NURS 8100 Policy Analysis Summary

The purpose of this discussion post is to provide information on a health care topic of interest to policy makers. The policy brief development around staff staffing for our hospitals is a point of interest that should be brought to attention on a larger scale. The writer would like to discussion Michigan specifically regarding safe staffing in hospitals. The problem is there is no law in Michigan, that limits the number of patients a registered nurse can be assigned or the number of hours registered nurses are forced to work.

Some ICU’s in Michigan, a registered nurse may have up to four patients at a time but in other Michigan hospitals the registered nurse may have a limit of one to two. “The risk of dying in the ICU increases by a factor of 3.5 when the patient-to-nurse ratio is greater than 2.5 to 1” (Neuraz et al., 2015). Registered nurses are reporting that their workload is rarely or never adjusted when they report having an unsafe assignment. Michigan hospitals do not have to disclose current staffing levels. Registered nurses can be fired for refusing to work longer hours because administration classifies this as patient abandonment – this could also lead to the nurse losing their license. Scientific studies provide evidence of the link between inadequate registered nurse staffing and poor outcomes for hospital patients. Evidence supports: “The risk of death from cardiac arrest in the hospital is nearly 20% higher on the night shift, when RN staffing typically lower” (Peberdy et al., 2008). Additionally, not only do patients have a higher risk of dying of cardiac arrest due to staffing they also have an increase risk of getting an infection during their hospital stay. “Patients cared for in hospitals with higher RN staffing were 68% less likely to acquire infections” (Rogowski et al., 2013).

The involvement of Michigan Nurse Association has been a positive push towards the resolution of the staffing issues that Michigan hospitals have. The primary two things that MNA has done to support the Safe Patient Care Act: Connect members with legislators to share their stories and grown bipartisan support for the legislation and recruited the most cosponsors in the legislation’s history. The bipartisan Safe Patient Care Act is a plan to increase the safety of patients in Michigan hospitals and retain our nurses in an already stressful environment. The issue at hand is that there is no law that limits the number of patients a registered nurse can be assigned to take care of in the hospital. This is not only alarming nut is very unsafe for both the patient and nurse. There is also no law to prevent hospitals from making nurses work unlimited hours (leading to shifts of 14, 16 or even 20 hours). Nurses are becoming exhausted and stressed which increases the risk of mistakes and errors which is a very dangerous situation. Quality care and patient advocacy is a priority of the registered nurse. Understaffing and being overworked leads to unplanned events such as falls, infections, medication errors and deaths. There is a solution to lowering these risks and making a safer environment for our patients and registered nurses. “The Michigan Safe Patient Care Act is a 3-part bipartisan package in the state House and Senate that addresses rampant RN understaffing and excessive forced RN overtime. It will force administrators to make decisions based on patients’ needs, rather than misguided cost-cutting in the hospital industry” (MI Nurse Association, 2021).

The solution is the Michigan Safe Patient Care Act! The Michigan Safe Patient Care Act is a 3-part bipartisan package in the state House and Senate that addresses rampant RN understaffing and excessive forced RN overtime. It will force administrators to make decisions based on patients’ needs, rather than misguided cost-cutting in the hospital industry.

References

Lavis, J. N., Permanand, G., Oxman, A. D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Research Policy & Systems, Health Research Policy & Systems, 71–79.

MI Nurse Association. (2021). The bipartisan Safe Patient Care Act. https://www.misaferhospitals.org/uploads/7/7/1/1/7711851/with_bill_numbers_2021_spca_bills_cheat_sheet.pdf

Neuraz, A., Guérin, C., Polazzi, S., Aubrun, F., Dailler, F., Lehot, J.-J., Piriou, V., Neidecker, J., Rimmelé, T., Schott, A.-M., & Duclos, A. (2015). Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study. Critical Care Medicine, 43. https://doi.org/10.1097/CCM.0000000000001015

