Exam (elaborations) NR 505 HEALTH CARE POLICY; POLICY PRIORITY ISSUE- SAFE STAFFING

Exam (elaborations) NR 505 HEALTH CARE POLICY; POLICY PRIORITY ISSUE- SAFE STAFFING Patient safety is defined as the prevention of harm to patients, and is the number one priority in healthcare facilities. All healthcare facilities have policies in place to keep patients as safe as possible. These policies can include anything from preventing infection to education. Every facility will have different policies in place, thus all patient safety policies will emphasize a culture of safety in a suitable environment. One policy that is of concern is the minimum number of nurses staffed on a unit at any given time, or the nurse to patient ratio. Every state and every healthcare facility has their own nurse to patient ratio. Throughout most of the country, including New York, the nurse to patient ratio is frequently one nurse to seven or eight patients on a medical/surgical unit; this is a high workload and puts a burden on nurses increasing the risk for many things, such as medication and medical errors, infections, falls, and fatigue. Evidencebased research supports the theory that the nurse to patient ratio has a direct impact on patient safety. The policy in place setting the minimum number of nurses staffed on a unit needs to be ratified for the safety of patients, and nurses; policymakers and politicians need to be made aware of the benefits of adequate nurse staffing through evidence- based research. Context Healthcare representatives and nursing managers refuse to lower the nurse to patient ratio, despite the benefits it has on patient safety. The number one reason healthcare representatives and nursing managers refuse to lower the ratio, or even investigate the issue, is because of the cost. In order for healthcare facilities to lower the ratio they would have to hire more nurses, increasing their spending; however, because of the high workload patient safety suffers. Nurses are caring for too many patients at one time, leading to fatigue and medical This study source was downloaded by from CourseH on :00:51 GMT -05:00 This study resource was shared via CourseH POLICY PRIORITY ISSUE- SAFE STAFFING 3 errors. With a high workload nurses will rush to get what needs to be done in the given amount of time, increasing the risk of medical errors, especially when fatigued. The increased workload also gives nurses less time to care for each patient, increasing the risk for falls and infections. In California, after years of fighting, policymakers passed legislation, assembly bill 394, decreasing the nurse to patient ratio to 1:5; this is the only state to have such a law. When this policy went into effect in California stakeholders wanted insight on the impact it would have on healthcare. There have been numerous studies comparing California hospitals to other hospitals around the country, gauging the impact nurse to patient ratios have on patient safety; and the majority of the studies support the idea of a lower ratio with a select few stating there was no conclusive evidence. Goals/options The ultimate goal is to have a policy put in place that will lower the nurse to patient ratio. A policy change will not happen overnight, so even getting policymakers and politicians, as well as healthcare administration and nurse mangers, to look into this issue is a step in the right direction. In order to influence policymaker’s nurses can lobby in their respective states. There is also a nationwide coalition that is fighting for a policy similar to assembly bill 394; all nurses can join this coalition and support them. National Nurses United have put together a national campaign for safe RN-to-patient staffing ratios. Evaluation of options In order to have policymaker’s seriously considering passing nurse staffing legislation they have to be made aware that it is an ongoing issue, therefore having a coalition to lobby is This study source was downloaded by from CourseH on :00:51 GMT -05:00 This study resource was shared via CourseH POLICY PRIORITY ISSUE- SAFE STAFFING 4 ideal. Each state will have their own coalition that can be joined, but it is also a good idea to be a part of a nationwide coalition. Recommended solutions The only solution that is acceptable is passing legislation mandating a reduce nurse to patient ratio to 1:5 like in California. According to National Nurses United there are already two bills in congress The National Nursing Shortage Reform and Patient Advocacy Act | S. 864 (Boxer) in the senate, and Safe Nurse Staffing for Patient Safety and Quality Care Act - HR 1602 (Schakowsky), in the House of Representatives. Since there are already two safe staffing bills in congress, they just need to be built upon. Empirical Evidence The knowledge gap that evidence- based research could fill, regarding appropriate staffing of nurses, is the outcome of patient quality of life, and patient mortality rates. There is evidence that supports the need for lower nurse to patient ratio. A study titled “State-Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction” showed that with a lower nurse to patient ratio mortality rates in California hospitals were 10-13% lower compared to hospitals in Pennsylvania and New Jersey. This study also showed that higher staff levels resulted in reduced nurse workload, therefore less nurses felt ‘burnt out’, and satisfaction and retention was increased. A different study titled ‘Nurse Staffing – A Summary of Current Research, Opinion and Policy’ is a research article based on surveys of nurses and patients and their relation to nurse staffing and patient outcomes. The research found that with a higher registered nursing staff there were less hospital-related mortalities, less failure to rescue, less hospital acquired pneumonia, and shorter hospital stays for medical patients. This study source was downloaded by from CourseH on :00:51 GMT -05:00 This study resource was shared via CourseH POLICY PRIORITY ISSUE- SAFE STAFFING 5 Impact and Importance to Nursing The fact that healthcare facilities are not properly staffed leads to a whole host of problems, most notably an increased mortality rate. Inadequate staffing increases the risk for patient falls, nosocomial infections, medical errors, and an increased workload on nurses. Nurses are the healthcare providers that have the most contact with patients, and therefore will have a significant impact on them. “…medical errors are the third-leading cause of death in the United States and a Lancet study that found that increasing the number of patients that each hospital nurse serves by one apparently results in a 7 percent increase in patient mortality.” (Kitchenman, 2015) Conclusion There is evidenced-based research that supports the adequate number of nurses being staffed, and points out the negative impact inadequate nurse staffing can cause. It is clear that nurses affect patient outcomes, and an increase in nurse staffing will result in higher quality patient outcomes. With adequate staffing nurses will feel less overwhelmed, and there will be a lower rate of patient mortality, less hospital related infections and death, and shorter hospital stays. In order to have a mandated ratio put in place we have to make policymakers aware that staffing is an issue, through coalitions and lobbying. There are already two safe staffing bills in congress that can be built upon. This study source was downloaded by from CourseH on :00:51 GMT -05:00 This study resource was shared via CourseH POLICY PRIORITY ISSUE- SAFE STAFFING 6 References UCLA Public Health. (2011). Nurse understaffing linked to increased risk of patient mortality. Research Highlights. New England Journal of Medicine. June 2011 Kitchenman, A. (2015). Nurses urge state to increase mandated staffing levels at hospitals. NJ Spotlight. National Bureau of Economic Research. The Effect of Hospital Nurse Staffing on Patient Health Outcomes: Evidence from California’s Minimum Staffing Regulation. Agency for Healthcare Research and Quality. State-Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction.