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PUN688 Health Policy In A Global Context

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  • Course Code: PUN688
  • University: Queensland University Of Technology
  • Country: Australia


Identify a current or recent health policy issue facing a government, or a particular level of government, in a country of your choice.

Prepare a critical analysis of the policy issue and its surrounding context. This should include:

  1. An in-depth account of the policy issue.
  2. A description of the issue’s position, and relevance to other items, currently on the government’s broader policy agenda.
  3. The identification of relevant stakeholders as well as their roles and positions with regards to the policy issue.
  4. A critical evaluation of the situational, structural, cultural and environmental factors which led to a government response in relation to this issue.


The Policy

The Safe Staffing for Nurse and Patient Safety Act 2018 was introduced by Oregon’s Senator Jeff Merkley and Representative David Joyce to make hospitals secure for both the health care staff and patients. The bill was cosponsored by Reps. Suzan DelBene (D-WA), Suzanne Bonamici (D-OR), plus Tulsi Gabbard (D-HI). This policy needs hospitals taking part in Medicare to implement sufficient staffing programs for nursing services, as well as establishes whistleblower safeguards for staff and patients in the hospital setting. The legislation modifies title XVIII (Medicare) of the Social Security Act that needs an execution of health care-wide staffing programs for nursing services provided in the hospital setting.

The policy is founded on the fact that ensuring patient safety, as well as care has often been a main concern; however, has experienced several challenges when nursing staff are overworked while hospital facilities are short-staffed. Safe staffing is paramount in enhancing the quality of patient care, lowers medical errors, and enhances nurse retention. The policy demands that there should be a plan that is appropriate for registered nurses (RNs) to offer direct care in every hospital unit to the patient in addition to on each shift of the health care facility to guarantee staffing levels: a) deal with the distinctive features of the patients along with the health care units; plus b) lead in delivery of secure, excellence care to the patient with particular necessities (Mosadeghrad, 2013). The policy also needs those hospitals that are participating to institute a hospital nursing staffing committee that shall execute such plan and other programs, identifies civil financial along with other consequences for the breach of the necessities of this specific Act, as well as create whistleblower safeguards against possible prejudice besides retaliation entailing patients or staff of the health care facility for their complaints, or participation in investigations in relation to the plan (Reiter et al., 2006).

In addition, the bill demands that hospitals should institute a committee that is composed of at around fifty-five55 percent direct care nurses to generate nurse staffing programs, which are definite to each hospital. The bill underscores the fact that nurses across the nation understands that patients menace of longer hospital stays, amplified infections as well as preventable injuries when units are short-staffed. Thus, understaffing too results in reduced retention along with greater rates of injury plus burnout. The drafters of the bill projected the looming shortage of RNs, which is anticipated to increase as baby boomers age, as well as the need for health care to expand. Therefore, the legislation will help to address the policy issue of understaffing by improving the retention of RNs and make sure those patients in hospitals gets quality and safe care (Tevington, 2011).

The American Nurses Association (ANA) applauded the introduction of the legislation by saying that RN staffing makes an important distinction for the patients in hospitals and the quality of care. In addition, ANA asserts that proper nurse staffing ensures the safety of the patients and safeguards them from avoidable impediments, even reducing the peril of possible death. ANA believes that the legislation will fundamentally empower direct care nurses to ascertain the distinctive plus different requirements of the patients in the hospital to guarantee safety, as well as quality results of nursing care (Zazzali et al., 2007).



In the past, there are many staffing bills that have been introduced in past Congress; however, these bills in nurse staffing have failed to sail through the committee. The Safe Staffing for Nurse and Patient Safety Act of 2018 is somehow unique from the previous iterations. One of the primary items to the legislation is to base staffing levels on the need rather than just strictly on figures that have been in the instance of previous legislations. In this manner, staffing levels could offer for optimal care towards helping deliver safe and quality care to patients. Because of the huge reductions in nursing budgets, employers in the US have been struggling with the problem of understaffing where fewer nursing staff are working for longer hours, as well as taking care of very sick patients.