Peberdy, M. A., Ornato, J., Larkin, G. L., Braithwaite, R. S., Kashner, T. M., Carey, S., Meaney, P., Cen, L., Nadkarni, V., Praestgaard, A., & Berg, R. (2008). Survival From In-Hospital Cardiac Arrest During Nights and Weekends. JAMA. http://www.protectmasspatients.org/pdf/JAMA_2_08_Cardiac_Arrest.pdf

Rogowski, J. A., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, E. T. (2013). Nurse staffing and NICU infection rates. JAMA Pediatrics, 167(5), 444–450

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The nursing profession is the largest segment of the nation’s health care workforce. Several barriers prevent nurses from responding effectively to rapidly changing healthcare settings and an evolving healthcare system. Although more than a quarter-million nurses are advanced practice registered nurses (APRNs), who have master’s or doctoral degrees and pass national certification exams, they are limited in their exercise to practice. Regulations regarding the scope of practice vary and effects different types of nurses from state to state. Most states do not have rules that allow nurse practitioners to see patients and prescribe medications without a physician’s supervision (American Association of Nurse Practitioners, 2019). States that restrict APRNs’ ability to practice according to their licensure authority are associated with geographic health care disparities, higher chronic disease burden, primary care shortages, higher costs of care, and lower standing on national health rankings (American Association of Nurse Practitioners, 2013).

A major influence that full practice authority is the decrease in the unnecessary repetition of orders, office visits, and care services. Greater use of NPs projects over $16 billion in immediate savings would increase over time (American Association of Nurse Practitioners, 2013). Overall, the recommendations are geared toward advancing the nursing profession and are focused on actions required to meet best long-term future needs rather than needs in the short term.

Reference

American Association of Nurse Practitioners. (2013). Nurse practitioner cost effectiveness. https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-cost-effectiveness

American Association of Nurse Practitioners. (2019). Scope of practice for Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

The policy I addressed was the Title VIII Nursing Workforce Reauthorization Act of 2019. This policy/bill expands and empowers nursing workforce development programs through FY2024 (Congress, n.d.). This bill builds on the Institute of Medicine (IOM) (2010) report that recommends nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progress. This policy/bill was first passed in 2017 and has required significant nursing leadership advocation. I utilized a framework by Fawcette and Russell (2001) to look at social, ethical, legal, and financial impacts of the policy.

Numerous options/solutions for addressing the policy were addressed including no change, partial change, and a radical change. A partial solution to the barrier of nursing education funding would be the proposal of the Title VIII Nursing Workforce Reauthorization Act. This could encourage the standardization of nursing programs and create one uniform degree requirement for entry level nursing. Nurses could also access clear instructions on how to advance their degree with various clinical pathways outlined. This solution requires nursing leaders to be a strong advocate both in policy reform and nursing organizations to fill the gap until a more radical solution could be proposed. This can positively impact the nursing practice as it increases nurse education dollars and could improve staff to patient radios for improved patient outcomes. A radical change to address the nursing education pipeline would be providing free four-year education at a public university. This would take significant funding from taxpayers and bipartisan support. This radical solution would require nursing leaders to be highly involved in nursing legislature to ensure the solution was implemented. The cost of this radical option could be exorbitant and would require significant dedication, consensus, and support to obtain. The impact to the nursing profession as a result of this solution is unknown but one can posit that it would increase the number of healthcare professionals entering the field, improve staffing ratios and ultimately positively impact patient and organizational outcomes.

References

Congress. (n.d.). H.R. 728 Title VIII Nursing Workforce Reauthorization Act of 2019. https://www.congress.gov/bill/116th-congress/house-bill/728

Fawcette, J., & Russell, G. (2001). A conceptual model of nursing and health policy. Policy, Politics, & Nursing, 2(2), 108-116. https://doi.org/10.1177/152715440100200205

Institute of Medicine (2010). The future of nursing: Leading change, advancing health.

NURS 8100 Policy Analysis Summary