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The Problem

Dsicuss about the Relationship Between Registered Nurses And Nursing.

The experience and education of nursing practitioners have to be made a priority in order to guarantee quality and safe health care of patients in our country. The rate of negative patient outcomes tends to increase in the hospital with inadequate staffing. The decrease in nursing has the potential of several negative outcomes such as shock, urinary tract infections, cardiac arrest and pneumonia. These negative outcomes made the state legislature to come up with staffing policy that will ensure hospital have adequate staffing. The problem of understaffing is not only affecting the patients but also the nurses delivering services to the patients. This essay is going to discuss and analyze The Registered Nurse Safe Act of 2015 concerning the problem concept, the policy framing and process, policy solutions as well as its effectiveness. Health policies are very important and they should be implemented effectively to ensure the health of all citizens is guaranteed.

Staffing of hospitals has been a major problem experienced by both state and federal government. Nurses play a very critical role in ensuring quality health care is delivered to the patient and most of the hospitals in the country were understaffed by the year 2015. This posed a very big problem that the policy intended to solve and ensure quality and effective health welfare of the citizens. The policy has concentrated on the problem of increasing the number of nursing in hospitals but it has overlooked the shortage of doctors and other health officers in these hospitals. The doctors, nurses and other health practitioners have to work together and for the hospitals to achieve quality healthcare targets. The policy, therefore, concentrated on the nurse shortage and ignored other health problems including adequate medical equipment and drugs as well as good information management in these hospitals. The highlighted problem of understaffing of nurses has taken the center stage of this policy due to the potential problems it could bring in the health sector. The implementation of this policy was aiming at eliminating the problems that are caused by the understaffing of nurses in hospitals so as to improve the quality of health services offered in hospitals all over the nation.

The Registered Nurse Safe Staffing Act of 2015 was announced in 29th of April the year 2015. The policy is an amendment of the XVIII of the Social Security Act and it ensures all the hospitals participating in Medicare are implementing a staffing plan (Tortorice, 2013). The policy imposes that hospitals should an appropriate number of registered nurses in each shift and each unit to provide direct patient care. The staffing levels in the hospitals should addresses certain factors such as the hospital units, the unique characteristics of patients and the delivery of quality, safe and consistent healthcare are required in the health standards. The policy requires a nurse staffing committee to be established by all the participating hospitals. The committee will be responsible for ensuring this policy is implemented and deal with the civil monetary consequences that may arise due to the violation of this policy.

Policy Framing and Process

The phrases and word mostly used in this policy include the nurse, patients, quality and safe patient care. These phrases and words show that the policy meanly resolves around patients healthcare and the role of the nurses in ensuring health care services are efficient. The underlying assumption behind the word nurse in this policy it has been used to represent all the other health practitioners such as clinical officers and laboratory technicians excluding the medical doctors. The staffing of all these medical officers is also very important in achieving the efficient patient care in the participating hospitals. The framing of this policy has identified various stakeholders that are closely affected by the formation and implementation of the policy. Lois Capps is the person who sponsored this legislation (Fowler and Comeaux,, 2017).  Ten co-sponsors from around seven states and only one was a Republican while the rest were Democrats. The Congress subcommittee on health was involved in going through the legislation and gave their recommendations. The policy applies to all the social groups in the country and this implies the policy will ensure equality. The rich have the financial ability to go to private hospitals and receive the best health services and the policy ensures that the average citizen going to a federally managed hospital can also get quality health care.

There are moral judgments expressed in this policy. The Registered Nurse Safe Staffing Act does not just concentrate on the number of nurses in the hospitals but also looks at the code of ethical conduct and the professionalism of the nurses. The policy requires that the nurses meet certain moral standards as they offer health care services to their patients.

The development of this policy involved various stakeholders before it was fully formulated. Lois Capps sponsored the bill and it was introduced on the 29th of April 2015 to the House Ways and Means and on 1st of May the same year it was presented to the Subcommittee on Health.  The American Nurses Associations (ANA) were also involved and they made several recommendations to the legislation (American Nurses Association, 2015, p15). Some of the recommendations they made include professional certification, RN education and clinical experience. ANA also recommended on the whistleblower protection and public reporting of stuffing information done by the hospitals.

 The main stakeholders involved were four. First, the providers, who have the perception of nursing in terms of quality and accurate diagnosis and efficient healthcare that will ensure positive outcomes are obtained. The second stakeholders are the taxpayers whose main concern is to receive a cost-effective medical care. The third stakeholder considered in this policy is the employers. The employers who are to ensure they do the staffing of nurses have to control costs and the quality of healthcare at the same time. The fourth stakeholder in this policy is the patients who require positive outcomes, compassion and quality care provided to them at an affordable cost.

