NURS 8100 Discussion 1: Policy Analysis Summary ANSWER

Collaborative practice agreements are vital in creating a formal relationship between healthcare providers from different specialties. This collaboration allows expanded services the healthcare providers can provide to patients and the healthcare team. Moreover, in any collaboration, each health care professional often has information that the other professional needs to have to practice successfully (Aghamohammadi, Dadkhah, & Aghamohammadi, 2019). There is a shortage of primary care providers available to the population and allowing advanced practice providers full practice authority would lessen this shortage. If APRNs were able to practice within their full scope of practice it would assist in creating the labor force required to meet the demands of today’s population. APRNs have a unique set of skills and knowledge that could be utilized and delivered in the community setting where access to healthcare is lacking (National Academies Press, 2016). Due to the Affordable Care Act, 32 million Americans will be added to the already insured population (U.S. Department of Health & Human Services, 2021).

With such a shortage and increased demand for primary care providers, it is only logical to broaden the scope of practice for APRNs who are more than capable of providing primary care to the millions in need. Many argue that due to the longer education of physicians that nurse practitioners are not capable to provide the same care but in practice, there has not been a difference in the quality of care or safe care between the two. Allowing nurse practitioners to practice without barriers allows the APRNs to meet all the needs of the patients that they are caring for. Giving more people access to primary care and control over their own health. APRNs are more than capable to provide adequate care for their patients, ensuring that there are no restrictions on providing high-quality safe care can help eliminate the shortage of primary care providers. Texas expanding the scope of practice for the APRN role and eliminating the barriers that are placed by the state will allow the APRNs to practice to their full potential for their education and training. Decreasing the number of shortages for primary care providers and evolving along with the increased healthcare demands for the underserved now insured population. The implementation of legislation change starts with each APRN, through research and the literature the tools are provided to enforce these changes.

References

Aghamohammadi, D., Dadkhah, B., & Aghamohammadi, M. (2019). Nurse-Physician Collaboration and the Professional Autonomy of Intensive Care Units Nurses. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 23(4), 178–181. https://doi.org/10.5005/jp-journals-10071-23149

U.S. Department of Health & Human Services. (2021). New HHS Data Show More Americans than Ever Have Health Coverage through the Affordable Care Act. Retrieved from https://www.hhs.gov/about/news/2021/06/05/new-hhs-data-show-more-americans-than-ever-have-health-coverage-through-affordable-care-act.html

National Academies Press. (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US). Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK350160/

Sample Answer 2 for NURS 8100 Discussion 1: Policy Analysis Summary ANSWER

The selected policy is HB3871 Safe Patient Limits Act, which is currently pending action in the Illinois Legislature. The proposed policy sets a minimum nurse staffing requirement for all hospitals in Illinois. It states the maximum number of patients assigned to a registered nurse in specific situations. It also provides that nothing shall bar a healthcare facility from assigning fewer patients to a registered nurse than the limits stated in Act (Illinois General Assembly, n.d.). Besides, it provides that nothing in the Act stops the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act. Nonetheless, the maximum patient assignments in the Act may not be exceeded, despite using and applying any patient acuity system.

The policy can be addressed by having each hospital’s clinical team make staffing decisions for their hospitals depending on the unique circumstances at the specific hospital at any given time (Han et al., 2021). The policy can also be addressed by having professional nursing organizations advocate the implementation of the mandated staffing ratios in all hospitals to promote better working conditions for nurses and improve patient safety and quality of care. Implementing the policy can reduce nurse burnout and low job satisfaction associated with high workloads and physical and emotional fatigue (Lasater et al., 2021). In addition, it can improve the safety of patient care and patient outcomes and reduce healthcare costs.

 

References

Han, X., Pittman, P., & Barnow, B. (2021). Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing. Medical care, 59(10 Suppl 5), S463. doi: 10.1097/MLR.0000000000001614

Illinois General Assembly. (n.d.). Bill status for HB2604. https://www.ilga.gov/legislation/BillStatus.asp?DocTypeID=HB&DocNum=2604&GAID=15&SessionID=108&LegID=118738

Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., & McHugh, M. D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study. BMJ open, 11(12), e052899. doi:10.1136/bmjopen-2021-052899

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Sample Answer 3 for NURS 8100 Discussion 1: Policy Analysis Summary ANSWER

            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.  

Sample Answer 4 for NURS 8100 Discussion 1: Policy Analysis Summary ANSWER

Gun violence is an urgent, complex, and multifaceted problem. According to new data issued by the Centers for Disease Control and Prevention (CDC), gun deaths are reaching epidemic levels in 2019. This intolerable tendency has continued for years, and it is past time for it to end. The stakes are at an all-time high. In total, 39,707 Americans were killed by firearms in 2019. This corresponds to almost 3,300-gun deaths every month, over 763 per week, and nearly 109 per day. Rates of firearm suicide and homicide continue to grow year after year. Each act of gun violence wreaks havoc on families and communities, leaving survivors to deal with sorrow, loss, and trauma (Nguyen, 2021).

Numerous gun-control strategies have been linked to lower gun-related morbidity and mortality rates. For example, requiring prospective gun purchasers to obtain a license, allowing for the temporary removal of guns from people who are in danger of killing themselves or others, and regulating safe storage have all been related to decreased rates of homicide, suicide, and unintentional gun deaths (Crifasi et al., 2021). Gun-control law is decided at the federal level, but healthcare providers can help minimize gun violence at the local level as well. Health professionals can help with research, questionnaires, and listening sessions to gather data for working papers that will eventually serve as background material for future legislation. These experts can campaign for gun safety on a local level by collaborating with local legislators, political action groups, and other lobbying initiatives aimed at swaying public opinion. The people may not have the ability to directly participate in the development of gun-control legislation, but their votes have a large influence on legislators (Healthcare Management, 2022). As the most noble profession, nurses have a collective obligation to reduce gun violence. Parents and caregivers seek advice from nurses. Nurses must utilize their influence and relationships with families to highlight gun violence and safety. Nurses are at the forefront of health promotion for a variety of medical illnesses and are therefore in an ideal position to incorporate screenings for gun violence and safety into routine workflows (Muir, 2021).

References

Crifasi, C. K., Ward, J. A., McGinty, E. E., Webster, D. W., & Barry, C. L. (2021). Public opinion on gun

policy by race and gun ownership status. Preventive Medicine, 149, N.PAG. https://doi.org/10.1016/j.ypmed.2021.106607

Healthcare Management (2022). How Can Healthcare Professionals Help with Gun Violence? Retrieved

from https://www.healthcare-management-degree.net/faq/how-can-healthcare-professionals-help-with-gun-violence/

Nguyen, A. (2021). New CDC Data Underscores Urgency of America’s Gun Violence Crisis. Retrieved from

https://giffords.org/blog/2021/01/new-cdc-data-underscores-urgency-of-americas-gun violence-crisis/

Muir, M.S.P. (2021). Gun violence: A chronic disease affecting American youth. Pediatric Nursing, 47(4),

200-201.

Sample Answer 5 for NURS 8100 Discussion 1: Policy Analysis Summary ANSWER

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