Current Healthcare Policy

Discuss 2 Please don’t combine everything. Answer each question separately for clarity

1A:Identify a current healthcare policy in your current role that you would like to see revised. Why? What would be the projected outcomes?

1B: discuss both the obvious and the non-obvious stakeholders?

1C: Which stakeholders to you have the potential to influence?

1D: What barriers do you face with reaching stakeholders and allowing them to buy in?

1F Take the identified healthcare policy and. Identify both obvious and non-obvious stakeholders.

1G:Also identify stakeholders that you have the potential to influence.

1H:Determine the effect of healthcare politics on the healthcare stakeholders, state and federal government, and the nursing profession (

1J: Analyze legislative process and the impact of special interest lobbies


2A: How have you seen the diverse interests of healthcare stakeholders impact patient care in your nursing practice or in the practice of other nurses?

2B: In general, do you think political action committees (PACs) and special interest groups (SIGs) contribute to or detract from improvements in patient healthcare? Provide an example to illustrate your thoughts.

2C: What role should politics play in healthcare reform? What role should the DNP-prepared nurse play in the political process that impacts healthcare reform?


Nurse Staffing Ratios

Policy Options

Joanne Spetz

“The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities.”

John F. Kennedy

The importance of nursing to the delivery of high-quality health care has been recognized since the inception of the practice of nursing. Various factors contribute to the quality of nursing care including the expertise of nursing staff, availability of supportive personnel and other health professionals, good communication among the care team, and the nurse/patient ratio. It was not until the early 2000s that high-quality empirical research found consistent relationships between licensed nurse staffing and the quality of patient care (Lang et al., 2004; Kane et al., 2007).

Concerns about the effects of changes in nurse staffing levels in the 1990s, combined with the increasing influence of nursing unions, resulted in the passage of California Assembly Bill (AB) 394 in 1999, the first comprehensive legislation in the United States to establish minimum staffing levels for registered nurses (RNs) and licensed vocational nurses (LVNs) in hospitals. This bill required that the California Department of Health Services (DHS) establish specific staffing ratios. These were announced in 2002 and implemented beginning in 2004. Since then, other states and the federal government have considered developing regulations for nurse staffing in hospitals. In 2014, for example, Massachusetts passed legislation mandating a ratio of one or two patients per nurse in intensive care units (Associated Press, 2014).

The Establishment of California’s Regulations

Throughout the late 1990s and early 2000s, there was substantial debate about the changes in hospital staffing that had occurred in the 1990s and the effects of such changes on the quality of care (Aiken, Sochalski, & Anderson, 1996; Spetz, 1998; Unruh & Fottler, 2006; Wunderlich, Sloan, & Davis, 1996). In some states, legislators and regulatory agencies considered staffing requirements with an aim to increase the numbers of nurses and other health care personnel working in hospitals and other settings. As the 1990s ended, a shortage of RNs emerged, and concern about poor staffing in hospitals continued (Kilborn, 1999). It was in this environment that AB 394 was passed by the California legislature. Previous Republican governors had vetoed similar legislation, but union-friendly Democratic Governor Gray Davis signed AB 394, satisfying union efforts to pass minimum-ratio legislation. AB 394 charged the California DHS with determining specific unit-by-unit nurse/patient ratios.

The DHS began an extensive effort to determine the new minimum nurse staffing ratios, with little research to guide them (Kravitz et al., 2002; Lang et al., 2004; Spetz et al., 2000). To help develop the proposed ratios, the DHS commissioned a study by researchers at the University of California, Davis (Kravitz et al., 2002). It also received recommendations about the ratios from stakeholders, ranging from the California Hospital Association (CHA) proposal of a ratio of 1 licensed nurse per 10 patients in medical-surgical units and the California Nurses Association recommendation of 1 517licensed nurse per 3 patients in medical-surgical units. The ratios established by DHS were between those recommended by the CHA and the unions, with a 1 : 6 ratio in medical-surgical units starting January 1, 2004, and a 1 : 5 ratio in medical-surgical units commencing in January 2005. Other units have higher minimum-ratio requirements. The minimum ratios do not replace the requirement that hospitals staff according to a patient classification system (PCS); if a hospital’s PCS indicates that higher staffing is needed, the hospital should staff accordingly.