Policy Solutions

The policy mainly represented the interests of the patients and the nurses in America. The patients are the main concern in this policy since the main aim of the policy is to ensure that patients receive quality health care services from the nurses. The full implementation of this policy ensures that the patients receive these quality health care services at an affordable cost. Customers' satisfaction has been outlined and the patients are provided with complaint framework to channel their dissatisfaction to the appropriate personnel in the event that they have not received services as per the expected standards. The nurses' interests have also been presented in this policy since the policy outlines the favorable working conditions they are supposed to be provided to ensure that they are able to provide the quality care to their patients. For instance, according to the policy, the nurses would not be forced to work in units they did not train for without prior orientation and they are also offered the whistleblower protection. The ratio of nurses to patients is expected to be high so that they will give close attention to their patients.

There several competing ideas and interests among the stakeholders involved in the development of the Registered Nurse Safe Staffing Act.  The patients presume their employer to give them a health cover having various options that are customizable as per the patients' specific needs. The patients also expect their employer to finance a large part of their health insurance covers. The conflict of interest comes in where the providers have to use the treatment tests and technology to provide quality preventive care to the patients but the payers are expecting to receive this at a low cost. Therefore, the providers have to compromise cost for quality healthcare and they are left bearing the risk of huge losses. The patients also want the providers to follow a clear diagnostic plan that reaches an accurate diagnosis and treatment with a minimum number of tests and fewest visits at the hospital.  There is also a complicit of interest since the employers always want to lower their operating costs and increasing the number of nurses in their hospitals is going to cause a rise in the funds they spend in paying the nurses. The employers want the patients to pursue needed care and follow the instructions of the provider. The employers would always think that they are being confined in a tough situation by this policy.

Effectiveness of the Policy

‘The rule of the game' in the health industry is to always ensure the balance between economic factors and the various social issues related to health care. As much as the providers and the employers may have economic concerns that the policy is likely to raise, they will have to accept their specified obligations. The quality of healthcare is a social issue that has to be considered irrespective of the potential economic disadvantages it might bring to the other stakeholders. The policy is also trying to tackle the issues of equal opportunities to quality healthcare for the various social classes in the country. Like in any other business, customer satisfaction is very crucial thus the same applies for patients' satisfaction in receiving good health care services. The employers have to ensure they meet the nurse staffing requirements as specified in the policy or they face the risk of being charge very huge monetary fines. The providers and employers have no option but comply with the regulations or their certifications for operating may be revoked.

Health care has always been given priority by both the state and federal government year in year out and this gives the bill an opportunity window to be developed and be enacted as a law. The Registered Nurse Safe Staffing Act policy has brought a very critical issue to the attention of the Congress for so long. The nursing shortage has been highlighted and this requires legislators, governments, hospitals and CEOs to work together and ensure that this problem facing the healthcare services is solved amicably. The nurse per patient ratio, quality of patient care, unsafe working environment and job burnout has been seen as issues that require collective responsibility from various sectors (Cho et al, 2016, p 210). The policy is likely to be implemented due to the high priority attached to the problem of nurse understaffing in the country.

The policy is putting up solutions to the address the problem of poor health care services that is caused by the shortage of nurses in hospitals. The main aim of the policy is to provide the various requirements that will ensure optimal nursing care for patients (Buchan et al, 2015, p 165). In October 2002 the Journal of the American Medical Association published a study that cited high patient to nurse ratio to be the leading cause of nurse dissatisfaction with their jobs as well as the increase in patient mortality rates in US hospitals. The study was done across 168 hospitals and it concentrated on the data of more than 230000 surgical patients. The study found out that the increase in a single patient in the existing patient to nurse ratio has the potential of increasing the mortality rate by 7 % and the job dissatisfaction of the nurse by a 15% increase. The problem of the increased mortality rate caused by the insufficiency of nurses is further worsened by the potential of several negative outcomes such as shock, urinary tract infections, cardiac arrest and pneumonia.

Stakeholders

The policy has outlined the standards service providers and employers in the hospital sector have to meet to ensure that patients receive quality healthcare services from the nurses. 