This circumstance compromises the safety and safety of the care that will contribute to nursing shortage in the country. As a result, this will create an environment, which propels nurses from the bedside. Studies have demonstrated that safe nursing environment directly correlates to patient outcomes. A research that was published in the “Journal of the American Medical Association” in 2002 attributed greater patient-to-nurse ratio in health care settings with augmented patient mortality along with increased nurse disappointment with their jobs in the hospital. The research that examined the result data from over 230,00 surgical patients discharged from 168 hospitals established that each extra patient per given nurse was linked to around 7 percent raise in the probability of patient mortality , as well as a rise in job displeasure for the nursing staff. Consequently, modification of this line between what is secure and helpful, against what is affordable and sustainable is what should be done (Banaszak-Holl et al., 2013).

Overpoweringly, research supports sufficient nurse staffing in the US towards enhancing the quality in addition to safety of care in the long-term. In the last few years, studies have shown a decline in patient mortality plus morbidity and a rise in safety of the patients when hospital units are adequately staffed. This implies that with sufficient staff members in hospital units will reduce cases of mortality and complications of the patients may be prevented or lowered. Therefore, it is paramount for nursing staff to have adequate capital to care for their patients since nursing staff encounter moral suffering while they are not in a position to offer the kind of care that they recognize their patients require (Lin, 2012).



The stakeholders of this legislation comprise stakeholders in the mainstream health care settings around the world. The stakeholders include: a) health care providers, who perceive the aspect of staffing as a technical sense of precision of diagnosis, suitability of care along with the outcomes attained, b) the health care actors that focus on the most cost-effective technique of care in hospital or health care setting, c) the employers that need to be in control of costs and offer suitable care to the patients’, d) the government that has the responsibility of funding the staffing process and creating the necessary environment for nurses, and e) patients, who need compassion, care, as well as positive outcomes that is affordable as much as possible when it comes to cost (Jonas & Kovner, 2015).

Furthermore, conflict with the shareholders comprises the patients who anticipate a company to provide a broad array of alternatives for the health treatment, which may be personalized to their particular needs. These patients too look for the company to finance the mainstream of the expenditure due to the health care insurance. Thus, providers will want to offer excellent service utilizing the most precise and novel tests along with treatments and to offer preventative care that cannot cover with the available resources. Payers of the insurance demands the providers should pursue a comprehensible, evidence-based, diagnostic program, as well as reach a precise diagnosis besides treatment program with the least hospital visits, as well as slightest number of tests. On the contrary, employers strive to keep or reduce their cost payment and they need the patient/workers to look only the required care, adhere to health care providers’ guidelines, plus recuperate faster to full utility (Gutsan et al., 2018).


Critical Evaluation

The current situation in the US prompted the drafters of the legislation to focus on designing an Act that will address the current situation on nurse shortage in the US. The nurse shortage in the US has become an endemic in the past few decades where this has resulted in poor and unsafe care among the patients. The quality of nursing care has declined significantly in the US because the worsening ratio of nurse to patients. The shortage of the RNs have been impacted by the increasing number of older population with more than 80 percent of the older people over 65 years old have chronic diseases that are current and needs more care from the nurses, resulting in poor quality of care. The combination of nurse shortage and the growing number of older people seeking nursing services prompted the government to come up with this legislation to address this situation (McHugh et al., 2013).

The environmental factors that influenced the government to introduce the legislation were the current environment in the workplace is strenuous to nurses who are overwhelmed by the demands of the job. The current war environment has prevented the nurses from proving quality care because their numbers are inadequate (Lapane & Hughes, 2007). Thus, the ward level, factors like the ward practice environment besides the percentage of nurses with degrees have been established to considerably impact safety outcomes because of the current environment where these nurses operate. Stressing environment has been found to have negative consequences on nurses towards providing high-quality care to patients seeking these services. Stress and job burnout are linked to specific demands of job that include overload and variables in workload because of the nurse staffing problem that create a stressful environment for nurses making them to be less productive. Furthermore, a strong safety climate is linked to positive attitudes amongst nurses that may influence the adoption of safe behaviors and practices, as well as assist lower accidents and promote high quality care. Understaffed environment will mean that nurses will provide the needed care for the patients in their disposal because of the unfavorable environment.


