, L., Clarke, S., Sloane, D., Sochalski, J., & Silber, J. H., 2002). In a 2018 cross-sectional study, nurse staffing and missed nursing care were associated with increased mortality rates. An increase in workload by one patient An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% and 16% increase in the odds of a patient dying within 30 days of admission (Ball, J., Bruyneel, L., Aiken, L., Sermeus, W., Sloane, D., Rafferty, A. M., . . . RN4Cast Consortium, 2018). Another study links the nurse work environment with survival rates of in-hospital cardiac arrest patients (IHCA). The cross-sectional study used data from 75 hospitals in 4 states. The results revealed each additional patient per nurse on medical-surgical units was associated with a five percent lower likelihood of surviving an IHCA to discharge. Additionally, poor work environments decreased the odds of survival of an IHCA by sixteen percent compared to patients cared for in better work environments (McHugh, M., Rochman, M., Sloane, D., Berg, R., Mancini, M., Nadkami, V., . . . American Heart Association's Get With the Guidelines Resuscitation Investigators, 2016). The studies support the large body of literature suggesting patient outcomes are improved when nurses have a reduced nurse-to-patient ratio.