The available nurses in the hospitals have been forced to work for long hours and serve very many patients and this compromises the quality of service delivered to the patients (Dellefield et al, 2015). The policy also gives guidelines concerning the education and experience of the nurses to guarantee that the satisfied nurses have the required skills that will facilitate quality service delivery to their patients. The policy requires hospitals to have an elaborate complaint handling framework for handling the dissatisfaction of their patients as a way to ensure that the quality of service delivered is according to the standards. The policy is solving the problem by ensuring that the number of nurses is enough too and they are also given a good working environment that promotes quality delivery of healthcare services. The hospitals are expected to give periodic public reporting of staffing information including the patient to nurse ratio and this ensures the regulations are met. The monetary implications imposed for violating this policy also ensure that the participating hospitals put an effort to ensure they operate according to the given standards.

There are also alternative solutions that will ensure quality healthcare service delivery to patients that the policy has overlooked. Improvement of the medical equipment and drugs in the hospitals will also ensure that the hospitals deliver efficient healthcare services to patients. Technology and new innovations in medicine should have been employed to dry and solve the nursing shortages experienced in hospitals. Proper information management in the hospitals is also an alternative solution to facilitate the delivery of quality services to patients.

The effective implementation of this policy has been faced by several political and economic factors. The major hindrance to the implementation of the policy is the cost that comes with the additional staffing as well as the economic repercussion for not meeting the requirements. The employers find it straining to afford the extra nurses and also the available qualified nurses in the country are not adequate to fill the staffing gap. The reimbursements will increase due to the increase of RN staffing and this will lead compulsory cuts somewhere else. (Stokowski, 2009). The financial and political consequences of the compulsory staffing will eventually result in so much government interference, inadequate staffs with the required skills, and the high cost of implementation.

Competing Ideas and Interests

 The effective implementation will, however, have so many positive impacts on the quality of healthcare service delivery.  This is because the patient to nurse ratio has always been associated with the increase in mortality rate and the dissatisfaction of nurses with their job (Buerhaus, 2010). Looking at the mandated nursing that was implemented in 1999 in California we can find a lot of information that supports this policy.

Conclusion

In summary, the experience and education of nursing practitioners have to be made a priority in order to guarantee quality and safe health care of patients in our country. Understaffing is a problem that is facing the majority of hospitals all over our country and this affects the quality of healthcare services the patients receive. The problem of understaffing is not only affecting the patients but also the nurses delivering services to the patients. The Registered Nurse Safe Act of 2015 outlines the possible solution to this problem and how the various stakeholders are to cooperate.

American Nurses Association, 2015. ANA commends introduction of the registered nurse safe staffing act. American Nurses Association News Release, 4(29), p.15.

Buchan, J., Twigg, D., Dussault, G., Duffield, C. and Stone, P.W., 2015. Policies to sustain the nursing workforce: an international perspective. International nursing review, 62(2), pp.162-170.

Buerhaus, P, 2010. What is the harm in mandating staffing regulations? New York, Medscape.

Cho, S.H., Lee, J.Y., June, K.J., Hong, K.J. and Kim, Y., 2016. Nurse staffing levels and proportion of hospitals and clinics meeting the legal standard for nurse staffing for 1996~ 2013. Journal of Korean Academy of Nursing Administration, 22(3), pp.209-219.

Dellefield, M.E., Castle, N.G., McGilton, K.S. and Spilsbury, K., 2015. The relationship between registered nurses and nursing home quality: An integrative review (2008-2014). Nursing Economics, 33(2), p.95.

Fowler, D. and Comeaux, Y., 2017. The legislative role in nurse staffing ratios. MedSurg Nursing, 26(2), pp.12-14.

Johansson-Pajala, R.M., Jorsäter Blomgren, K., Bastholm-Rahmner, P., Fastbom, J. and Martin, L., 2016. Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: a qualitative study of medication management. Scandinavian journal of primary health care, 34(1), pp.37-45.

Law, B.Y.S. and Chan, E.A., 2015. The experience of learning to speak up: a narrative inquiry on newly graduated registered nurses. Journal of clinical nursing, 24(13-14), pp.1837-1848.

Martin, C.J., 2015. The effects of nurse staffing on quality of care. MedSurg Nursing, 24(2), pp.S4-S4.

Rajecki, R. Mandatory nurse staffing ratios: boon or bane. 2009, Modern Medicine

Rogowski, J.A., Staiger, D.O., Patrick, T.E., Horbar, J.D., Kenny, M.J. and Lake, E.T., 2015. Nurse staffing in neonatal intensive care units in the United States. Research in nursing & health, 38(5), pp.333-

Ross, H., Tod, A.M. and Clarke, A., 2015. Understanding and achieving person?centred care: the nurse perspective. Journal of clinical nursing, 24(9-10), pp.1223-1233.

Stokowski, L, 2009. Safe staffing Legislation, New York. Medscape.

Tortorice, J, 2013.The scoop on the registered nurse staffing bill. CeuFast.com Blog

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