Furthermore, the government while introducing the legal to address the safe nurse staffing, considered then organizational culture that exists in many health care settings in the US. The US health care setting is faced with the greatest turnover that impacts the delivery of quality service to the patients. The government understood that there was a problem of nurse turnover and to address this problem, there was the need to design a safe nurse staffing approach to stop this culture. Nursing personnel turnover is a vital matter in implementing a high-quality nursing services, because nursing facilities constantly experiencing high personnel turnover have inferior eminence of care that will affect the expectations of the patient.  Understaffing, particularly during peak occupancy, is linked unfavorable outcomes amongst staff and patients (Rejecki, 2009).

Based on social and economic factors, the perceived limitations to regulated nurse staffing comprise costs to implement extra staffing and the way to deal with the consequence in the nursing shortages. In addition, requiring hospitals to boost registered nurses (RNs) staffing without growing reimbursements could result in compensatory cuts somewhere else. Some specialists has maintained that expenses connected to growing the percentage of RNs may nearly entirety be offset by lowering stays in hospitals, lowering complications, as well as lowering patient deaths (Cañadas-De et al., 2015). Nonetheless, in an article by Buerhaus, the political, as well as financial consequences of mandated staffing could lead to additionally interference of government, greater cost of implementation, challenge in having staff accessible for the dynamics entailed with the staff needed, and requirements of the patients (Buerhaus, 2010). Certainly, if one look at the mandated nurse staffing ratios, which was implemented in California, in 1999, it is simple to establish studies, which powerfully supports or negates the effect that only confirms that this is something, which is absolute and is hard to assess. Therefore, the mandated staffing, as well as staffing founded on acuity, would imply mandatory overtime along with additional shifts. Also, it can have inexpert nurses that covers unfamiliar region, just to guarantee culture quota is up to regulation (Tevington, 2011).



Alexander JA, Weiner BJ. & Griffith J. (2006). Quality improvement and hospital financial performance. Journal of Organisational Behaviour. 27:1003–29.

Banaszak-Holl J. Castle N. G. Lin M. & Spreitzer G . (2013). An assessment of cultural values and resident-centered culture change in U.S. nursing facilities. Health Care Management Review , 38, 295–305.

Buerhaus P. 2010. What Is the Harm in Imposing Mandatory Hospital Nurse Staffing Regulations? Nursing Economics. 28(2):87–93

Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & De la Fuente, E. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240-249.

Gutsan, E., Patton, J., Willis, W.K., & Coustasse-Hencke A. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. Presented at the 54th Annual MBAA Conference, Chicago, IL.

Jonas, S., & Kovner, R. (2015). Health Care Delivery in the United States. New York, NY: Springer Publisher Company.

Lapane K. L. & Hughes C. M . (2007). Considering the employee point of view: perceptions of job satisfaction and stress among nursing staff in nursing homes. Journal of the American Medical Directors Association , 8(1), 8–13.

Lin, Y. W. (2012). The causes, consequences, and mediating effects of job burnout among hospital employees in Taiwan. Journal of Hospital Administration, 2(1), p15.

McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals With Higher Nurse Staffing Had Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing. Health Affairs (Project Hope), 32(10), 1740–1747.

Mosadeghrad AM. (2013). Healthcare service quality: Towards a broad definition. Int J Health Care Qual Assur. 26:203–19.

Reiter KL, Harless DW, Pink GH, Spetz J, & Mark B. (2006). The Effect of Minimum Nurse Staffing Legislation on Uncompensated Care Provided by California Hospitals. Medical Care Research and Review. 68(3):332–51.

Rejecki, R. (2009). Mandatory nurse staff ratios:boon or bane. RN. 72(1):22-5.

Tevington, P. (2011). Mandatory nurse-patient ratios. Medsurg nursing, 20(5), 265.

Weiner, E. (2014). The Effects of Mandated Nurse-to-Patient Ratios on Reducing Preventable Medical Error and Hospital Costs. Law School Student Scholarship. Paper 604.

Welton M. J. (2007). Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach. The Online Journal of Issues in Nursing, 12 (3); 19-78.

Zazzali J. L. Alexander J. A. Shortell S. M. & Burns L. R . (2007). Organizational culture and physician satisfaction with dimensions of group practice. Health Services Research , 42(3 Pt 1), 1150–1176.


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