Discussion 1: Policy Analysis Summary NURS 8100

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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.

There are so many sources that entail the life of Florence Nightingale. This version makes me envision Florence as a very inspiring accolade. Florence Nightingale refused to be married when she was 17 years old as she chose to answer her calling despite her parents being against enrolling as a nursing student at the Lutheran Hospital in Germany. Nightingale faced a cholera outbreak in an unsanitary environment when she returned from school to London and worked at Middlesex hospital. She worked hard to improve the environment’s sanitation, significantly decreasing the number of deaths. All the hard work eventually affected Nightingale’s health. The Crimean War happened between the British and Russian Empires, and many soldiers were admitted into military hospita

Discussion 1 Policy Analysis Summary NURS 8100

ls. There were not enough female nurses stationed at Crimea hospitals. England then was angry due to the neglect of the soldiers who had fallen ill and injured and lacked medical care due to insufficient caregivers leading to dreadful unsanitary, and inhumane conditions. Nightingale then was called to her calling despite barely recovering from her illness. She assembled a team of nurses and sailed them to Crimea. Nightingale and her nurses warned of the conditions they were about to face but were still unprepared for what they witnessed upon their arrival.

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.

Discussion 1: Policy Analysis Summary
Health care policy can facilitate or impede the delivery of services. For the past several
weeks, you have been engaging in an authentic activity by critically analyzing a specific
health care policy and various aspects of the impact associated with its implementation.
A critical step in the policy process is communicating your findings with others. This
week, you will share information from your policy analysis and its implications.
To prepare:
 Briefly summarize your policy analysis, focusing on the implications for clinical practice
that may be most relevant or interesting for your colleagues. Include how evidence-
based practice influenced the policy, policy options, or solutions.
By Day 3
Post a 1- to 2-paragraph succinct summary of your policy analysis paper. Include at
least two of the options or solutions for addressing the policy and the resulting
implications for nursing practice and health care consumers.
Read a selection of your colleagues’ postings.
By Day 5
Respond to at least two of your colleagues sharing insights or contrasting perspectives
based on readings and evidence, and the practice implications of the policy.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question
posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting.

Note what you learned and/or any insights you gained as a result of the comments
made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning
Resources and any additional sources.
Submission and Grading Information
Grading Criteria
Week 11 Discussion 1 Rubric
Post by Day 3 and Respond by Day 5
To participate in this Discussion:
Week 11 Discussion 1

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion 1: Policy Analysis Summary NURS 8100

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NURS 8100 Discussion 1: Policy Analysis Summary ANSWER

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NURS 8100 Discussion Federalism’s Impact On Policy

NURS 8100 Discussion Policy And State Boards Of Nursing

NURS 8100 Discussion Technology And Cost Containment

NURS 8100 Discussion Agenda Setting

Discussion : Nursing And Health Policy In Other Nations NURS 8100

NURS 8100 Discussion 2: Advocating Through Policy

NURS 8100 Discussion: Federalism’s Impact on Policy ANSWER

NURS 8100 Discussion: Individual Right Versus the Collective Good ANSWER

NURS 8100 Discussion: Selecting a Policy Analysis Framework

NURS 8100 Discussion: Agenda Setting

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NURS 8100 Week 1 Discussion The Doctoral Degree and Professional Nursing Practice

NURS 8100 Discussion Nursing and Health Policy in Other Nations

NURS 8100 Discussion Policy and State Boards of Nursing

NURS 8100 Discussion Federalism’s Impact on Policy

NURS 8100 Discussion Individual Right Versus the Collective Good

NURS 8100 Discussion Technology and Cost Containment

NURS 8100 Discussion Selecting a Policy Analysis Framework

NURS 8100 Discussion Agenda Setting

NURS 8100 Discussion Unintended Consequences of Health Care Reform

NURS 8100 Staying Current Online Resources

NURS 8100 Describe One or More Conditions or Challenges Specifically Related to the Passing of the PPACA

NURS 8100 With Posting Instructions in Mind, Select Either the Individual Mandate or Accountable Care Organizations as the Focus of your Discussion This Week

NURS 8100 Identify a State or National Politician (State Representative or Legislator, Senator, Congressman, Governor, etc.), or Aide, Whom You would Like to Interview

