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Discussion 1: Policy Analysis Summary

NURS 8100 Discussion 1: Policy Analysis Summary

Discussion 1: 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

Discussion 1 Policy Analysis Summary
Discussion 1 Policy Analysis Summary

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.

I agree with your insightful post. American Nurses Association (ANA) (n.d.) projects 194,500 average annual openings for registered nurses between 2020 and 2030, with employment projected to grow by 9%. It seems that retaining nursing staff is a major contributing factor to the increased nurse-to-patient ratio.

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California implemented the first state-mandated nurse-to-patient staffing standards in acute care hospitals in 2004 (Leigh, Markis, Iosif, & Romano, 2015). Unfortunately, it only takes effect at a state level versus a national level. Additional states have adopted policies related to nursing staffing, except California remains the only state with mandated minimum ratios. American Nurses Association (ANA) supports the policy changes to improve patient outcomes and patient safety. An immediate supply of highly trained and qualified nursing personnel is essential to continue to deliver excellent health care in Michigan.

Reference

Leigh, J. P., Markis, C. A., Iosif, A.-M., & Romano, P. S. (2015). California’s nurse-to-patient ratio law and occupational injury. International Archives of Occupational and Environmental Health88(4), 477–484. https://doi.org/10.1007/s00420-014-0977-y

Workforce. ANA. (n.d.). Retrieved May 3, 2022, from https://www.nursingworld.org/practice-policy/workforce/

Hello Randi,

That no law limits the number of patients nurses can be assigned to or the hours they work in Michigan implies that the nurses are stretched too thin. Staffing in Michigan has been a chronic problem and should be addressed to ensure that the nurses are safe enough to keep their patients. The Michigan Nursing Association has come forward to call on Michigan legislators to set limits on the patients’ nurses can be assigned to in hospitals (Legislation & advocacy, 2021).

The MNA is pushing for protection against the overworking nurses. The COVID-19 pandemic only exacerbated the issue leading to health workers’ burnout. In March, a bipartisan proposal gained traction in the Senate and the House of Representatives (Michigan HB4482 | 2021-2022 | 101st legislature, n.d.). The Patient Safe Care Act addresses three main issues. To begin with, it would ensure that the nurse to patient ratio is based on the nurses’ expertise. Secondly, there would be a limit on overtime for nurses to reduce burnout. Finally, it would hold hospitals accountable for the full transparency of that patient-to-nurse ratio. If this bill passes, it will ensure that the nurses are supported in their profession and can take good care of their patients.

References

Legislation & advocacy. (2021, January 15). Michigan Nurses Association. https://www.minurses.org/legislation-advocacy/

Michigan HB4482 | 2021-2022 | 101st legislature. (n.d.). LegiScan. https://legiscan.com/MI/bill/HB4482/202

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 open11(12), e052899. doi:10.1136/bmjopen-2021-052899