Exposing Current Flaws in Policy, Profssionalism, Leadership and Management Regarding Safestaffing in the Implementation of the Affordable Care Act

I am a Nursing Student at the University of Massachusetts Boston and a resident of Roxbury. The purpose of this memo is to propose a healthcare policy on adequate nurse staffing levels. The State of Massachusetts is highly understaffed a situation which requires immediate measures to correct this disarray (MNA, 2017). The policy will involve an audit in all the public hospitals in Massachusetts this will help determine the number of nurses needed. This policy should be implemented as it will offer a solution to the long-term problem of limited nurses in health centers to a surplus of patients. Research indicates that nurses are essential for quality healthcare for both private and public health centers. Adequate nurse staffing levels are critical

Mandatory nurse-patient ratios have been a controversial topic facing nurses for decades. Nurses, patients, physicians, nursing organizations, researchers, hospitals, federal government, and state governments have opposing views in regard to mandatory nurse-patient ratios. Those that support the idea of mandatory nurse-patient ratios believe that there would be an improvement in quality of patient care, decreased nursing shortages, increased job satisfaction, decreased client hospitalization, and increased nurse recruitment (Pamela Tevington, 2012). Groups that oppose mandatory nurse-patient ratios believe that mandatory staffing laws ignore factors such as the level of care a patient requires from a nurse, treatments, length of hospitalization, improvements and differences in technology, the expense of an increased nursing staff, and nurse experience and education (Tevington, 2012).

Primarily, it is crucial for health care organizations to focus on ensuring safe and quality patient care, as well as improved job satisfaction by enforcing an optimal and adequate nurse-to-patient ratio and creating innovative and long-term strategies through a collaborative effort. In order to ensure the safety of patients and nurses, state-mandated safe-staffing ratios are necessary. Adequate nurse staffing is key to patient care and nurse retention, while inadequate staffing puts patients at risk and drives nurses from their profession. As baby boomers age and the demand for health care services grows, staffing problems will only intensify. Consequently, safe-staffing ratios have become such an ever-pressing concern. In 2004, California became the first state to implement minimum nurse-to-patient staffing ratios, designed to improve patient care and nurse retention. Subsequent studies show that California’s program measurably improved patient care and nurse retention.

If we know that adequate staffing levels will improve patient outcomes, how do we get there? Are mandated patient-to-nurse ratios the answer? The people of the state of California thought so in 2004, with the passage of Bill

In 2011, nurses from El Paso became upset due to the low nurse staffing in hospitals. To raise awareness of this issue, these nurses protested outside of Las Palmas hospital. The shortage of nurses in hospitals results in the patients-to-one-nurse ratio to increase. The issue of too many patients to one nurse causes nurses to become exhausted, and also patient mortality to increase due to poor care. Hospitals believe in saving money for other things rather than hiring more nurses to solve this problem. Although, hospitals from California had the same issue, Californian nurses took action to resolve the nurse staffing issue. Eventually, the state of California passed a Nurse to Patient Ratio Law in 1999, which provided a solution to the nurse staffing issue. Therefore, this issue in El Paso can be resolved if nurses follow the same footsteps as the nurses from California.

The Registered Nurse Safe Staffing Act of 2015 (H.R. 2083) was introduced by Senator Lois Capps to amend title XVIII of the Social Security Act to provide patient protection by establishing safe nurse staffing levels. It proposes a balanced approach to ensure adequate RN staffing. It ascertains that direct care nurses, working closely with managers, are best equipped to determine the staffing level for the patients on their units. Higher patient loads put patients at risk for longer hospital stays, increased infections, avoidable medication errors, falls, injuries and even death. The Act considers RN educational preparation, professional certification and level of clinical experience, the number and capacity of available health care personnel, and the geography of a unit including available technology in relation to patient

Nursing staff may be limited, and therefore could reflect poorly on patient care. With nursing staff shortages, client cares are being missed. With patient cares not being completed thoroughly, this can lead to dimmer patient outcomes. Does staffing really play that big of a role in how a patient’s outcome is determined? I will discuss some of the findings in the article and how they correlate to the patient’s response to treatment. I will show that the study suggests that staffing may have a direct result on patient outcomes. I will also discuss how I think that this will help me as I further my career in the nursing field.