Learning Resources

Note: To access this week’s required library resources, please click on the link to the
Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical
approach (7th ed.). New York, NY: McGraw-Hill Medical.
 Chapter 17, “Conclusion: Tensions and Challenges”
This chapter concludes with final thoughts on the challenge of providing quality
health care and controlling health care costs. The solution is likely to be resolved
only by a collaborative approach, involving all health care stakeholders, and by
health professionals taking the lead.
Howard, J., Levy, F., Mareiniss, D. P., Craven, C. K., McCarthy, M., Epstein-Peterson,
Z. D., & et al. (2010). New legal protections for reporting patient errors under the Patient
Safety and Quality Improvement Act: A review of the medical literature and
analysis. Journal of Patient Safety, 6(3), 147-152.
Note: You will access this article from the Walden Library databases.
The authors studied the dissemination of information on the Patient Safety and Quality
Improvement Act (PSQIA), a federal act that affords protection to those reporting
medical errors. They found medical literature to be inadequate in this regard, and as a
result, medical personnel were uninformed on their legal protections. This lack of
information has become a barrier to policy implementation.
Jacobson, N., Butterill, D., & Goering, P. (2003). Development of a framework for
knowledge translation: Understanding user context. Journal of Health Services
Research & Policy, 8(2), 94–99.
Note: You will access this article from the Walden Library databases.
Lau, B., San Miguel, S., & Chow, J. (2010). Policy and clinical practice: Audit tools to
measure adherence. Renal Society of Australasia Journal, 6(1), 36–40.
Note: You will access this article from the Walden Library databases.

The authors study the compliance to renal-care policies by health care professionals.
They conclude with the necessity for nurses to support evidence-based protocols as
well as to obtain continuing education on new protocols.
McCracken, A. (2010). Advocacy: It is time to be the change. Journal of Gerontological
Nursing, 36(3), 15-17.
Note: You will access this article from the Walden Library databases.

The author proposes that nurses, as patient advocates, need to be more involved in the
making of health care policy instead of reacting to policies that are constantly changing.
The article provides a guide to help organize initial policy efforts.
Nannini, A., & Houde, S. C. (2010). Translating evidence from systematic reviews for
policy makers. Journal of Gerontological Nursing, 36(6), 22–26.
Note: You will access this article from the Walden Library databases.

The article cites geronotological nurses as examples of those who are able to translate
research into policy briefs that can be clearly understood by policy makers.
Geronotological nurses are in this unique position because of their clinical experience
and educational background.
Paterson, B. L., Duffet-Leger, L., & Cuttenden, K. (2009). Contextual factors influencing
the evolution of nurses' roles in a primary health care clinic. Public Health Nursing,
26(5), 421-429.
Note: You will access this article from the Walden Library databases.

This article provides details on a study conducted in a nurse-managed clinic related to
the changing roles of nurses. The authors found that nurses, in response to social,
political, and economic forces, became involved in advocacy for the clinic through
political action, government funding issues, and media relations roles.
Sistrom, M. (2010). Oregon's Senate bill 560: Practical policy lessons for nurse
advocates. Policy, Politics, & Nursing Practice, 11(1), 29-35. doi:
10.1177/1527154410370786
Note: You will access this article from the Walden Library databases.

The author uses the efforts by a nurse advocate in lobbying for an Oregon bill related to
healthy food in public schools to illustrate nurse advocacy and policy making. The bill,
developed in response to childhood obesity, did not immediately become law. The
author concludes with the importance of considering the political environment when
creating successful policy.
Spenceley, S. M., Reutter, L., & Allen, M. N. (2006). The road less traveled: Nursing
advocacy at the policy level. Policy, Politics, & Nursing Practice, 7(3), 180-194. doi:
10.1177/1527154410370786
Note: You will access this article from the Walden Library databases.

Nurses have always been advocates at the patient-level of care, but the authors of this
article promote the need for all nurses to become advocates at the policy level as well.
They discuss factors that have kept nurses from getting involved with policy making and
they provide strategies to resolve these challenges.
Wyatt, E. (2009). Health policy advocacy: Oncology nurses make a difference. ONS
Connect, 24(10), 12-15.
Note: You will access this article from the Walden Library databases.

The author presents information on two nurses who have become health care policy
advocates—one as a policy maker and one as an elected legislator. Both have been
able to use their perspectives from their nursing careers to affect health policy.
Zomorodi, M., & Foley, B. J. (2009). The nature of advocacy vs. paternalism in nursing:
Clarifying the ‘thin line.’ Journal of Advanced Nursing, 65(8), 1746-1752.
Note: You will access this article from the Walden Library databases.

The authors attempt to distinguish the concepts of advocating for a patient and
paternalism, or overriding a patient’s wishes. They provide clinical examples to illustrate
the differences between these concepts, and they conclude with strategies to use in
practice.
Required Media
Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy:
Advocating through policy. Baltimore: Author.

Note: The approximate length of this media piece is 7 minutes.

In this media presentation, Dr. Joan Stanley and Dr. Kathleen White discuss how
nurses can influence practice and engage in advocacy through the policy process.

Accessible player
Optional Resources
Birnbaum, D. (2009). North American perspectives: POA, HAC and never
events. Clinical Governance: An International Journal, 14(3), 242–244.

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

ALEXA-MARIE

RE: Discussion 1 – Week 11

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Policy Analysis Summary

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

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SARAH

RE: Discussion 1 – Week 11

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            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.