The 1990s saw a positive improvement in restructuring the hospital environment and staffing. California has adopted a law that mandates nurse-to-patient ratios in the acute care setting. We propose that that a standardized nurse-patient ratio should be adopted in the state of Texas. This would help with help ameliorate some of the issues our state is facing today. The proposed idea would decrease the expenses that come with increased healthcare mistakes, nurse burnout rates, and the increased risk of malpractice lawsuits. Standardized nurse-patient ratios would affect nursing practice, healthcare delivery, and healthcare consumers positively and in ethical manner. Tevington (2011), stated that mandated nurse-patient ratios, would

The broad research problem leading to this study is the belief that nursing shortage in facilities leads to patient safety issues. The review of available literature on this topic shows strong evidence that lower nurse staffing levels in hospitals are associated with worse patient outcomes. Some of these outcomes include very high patient to nurse ratio, fatigue for nurses leading to costly medical mistakes, social environment, nursing staff attrition from the most affected facilities. The study specifically attempts to find a way to understand how nurse

The patient problems of safety and quality care are applicable across the health care continuum. In a report released by the International Council of Nurses (2013) results from several research articles in support of the purpose for your proposed project are summarized. For example; in a multi-year study “increased workload, and unstable nursing unit environments were linked to negative patient outcomes including falls and medication errors …” (Duffield et al., 2011, p. 244). Specifically, researcher found “Lower levels of RN staffing are associated with higher rates of OPSN—urinary tract infections, pneumonia, shock and cardiac arrest, upper gastrointestinal (GI) bleeding, failure to rescue—and

According to an article by Stacy Burling about a new University of Pennsylvania study finding that the lives of hundreds of surgical patients could be saved if hospitals in Pennsylvania and New Jersey followed the minimum nurses staffing ratios that have been required in California since 2014. The study also showed that nurses in California where staffing was better liked their jobs more and felt less burned out because of it as well. The article tells that given that you’ll have more patients and you don’t want to increase (nursing) ratios, the only way you’re going to do that is with more personnel . . . But finding them is not easy. With an average age of a nurse being 48-55 years, it’s going to be much more

Allen, D. (2013). Evidence shows that staff ratios can work. Nursing Standard. Retrieved 2016, from http://www.24activ.com/tickets/scp/public_attachment.php?id=25635

Low nursing staffing levels and the steady influx of patients, related to negative patient outcomes have always been an ongoing issue within the nursing field. Nurse unions nationwide have gathered for years for congress to propose a mandate minimal nurse to patient ratios as they have passed the law in California. With the increase in patients and the continuum of inadequate staffing causes the concern for severity of illnesses, hospital acquired infections, patient safety, job dissatisfaction, medication errors and even patient mortality. The biggest challenge with imposing this law causes the increase and overall cost of care and does not guarantee an improvement in quality, with positive patient care outcomes. Nonetheless, to low patient to nurse ratios are important. A nurse that is treating 6 or more patients lowers the ability for the nurse to properly, assess, diagnosis, implement, educate, and evaluate the patient while in an impatient setting. A disproportionate amount of patients to nurses causes the likelihood of patients being readmitted back into the hospital 30 days or earlier with the same prognosis or worst.

A changing economy and dwindling finances in the United States have created a challenge for healthcare funding, thus creating the need for amendments to the original Public Health Service Act (Public Health Reports, 1994). The proposed National Nursing Shortage Reform and Patient Advocacy Act (§ 864, 2015-2016) mandates that nurse staffing requirements will be sent to the Department of Health and Human Services (HHS) to guarantee minimum nurse/patient ratios. The proposed legislation gives precise numbers for nurse/patient ratios. Examples for direct care registered nurses include: one direct care registered nurse for every patient in an emergency trauma unit; one registered nurse for every two patients in critical care and intensive care units; one registered nurse for every three patients in the emergency room and telemetry units; one registered nurse for every four patients in intermediate care units and psychiatry units; one registered nurse for every five patients in rehabilitation units; etc. (§ 864, 2015-2016). Not only are nurse-to-patient ratios addressed, differentiation is made between ratios acceptable for registered nurses versus licensed practical nurses. Bill § 864 gives precise allowable ratios for licensed practical nurses. The bill also mandates exact numbers of nurse-to-patients ratios that are to be used and stipulates that averaging by hospitals is prohibited. Moreover, if persons requiring extra staffing are Medicare eligible, it will be the

The healthcare profession is a rewarding though equally challenging career. The challenges often persist due to the absence of universal legislations addressing significant issues in the profession. One of these problems is the understaffing of nursing professionals. Inadequate staffing often leads to increased job loads on the few existing employees, thus perpetuating the likelihood of decreased quality in patient care, possibly resulting in unfavorable patient outcomes. The best approach to solving such a problem is the adaptation of legislations, which would effectively authorize fixed nurse-to-patient ratios to ensure adequate staffing. In addition, private health care institutions must also ensure that they employ enough health practitioners, especially nurses to help address the concerns of understaffing.